One of the most confusing areas of dentistry is the concept of altering a patient's natural occlusion through equilibration.
To fully understand equilibration, think of it as three separate adjustments of how a patient's teeth contact each other at intercuspal position, at edge-to-edge position and through pathways of guidance.
In most cases, patients fair very well without equilibration being incorporated into their treatment plan – but for those who do, it's helpful to know your goals before starting.
1. Even, stable occlusal contacts on teeth in centric relation: Our goal in intercuspal position is to seat the condyle so the mandible can only move in three different directions: forward, left and right. This creates a repeatable position and ultimately eliminates any posterior interference in your patient's occlusion.
2. Harmonious anterior guidance with posterior disclusion in lateral and protrusive: When a patient does need to be equilibrated, your main goal is to eliminate any posterior interference. Typically, you want to end up with canine guidance in the left and right excursions and protrusive guidance on central incisors. Ultimately, an ideal result will have the anterior teeth to touching with the posterior teeth separating to limit force during excursions.
3. Lack of fremitus or mobility on guiding teeth: The anterior teeth are providing the guidance and it's imperative to design them accordingly to prevent them from mobilizing or wearing away. Being aware of the pathways of guidance in your patient is crucial in order to have a successful and comfortable result.
The main purpose of equilibrating a patient's teeth is to ensure they have stable contacts on all of their teeth to prevent any wearing, mobilizing or fracturing in the future. Another important thing to keep in mind when you're testing the patient's bite is to always refer to the centric relation rather than asking the patient to bite. Repeatability is key in this procedure and just asking your patient to bite down will cause you to chase equilibration and lead to a less than ideal result.