Introduction
This
research addresses the issue of normal occlusion and characteristics
that govern it, according to gnático system elements, so there should be
an intimate relationship between temporomandibular joint. Periodontium,
tooth organs and muscles of mastication which are of vital importance
in centric relation and centric occlusion, which together result in an
organic occlusion.Dental occlusionDental
malocclusion and craniofacial relationships, in terms of their
characteristics and importance there to be any dental or skeletal
malposition, in this case both jaws. The
deficit of mastication which will result in obtaining swallowing
problems, but especially in the breakdown and absorption of nutrients in
the stomach and small intestine respectively.
This
issue is of vital importance in our field of dentistry, and that
through this knowledge of normal and pathological anatomical area may be
diagnosed with any disease of this nature.
It
includes the abnormal shape, size and number of dental bodies, clinical
features and the training period of each abnormality. And the various affectations in the dental tissues. These
anomalies are rare and their origin is different, occurring through
heredity, congenital and acquired by any social habit present.
Among
the most common maxillofacial pathology observed in our patients are
associated with dental caries with pulpal complications in the primary
and permanent dentition, the pathologies associated with disfiguring bad
habits, and the serious consequences that bring premature withdrawals. Precisely these injuries are not covered in this work. The
rare, are what interest us as being unusual is often diagnosed in the
wrong way and can sometimes have serious consequences for patient
health.
INDEX
CHAPTER 1. Centric occlusion
Overview
Definition
Occlusion factors
Clinical Features
CHAPTER 2. Dental malocclusion
Overview
Class I
Class II Division I and Division II
Class III
Treatment
CHAPTER 3. Parafunctions
Overview
Description
Tightening
R echinamiento or Bruxism
Occlusal trauma
Treatment
CHAPTER 4. Dental abnormalities
Overview
Description
Anomalies of Form
Abnormalities of Size
Abnormalities in a coronary
Abnormalities of number
Abnormalities of structure
Treatment
CENTRIC OCCLUSION
The dental occlusion is also called, occlusion centric occlusion usual; Normoclusion and maximum intercuspation. Exhibits in the literature for various definitions which will be referred to the most current.
Definition
Position of the mandible on the maxilla, in which there is maximum intercuspation of teeth. 1
Closing ceremony of both jaws, with their dental arches as a result of mandibular neuromuscular activity. 2
Occlusal
relationships established in maximum intercuspal position with a
limited area in mm occlusal around this position is called central area
of dental occlusion (intercuspal position and retruded contact
position). In
contrast, occlusal relationships determined outside of the downtown
area, including the so-called eccentric area of dental occlusion
(laterotrusive position, and lateroprotusiva protusiva).
The
highest expression gnático system health is that given by the
congruence physiological posterior centric relation occlusion in harmony
with the central position of not giving this link will result in the
short or long term pathological occlusion or non-pathological occlusion.
ORGANIC FACTORS OCCLUSION
A. - FIXED FACTORS
Determined by the temporomandibular joint and neuromuscular system
a) Relationship central
b) Center axes of rotation
c) condylar path
2. - Modifiable factors
Determined by the teeth and periodontium
a) Harmony of the arcades
b) vertical dimension
c) Relations dentolabiales
d) On vertical and horizontal bites
e) Topography occlusal
Determined by a spiral motion (dynamic)
f) Plan of occlusion:
Curve anteroposterior (Spee)
Compensation curve (Wilson)
CLINICAL FEATURES
- Foreign teeth in intercuspal position, based on contact points and occlusal load in the posterior.
- Position and intercuspal position miocéntrica.
- Stability preventing occlusal tooth migration.
- Axiality of occlusal forces with respect to the axes of the posterior teeth.
- Intercuspal position in harmony with the physiological centric relation (no more than 2mm).
- During the protrusion and laterotrusion, you desocluir previous parts of the later Guide (above).
- In relation to healthy periodontium parafunctions.
- Activities normal functional chewing, swallowing and breathing fonoarticulación.
- Absence of dysfunctional symptoms in relation to parafunctions
Dental malocclusion
Angle
studied mesiodistal relationship of the teeth based on the position of
the first permanent molars and described the different malocclusions. He called classes.
If
we go through the normal occlusion, we see that the upper first molar
articulates with the lower first molar mesiobuccal cusp so that the
higher the PIM fits into the buccal groove separating the first buccal
cusp of the first molar, this is called NORMOCLUSION or neutroclusion.
Class I malocclusion
When there are poorly positioned teeth and the molar ratio is normoclusión, said to be a Class I malocclusion Class
I malocclusion often dental, relations are normal basal bone and dental
problems in general are often in the previous group.
Can be found in class I different tooth positions, but also can be found in other types of malocclusions.
1. Crowding
2. Spacings
3. M before and after cross ordidas
4. Open bites
5. Canine high
6. Individual malpositioned teeth one or more
1. Crowding
The crowding is when the teeth do not fit in the dental arch, usually for lack of space
2. Spacings
The
spacing is the opposite of the above, the teeth are diastema
(separations), so there are no points of contact, because there are
arcade longest tooth material.
3. Anterior and posterior crossbites
The
anterior cross-bites is when the upper incisors are in PIM occluding
the opposite, the upper incisal edges rest on the lingual surfaces of
the lower incisors. This is also going to see in class III malocclusions.
Anterior crossbite
Anterior crossbite with spacings
A
later level, the upper molars in normal protrude the lower, when the
reverse happens we say we have a posterior crossbite, which also is
common in class III.
Posterior crossbites, the molar ratio is neutroclusion
4. Open bites
The open bite is when PIM contacts in posterior teeth and no contacts to the previous level. This
type of tooth malposition is not only typical of Class I malocclusion,
may be found in cases of severe skeletal malocclusions. A later level we can find an open bite back there prior contact in maximum intercuspation and not in the posterior segment.
Anterior open bite
5. Canine high
The canines high is just a cluster due to lack of space and for being the last to erupt in the maxillary arch.
High ectopic canines and canine has erupted on the palate
6. Individual malpositioned teeth one or more
The
tooth malposition of one or more parts can be very variable, we look
always to the molar ratio together with the study cephalometric
diagnosis of malocclusion.
Class II malocclusion
Class
2 malocclusion are also called distoclusions, since the position of
maximum intercuspation, the first permanent molar occludes with the
distal superior, ie, is more posterior.
Neutroclusion ratio and ratio of distal occlusion.
Class 2 malocclusion is subdivided into two:
• Division 1
• Division 2
Both have in common only the distal occlusion, we see that tooth position is totally different.
CLASS II. Division I
Malocclusion Class 2 Division 1 is characterized by a distal occlusion and also it almost always:
• Large projection of the upper incisors. The upper jaw is usually advanced and retruded mandible, only give us accurate cephalometric discrepancy marrow.
• There may be anterior open bite
• The arches are narrow triangular form and thus are common dental crowding.
• The upper incisors can rest on the lower lip.
Malocclusion Class 2 Division 1
CLASS II. Division II
Class 2 malocclusion 2 is a division distoclusion characterized by:
• Large overbite
• vestibuloversion of upper lateral incisors
• linguoversion of the upper central incisors
• Generally broad dental arches, square.
• They usually have very sharp curve of Spee
Malocclusion Class 2 Division 2
CLASS III MALOCUSION
Mesioclusiones called because the first molar is more than the upper mesially when the jaws are in maximum intercuspation.
Are often characterized by.
• mesioclusion
• Anterior crossbite and posterior crossbite may have.
• In general, large jaws and small maxilla. They are called prognatismos progenies and mandibular.
• malocclusions are inherited.
Class III molar ratio. Several cases
We
have to differentiate classes of functional 3 true or false, they are
false malocclusions because there is a mandibular advancement in the
closure, centric relation is modified to find a tooth interference and
get the PIM, the jaw must perform an anterior displacement. They are also called pseudoprognatismo.
Models representing close in centric relation. We
see that if it were not for the interference level of the incisors, the
molar ratio would neutroclusion, but contact the incisors, to achieve
the PIM the patient must advance the mandible thus becomes a class 3
molar ratio being false. This
dynamic can only see her jaw on the patient, can occlude the models in
class 3 and not knowing that this is a false progeny.
False class 3, we see the tooth wear by interference
DENTAL
The dentist can detect interferences in the bite, major, glaring, obvious and severe. These can be removed, wearing, carving, smoothing the cusps of tooth enamel organs with interference. This can result in relief, which makes the patient begins to "believe" and trust your dentist.
When
the pain is very acute, intense, preventing chewing, you can not open
his mouth enough to work in it, the dentist may soon make a "plate" that
sits between the maxillary central incisors to prevent contact with the molars and the patient bite down on it alone. Is achieved, the muscles relax, the fits and reduces joint pain quickly by muscle spasm. Deprogrammer called before. Used only within 24 hrs. and one week, until you can open your mouth. And it is worn as long as possible, especially for sleeping. You can not use more than 20 days in a row because it gives other problems.
Neff plate or anterior deprogrammer. It is used 24 hours to release the contracture and pain. Is acrylic and is placed as shown in the drawing. Laterally looks like the picture on the right "B". Position and function that would serve a plate Muscle relaxant which occupies the entire dental arch. Anterior and posterior teeth.
1. PLATE
NEURO-MIO-RELAXING: This is a device made of rigid transparent acrylic,
which is placed mainly in the upper dental arch, with proper adjustment
of the anterior teeth and oral cavity of each patient to avoid occlusal
interference and allow the jaw to reposition correctly with the settlement in Centric Relation of the joint. Thereby achieving muscle relaxation and balance Stomatognathic System.
Its basic function is to act as balancer unbalanced bite, so that the muscles work in harmony and get them to relax. Its use for a few weeks, allowing the swelling of the joint and regeneration.
Also be used as a night guard, to avoid wearing forces broken teeth or structures placed by the dentist. This board breaks the vicious cycle of tightening-interference-lever-muscle spasm-pain. The patient will continue pressing, but there is no interference, no levers, no contracture, pain is going. Having
achieved that goal, which can take anywhere from days, weeks or even
several months, the dentist may propose to the patient, do an occlusal
adjustment.
2. OCCLUSAL SET: Consists of once relaxed the muscles, eliminate interference that prevent jaw bite into balance with the joint. For this class, wears selectively, the enamel of the molars and premolars that are in interference. This is irreversible. That's why an expert should do.
3. COMPOSITE
Sometimes occlusal adjustment involves the addition of tooth substance in the anterior white filling material (composite). Usually done in the hidden faces of the canines. This is reversible.
With
neuromiorelajante plate (plate discharge plate bruxism, Michigan plate,
etc. occlusal intermediaries. Are synonyms for the same) and occlusal
adjustment, it solves 90% of cases.
4. - Orthodontics, porcelain crowns and orthognathic surgery
Severe cases require orthodontics, occlusal plane correction with porcelain crowns or orthognathic surgery.
Previously
it was thought that orthodontic treatment were exclusively for
children, but today we know that can be performed at any age, with
excellent results. Also
mistakenly believe that treatments are aimed only improve aesthetics,
but really orthodontic treatment go beyond that, because they improve
the function, aesthetics and health course.
Orthodontic treatment is generally carried out with brackets that can be metallic or aesthetic. The
latter may be plastic (have the disadvantage of being deformed by
temperature changes and are pigmented easily buccal) or ceramic (are
high quality and does not have the disadvantages of plastic, but the
cost is higher).
Parafunctions OF OCCLUSION
Clenching and grinding
Are two stomatological-neurotic habits best known and therapies that require disposal conducive to achieving more often.
TIGHTENING
It
occurs when occlusion acts as an intermediary between emotion and the
resulting static muscle contraction, not associated with any function. The
habit can be presented in a day and / or night, is more prevalent in
females and is the most harmful of the two parafunctions.
Grinding
It
occurs when occlusion acts as an intermediary between emotion and
dynamic muscle contractions resulting not associated with any function. It can be day and / or night.
The
grinding is also known as bruxism, is manifested clinically by
involuntary jaw excursions that produce intermittent friction
interocclusal on selected pieces unconsciously. It
is the expression of emotional tension continued consientizada not as
well as aggressive tendencies or distress somaticized in the mouth.
It is observed more frequently in individuals who present with severe behavioral disorders. Bruxism occurs more frequently in male subjects.
"The
jaw movements of bruxism are the result of unconscious search for
patient centric relation, occlusal removing barriers which prevent it
from" 3
The
type of occlusal wear and / or incisal indicate the mode in which each
patient exercises his Bruxism, and consider the degree of wear, the same
location and degree of sensitivity according to the following scale:
Grade 1: Only wear of enamel.
Grade 2: Wear of dentine.
Grade 3: Reduction of the extent of the crown in a third of its original size, or advanced wear (lingual or vestibular).
Grade 4: Reduction of the extent of the crown in more than one-third or pulp damage.
TREATMENT
The first option is to institute therapy "saved" interocclusal called orthotics, over any other.
Are
indicated for the adherence of lost relationships (mandibular and
dental), achieving optimal performance of the positions and functions of
gnático system. Thus relieve the tensions and possibilities of recurrence of individual neurotic habits.
Later
occlusal adjustment is effected by mechanical wear on the parts of the
patient, in order to achieve stability in the list and functions before
if reconstruction is indicated.
The total occlusal reconstruction is the ideal treatment as it offers case permanency rehabilitated.
Occlusal trauma
It
is accepted that the inflammatory and destructive diseases such as
gingivitis and periodontitis, are the response of the effects of plaque
on periodontal tissue.
But
there are other factors that influence the action of bacteria on the
host, emphasizing its harmful effects, these factors are local,
defective restorations, dental malformations and mouth breathing 5
The
trauma of occlusion is the injury that occurs in periodontal supporting
tissue (ligament, bone and cement) as a result of traumatic occlusal
forces, so is the bite force that exceeds the resistance or tolerance of
the supporting tissues.
Clinical examination
The
data more indicative is the presence of tooth mobility and flemitus
(vibration of a tooth in occlusion), a sign that reflect inflammation in
the periodontal ligament. This inflammation causes pain is not localized.
DENTAL ANOMALIES.
Most
dental deformities occur between the sixth and eighth week of
intrauterine life because in this period includes the transformation of
important embryonic structures such as the dental sac, dental papilla
and dental organ in the process will result histodifferentiation to the formation of enamel, dentin and cement.
Odontogenesis
is the process of tooth formation, which is continuous begins with the
formation of the crown and ends with root formation, the ability of
dentin formation continues throughout the life of the tooth.
Dental
anomalies are congenital malformations of tooth tissue that occur due
to lack or increase in the development of these, they can be in shape,
number, size, structure, position even cause delay in the change of the
deciduous to
permanent and sometimes lack of development of the jaws of these
anomalies in this paper will refer to those related to the teeth.
Classification of dental anomalies
A. Anomalies of Form
1) Dilaceration
2) Fusion
3) Concrescence
4) T aurodontismo
5) Pearl Enamel
6) Dens Dens in
7) gemination
8) Sindesmo crown-root
B. Abnormalities of Size
1) Macrodontia
2) Microdontia
C. Abnormalities in a coronary
1) accessory cusps.
2) spurs enamel
3) Tooth and mulberry molars Hutchinson
D. Abnormalities of Numbers
1) Hypodontia - oligodontia
2) hyperdontia - Supernumerary
E. Structural abnormalities
? Affect the enamel, (Hereditary)
1. Amelogenesis Imperfecta
a. Hypoplasia
b. Hypocalcification
c. Hypo maturation
? Affect Dentin (Hereditary)
2. Dentinogenesis Imperfecta
3. Root Dentine dysplasia type-1
4. Coronary dentin dysplasia type-2
A. Anomalies of Form
1) Merger or Sinodonty: Union of two teeth or germs developing in a single structure. May be complete or incomplete according tooth development in the time of bonding. The merger is before calcification and may be between two normal teeth, between a supernumerary tooth and normal. It has an incidence of 0.5% is more common in the primary dentition. Fused
teeth can have two separate pulp chambers, many show large bifid crown
with a camera that makes it difficult to differentiate them from the
geminate.
2)
gemination: In one enamel organ form two teeth or trying to form.
Represents an incomplete division of a single tooth bud gives rise to a
bifid crown or the attempt to form two teeth from a tooth germ. Usually there is only one duct. Called in literature "double tooth", this is used to define both fusion and gemination to be a neutral term.
3)
Concrescence: A form of fusion in which the teeth are united by the
cement, usually occurs near the apical third and is more common in upper
molars.
Concrescence true: The process of fusion occurs during odontogenesis.
Concrescence acquired: The fusion process occurs once it has completed the formation of roots.
4) Dilaceration: excessive angulation of the tooth root.
5)
Dens in Dente: Lateral upper incisors may present an invagination of
the pit or pits cingular palate is particularly deep at times and leads
to a chamber formed by invagination of the developing tooth germ.
Type 1. Invagination limited to the tooth crown. There may or may not communicate with the pulp.
Type 2. It extends distally to the cementoenamel junction, but does not reach the periodontal ligament.
Type 3. It extends as type 2 beyond the cementoenamel junction, but communicates with the lateral or apical periodontium. This leads to a passageway of bacteria involves the future of the tooth. Radiographically there is a characteristic image that looks like a tooth within a tooth
6) Taurodontism: Change in the shape of the tooth for displaced furcation, or very near the apex. Usually
seen in molars and premolars associated with chromosomal syndromes
(Down, Klinefertel), some descendants of races indigenous Mayans,
Aztecs, Incas, and hypohidrotic ectodermal dysplasia syndrome,
tricho-dento-osseous. Not require treatment. Is due to a failure in the pod Hertwing
7)
Pearl Enamel: These consist of enamel formation in spherical form at
the root of a tooth is generally seen in maxillary molars, second or
third, and is rather rare, and the main complication in the disease
would periodontal treatment, to be affected in the root surface that is the pearl of the enamel.
8)
Sindesmo crown-root: This is a characteristic entity characterized by
the presence of a fissure that separates the girdle of the root, and
then extended apically. It
is situated mainly in the palatal of the upper lateral incisors, and
results in untreatable periodontal defects, which eventually lead to
tooth extraction. Dentin may also communicate, and even the pulp with the tooth surface through the crack, which may also lead to pathology pulp.
B. Abnormalities of Size
1)
Macrodontia: Any tooth or group of teeth greater than normal, is of
unknown etiology when it affects a single tooth, but the widespread
Macrodontia may be due to hormonal imbalance as in the case of pituitary
gigantism, sometimes there is an illusion Macrodontia
generalized if the jaws are small relative to the size of the teeth,
resulting in an abnormal pattern of eruption, dental crowding and lack
of space in the dental arch. The real Macrodontia affecting all teeth is rare, it is more commonly seen in a dental group.
2) Microdontia: It consists in a reduction in the size of the teeth. Microdontia
talk about absolute or true when the teeth are actually below normal,
and discuss relative microdontia when in fact there is but a normal
maxillary teeth larger than normal. We
can also classify as widespread or total microdontia with involvement
of all teeth, and localized or partial, with involvement of a tooth or
group of individual teeth.
The real generalized microdontia is very rare and occurs mainly in pituitary dwarfism, and a syndrome such as Down.
C. Abnormalities in a coronary
1) accessory cusps: cusps are abnormal growths. Can appear in any dental group, and in any location.
The accessory cusps are often considered abnormal function of the racial group to which we are referring. Thus, the tubercle of Carabelli, present in about 90% of Caucasians, is an anomaly in the Mongolian race. With the so-called cusp or tubercle paramolar Bolk, the opposite occurs. The anomaly contrary, by reducing the number of cusps, it is very rare. Where that occurs often affects third molars, teeth that are highly variable due to its instability anatomical phylogenetics.
2)
Spurs enamel: This involves the projection of cervical enamel into the
furcation area of multi-rooted teeth, especially molars, and more at
the buccal than the lingual. Sometimes the cement covering them, so go unnoticed. His problem is that they can facilitate the development of periodontal loss of the epithelial attachment in that area.
3)
Tooth Hutchinson and mulberry molars: These anomalies are derived form
of abnormal enamel development, as will be described in detail in the
section of enamel abnormalities in a later article.
D. Abnormalities of Numbers
1) partial anodontia or hypodontia: We use this term when a loss of up to 6 teeth in the dental arch. The prevalence of partial anodoncias is very high, reaching, according to some authors, up to 20% of the population. Affects different dental groups, with predominance of the upper lateral incisors, second premolars and third molars. Generally teeth are affected more often we see that are more distal teeth of different tooth groups. The hypodontia have a strong genetic pattern, and often repeated the same agenesis in different individuals of the same family.
Left lateral incisor agenesis in a patient of 20 years who is just exfoliate the temporal side. We rule out the existence of a radiographic dental inclusion, and warn the patient of frequent family pattern of the anomaly.
Agenesis of the four second premolars. Given
a delay of more than a year in the exfoliation of primary teeth, we
must make a radiological study to determine if there is agenesis,
delayed eruption, or an obstacle to the eruption.
2) Hipergenesia: In the presence of too many teeth we call hipergenesia or hyperdontia. At the call excessive teeth supernumerary, so called because they exceeded the normal number in the arcade. The hipergenesia may coincide in the same individual with agenesis, so not always hipergenesia to an increased number of teeth. Therefore, we prefer to analyze the number of teeth per group teeth (incisor, canine, premolar and molar).
The hipergenesias have a frequency ranging between 0.5 and 3%, with some variability race. They are, as agenesis, more frequent in the permanent dentition in the storm. They are found most often in the maxilla, especially at the midline and distal to the molars. Supernumerary teeth are often unique, but may be multiple. In this case, often associated with syndromes such as cleidocranial dysplasia and Gardner syndrome.
Clinical forms:
Its frequency is hipergenesia specific clinical forms that have their own names. We highlight four:
• Mesiodens. It is located between the upper central incisors. This is usually a tooth attachment, and it usually exhibits anomalous, conical or peg. Often leads to malposition or diastema of the central incisors.
• Peridens. It is located in the premolar region, frequently in the vestibular. It is more common in the jaw. They can have normal or abnormal morphology.
• paramolar. Located in buccal or palatal molars. More common in first and second molar. You can merge with a resulting molar tubercle paramolar.
• distomolar. Distal to the third molar. Abnormalities
in the size of the teeth originate at later stages of embryological
development that abnormalities of number, particularly at the stage of
morphodifferentiation. The default size anomaly is called microdontia macrodontia and excess.
Mesiodens. Located between the two central incisors, supernumerary accessory this almost always requires extraction.
Paramolar
Tooth, supernumerary to the height of the molars, and the tuber
paramolar, some authors are different causal gene expressivity.
F. Structural abnormalities
? Affect the enamel, (Hereditary)
1. Amelogenesis Imperfecta
a. Hypoplasia
b. Hypocalcification
c. Hypo maturation
It is a tooth development disorder in which the teeth are covered with a thin enamel layer that forms abnormally.
Amelogenesis imperfecta is passed down through families as a dominant trait. That means you only need to get the abnormal gene from one parent to acquire the disease. The tooth enamel is soft and thin. The teeth are yellow and are easily damaged, and both baby teeth and permanent affected
? Affect Dentin (Hereditary)
2. Dentinogenesis Imperfecta
3. Root Dentine dysplasia type-1
4. Coronary dentin dysplasia type-2
Dentinogenesis
imperfecta is a genetic dental disease that is inherited as an
autosomal dominant trait, causes defective dentin formation and may be
associated with a frequency amelogenesis imperfecta (defective enamel
formation) and affects both the primary dentition or as the final milk, as soon as it is formed.
The teeth are translucent, grayish or yellowish. The
enamel is easily removed and constant friction between the teeth,
leading to destruction of dentin formation with flat teeth.
