Parker M W
Branch Dental Clinic, Naval Submarine Base Bangor, Silverdale, Washington.
Dent Clin North Am. 1993 Jul;37(3):341-51.
All occlusal therapy relates ultimately to the hinge position of the mandible. By consensus, the optimum hinge position is centric relation, the most anterosuperior position of the condyles in the glenoid fossae, articulating against the eminences, with the disks properly interposed. Also by consensus, the optimum occlusal scheme is mutual protection, in which the posterior teeth contact simultaneously and equally in centric occlusion, the canines disclude the posterior teeth in lateral excursions, and the anterior teeth disclude the posterior teeth in protrusion. Whenever CR cannot be used as the starting point of occlusal treatment, or when sufficient canine support is lacking, the clinician may have to prescribe a treatment condylar position other than CR or modify the occlusal scheme. Mutual protection occlusion is the simplest to develop and CR is the simplest starting point. Departures from these ideals create added complexities for the dentist. The greater the number of excursive contacts in the occlusal scheme, the more involved the equilibration of those contacts. A treatment condylar position other than CR may not be repeatable when needed, and two studies suggest that it may change over time. Without a stable, repeatable foundation supporting it, the occlusion may be in jeopardy. The removal of occlusal interferences, although not warranted as a routine prophylactic measure, is indicated under certain conditions. When beginning a significant amount of occlusal treatment, the clinicians may remove closing interference to achieve CR at the desired vertical dimension. They may remove excursive interferences that they do not want to perpetuate in the new scheme. Selective removal may alleviate the signs of trauma from occlusion. There may be periodontal justification for axializing and equilibrating occlusal forces. Nonaxial forces on teeth with cervical erosion should be reduced as a means of limiting further erosion and protecting cervical restorations. When occlusal disharmony has been shown to reactivate a TMD, an equilibration or a more extensive rehabilitation may be necessary in the second phase of TMD treatment. In the symptomatic phase of a TMD, however, only reversible measures are appropriate. In this time of fast-moving change in restorative techniques and products, all operative dentists should raise their consciousness of occlusal principles. Occlusal forces set limits on the selection of materials and often prescribe the design features needed for a successful outcome. With structurally or periodontally compromised teeth, the occlusal planning to minimize nonaxial forces lies at the heart of the restoration. Virtually all restorative dentistry is affected by the occlusal forces of the teeth in function.(ABSTRACT TRUNCATED AT 400 WORDS)
所有咬合治疗最终都与下颌骨的铰链位置相关。大家一致认为，最佳铰链位置是正中关系，即髁突在关节窝中最前上方的位置，与关节结节相接触，且关节盘正确地介于其间。同样大家也一致认为，最佳咬合方案是相互保护型，即在正中咬合时后牙同时且均匀接触，在侧方运动时尖牙使后牙脱离接触，在前伸运动时前牙使后牙脱离接触。每当正中关系不能用作咬合治疗的起始点，或者当缺乏足够的尖牙支持时，临床医生可能不得不指定一个不同于正中关系的治疗髁突位置，或者修改咬合方案。相互保护型咬合是最容易制定的，正中关系是最简单的起始点。偏离这些理想状态会给牙医带来更多的复杂性。咬合方案中的非正中接触越多，这些接触的调合就越复杂。一个不同于正中关系的治疗髁突位置在需要时可能无法重复，并且两项研究表明它可能会随时间变化。如果没有一个稳定、可重复的基础来支持，咬合可能会受到影响。去除咬合干扰，虽然作为常规预防措施没有必要，但在某些情况下是需要的。当开始大量的咬合治疗时，临床医生可能会去除闭合干扰，以在期望的垂直距离上实现正中关系。他们可能会去除那些他们不想在新方案中持续存在的非正中干扰。选择性去除可以减轻咬合创伤的症状。从牙周角度来看，使咬合力轴向化并进行调合可能是合理的。对于有颈部侵蚀的牙齿，应减少非轴向力，以限制进一步侵蚀并保护颈部修复体。当咬合不协调已被证明会使颞下颌关节紊乱病复发时，在颞下颌关节紊乱病治疗的第二阶段可能需要进行调合或更广泛的修复。然而，在颞下颌关节紊乱病的症状期，只适合采取可逆性措施。在修复技术和产品快速变化的这个时代，所有从事口腔手术的牙医都应该提高对咬合原则的认识。咬合力对材料的选择设置了限制，并且常常规定了成功治疗所需的设计特征。对于结构或牙周受损的牙齿，使非轴向力最小化的咬合计划是修复的核心。实际上，所有的口腔修复学都受到功能状态下牙齿咬合力的影响。（摘要截选至400词）
