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A contemporary and evidence-based view of canine protected occlusion

2007; Elsevier BV; Volume: 132; Issue: 1 Linguagem: Inglês

10.1016/j.ajodo.2006.04.026

1097-6752

Donald J. Rinchuse, Sanjivan Kandasamy, James J. Sciote,

Temporomandibular Joint Disorders

Dentists and orthodontists at one time or another have been exposed to the gnathological concept of occlusion. Certainly, a well-known and advocated precept of gnathology is that of "canine (mutually) protected occlusion (CPO)." The basic premise of CPO is that, on laterotrusive movements of the mandible, only the canines (possibly first premolars) contact and therefore protect the remaining dentition from adverse occlusal torsion forces on contacts to and from centric occlusion (and/or centric relation). Furthermore, it is contended that CPO is the optimal (ideal) type of functional occlusion for the natural dentition vis-à-vis dentures and is the functional occlusion type toward which restorative and orthodontic treatments should be directed. 1 D'Amico A. The canine teeth: normal functional relation of the natural teeth of man. J S Calif Dent Assoc. 1958; 26: 6-23 Google Scholar , 2 Scaife R.R. Holt J.E. Natural occurrence of cuspid guidance. J Prosthet Dent. 1969; 22: 225-229 Abstract Full Text PDF PubMed Google Scholar It is also argued that orthodontists who do not obtain canine protected functional occlusions are doing a disservice to their patients and possibly not practicing state-of-the-art orthodontics. 3 Roth R.H. The maintenance system and occlusal dynamics. Dent Clin North Am. 1976; 20: 761-788 PubMed Google Scholar , 4 Roth R.H. Temporomandibular pain-dysfunction and occlusal relationship. Angle Orthod. 1973; 43: 136-153 PubMed Google Scholar , 5 Roth R.H. Functional occlusion for the orthodontist II. J Clin Orthod. 1981; 25: 100-123 Google Scholar , 6 Cordray F.E. Centric relation treatment and articulator mountings in orthodontics. Angle Orthod. 1996; 66: 153-158 PubMed Google Scholar , 7 Chiappone R.C. A gnathologic approach to orthodontic finishing. J Clin Orthod. 1975; 9: 405-417 PubMed Google Scholar , 8 Slavicek R. Interview on clinical and instrumental functional analysis for diagnosis and treatment planning Part 1. J Clin Orthod. 1988; 22: 358-370 PubMed Google Scholar , 9 Slavicek R. Interview on clinical and instrumental functional analysis for diagnosis and treatment planning Part 2. J Clin Orthod. 1988; 22: 430-433 PubMed Google Scholar , 10 Slavicek R. Instrumental analysis of mandibular casts using the mandibular position indicator Part 4. J Clin Orthod. 1988; 22: 566-575 PubMed Google Scholar That is, gnathologists maintain that orthodontists who do not establish a gnathologic finish, including CPO, potentially predispose patients to temporomandibular disorders (TMD) and orthodontic tooth relapse. 3 Roth R.H. The maintenance system and occlusal dynamics. Dent Clin North Am. 1976; 20: 761-788 PubMed Google Scholar , 4 Roth R.H. Temporomandibular pain-dysfunction and occlusal relationship. Angle Orthod. 1973; 43: 136-153 PubMed Google Scholar , 5 Roth R.H. Functional occlusion for the orthodontist II. J Clin Orthod. 1981; 25: 100-123 Google Scholar , 6 Cordray F.E. Centric relation treatment and articulator mountings in orthodontics. Angle Orthod. 1996; 66: 153-158 PubMed Google Scholar , 7 Chiappone R.C. A gnathologic approach to orthodontic finishing. J Clin Orthod. 1975; 9: 405-417 PubMed Google Scholar , 11 Crawford S.D. Condylar axis position, as determined by the occlusion and measured by the CPI instrument, and signs and symptoms of temporomandibular dysfunction. Angle Orthod. 1999; 69: 103-116 PubMed Google Scholar