Restorative dentistry and occlusal harmony

By Van B. Haywood, DMD

estorative dentistry is built on a foundation of solid occlu- Rsion. If the occlusion is not The patient says the bite Your ceramic crowns addressed, then no matter how good feels off on the new restoration. always seem high in occlusion. the margins or shade match are on a 4 After drying the teeth, have the Crowns should be seated completely, restoration, the patient will ultimate- patient grind his or her teeth on a especially zirconia ceramic crowns, ly “chew it up and spit it out.” light-colored articulating paper such to avoid grinding on the occlusal Here are some insights about the as red. Then air-dry the teeth and surfaces and fracturing or grinding impact of occlusion on restorative have the patient tap into maximum through the ceramic. Seating is best dentistry: intercuspation (MI) on a different- accomplished using a disclosing me- colored articulating paper such as dium, which is the same thickness as blue. On examination, there should the final cement and basically takes be blue dots on all the teeth and an impression of the fit of the crown Your new restoration was blue dots with red lines only on the at the point of seating. Time spent fine when the patient left the office, anterior teeth. If you see any red seating the crown completely using but it is high in occlusion the next lines on the posterior teeth or if the this technique will be rewarded by day. After a routine dental appoint- blue dots are larger than one mil- excellent occlusion with minimal ment for a restoration, patients who limeter, you have working and non- adjustment. have tight, tired muscles from grind- working interferences that need to ing or clenching may not be able be removed to change the bite sensa- to close completely. They will close tion and avoid increased muscle on their front teeth, but due to the activity, tooth wear or headaches. Crowns that were once spastic contraction of the muscles good now have notches at the from excessive use, the condyle does margins. Gingival notches may be not seat completely, and the back related to heavy forces on the teeth teeth are out of occlusion. It may Explaining to patients that causing tooth flexure. Restoration take several hours or days for the restoring one broken tooth often of these areas is best done with resin muscles to relax and allow complete requires adjusting two teeth. Often modified glass ionomers rather than closure. At the beginning of the a tooth with a crack is caused by the composite resin. However, the cause restorative appointment, observe or opposing tooth, which needs some of the notches must be identified mark the occlusion on the most pos- adjustment to eliminate a “plunger and treated, or the restorations will terior remaining teeth. If the patient cusp” before restoring a fractured fail in the same manner as the tooth. cannot reproduce that point of con- area on a tooth. Failure to shorten See HARMONY, page 5 tact after being open for a time, you and reshape the opposing tooth with must ensure that the new restoration a limited occlusal adjustment may is out of occlusion as much as the shorten the life of the most posterior contact, or it will be new restoration on high when the muscles finally return the fractured tooth. to their normal function the next day. Often, you have to bring the patient back for an adjustment.

DentalPracticeSuccess FALL 2016 HARMONY Continued from page 4

tions are placed that interfere with this slide path. Evaluate the slide path from CR to MI, Some in addition to the MI crowns seem to work contacts and lateral great while others movements, when have to continually be placing restorations. Dr. Haywood’s article, “Restor- adjusted. The choice of ative dentistry and occlusal which articulators to use for harmony,” reprinted here with indirect procedures is based on permission, appeared in the Fall the occlusal scheme of the patient. You have just 2016 issue of Dental Practice Success. If the tooth being restored does placed a posterior composite not involve any functional guid- which the patient says still feels Dental Practice Success is a high, but there is no contact on quarterly digital publication that ance, then a quadrant or triple brings together well-known dental tray impression is appropriate. the restoration. Your teeth can practice management counselors 5 If the tooth being restored is detect the thickness of a hu- who serve up the best advice on a involved in functional guidance, man hair, less than 40 microns. wide range of topics. then a semi-adjustable articulator Sometimes the bonding agent has Visit the ADA Center for Profes- should be considered. Adjusting traveled into an occlusal contact sional Success website, Success. the patient’s occlusion before the area but cannot be seen. A slow ADA.org/dps for more practice tips from Dental Practice Success. crown is placed will also help. speed latch-type round bur will cut composite, but not damage Editorial and Advertising enamel. Run the slow speed bur Policies Any statements of opinion or fact over the occlusal contacts on the are those of the authors and do Using splints to adjust tooth, removing the bonding not necessarily reflect the views the occlusion when they come agent and remark. The occlusal of the American Dental Associa- from the lab is too frustrating. contacts should still be present, tion. Neither the ADA nor any of Bruxism splints are best construct- but the patient should feel fine its subsidiaries have any financial ed if the interocclusal record (bite) interest in any products mentioned with the bonding agent removed. in this publication. Any reference is taken at the desired vertical to a product or service, whether dimension of the splint in centric All of these areas are occlusal in advertisements or otherwise, relation (CR). Using this record- issues that are made visible in the is not intended as an endorse- ing of the vertical dimension of restorative outcomes. Addressing ment or as approval by the ADA the final splint technique does not or any of its affiliated organiza- or recognizing them can lead to a tions unless accompanied by an require a semi-adjustable articula- much more satisfied patient. authorized statement that such tor, since there are no “arch of approval or endorsement has closure” issues, and there will be been granted. Dr. Haywood, is minimal occlusal adjustments. professor in the All matters pertaining to adver- Department of Oral tising should be addressed to Rehabilitation, Dental the advertising sales manager, College of Georgia at Augusta Sales and Marketing Depart- The patient complains University, Augusta, Georgia. He ment, American Dental Associa- the new restoration does not teaches courses in fixed prosthodon- tion, Publishing Division, 211 E. Chicago Ave., Chicago, IL 60611, feel right. tics, occlusion and esthetics, as If there is a difference well as in sophomore and junior 1-312-440-2740, fax 1-312-440- between CR and MI, then you student clinics. While he is more 2550. All advertising appearing should determine whether it is known for his introduction of tray in ADA publications must comply beneficial or possible to make bleaching to the world in 1989, with official published standards of the American Dental Association, them coincide before the new res- he directs the occlusion course, and has published on articulators, a copy of which is available on toration is placed. If it is not, you splints and occlusion. His website is request. should make certain no restora- www.vanhaywood.com. DentalPracticeSuccess FALL 2016