Fundamentals of Fixed Prosthodontics. James C. Kessler
Med Oral Pathol Oral Radiol Endod 2008;106:769–772.
37. Ruggiero SL, Fantasia J, Carlson E. Bisphosphonate-related osteonecrosis of the jaw: Background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:433–441.
38. Hess LM, Jeter JM, Benham-Hutchins M, Alberts DS. Factors associated with osteonecrosis of the jaw among bisphosphonate users. Am J Med 2008;121:475–483.
39. Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonateinduced exposed bone (osteonecrosis/osteopetrosis) of the jaws: Risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 2005;63:1567–1575.
40. Sedghizadeh PP, Stanley K, Caligiuri M, Hofkes S, Lowry B, Shuler CF. Oral bisphosphonate use and the prevalence of osteonecrosis of the jaw: An institutional inquiry. J Am Dent Assoc 2009;140:61–66.
41. Scully C, Madrid C, Bagan J. Dental endosseous implants in patients on bisphosphonate therapy. Implant Dent 2006;15:212– 218.
42. Wright EF. Referred craniofacial pain patterns in patients with temporomandibular disorder. J Am Dent Assoc 2000;131:1307– 1315 [erratum 2000;131:1553].
43. Tallents RH, Hatala M, Katzberg RW, Westesson PL. Temporomandibular joint sounds in asymptomatic volunteers. J Prosthet Dent 1993;69:298–304.
44. US Department of Labor, US Department of Health and Human Services. Joint Advisory Notice: Protection Against Occupational Exposure to Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV). Washington, DC: US Department of Labor, US Department of Health and Human Services, 1987.
45. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic diseases. Centers for Disease Control and Prevention. MMWR Recomm Rep 1998;47(RR-19):1–39.
46. Centers for Disease Control and Prevention. Viral Hepatitis. http://www.cdc.gov/hepatitis/. Accessed 10 Apr 2009.
47. Mast EE, Weinbaum CM, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: Recommendation of the Advisory Committee on Immunization Practices (ACIP). Part II: Immunization of adults. MMWR Recomm Rep 2006;55(RR-16):1–33 [erratum MMWR Morb Mortal Wkly Rep 2007;56:1114].
48. Centers for Disease Control. Hepatitis B virus vaccine safety: Report of an inter-agency group. MMWR 1982;31:465–467.
49. Centers for Disease Control. The safety of hepatitis B virus vaccine. MMWR 1983;32:134–136.
50. Infection control recommendations for the dental office and the dental laboratory. Council on Dental Materials, Instruments and Equipment. Council on Dental Practice. Council on Dental Therapeutics. J Am Dent Assoc 1988;116:241–248 [erratum 1988;116:614].
51. National Board for Certification of Dental Laboratories. Infection Control Requirements for Certified Dental Laboratories. Alexandria, VA: National Association of Dental Laboratories, 1986.
Table 1-1 Correlation between HbA1c and mean plasma glucose29
| HbA1c | 6 | 7 | 8 |
| Mean plasma glucose (mg/dL) | 126 | 154 | 183 |
2 Fundamentals of Occlusion
Unfortunately, the occlusion is frequently overlooked or taken for granted in providing restorative dental treatment to patients. This may be due in part to the fact that the symptoms of occlusal disorders are often hidden from the practitioner untrained to recognize them or to appreciate their significance. Long-term successful restoration with cast metal or ceramic restorations is dependent on the maintenance of occlusal harmony.
While it is not possible to present the philosophies and techniques required to render extensive occlusal reconstruction in this limited space, it is essential that the reader develop an appreciation for the importance of occlusion. The perfection of skills required to provide sophisticated treatment of complex occlusal problems may take years to acquire. However, the minimum expectation of the competent practitioner is the ability to diagnose and treat simple occlusal disharmonies and to produce restorations that will not create iatrogenic occlusal or temporomandibular disorders.
Centric Relation
In restorative treatment, the goal is to create occlusal contacts in posterior teeth that stabilize the mandibular position instead of creating deflective contacts that may destabilize it. In restorative treatment, the occlusion should be in harmony with the optimum condylar position, centric relation, which is an anteriorly, superiorly braced position along the articular eminence of the glenoid fossa, with the articular disc interposed between the condyle and eminence.1 This position is the most orthopedically stable position, and because it is a result of activated elevator muscles, it is also the most musculoskeletally stable position.2
This position of the condyles in the glenoid fossae has been discussed and debated for years. It is used in dentistry as a repeatable reference position for mounting casts in an articulator.3,4 The term attempts to define the optimum relative position between all of the anatomical components. Ideally, that condylar position is also coincident with maximal intercuspation of the teeth.4,5
For the concept of centric relation to be meaningful, the basic anatomy of the temporomandibular joint (TMJ) must be understood (Fig 2-1). The bone of the glenoid fossa is thin at its most superior aspect and is not suited to be a stress-bearing area. However, the slope of the eminence in the anterior aspect of the fossa is composed of thick cortical bone that is capable of bearing stress.
The articular disc is biconcave, devoid of nerves and blood vessels in the central area, and tough—much like a piece of shoe leather. It has a few muscle fibers attached in the anterior aspect from the superior lateral pterygoid muscle. The disc is attached to the condyle on its medial and lateral aspects and should be interposed between the condyle and articular eminence during function. The condyle is not spherical but has an irregular, elliptical shape. This shape helps to distribute stress throughout the TMJ rather than concentrating it in a small area.
Many methods have been used to guide the mandible into an optimal position. Earlier concepts of centric relation involved the most posterior condylar position in the fossa. The condyle was sometimes forcefully manipulated into the rearmost, uppermost, and midmost (RUM) position within the glenoid fossa,4,6–8 using chin point guidance. However, when the condyle is retruded, it might not be seated on the central area of the articular disc; instead, it might be on the highly vascular and innervated retrodiscal tissues (the posterior attachment) posterior to the disc9 (Fig 2-2). This can occur if the inner horizontal portion of the temporomandibular ligament has been unduly traumatized so that it no longer supports the condyle in a more anterior, physiologic position. It is presently thought that rather than being a physiologic position, this is frequently an abnormal, forced position that could create unnecessary strain in the TMJ. In this circumstance, the disc is displaced anteriorly, and clicking of the joint is frequently observed as the patient opens and closes.
The more recent concept describes a physiologic position in terms of the musculoskeletal relationships of the structures10 (Fig 2-3). It is not a forced position; rather, the mandible is gently guided by the operator using the bilateral method11 or by allowing natural muscle action to place the condyle in a physiologically unstrained position.12