Upper teeth from the backside with red patches on the tips of each tooth.

For many, occlusion is one of the most confusing topics in dentistry. So much of occlusion is unpredictable because it relies on how the patient responds, and of course various patients will respond differently. The following are some of the most common questions that dentists often ask about occlusion:

  • If I just use the patient's existing occlusion, will I be successful?
  • If I change the occlusion, how will I know it will be successful?
  • If I remove the patient's occlusion, how do I recreate it?
  • If the patient has severe tooth wear, how can I predict my treatment will be successful?
  • What can I do to increase my chance to success when restoring worn teeth?

For years there have been some fairly strong opinions about how occlusion should be managed. Classically, occlusion was a pretty dogmatic, rigid discipline. There was one occlusal scheme that was ideal when a patient presented; if the patient didn't match the ideal scheme that became justification for treatment. In most instances, the treatment will be successful, but the question is, was the treatment necessary? The following are key elements to occlusion:

  • Intercuspal position
  • Pathways and patterns of guidance (which teeth touch; what's the pathway that the mandible follows?)
  • Edge to edge and beyond
  • Vertical dimension

The confusion comes from several philosophies about how occlusion should be managed. The following are four prevailing viewpoints related to occlusion:

  • Gnathology (arguably the oldest occlusal philosophy)
  • Bioesthetics
  • Neuromuscular
  • Pankey-Dawson

Ironically, the main problem that these ideas all present is that they all have advantages – and they all work most of the time, and they all fail some of the time. What all these philosophies have in common is that they all want the teeth to touch and hit evenly when a patient bites.