Smile Design and Functional Occlusion

What is dental occlusion? It sounds pretty “occluded,” right? Well, the truth is that it appears very esoteric to many dentists. So, don’t feel so bad if you do not understand the concepts of the human masticatory system.

What does it have to do with cosmetic dentistry? EVERYTHING... And this is why I am writing this blog post.

aesthetics equals function

Everybody interested to get his or her smile rejuvenated needs to have at least an idea about what occlusion means. There is no aesthetic element in the human smile that doesn’t relate to a specific function. Anything beautiful, and for that matter also anything ugly, created by nature serves the purpose of survival.

I have given numerous lectures to cosmetic dentists in my professional life and I have always found it very rewarding to see the cognitions that people get when they start to understand how aesthetics is related to function.

So, how does this apply to the human dentition and our smiles? It is quite amazing how teeth are built in little compartments of our facial bones, totally programmed by our genetic code that already “knows” which shape upper and lower teeth have to attain to eventually fit together when they have completely erupted. But this will be the subject of a separate blog.

Dentists have tried to compile what they knew about masticatory function and attempted to develop dogmatic approaches for changing or rehabilitating dental anatomy. This has created quite a confusion in the dental community and it has become apparent that the dental professional should understand occlusion well enough so that they are capable to combine the most useful occlusion viewpoints to create their own treatment approach.

In addition, no patient is the same. Every patient benefits from an entire spectrum of dental treatment options of which the general or cosmetic dentist can choose. The better they understand the basic function of the masticatory system, the better they will be able to assimilate any dogmatic viewpoint about this subject and select the most useful aspects for their treatment strategy.

Dental occlusion is the foundation of everything we do in cosmetic dentistry and smile design. The majority of my patients who present with an “aging” smile actually have worn teeth: they have lost their original genetically determined dental anatomy and have adopted functional patterns that are rather destructive to their dentition than beneficial.

So, if we want to reverse the age of a smile, we need to understand how we can create a more youthful smile without establishing an anatomy and “aesthetics” that has nothing in common with the biomechanical and neuromuscular environment of a particular person. Hence, cosmetic dentists need to know how to analyzed these parameters in a patient’s mouth, even if they just intend to place porcelain veneers for a smile makeover.

This website discusses some of the principles and will continue to add content that will cover every important aspect of smile design as it relates to neuromuscular function. We should remember that this website is for patients and laymen. I will therefore attempt to remain very simple when outlining the correlation between aesthetics and function that you, the potential patient, need to understand. Sounds good?

For the interested professional, we will add references of publications in peer-revied journals, which will allow them to study this subject in more detail. I will discuss the functional elements of smile design, such as functional pathways, anterior guidance, lingual contours, vertical dimension of occlusion, functional matrix, and much more on the static pages of this website. Stay put!

For starters, here are some basic references:

Dawson P. Functional Occlusion: From TMJ to Smile Design. 2007. Mosby/Elsevier.
Celenza FV. Occlusion: The state of the art. 1978. Hicago: Quintessence.
Kim SK. A study of the effects of chewing patterns on occlusal wear. J Oral Rehabilitation 2001; 28(11): 1048-55.
Gillen RJ. An analysis of selected normative toolh proponions. Int J Prosthodontics 1994;7(5):410-7.
Misch CE. Guidelines for the maxillary incisal edge position – a pilot study: the key is the canine. J Prosthodontics 2008; 17(2): 130-134.
Vig RG. The kinetics of anterior tooth display. J Prosthetic Dentistry 1978; 39(5): 502-504.
Gibbs. Jaw movements and forces during chewing and swallowing and their clinical significance. Advances in occlusion. Los Angeles: John Wright; 1982. Pp. 2-32.
Hiiemae K. Natural bites, food consistency and feeding behavior in man. Arch Oral Biology 1996; 41(2): 175-189.
Terry DS. Aesthetic and restorative dentistry: material selection and technique. Stillwater (MN): Everest Publishing Media 2009. Pp. 82-85.
LeSage B. Revisiting the design of minimal and no-preparation veneers: a step-by-step technique. J California Dental Association 2010; 38(8): 561-569.
Dawson PE. Aesthetics and function: conflict or complement? Dentistry Today 2007; 26(10): 80, 82-83.
Calamia JR. Smile design and treatment planning with the help of a comprehensive esthetic evaluation form. Dental Clinic of North Amreica 2011; 55(2): 187-209.
Hussain K. Challenging nature: wax-up techniques in aesthetics and functional occlusion. Br Dental J 2011; 11(11): 575-576.
Pound E. Utilizing speech to simplify a personalized denture service (1970); republished in J Prosthetic Dentistry 2006; 95(1): 1-9.
Regish KM. Techniques of fabrication of provisional restoration: and overview. International Journal of Dentistry 2011, Article ID 134659, 5 pages.

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