ACADEMICS AND EDUCATION
Evolution of Occlusion and Occlusal Instruments
学术和教育咬合和咬合器械的演变

Curtis M. Becker, DDS, MSD* and David A. Kaiser, DDS, MSD
Curtis M. Becker, DDS, MSD*和 David A. Kaiser, DDS, MSD

Abstract 摘要

All occlusal concepts are based, in part, on theory, and all theories may have borrowed from the past. This article reviews the evolution of occlusal concepts to understand how differing theories interrelate, where they agree, and where each concept contributed to the ongoing understanding and evolution of occlusion principles. Also, the flexible and practical concept of biologic occlusion is presented. The philosophy of biologic occlusion is one that functions in health. The goals of biologic occlusion are also presented.
所有的咬合概念都部分基于理论，而所有的理论都可能借鉴了过去的理论。本文回顾了咬合概念的演变过程，以了解不同理论之间的相互关系、它们在哪些方面达成了一致，以及每个概念在哪些方面对咬合原理的不断理解和演变做出了贡献。此外，文章还介绍了灵活实用的生物咬合概念。生物闭塞的理念是在健康中发挥作用。此外，还介绍了生物闭塞的目标。

J Prosthod 2:33-43. Copyright © 1993 by the American College of Prosthodontists.
J Prosthod 2:33-43.版权所有 © 1993 年美国口腔修复学院。
INDEX WORDS: occlusion, articulator, gnathology, transographics, cranial orthopedics, centric relation, biological ocelusion
索引词：咬合、发音器、解剖学、透视图、颅骨矫形、中心关系、生物咬合
WHEN STUDYING modern concepts of occlusion, one should consider how current principles evolved (Fig 1). Because modern schools of occlusion may vary, acccptance or rejection of principles tends to be based on: (1) past training (dental school), (2) personality of the authority presenting the theory, (3) the latest fad, (4) ease in technique, and (5) scientific evidence. All occlusal concepts are based in part on theory, and all of these theories borrow in part from the past. This article reviews the evolution of occlusal concepts: not with the idca of criticism of each theory, but with attempt to evaluate these theories, their interrelationships, where they agree, and where each concept contributed to our ongoing understanding of occlusion.
在研究现代咬合学概念时，应该考虑当前的原则是如何演变而来的（图 1）。由于现代咬合学派可能各不相同，对原则的接受或拒绝往往基于：(1) 过去的培训（牙科学校），(2) 提出理论的权威的个性，(3) 最新的流行趋势，(4) 技术的易用性，以及 (5) 科学证据。所有的咬合概念都部分基于理论，而所有这些理论都部分借鉴了过去的理论。本文回顾了咬合概念的演变过程：不是对每种理论进行批判，而是试图评估这些理论、它们之间的相互关系、它们在哪些方面达成了一致，以及每种概念在哪些方面促进了我们对咬合的不断理解。

Early Concepts 早期概念

The first mechanical articulator was invented by J.B. Gariot in 1805.

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It was a plain line instrument and it is still in use today (Fig 2). In 1858 Bonwill described his triangular theory whereby he postulated that the distance from the incisal cdges of the lower incisors to each condyle is 4 inches, and the distance between the condyles is 4 inches (Fig 3). Bonwill proposed a
第一台机械关节器由 J.B. Gariot 于 1805 年发明。

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这是一种普通的线性器械，至今仍在使用（图 2）。1858 年，Bonwill 提出了他的三角形理论，即从下切牙切缘到每个髁突的距离为 4 英寸，髁突之间的距离为 4 英寸（图 3）。邦威尔提出了一个

concept of bilateral balanced occlusion

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and developed an articulator that applied his 4-inch triangular theory.

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In 1866 Balkwill discovered that during lateral jaw movement, the translating condyle moved medially.

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In 1890 the German anatomist Von Spee observed that the occlusal plane of the teeth followed a curve in the sagittal plane. Von Spee attempted to describe the relationship between the condylar path and this compensating curve, or “curve of Spee,” by stating that the steeper the condylar path (in protrusive), the more pronounced would be the compensating curve.

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We know today that this relationship is not necessarily true; however, from the concepts of these three men came the age of occlusal theory and occlusal articulators. Literally hundreds of articulators came and went in the early

1900 s .^{7, 8}

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他提出了双侧平衡咬合的概念，并开发了一种应用他的 4 英寸三角形理论的发音器。

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1866年，Balkwill发现在下颌横向运动时，平移髁突向内侧移动。

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1890 年，德国解剖学家 Von Spee 观察到牙齿的咬合面在矢状面上有一条曲线。Von Spee 试图描述髁突路径与这条补偿曲线（或称 "Spee 曲线"）之间的关系，他指出，髁突路径越陡（前突），补偿曲线就越明显。

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我们今天知道，这种关系并不一定是正确的；但是，从这三个人的概念中诞生了咬合理论和咬合矫治器。

1900 s .^{7, 8}

早期，数以百计的咬合器层出不穷。

Age of Occlusal Theories and Occlusal Articulators
咬合理论和咬合器的时代

In 1899 Snow devised a method for transferring articulated casts to the articulator with a face bow.

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In 1901 Christensen observed the opening of the posterior teeth in mandibular protrusion (Christensen phenomenon).

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Christensen then developed a technique for registering the degree of posterior separation and an articulator with adjustable condyle controls. This was still a two-dimensional instrument, but an cvolutionary improvement over the Gariot instrument. In 1908 Bennctt described the immediate side shift (Bennett movement). " The origin for the introduction of the incisal pin to articulators is unclear

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; however, the first published article where an incisal pin is demonstrated was
1899 年，斯诺设计出一种方法，可以用面弓将铰接铸模转移到铰接器上。

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1901年，克里斯滕森观察到下颌前突时后牙张开的现象（克里斯滕森现象）。

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克里斯滕森随后开发了一种记录后牙分离程度的技术和一种带有可调髁状突控制装置的关节器。这仍然是一种二维仪器，但与 Gariot 仪器相比有了革命性的改进。1908 年，Bennctt 描述了即时侧移（Bennett 运动）。"

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将切牙针引入矫治器的起源尚不清楚；不过，第一篇展示切牙针的发表文章是

Evolution of Occlusion 闭塞的演变

Figure 1. Diagrammatic representation of the evolution of occlusion.
图 1.闭塞演变示意图。

Figure 2. Plain line articulator similar to that invented by.J.B. Gariot in 1805. written in 1910 by Gysi.

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Gysi’s instrument was one of the first to allow for the Balkwill-Bennett movements.
图 2.类似于 J.B. Gariot 于 1805 年发明的平线发音器，1910 年由 Gysi 编写。

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Gysi的发音器是最早允许使用 Balkwill-Bennett 运动的发音器之一。

Before 1916 Monson formulated a three-dimensional occlusal philosophy by combining the concepts of Bonwill’s 4 -inch triangle and bilateral balanced occlusion, Von Spee’s compensating curve, and the observances of Balkwill and Christensen on condylar movement.

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This occlusal model was named the Spherical Theory (Fig 4) and was one of the first attempts at presenting a working theory of threedimensional occlusal concepts. Monson then developed an articulator that attempted to allow the dentist to apply the concepts of the spherical theory in prosthetic dentistry; however, Monson’s instrument did not provide for the condylar movements as described by Balkwill and Bennett. The occlusal
1916年之前，Monson将Bonwill的4英寸三角形和双侧平衡咬合的概念、Von Spee的补偿曲线以及Balkwill和Christensen对髁突移动的观察结合起来，提出了一种三维咬合理念。

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这个咬合模型被命名为球形理论（图 4），是最早提出三维咬合概念工作理论的尝试之一。随后，Monson 开发了一种咬合器，试图让牙医将球面理论的概念应用到修复牙科中；然而，Monson 的咬合器并没有提供 Balkwill 和 Bennett 所描述的髁突运动。咬合

Figure 3. Bonwill’s 4-inch triangular theory of 1858.
图 3.1858 年邦威尔的 4 英寸三角形理论。
concepts, techniques, and the articulator advocated by Monson was extremely popular throughout the 1920s and though Monson’s articulator is no longer in use, vestiges of the spherical theory are still in use today.
虽然孟森的衔接器已不再使用，但球面理论的残余至今仍在使用。

During and after the time Monson was unveiling his spherical theory of occlusion,

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there was a period of time where technical advances were being perfected in the recording of jaw relations and in the sophistication of articulators. The work of Gysi exemplified this desire for technical improvement. In 1910 Gysi improved on Balkwill’s arrow point tracer to allow visual registration of centric relation.

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Gysi
在孟森揭示其球形咬合理论期间和之后的一段时间里，

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在记录颌关系和复杂发音器方面的技术进步日臻完善。吉西（Gysi）的工作就体现了这种对技术改进的渴望。1910年，Gysi改进了Balkwill的箭尖描记器，实现了中心关系的可视化记录。

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吉西

Figure 5. One of Gysi’s adjustable articulators, which used an incisal pin.
图 5.Gysi 的一种可调铰接器，使用切牙针。
also developed a series of articulators with surprising sophistication and adjustability

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(Fig 5).

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（图 5）。

Geometry of the articulator movements became paramount for justification of theorics replacing scientific investigation and observation. In 1918 Hall presented his conical theory,

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where it was believed that the condyles were not the guides to mandibular movement. Instead, the occluding planes of the teeth were the guides for mandibular movement. Bilateral balance was one of the goals of this theory. Geometry was used as justification and an articulator was developed to fit the theoretical concepts (Fig 6).
发音器运动的几何学成为了取代科学调查和观察的理论依据。1918 年，霍尔提出了他的锥形理论

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，认为髁状突不是下颌运动的导向。相反，牙齿的咬合平面才是下颌运动的导向。双侧平衡是这一理论的目标之一。该理论以几何学为依据，并根据理论概念开发了一个发音器（图 6）。

In 1921, the engineer Hanau introduced an occlu-
1921 年，工程师哈瑙推出了一种闭合器。
Figure 4. Monson’s Spherical theory was one of the first three-dimensional occlusal concepts.
图 4.Monson 的球形理论是最早的三维咬合概念之一。

Figure 6. The Hall articulator was developed to implement the Conical Theory of Occlusion and was based on geometrical relationships.
图 6 霍尔发音器霍尔发音器是为实现锥形闭塞理论而开发的，以几何关系为基础。
sal instrument (Fig 7) that was based on the scientific writings of Snow and Gysi.

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Hanau rejected the spherical theory and proposed the “rocking chair” denture occlusion in 1923.

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This rocking chair theory involved heavy contact to the first molar areas to compensate for the “resiliency and like effect,” which referred to the resiliency of soft tissue and temporomandibular joint. Hanau advocated bilateral bal-
图 7），它以斯诺和吉西的科学著作为基础。

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1923年，Hanau否定了球形理论，提出了 "摇椅式 "义齿咬合。

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这种摇椅理论涉及第一磨牙区域的重接触，以补偿 "弹性和类似效应"，这是指软组织和颞下颌关节的弹性。哈瑙主张双侧平衡

Figure 7. A Hanau articulator. anced occlusion with eccentric mandibular movements and was the first to advocate that articulator movements should be the equivalent of mandibular movement.

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图 7 哈瑙发音器用偏心下颌运动辅助咬合的哈瑙发音器，是第一个主张发音器的运动应等同于下颌运动的人。

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In 1929 Stansberry modified Gysi’s arrow point tracer by adding a central bearing point that allowed convenience in making the centric relation record and eccentric jaw position records. These records were then used to transfer casts of the patient to the articulator, the Stansberry Tripod (Fig 8).

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1929 年，斯坦斯贝里对吉西的箭形点描记器进行了改进，增加了一个中心支承点，方便了中心关系记录和偏心下颌位置记录的制作。这些记录随后被用于将患者的石膏模型转移到斯坦斯贝里三脚架（图 8）上。

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In the 1930s Meyer was advocating the use of the functionally generated path or “chew in” techniquc for recording bilateral balancing contacts in eccentric movements.

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At about this same time, articles began to appear that questioned the Monson theory. The Avery brothers, in 1930, introduced the “antiMonson Theory,” which advocated a reverse occlusal curve of Wilson-lateral compensating curve (Fig 9).

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The Avery brothers theorized that this reverse curve would stabilize the lower complete denture. The theory was based in part on the observation that the occlusion of dentures and natural dentitions tend to wear in a reverse curve fashion, ie, maxillary lingual cusps and mandibular buccal cusps showing the most wear. The anti-Monson theory does not allow for bilatcral balance in eccentric jaw movements and was one of the first occlusal theories to abandon this concept. Pleasure, in 1937, introduced his “Pleasure curve” (Fig 10),

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which advocates the anti-Monson reverse curve except for the second molars. The second molars are tipped up to allow for bilateral balance of three points (incisal and both
20 世纪 30 年代，迈耶主张使用功能生成路径或 "嚼入 "技术来记录偏心运动中的双侧平衡接触。

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大约在同一时期，开始出现质疑孟森理论的文章。Avery 兄弟于 1930 年提出了 "反孟森氏理论"，主张采用威尔逊-侧补偿曲线的反向咬合曲线（图 9）。

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艾弗里兄弟认为这种反向曲线可以稳定下部全口义齿。该理论的部分依据是观察到假牙和天然牙的咬合倾向于以反向曲线的方式磨损，即上颌舌尖和下颌颊尖磨损最严重。反孟森氏理论不考虑偏心颌运动中的双颌平衡，是最早放弃这一概念的咬合理论之一。1937年，Pleasure提出了他的 "Pleasure曲线"（图10），

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主张反孟森反曲线，但第二磨牙除外。第二磨牙向上倾斜，以实现三点（切牙和两侧磨牙）的双侧平衡。

Figure 8. The Stansberry Tripod articulator.
图 8.斯坦斯贝里三脚架关节器。

Figure 9. Diagram of the anti-Monson concept as proposed by the Avery brothers in 1930.
图 9.艾弗里兄弟于 1930 年提出的反孟森概念示意图。
second molars) in eccentric movements. The Pleasure curve retained the alleged benefits of the antiMonson curve while allowing for bilateral balance in eccentric movements.
第二臼齿）的偏心运动。愉悦曲线保留了反孟森曲线的优点，同时在偏心运动中实现了双侧平衡。

The occlusal concepts proposed during this period of dental history from 1800 to approximately 1930, which one could call the age of occlusal theories, can be summarized as being basically formulated for complete denture patients in which bilateral balanced occlusion in eccentric movements was considered essential. The efforts by these dental pioneers to develop occlusal instruments were driven primarily by the need to implement the proposed occlusal theory.
从1800年到1930年左右的这段牙科历史可以被称为咬合理论的时代，在此期间提出的咬合概念基本上是针对全口义齿患者而制定的，在偏心运动中双侧平衡咬合被认为是至关重要的。这些牙科先驱开发咬合器械的努力主要是为了实现所提出的咬合理论。

Modern Occlusal Concepts 现代咬合概念

Pankey, Mann, Schuyler System
潘基、曼恩、斯凯勒系统

In the late 1920s, groups of researchers began to formulate systematic approaches to restoring the natural dentition. Pankey and Mann are examples of this evolutionary process of formulating concepts for natural dentitions while also devising a systematic approach to reconstructive dentistry. The PankeyMann System was originally an amalgamation of the Monson theory and the Meyer functionally generated path technique, where they attempted to gain bilateral balance in eccentric movements (a holdover from complete denture occlusal theories). The technique involved restoring the mandibular posterior occlusion to a 4 -inch sphere as described by Monson.
20 世纪 20 年代末，一些研究人员开始制定系统的方法来修复自然牙列。潘基和曼就是这一演变过程中的典范，他们在为自然牙体制定概念的同时，也为重建牙科设计了一套系统的方法。Pankey-Mann系统最初是Monson理论和Meyer功能生成路径技术的混合体，他们试图在偏心运动中获得双侧平衡（这是全口义齿咬合理论的遗留问题）。该技术包括将下颌后咬合恢复到孟森所描述的 4 英寸球形。

Figure 10. Diagram of the Pleasure curve as proposed by M.A. Pleasure in 1937.
图 10.M.A. Pleasure 于 1937 年提出的 Pleasure 曲线图。
The maxillary posterior occlusion was then fabricated to the mandibular occlusal form by using the maxillary anterior teeth as guides

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for the “chew in” registration as advocated by Meyer.

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A suspension instrument (Fig 11) was used for articulating the casts, which had no functional movement capability. It was argued that articulator movement was unnecessary because functional limits were recorded with the “chew-in” registration.

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按照迈耶（Meyer）提倡的 "嚼入 "登记方法，以上颌前牙为引导，将上颌后牙咬合制作成下颌咬合。

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使用悬吊器械（图 11）对铸型进行铰接，该器械没有功能性移动能力。有一种观点认为，由于 "嚼入 "登记记录了功能极限，因此衔接器的移动是不必要的。

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A few years later Schuyler joined with Pankey and Mann to evolve what is now known as the P.M.S. (Pankey, Mann, Schuyler) System.

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This occlusal system retained the Monson spherical theory and the functionally generated path technique; however, under Schuyler’s influence

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: (1) the balancing side contacts were eliminated; (2) the importance of incisal guidance was elevated; (3) the concept of “long centric” or “functional centric occlusion” was proposed in which centric occlusion is thought of as an area of contact rather than a point contact; and (4) the Hanau occlusal instrument with arbitrary face bow and Broadrick occlusal plane analyzer was adopted.

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几年后，Schuyler与Pankey和Mann共同发展了现在的P.M.S.（Pankey、Mann、Schuyler）系统。

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这个咬合系统保留了孟森球面理论和功能生成路径技术；但是，在 Schuyler 的影响下，

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：(1) 取消了平衡侧接触；(2) 提高了切缘引导的重要性；(3) 提出了 "长中心 "或 "功能性中心咬合 "的概念，将中心咬合视为接触区域而不是点接触；(4) 采用了带有任意面弓和 Broadrick 咬合面分析仪的 Hanau 咬合仪。

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Gnathology 解剖学

At approximately the same time that Pankey and Mann were formulating their concepts of occlusion, another group of researchers headed by McCollum
大约在潘基和曼恩提出闭塞概念的同时，以麦科伦为首的另一组研究人员

Figure 11. A suspension instrument was originally used by the Pankey-Mann-Schuyler system of occlusion. Note this instrument is basically a plain line instrument.
图 11.悬吊器械最初用于潘基-曼-舒勒咬合系统。请注意，这种器械基本上是一种普通的线条器械。
was studying mandibular movement.

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The main thrust of their study was the rotational centers of the condyles in three dimensions: vertical plane; sagittal plane; and horizontal plane. One assumption was that the horizontal rotational center passes through both condyles (collinear hinge axis). These researchers believed that if the rotational centers in the condyles could be located, and if the border movements of these rotational centers were recorded and reproduced on a sophisticated three-dimensional articulator, then all functional motions for the patient could also be reproduced by that instrument. Once the basic concepts were formulated, research efforts were centered on methods to locate and record these rotational centers and their border movements. Many ingenious inventions were tried and discarded until finally the instrument we know as the pantograph evolved. With the pantograph one could, for the first time, record the three-dimensional border movements of the condylar rotational centers. Great efforts were then directed to develop highly sophisticated three-dimensional adjustable articulators that would accept and reproduce the measurements recorded by the pantograph. The concepts taught by McCollum and his associates eventually became known as Gnathology.
在研究下颌骨运动时。

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他们研究的重点是髁突在三个维度上的旋转中心：垂直面、矢状面和水平面。其中一个假设是水平旋转中心穿过两个髁突（共轭铰链轴）。这些研究人员认为，如果能够找到髁突的旋转中心，并在精密的三维关节器上记录和再现这些旋转中心的边界运动，那么患者的所有功能运动也都可以通过该仪器再现。基本概念提出后，研究工作就集中在定位和记录这些旋转中心及其边界运动的方法上。许多巧妙的发明被尝试和抛弃，直到最后形成了我们所熟知的受电弓。有了受电弓，人们第一次可以记录髁突旋转中心的三维边界运动。随后，人们开始努力开发高度精密的三维可调铰接装置，以接受和再现受电弓记录的测量结果。麦科勒姆和他的同事们所传授的概念最终被称为 "解剖学"。

Gnathologic theory at this early time included: (1) establishing via a hinge axis location the rotational centers of the condyles; (2) recording the threedimensional envelope of motion of the condyles via the pantographic tracing; (3) maximum intercuspation of the teeth when the condyles are in their hinge position; and (4) bilateral balance with eccentric jaw movements. Because these gnathologic researchers felt that the condyles were the determinants of occlusal schemes, they discovered that the side shift of the condyle would greatly affect cuspal position, especially if bilateral balance was deemed beneficial.
早期的髁突学理论包括(1) 通过铰链轴位置确定髁突的旋转中心；(2) 通过泛影描记记录髁突运动的三维包络；(3) 当髁突处于铰链位置时，牙间隙最大；(4) 偏心下颌运动的双侧平衡。由于这些咬合学研究人员认为髁状突是咬合方案的决定因素，因此他们发现髁状突的侧移将极大地影响尖牙的位置，尤其是当双侧平衡被认为是有益的时候。

Two of the early gnathologic researchers, Stallard and Stuart, felt that the basic theory of mandibular movement was fundamentally correct, but the application of this knowledge was misdirected. They proposed eliminating the balancing contacts in eccentric jaw movements by having the canines on the working side disclude the posterior teeth; they named it the Cuspid Protection Theory.

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This also became known as the Mutually Protected System.

^{41}

早期的两位下颌运动学研究者 Stallard 和 Stuart 认为，下颌运动的基本理论从根本上讲是正确的，但对这一知识的应用却出现了偏差。他们建议让工作侧的犬齿排除后牙，从而消除偏心下颌运动中的平衡接触；他们将此命名为尖牙保护理论。

^{40}

这也被称为相互保护系统。

^{41}

A number of other technical developments evolved during the 1940s and 1950s that helped the popularity and accessibility of the gnathologic concepts. Payne

^{42}

and Thomas

^{43}

developed systematic waxing techniques that allowed for the development of an
20 世纪 40 年代和 50 年代，其他一些技术的发展也促进了脱毛学概念的普及和推广。佩恩 (Payne)

^{42}

和托马斯 (Thomas)

^{43}

开发了系统的脱毛技术，从而可以发展出一种

Figure 12. The Stuart articulator.
图 12.斯图尔特铰接器
acceptable occlusal scheme when all the posterior teeth had been prepared. Stuart improved the design of the gnathologic instrument (Fig 12). Guichet greatly simplified the pantographic recorder and developed his gnathologic instrument, the Denar (Fig 13). Guichet brought gnathology into the average dental office through extensive continuing educational courses for the practitioner and organized study clubs.

^{44, 45}

Guichet also advocated overcompensation of the gnathologic instrument settings to give
当所有的后牙都准备好后，可以接受的咬合方案。Stuart 改进了咬合仪器的设计（图 12）。吉歇（Guichet）大大简化了泛影记录器，并开发了他的咬合仪器 Denar（图 13）。Guichet 通过为执业医师开设大量继续教育课程和组织学习俱乐部，将咬合学带入了普通牙科诊所。

^{44, 45}

Guichet还提倡对咬合仪器的设置进行过度补偿，以获得更好的效果。

Figure 13. The Denar articulator.
图 13.德纳尔铰接器。
increased disclusion rather than laboriously making the instrument follow the lines of the pantograph.

^{46}

而不是费力地让仪器沿着受电弓的线路运行。

^{46}

Transographics

During the 1950s, the engineer Page contended that each mandibular condylc has its own axis of rotation and that these axes are not collincar,

^{47, 48}

as was postulated by gnathologic theory. Page then developed an occlusal theory, which was called Transographics, and an occlusal instrument, the Transograph (Fig 14). This was designed to allow for independent three-dimensional condylar movement.

^{49}

Transographic theory questioned the need to record the total envelope of motion (pantographing) and instead advocated using wax registrations to record a much smaller functional area within the envelope of motion, which Page termed the “functional envelope.” Page felt that the occlusal form of posterior teeth was determined by the asymmetrical condylar axis, the functional envelope, and the angle of the mandible. Transographics lost favor as a widely accepted occlusal theory after Page died, but his theories did bring renewed interest in rescarch to prove or disprove the existence of collinear condylar axes. Preston, in reviewing this subject, states the following:
20 世纪 50 年代，工程师 Page 认为每个下颌髁状突都有自己的旋转轴，而这些轴并不像咬合学理论推测的那样，

^{47, 48}

是共轴的。佩吉随后提出了一种咬合理论，称为 "Transographics"，并发明了一种咬合仪器，即 "Transograph"（图 14）。其设计目的是实现独立的三维髁突运动。

^{49}

Transograph理论质疑记录整个运动包膜（受电弓）的必要性，而主张使用蜡型记录运动包膜内更小的功能区域，Page称之为 "功能包膜"。佩奇认为，后牙的咬合形态是由不对称的髁状突轴线、功能包膜和下颌角决定的。佩奇去世后，Transographics 作为一种被广泛接受的咬合理论失去了人们的青睐，但他的理论确实重新激发了人们对重新研究以证明或反驳髁突轴线是否存在的兴趣。普雷斯顿（Preston）在回顾这一主题时指出以下几点：

Past experiments have been usefful, but none have proven or disproven the presence of collinear or noncollinear condylar arcs. Only the arc of the rigid clutch and its associated mechanism is located. Such an apparent arc may result from the resolution of compound condylar movements.

^{5\%}

过去的实验很有用，但都没有证明或否定髁状突弧线的共线性或非共线性。只有刚性离合器及其相关机构的弧线被定位。这种明显的弧线可能是髁状突复合运动的结果。

^{5\%}

The value of the Transographic theory lies in the
横断面理论的价值在于

Figure 14. The Transograph articulator. unanswered questions it raised, such as: (1) are condylar axes collinear or asymmetrical?, (2) is immcdiate side shift normal function or the result of pathology?, and (3) should occlusal instruments be expected to reproduce jaw movement? The diminishing popularity of Transographics is apparently due more to its awkward instrument, lack of technical progress, and the passing of its chief spokesman rather than hard scientific rebuttal from academic research.
图 14.它提出了一些悬而未决的问题，例如：(1) 髁突轴线是平行的还是不对称的？(1)髁状突轴线是平行的还是不对称的？(2)不对称侧移是正常功能还是病理结果？Transographics 越来越不受欢迎的原因显然是其笨拙的工具、缺乏技术进步以及其主要发言人的去世，而不是学术研究的科学反驳。

Cranial Orthopedics 颅骨矫形

The most visible proponent of the concept of cranial orthopedics (also called oral orthopedics) is Gelb.

^{51 - 53}

The basic concept centers around the belief that the movement of the mandible is not influenced by the shape of the condyles, but the condyles may assume a certain shape because the mandible has assumed certain movements. Cranial orthopedics is interested in establishing postural relationships of the jaws. Occlusion is secondary to obtaining optimal postural relations of the mandible to the maxilla. The proper relationship of the head on the spine is essential for proper total body posture and balance. Thus, an improper jaw relationship will mean impaired posture and balance.

^{53}

颅骨矫形学（也称口腔矫形学）概念最明显的倡导者是盖尔布。

^{51 - 53}

这一基本概念的核心是认为下颌骨的运动不受髁状突形状的影响，但髁状突可能会因为下颌骨承担了某些运动而呈现出某种形状。颅骨矫形的目的是建立下颌的姿势关系。下颌与上颌的最佳姿势关系是咬合的次要条件。头部与脊柱的正确关系对于整个身体的正确姿势和平衡至关重要。因此，不正确的下颌关系将意味着姿势和平衡受损。

^{53}

Geometry is the primary basis for achieving postural balance, and like Hall

^{18, 19}

in the 1920s, geometry is used to justify the theoretical and the rapeutic treatment recommendations. Extensive planes of orientation are drawn on unmounted casts of the maxilla and the mandible. Four classes of malocclusion are possible based on these planes of orientation.

^{j 2}

Class A: correct occlusion; Class B: structural malocclusion; Class C: functional malocclusion; Class D: structuro-functional malocclusion.
几何学是实现姿势平衡的主要基础，就像 20 世纪 20 年代的霍尔

^{18, 19}

一样，几何学被用来证明理论和治疗建议的合理性。在未安装的上颌骨和下颌骨模型上绘制了大量的方位平面图。根据这些方位平面，可以将错颌畸形分为四类。

^{j 2}

A类：正确咬合；B类：结构性错颌；C类：功能性错颌；D类：结构-功能性错颌。

The recommended therapy (usually splint therapy, orthodontic movement, and/or reconstructive dentistry) is based on what is necessary to realign these planes of orientation into more favorable relationships.
建议的治疗方法（通常是夹板治疗、正畸运动和/或牙科整形）是基于将这些方向平面重新调整为更有利的关系所必需的。

The primary appeal to cranial orthopedics lies in the realization that the temporomandibular joint has an adaptable remodeling capacity that has been overlooked by the static relationship concepts traditionally espoused by the other modern schools of occlusion. The apparent universal lack of enthusiasm by the dental community for the teachings of cranial orthopedists can be traced to its reliance on unscientific geometrical justification.
颅骨矫形学的主要魅力在于它认识到颞下颌关节具有适应性的重塑能力，而这一点却被其他现代咬合学派传统上所信奉的静态关系概念所忽视。牙科界对颅骨矫形学家的学说显然普遍缺乏热情，这可以追溯到其对不科学的几何论证的依赖。

Mandibular Centricity (Centric Relation)
下颌中心（中心关系）

With the exception of cranial orthopedics, nearly all concepts of occlusion have embraced the practice of mandibular centricity, which early writers loosely referred to as centric relation (CR) but rarely defined this jaw position. Hanau, in 1929, defined centric relation as the position of the mandible in which the “condylar heads are resting upon the menisci in the sockets of the glenoid fossae, rcgardless of the opening of the jaws,” and he also states that the relation is “cither strained or unstrained.” Hanau preferred the unstrained centric relation associated with an accepted opening for the reference jaw relation.

^{54}

Niswonger, in 1934, described GR as a position where the patient can “clinch the back tecth.”

^{35}

Schuyler, in 1935, defined the centromaxillomandibular position or centric position as when the "upper lingual cusps are resting in the central fossae of the opposing lower bicuspids and molars. . .

^{556}

Thompson, in 1946, lamented the lack of knowledge upon which clinical procedures were based by stating "…some believe that, in centric relation, the condyles are in the most retruded position in their fossae, while others maintain they are not.

^{557}

除了颅骨矫形学之外，几乎所有的咬合概念都采用了下颌居中的做法，早期的作者将其松散地称为居中关系（CR），但很少对这种下颌位置进行定义。1929年，Hanau将中心关系定义为下颌的位置，即 "髁状突头位于盂窝窝内的半月板上，无论下颌是否张开"，他还指出这种关系是 "紧张或非紧张的"。Hanau 倾向于将与公认的下颌开度相关的非受约束中心关系作为参考下颌关系。

^{54}

1934年，Niswonger将GR描述为患者可以 "夹紧后牙 "的位置。

^{35}

1935年，Schuyler将颌中位置或中心位置定义为 "上舌尖位于对侧下双尖牙和臼齿的中心窝内。. .

^{556}

1946年，Thompson对临床程序所依据的知识的缺乏表示遗憾，他说："......一些人认为，在中心关系中，髁突在其窝内处于最后退的位置，而另一些人则认为它们不是。

^{557}

The early writers rarely if ever advocated manual manipulation of the mandible to achieve their centric jaw registration. Needles, in 1923, used an intraoral arrow point tracer in which "the patient retruded the mandible to its fullest extent."58 Schuyler, in 1932, advised using wax interocclusal records and "the patient may be requested to place the tip of the tongue far back on the palate and to hold it there while closing. It is quite impossible for onc to protrude the mandible when this position of the tongue is retained.

^{359}

Meyer, using the functionally generated path technique, did not attempt to manipulate the mandible other than to instruct the patient occasionally in "getting started by exerting a little pressure on the chin.

^{' 24}

Mandibular manipulation grew in acceptance with the increased interest in gnathologic philosophy, and writers began to warn of strain to the condyles. Robinson, in 1951, stated that the mandible "can be retruded beyond what we should consider centric into a strained retruded position.

^{650}

早期的作者很少主张通过手动操作下颌骨来实现下颌骨的中心对准。1923年，Needles使用口内箭头追踪器，"患者将下颌骨后缩至最大程度 "58 。1932年，Schuyler建议使用蜡质咬合间记录，"可要求患者将舌尖置于上腭后方，并在闭合时保持该位置。当舌头保持在这个位置时，下颌骨是不可能突出来的。

^{359}

Meyer 使用功能生成路径技术，除了偶尔指导患者 "开始时对下巴施加一点压力 "之外，没有尝试操作下颌骨。

^{' 24}

随着人们对下颌骨解剖学的兴趣日益浓厚，下颌骨手法也逐渐被人们所接受。罗宾逊在1951年指出，下颌骨 "可以后缩，超出我们认为的中心位置，进入紧张后缩位置。

^{650}

As the debate of how to define the “centric jaw position” escalated, new terms began to appear in the literature. Terms like “posterior border closure,” “relaxed closure,” “bracing position,” “hinge position,” “ligamentous position,” “retruded contact position,” and “terminal hinge position” added confusion. Even the different disciplines within dentistry could not agree on the definition of centric relation. Goldman and Cohen defined centric relation as the most posterior relation of the mandible to the maxilla from which “lateral movements can be made.”

^{61}

Glickman stated centric relation is "the most retruded position to which the mandible can be carried by the patient’s musculature.

^{*62}

Graber refused to be drawn into the controversy, stating only that the position must be "the unstrained, neutral position of the mandible…"63 Schluger, Yuodelis, and Page stated that centric relation is “the position assumed by the mandible relative to the maxilla when the condyles are in their rearmost, midmost position in the glenoid fossae.”

^{64}

This definition is very close to the gnathologic RUM definition as proposed by MoCollum and Stuart, where the condyles are in their “rearmost, uppermost, and midmost” position in their respective fossae.

^{65}

In an effort to standardize this and other commonly used terms, the Academy of Prosthodontics (formerly the Academy of Denture Prosthetics) has published the Glossary of Prosthodontic Terms. This glossary is updated periodically and has five editions since the first in 1956. Every time there is an update, the definition of centric relation changes. Avant, in 1971, decried the “seven definitions of centric relation” appearing in the 2nd edition of 1960.

^{66}

Schluger, Yuodelis, and Page confessed that the word “centric” may be the most “controversial term in dentistry,” not only from a semantic point of view but also due to differences in concept, and they admit that these serious differences in concept "may never be resolved."64 The newest edition (1987) of the Glassary of Prosthodontics Terms defines centric relation as “A maxillomandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective disks with the complex in the anterior-superior position against the slopes of the articular eminesces.” The authors of this 5th edition of the Glassary of Prosthodontic Terms state “This term (CR) is in transition to obsolescence.”

^{"}

Wishful thinking, or admission that the more we attempt to define this important concept of clinical dentistry, the more confusing it becomes? The current definition of CR is considerably different from the definitions used by Hanau, Niswonger, Schuyler, and the other early giants of dentistry. These clinical dentists recorded centric relation differently than is commonly done today, but the concept of mandibular centricity remains constant even
随着关于如何定义 "下颌中心位置 "的争论不断升级，文献中开始出现新的术语。后缘闭合"、"松弛闭合"、"支撑位置"、"铰链位置"、"韧带位置"、"后退接触位置 "和 "终端铰链位置 "等术语增加了混乱。就连牙科的不同学科也无法就中心关系的定义达成一致。Goldman和Cohen将中心关系定义为下颌与上颌的最后方关系，"在此关系上可以进行侧向移动"。

^{61}

Glickman指出，中心关系是 "患者的肌肉组织可以将下颌骨带到的最后退的位置"。

^{*62}

Graber拒绝卷入这场争论，只表示该位置必须是 "下颌骨未受约束的中立位置...... "63 Schluger、Yuodelis和Page表示，中心关系是 "当髁突处于盂窝的最后方、最中间位置时，下颌骨相对于上颌骨所处的位置"。

^{64}

这一定义非常接近MoCollum和Stuart提出的gnathologic RUM定义，即髁突在各自窝中处于 "最后、最上和最中 "的位置。

^{65}

为了将这一术语和其他常用术语标准化，义齿修复学会（前身为义齿修复学会）出版了《义齿修复术语汇编》。该词汇表会定期更新，自 1956 年第一版以来已经更新了五版。每次更新时，中心关系的定义都会发生变化。Avant 在 1971 年谴责了 1960 年第二版中出现的 "七个中心关系定义"。

^{66}

Schluger、Yuodelis 和 Page 承认，"中心 "一词可能是 "牙科中最有争议的术语"，这不仅是从语义的角度来看，也是由于概念上的分歧，他们还承认这些概念上的严重分歧 "可能永远无法解决"。"64最新版（1987 年）的《口腔修复学术语词典》将中心关系定义为："上下颌骨的关系，即髁突与各自牙盘最薄的无血管部分相衔接，复合体处于前上方位置，靠着关节突的斜坡。这本第五版《口腔修复术语库》的作者指出："这个术语（CR）正处于过时的过渡阶段"。

^{"}

是一厢情愿，还是承认我们越是试图定义这个重要的临床牙科概念，它就越是令人困惑？目前对 CR 的定义与 Hanau、Niswonger、Schuyler 和其他早期牙科巨匠所使用的定义大相径庭。这些临床牙医记录的居中关系与今天的通常做法不同，但下颌居中的概念始终不变，甚至是
though the definition and the techniques have evolved and probably will continue to evolve.
尽管定义和技术已经发生了变化，而且可能还会继续变化。

Biological Occlusion 生物闭塞

There is ample reason to believe that many successful long-term clinical treatments have been accomplished using each of the modern schools of occlusion. Because dentitions can be maintained successfully with several apparently conflicting occlusal concepts, there is a growing realization that occlusal concepts are not as “cut and dried” as we once thought. The flexible concept of occlusion is termed biological occlusion, and its philosophical goal is to achieve an occlusion that functions and maintains health. This occlusion may include malpposed teeth, evidence of wear, missing teeth, and centric occlusion may not always equal centric relation. The dominant factor is that this occlusion has shown its ability to survive, thus implying an age factor, ie, a teenager with temporomandibular joint symptoms does not fit this occlusal concept, while an asymptomatic 80 -year-old with balancing side contacts does. One who fits this concept needs no occlusal therapy. However, when occlusal therapy is indicated (ie, mutilated dentition, occlusal traumatism, temporomandibular joint dysfunction), then basic guidelines for occlusal design are needed. These goals are compatible with almost all of the occlusal concepts commonly used today for natural dentitions including P.M.S., Gnathology, and Transographics.
我们有充分的理由相信，许多成功的长期临床治疗都是通过现代咬合学派中的每一个学派完成的。由于多种看似相互冲突的咬合概念都能成功地维持牙体，人们越来越意识到咬合概念并不像我们以前认为的那样 "一刀切"。灵活的咬合概念被称为生物咬合，其哲学目标是实现咬合功能并保持健康。这种咬合可能包括牙齿畸形、牙齿磨损、牙齿缺失，而且向心咬合不一定总是等同于向心关系。最主要的因素是这种咬合已经显示出它的生存能力，这就意味着年龄因素，即一个有颞下颌关节症状的青少年不符合这种咬合概念，而一个无症状、有平衡侧接触的 80 岁老人则符合这种咬合概念。符合这一概念的人无需进行咬合治疗。但是，当需要进行咬合治疗时（即牙齿残缺、咬合创伤、颞下颌关节功能障碍），就需要制定咬合设计的基本准则。这些目标几乎与当今所有常用于天然牙的咬合概念兼容，包括P.M.S.、Gnathology和Transographics。

Goals of Biological Occlusion
生物闭塞的目标

No Interferences Between Centric Occlusion and Centric Relation
中心闭塞与中心关系之间无干扰

Very few patients naturally function in centric relation occlusion; however, centric relation is a very valuable position in restorative dentistry. To demand that the condyles be in their hinge position when the teeth are in the maximum intercuspal position and to stay that way for long periods of time is unreasonable. It is not unreasonable to assure that there are no cuspal interferences between centric relation

(CR)

and centric occlusion (CO), CR and CO as defined by the Glossary of Prosthodontic Terms, 1987.67
很少有患者能够自然地实现中心关系咬合；然而，中心关系在牙科修复中是一个非常有价值的位置。要求髁状突在牙齿处于最大牙间隙位置时处于铰链位置并长时间保持这种状态是不合理的。确保中心关系

(CR)

和中心咬合（CO）、CR和CO（1987年《口腔修复术语词汇表》67）之间没有尖牙干扰并不是不合理的。

No Balancing Contacts 无平衡触点

Years of observation, trial and error, and scientific investigation have brought realization that nonwork- ing contacts in natural dentitions have the potential of being very destructive. The criteria requires that disclusion occurs as the mandible moves laterally. Because the mandible can flex

^{68, 69}

and the articulator does not (except for the Transograph), the amount of disclusion needed can vary and must be tested in the mouth for each individual patient.
经过多年的观察、试验和科学调查，人们认识到自然牙列中的非工作接触具有很大的破坏性。该标准要求下颌骨横向移动时发生排阻。由于下颌骨可以弯曲

^{68, 69}

，而发音器不能弯曲（除 Transograph 外），因此所需的排阻程度可能会有所不同，必须在每个患者的口腔中进行测试。

Cusp-to-Fossa Occlusal Scheme
尖对窝咬合方案

While cusp tips can function effectively against marginal ridges, a cusp-fossa relationship is potentially more stable than any other relationship.
虽然尖突可以有效地对抗边缘脊，但尖突与窝的关系可能比任何其他关系都更稳定。

A Minimum of One Contact per Tooth
每颗牙齿至少有一个接触点

It is preferred that every vertical dimension cusp (buccal of the lower and lingual of the upper) be in full contact with the opposing fossa. However, there are times when this is not practical, thus as a bare minimum one should have at least one cusp-to-fossa contact for each posterior tooth. If this is not achieved, the noncontacting tooth has the potential of erupting and shifting into a malposition, producing a balancing interference. The potential for a contacting tooth to shift into malposition is diminished if the vertical dimension cusps are engaging opposing fossas.
每个垂直方向的尖牙（下牙的颊侧和上牙的舌侧）最好都能与对侧窝沟完全接触。然而，有时这并不现实，因此，作为最低要求，每颗后牙至少要有一个尖面与牙槽接触。如果做不到这一点，未接触的牙齿就有可能萌出并移位，产生平衡干扰。如果垂直方向的尖牙与相对的窝沟接触，接触牙移位到错位的可能性就会减小。

Cuspid Rise or Group Function
上颚隆起或群体功能

In order to assure that there are no balancing contacts, the working side must disclude the posterior teeth on the balancing side during lateral eccentric jaw movements. It is equally acceptable to achieve this disclusion with a cuspid rise or group function where the cuspid and/or bicuspids engage in lateral motion to disclude the balancing side occlusion. Also acceptable is a combination of cuspid rise and group function.
为了确保没有平衡接触，工作侧必须在下颌横向偏心运动时排除平衡侧的后牙。同样可以接受的是，通过尖牙上翘或组功能来实现这种排阻，即尖牙和/或双尖牙在侧向运动中啮合，以排阻平衡侧的咬合。同样可以接受的是结合尖牙上翘和牙群功能。

No Posterior Contacts With Protrusive Jaw Movements
下颌前移时无后部触点

As the mandible slides forward from the maximum intercuspal position, the anterior teeth should engage and progressively disclude the posterior teeth.
当下颌骨从最大颌间位置向前滑动时，前牙应与后牙啮合并逐渐脱离。

No Cross-Tooth Balancing Contacts
无交叉齿平衡触点

A cross-tooth contact occurs when the lower lingual cusps contact the upper lingual cusps on the working
当下舌尖与工作中的上舌尖接触时，就会出现交叉齿接触。
side. Because the lower lingual cusps are nonfunctioning, their reduction to eliminate contact in lateral excursion is simple and prevents interference with group function. The potential for fracture of these lower lingual cusps is also reduced.
侧。由于下舌尖牙没有功能，因此在侧移过程中减少它们以消除接触很简单，而且可以防止干扰牙群功能。下舌尖突骨折的可能性也降低了。

Eliminate All Possible Fremitus
消除所有可能的 Fremitus

Fremitus is the movement of teeth in function; this undesirable phenomena is also called functional mobility.

^{70}

Fremitus usually occurs with periodontally compromised support. Fremitus often cannot be seen, but can be felt digitally when the teeth are occluded or when engaging in eccentric mandibular movements.
自由移动是指牙齿在功能上的移动；这种不良现象也被称为功能性移动。

^{70}

自由活动通常发生在牙周支持受损的情况下。自由活动通常看不到，但在牙齿咬合或下颌偏心运动时可以用数字感觉到。

Obtain and Maintain a Neurological Release
获得并保持神经系统释放令

The goal is a perceivable relaxation of the muscles of mastication allowing the operator to manipulate the mandible with little or no resistance from the patient. The presence of this neurological release is one sign that the occlusion is progressing toward harmony with the muscles of mastication.
其目的是使咀嚼肌明显放松，使操作者能够在患者几乎没有阻力的情况下操作下颌。这种神经释放的出现是咬合正朝着与咀嚼肌和谐的方向发展的一个标志。

Summary 摘要

The historical origins of some concepts of occlusion have been discussed. The cornerstones for several prominent occlusal concepts that have been developed for natural dentitions and are currently being applied to restorative dentistry have been presented. It is presumptuous to state nature’s intent for an ideal occlusion and therefore it is recommended to avoid occlusal therapy for individuals who appear to be functioning in health, even if their occlusal scheme does not fit a concept of optimum occlusion. When occlusal therapy is unavoidable, it is suggested to treat within the guidelines of what has been called biological occlusion.
我们讨论了一些咬合概念的历史起源。介绍了几种著名的咬合概念的基石，这些概念是针对自然牙体提出的，目前正应用于牙齿修复。妄言自然界对理想咬合的意图是冒昧的，因此建议对那些看起来功能健康的人避免咬合治疗，即使他们的咬合方案不符合最佳咬合的概念。当咬合治疗不可避免时，建议按照所谓的生物咬合准则进行治疗。

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*Assoriate Clinical Professor, Department of Fixed Prosthodontics, School of Dentistry, University of Colorado, Denzer, $C O$ .
*科罗拉多大学牙科学院固定义齿修复系临床副教授， $C O$ 丹泽。
$^{†}$ Associate Professor and Interim Chairman, Department of Prosthodontics, University of Texas Health Science Center at San Antonio, TX.
$^{†}$ 德克萨斯大学圣安东尼奥健康科学中心口腔修复学系副教授兼临时主席。

Address reprinl requests to David A. Kaiser, DDS, MSD, Division of Prosthodontic Dentistry, University of Texas Health Science Center at San Antomio Dental School, 7703 Floyd Curl Dr, San Antonio, TX 78284 7090
如需转载，请联系：David A. Kaiser, DDS, MSD, Division of Prosthodontic Dentistry, University of Texas Health Science Center at San Antomio Dental School, 7703 Floyd Curl Dr, San Antonio, TX 78284 7090

Copyright (1) 1993 by the American College of Prosthodontists
$1059 - 941 X / 93 / 0201 - 0007 $ 5.00 / 0$

ACADEMICS AND EDUCATION Evolution of Occlusion and Occlusal Instruments 学术和教育 咬合和咬合器械的演变

Abstract 摘要

Early Concepts 早期概念

Age of Occlusal Theories and Occlusal Articulators咬合理论和咬合器的时代

Evolution of Occlusion 闭塞的演变

Modern Occlusal Concepts 现代咬合概念

Pankey, Mann, Schuyler System潘基、曼恩、斯凯勒系统

Gnathology 解剖学

Transographics

Cranial Orthopedics 颅骨矫形

Mandibular Centricity (Centric Relation)下颌中心（中心关系）

Biological Occlusion 生物闭塞

Goals of Biological Occlusion生物闭塞的目标

No Interferences Between Centric Occlusion and Centric Relation中心闭塞与中心关系之间无干扰

No Balancing Contacts 无平衡触点

Cusp-to-Fossa Occlusal Scheme尖对窝咬合方案

A Minimum of One Contact per Tooth每颗牙齿至少有一个接触点

Cuspid Rise or Group Function上颚隆起或群体功能

No Posterior Contacts With Protrusive Jaw Movements下颌前移时无后部触点

No Cross-Tooth Balancing Contacts无交叉齿平衡触点

Eliminate All Possible Fremitus消除所有可能的 Fremitus

Obtain and Maintain a Neurological Release获得并保持神经系统释放令