Adjusting the bite on new amalgam or composite restorations can be a daily challenge. With intra-coronal restorations like these we can at least look for areas of the tooth that were touching before we placed the restoration to also be touching after we place it. Of course this means that we need to use the articulating paper before we prep and remember what was touching.
For years I thought that the articulating paper was the part of my armamentarium that came out after the restoration was placed!
Similarly, for a crown or other occlusal coverage restorations, we can mark and note where the other teeth in the arch are touching before we begin preparing a tooth for a new restoration. Not only can we look ahead of time in the mouth, as we did for the intra-coronal restoration, but we can evaluate our mounted casts as well. We can then verify that the same teeth are touching after we place our provisional and eventually the final restoration, in addition to appropriate planned spots on our new restoration.
Even when we think ahead and use the tape before and after, it can still be confusing to understand what we are looking at. The three keys for me, regardless of type or brand are the following:
1. Adequately dry the teeth on both arches. This can obviously be done with air from the air/water syringe; however, when I started asking the patient to bite into tightly folded up tissue (as seen in the above photo) before using the articulating tape, my marks became much clearer.
2. Always use one color for excursive movements and another for biting (tap, tap). Minimally, this trains our eyes and allows us to discriminate where the new restoration is bumping when the patient moves. This also helps keep track of the spots we want to preserve for the stops. This technique also helped me begin to see function of teeth on a regular basis, helping all of my dentistry.
3. Have the patient bite hard without the tape immediately after removing the tape from the mouth. The spots that are hitting slightly harder or earlier will have a little white dot in the middle where the cusp penetrated through the thickness of the colors.
A few times in my career Iâve had a patient tell me that the new restoration still felt high even though I could see marks all over the arch. Sometimes I could barely see a mark on my new restoration. Using two colors to help differentiate a slight contact on an incline plane at the beginning of an excursive movement has allowed me to make intentional adjustments that give the patient immediate feedback.
Having the patient bite immediately after marking both colors to see the heaviest spots through it and making a small adjustment has made a big difference for me. Of course, drying all of the saliva consistently makes the rest easier too.
Learn more about occlusion and wear in addition to techniques relating to esthetics and treatment planning from the Spear Digital Suite.
View the free lesson:Â Bite Records in Restorative Dentistry.