교합의 원리(Fundamentals of Occlusion) > 교합학/TMJ

The Pankey Institute (Advanced Dental Education Training)를 설립한 Dr. L.D. Pankey는 치과의사 중 ‘master dentist’의 경지에 오르는 사람의 비율이 2% 미만이라고 말했습니다(Functional occlusion, Foreword). 이 말을 할 때 Dr. L.D. Pankey가 생각한 ‘master dentist’는, 환자의 상태를 정확하게 평가할 수 있고, 환자의 상태에 적합한 치료계획을 세울 수 있고, 세워진 치료계획에 따라 모든 치료단계를 정확하게 수행할 수 있는, 그런 치과의사라고 저는 생각합니다.
이 책은 咀嚼系(masticatory system)의 생리학적 원리를 바탕으로, 이상적인 보철물을 제작하는 과정, 이상적인 보철물이 갖추어야 하는 조건 등을 차례로 설명하고 있습니다. 이 책의 내용을 환자를 치료하는 과정에 하나하나 적용하다 보면 어느 순간 보철치료의 원리, 즉 교합의 원리를 총체적으로 이해할 수 있게 될 것입니다. 그리고, 교합의 원리가 생각했던 것보다 단순하다는 것을 깨닫게 될 것입니다.
독자 여러분들이 ‘master dentist’의 경지에 이르는 데, 이책이 도움이 되기를 바랍니다.

DDS, PhD, 코스모스치과 원장, 치의학 박사, 구강악안면외과 전문의, 경북대학병원 구강악안면외과 수료, 경북대학교 치과대학 졸업, 휠러의 치과 해부학 번역 출간 (2019)

Dedication 11
Acknowledgements 12
Contributors 13
Foreword 14
Preface 16
CHAPTER 1 - GLOSSARY 18
Introduction 19
1.1 Parametrics 20
1. Angles 20
2. Axes 27
3. Curves 30
4. Planes 33
5. Points 40
1.2 Articulation 42
1. Articulation 42
2. Angle Classification 46
3. Types of Occlusion 50
4. Guidance, Occlusal Contacts, Equilibration 55
1.3 Mandibular Movements 58
1. Mandibular Movements 58
2. Translation, Records 59
3. Space and Positions 60
4. Function, Parafunction, and Trauma 66
1.4 Occlusal Instruments 70
1. Articulator Classification 70
2. Types of Articulators and Devices 73
3. Components of the Articulator 79
4. Occlusal Recording Instruments 81
1.5 Temporomandibular Joint 87
1. Temporomandibular Joint and Displacements 87
2. Neuromuscular Dysfunction, Osteoarthritis, Orthosis 91
1.6 Review of Occlusal Terms 95
1.7 References & Illustrations 99
CHAPTER 2 - ANATOMY & PHYSIOLOGY 103
2.1. Temporomandibular Joint 104
1. Condylar Head 105
2. Condylar Fossa 107
3. Articular Disc 107
4. Articular Capsule and Ligaments 108
5. Vasculature and Innervation 109

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2.2 Neuromuscular System 114
1. Muscles that Close the Mandible 115
2. Muscles that Open the Mandible 115
3. Muscles of Swallowing 121
4. Muscles of Facial Expression 121
5. Muscles of Speech 124
6. Innervation 130
7. Reflex Actions 130
8. Occlusal Perceptions 137
2.3 Mandibular Movements 141
1. Border Movements 142
2. Centric Relation 144
3. Intra-border Movements 149
4. Mandibular Axes of Rotation 151
2.4 Dentition 153
1. Tooth Composition 154
2. Variations in Arch Size, Shape, and Position 155
3. Variations in Tooth Size, Shape, and Position 156
2.5 Periodontium 163
1. Biological Attachment 164
2. Gingival Fibers 164
3. Periodontal Ligaments 165
4. Osseointegrated Implant Connection 172
5. Occlusal Trauma 172
2.6 Occlusion and Morphologic Variations 178
1. Static vs. Dynamic Occlusal Contacts 179
2. Influence of Occlusal Determinants 190
3. Influence of Angle’s Classification 192
4. Influence of Tooth Surface Loss and Tribology 193
2.7 Anatomy & Physiology Review 209
2.8 References & Illustrations 213
CHAPTER 3 - OCCLUSAL INSTRUMENTS 218
3.1. Articulators, Components, and Classifications 219
1. Four Components of Articulators 220
2. Four Classes of Articulators 221
3. Factors that Control Occlusion 225
4. Orientation of the Dental Casts 227
5. Influence of the Condylar Elements 227
6. Bennett, IMLT, and Intercondylar Variations 230
7. Arcon and Non-Arcon Articulators 231
8. Differences between Adjustable Articulators 234
9. Virtual Articulators 235

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3.2 Selecting an Articulator 236
1. Clinical Use of a Class II Articulator 237
2. Clinical Use of a Class III Articulator 237
3. Comparing Semi- to Highly Adjustable Articulators 240
4. Attributes of a Virtual Articulator 243
3.3 Facebows and Maxillary Cast Orientation 244
1. Kinematic Facebows 245
2. Average Axis Facebows 245
3. The Influence of an Arbitrary Axis vs. THA 246
4. The Value of the Third Point of Reference 247
5. Orienting the Maxillary Cast 250
6. Facebow Compensations for Esthetics 251
3.4 Occlusal Interface Recordings 255
1. Interocclusal Registration Materials 256
2. Types of Interocclusal Registrations 257
3. Accuracy of Interocclusal Records and Dental Casts 258
4. Methods to Determine Tooth Contact 263
5. Mandibular Tracking Devices 264
3.5 Mandibular Cast Orientation 267
1. Common Errors with Impression Making 268
2. Common Errors with Cast Fabrication 273
3. Relating the Mandibular to the Maxillary Cast 276
4. Connecting the Dental Cast to the Articulator 276
5. Full-Arch vs. Segmental Cast Mounting 277
3.6 Condylar Elements 280
1. Using Average Recordings to Program an Articulator 282
2. Programming the Semi-adjustable Articulator 286
3.7 Anterior Guide Pin and Table 289
1. How to Program a Mechanical Guide Table 292
2. How to Construct a Customized Guide Table 292
3.8 Occlusal Instruments Review 296
3.9 References & Illustrations 300
CHAPTER 4 - OCCLUSAL DISORDERS & EQUILIBRATION 303
4.1 Occlusal Disorders 304
1. Deflective Occlusal Contacts 305
2. Understanding the Principles 310
4.2 Equilibration Methodology 318
1. Procedural Sequencing for the Dentate Patient 319

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4.3 Indications and Contraindications 326
1. National Institute of Health(NIH) Technology Assessment Conference 327
2. Dawson Commentary 328
3. When to Perform an Occlusal Adjustment? 330
4. When Not to Perform an Occlusal Adjustment? 330
5. Important Considerations 331
4.4 Occlusal Disorders & Equilibration Review 332
4.5 References & Illustrations 336
CHAPTER 5 - TEMPOROMANDIBULAR DISORDERS AND MANAGEMENT 338
5.1 Temporomandibular Disorders 339
1. Epidemiology of TMD 340
2. Role of the Clinician 341
5.2 Classification 342
1. Intracapsular vs. Extracapsular - TMD 343
5.3 Etiology 345
1. Historical Perspective 346
2. Articular Disorders 347
3. Inflammatory Disorders 348
4. Non-inflammatory Disorders 350
5. Trauma 350
6. Masticatory Muscle Disorders 352
5.4 Treatment and Management 354
1. Initial Management 355
2. NIH TMD Conclusions 355
3. Noninvasive, Reversible, and Irreversible Therapies 356
4. TMD and Orofacial Pain Education 376
5.5 Temporomandibular Disorders and Management Review 379
5.6 References & Illustrations 383
CHAPTER 6 - DIAGNOSIS AND TREATMENT PLANNING 390
6.1 Differential Diagnosis and Occlusal Stability 391
1. The Differential Diagnosis of Occlusion 392
2. Occlusal Stability 397
6.2 Non-physiologic Joints, Muscles, and Occlusion 399
6.3 Physiologic and Treatment Occlusion 403
1. Acquired Maximal Intercuspation Position 404
2. Centric Occlusion 406
3. Myocentric 407
4. Anterior Repositioning 408
5. Educator’s Consensus 409

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6.4 Orofacial Pain 410
1. Orofacial Pain Origin 411
6.5 Psychological Disorders 417
1. Psychological Disorders 418
2. Mental Status and Level of Functioning 420
3. Personality Disorders 421
4. Psychological Disorders Affecting Oral Conditions 423
5. Patient Management 424
6.6 TMJ Disorders, Orofacial Pain, and Mental Status Checklist 426
1. Temporomandibular Joint 427
2. Range of Motion 428
3. Parafunction 428
4. Orofacial Pain History 429
6.7 Occlusal Analysis 434
1. Morphological Variations 435
2. Angles and Planes 435
3. Alterations of the Dentition 438
4. Centric and Eccentric Relations 4389
6.8 Occlusal Analysis - Stability Interface System(OASIS) 447
6.9 ICD-9 454
6.10 Guidelines for the PDI Complete Edentulous Worksheet 461
1. Considerations for PDI in Predoctoral Education 462
2. Guidelines for the PDI Dentate Worksheet 464
3. Guidelines for the PDI Partially Edentulous Worksheet 464
4. Guidelines for Use of the Worksheet 467
6.11 Diagnosis and Treatment Planning Review 471
6.12 References & Illustrations 479


CHAPTER 7 - REMOVABLE PROSTHODONTIC OCCLUSION 482
7.1 Removable Prosthodontic Occlusal Schemes 483
1. Indications for Using Centric Occlusion as a Restorative Position 484
2. Pretreatment Deprogramming 484
3. Treatment Prosthesis Considerations 485
4. Differences Between Static and Gliding Tooth Contacts 485
5. Acceptable Static Tooth Contacts for Posterior Teeth 486
6. Acceptable Gliding Tooth Contacts for Posterior Teeth 486
7. Complete Denture - Removable Partial Denture 487
8. Removable Partial Denture - Fixed Partial Denture 487
7.2 Alternate Occlusal Schemes 494
1. Alternate Occlusal Schemes 495
2. Acquired MIP as a Restorative Position 495
3. Modifying MIP and Eccentric Contacts 495
4. Modifying the Occlusal Plane 496
5. Establishing Freedom from Centric Occlusion 497
6. Disocclusion When Incisors or Canines are Missing 497

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7.3 Anterior and Posterior Determinants 502
1. Geometric Theories 503
2. Posterior(Condylar) Determinants 505
3. Anterior(Incisor-canine) Determinants 505
4. Application of Concepts 512
7.4 Sequencing Treatment 513
1. Verification of Occlusal Stability 514
2. Methods to Achieve Occlusal Stability 514
3. Trial Bases and Interocclusal Records 515
4. Evaluate the Occlusal Vertical Dimension 520
5. Determining the Anterior Occlusion Plane 521
6. Determining the Posterior Occlusal Plane 522
7. Mounting Casts on an Articulator 522
7.5 Removable Prosthodontic Remount and Materials 523
1. Verification in the Laboratory 524
2. Verification in the Operatory 524
3. Clinical and Laboratory Remounts 524
4. Materials for Removable Prosthodontics 530
7.6 Removable Prosthodontic Occlusion Review 535
7.7 References & Illustrations 539
CHAPTER 8 - FIXED PROSTHODONTIC OCCLUSION 542
8.1 Fixed Prosthodontic Occlusal Schemes 543
1. Centric Occlusion as a Restorative Position 545
2. Pretreatment Deprogramming 549
3. Differences Between Static and Gliding Tooth Contacts 549
4. Acceptable Static Tooth Contacts for Posterior Teeth 550
5. Acceptable Gliding Tooth Contacts for Posterior Teeth 550
6. Acceptable Secondary Occlusal Schemes 550
8.2 Alternate Occlusal Schemes 555
1. Acquired MIP as a Restorative Position 556
2. Modifying MIP and Eccentric Contacts 556
3. Modifying the Occlusal Plane 556
4. Establishing Freedom from Centric Occlusion 557
5. Disocclusion when Incisors and Canines are Missing 557
8.3 Anterior and Posterior Determinants 562
1. Geometric Theories 563
2. Condylar(Posterior) Determinants 564
3. Incisor-canine(Anterior) Determinants 565
4. Application of Concepts 569

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8.4 Sequencing Treatment 570
1. Verification of Occlusal Stability 571
2. Methods to Achieve Occlusal Stability 572
3. Interocclusal Records 573
4. Evaluating the Occlusal Vertical Dimension 578
5. Determining the Anterior Plane 579
6. Determining the Posterior Plane 582
7. Mounting Casts 582
8.5 Fixed Prosthodontic Materials 583
8.6 Fixed Prosthodontic Occlusion Review 588
8.7 References & Illustrations 592
CHAPTER 9 - IMPLANT PROSTHODONTIC OCCLUSION 597
9.1 Implant Prosthodontic Occlusal Schemes 598
9.2 Implant Loading Protocols 619
1. Implant Loading Protocols 620
2. Criteria for Success 621
3. Cantilevered Prosthesis and Shortened Dental Arch 623
4. Bruxism 624
9.3 Implant Prosthesis-based Occlusal Schemes 627
1. Implant-Retained Single-tooth Restoration 628
2. Implant-Retained, Mucosa-supported Removable Prosthesis 628
3. Implant-Retained, Bar and Mucosa Supported Removable Prosthesis 629
4. Implant-Retained and Supported Fixed Complete Prosthesis - Acrylic Resin 629
5. Implant-Retained and Supported Fixed Complete Prosthesis - Ceramic 631
6. Implant-Retained and Supported Fixed Partial Prosthesis 632
9.4 Implant Prosthodontic Materials 634
9.5 Implant Prosthodontic Occlusion Review 641
9.6 References & Illustrations 645
CHAPTER 10 - ADVANCED OCCLUSAL CONCEPTS 649
10.1 Recognizing When to Refer 650
10.2 Complex Occlusion 652
10.3 Tooth Surface Loss and Occlusal Instability 655
10.4 Diagnosis 659
10.5 Treatment Planning 666
10.6 Treatment 669
1. Preliminary Restoration of the OVD and Anterior Guidance 675
2. Restoration of Maximal Intercuspation at Centric Occlusion 676
3. Definitive Restoration of Anterior Guidance 676
10.7 Prognosis, Outcome Assessment, and Maintenance 677
10.8 Advanced Occlusal Concepts Review 678
10.9 References & Illustrations 682

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