We all know that occlusion plays a big role in the longevity of not only our patients’ teeth but also any restorations that we provide for them. So, the question still remains: what should be our end goal – at least for most patients? While I am sure most lay people think there must be one simple answer to this question, if your dental school was like mine you might be a bit confused as we were taught a slightly different ideal occlusion from each department. Given this, it was easy to leave a bit confused. In fairness, I will say there is some simple reasoning behind why each department had their take on ideal occlusion – and the answer is there is no one ideal occlusion that works every time for every patient. As the saying goes, everything works some of the time and nothing works all the time.
Tips to Avoid Occlusion Confusion
With all of that being said, I would like to give you some tips I have found helpful when thinking of occlusion with my patients.
- Simplify your contact points
- While tripod contact points are great in theory, what happens when one of the point is heavier or lighter than the others? The answer is simple: physics dictates that. Now you have heavy contacts on one or more slopes; this means that either the teeth move and/or you have increased the risk an unintended CR/CO slide. Either way, you have introduced at least some level of instability. So, what is an easier solution that will often result in a more stable occlusion? Rather than attempting to achieve perfect tripodization on posterior teeth, you should create flat landing spots for the opposing cusps to contact.
- Smooth is the key
- When evaluating excursive movements, make sure that the movement is smooth and that there aren’t any places for your patients to grab and push. If your patient can grab somewhere, they will be able to create more force which increases the risks for breakage.
- Do not overload the laterals
- In most cases, it is perfectly fine for the lateral incisors to be contacted in excursive movements, but they should not be in contact by themselves. Rather, they should only make contact when they are sharing the load/contact with the canine or central incisor.
- When in doubt, test your theory
- As I stated above, everything works some of the time and nothing works all of the time. Keeping this in mind, while we usually want no posterior contacts in excursive movements, the simple fact is that some patients need group function or balancing contacts. If you are not sure if this is your patient, it is best to figure this out prior to finalizing their occlusion. This can be done with an occlusal orthotic, such as a Tanner appliance and/or provisional restoration.
John R. Carson, DDS, PC, Spear Visiting Faculty and Contributing Author http://www.johncarsondds.com