Tif Qureshi explains what to consider when choosing your approach.
It is important for all clinicians to have a good understanding of occlusion and the relationship it has with various treatment types. Because there are a number of conflicting approaches to managing occlusion, it can be a complex field. This can make it challenging for dentists to establish approaches which facilitate effective and appropriate patient care. When it comes to restorative dentistry, clinicians should understand the effects that different treatment types can have on occlusion, and be sure to undertake an approach which is appropriate in each case.
The importance of occlusal assessment
Even if a clinician is not looking to manage occlusal problems directly, it is still important to carry out an occlusal assessment in everyday dentistry. Any dental treatment can have an effect on occlusion. Whether they are carrying out a restoration, an orthodontic treatment, or an extraction, dentists must take the patient’s individual anatomy into account. A thorough occlusal assessment will allow dentists to carry out restorative treatments confidently, without the risk of accidentally creating problems.
A basic occlusal exam, when looking to carry out restorative dentistry, should include an extra-oral and intra-oral assessment, load testing of the joints, and an assessment of the ‘slide’ that occurs at maximum intercuspation. To assess the patient’s occlusion, and whether it might be significant when it comes to restorative treatment, clinicians should consider a number of things. It is important to check for signs of wear and determine which areas are affected, in addition to whether it might impact the success of the restoration. Clinicians should also check for any mobility, previous extractions and their impact, as well as the occlusal condition of any existing restorations. Practitioners should also take note of the first point of contact, as any changes to these particular teeth could have significant impacts on occlusion.
The relationship between occlusion and restorative dentistry
Occlusion is not static. Even though there is a relationship with the upper and lower teeth in contact, the way teeth move while chewing, for example, is also significant. When restoring dentition, it is important to take both of these relationships into account, while also understanding that the patient’s anatomy can adapt to changes in occlusion – but this can be unpredictable. Because of this, most restorations should aim to conform to the existing occlusion – providing function without having a negative impact on occlusion. This is known as a ‘conformative approach’, whereas, if more advanced restorative treatment is required, a clinician might follow a ‘reorganised approach’, altering the occlusal relationship.
If the patient requires major restorative treatment (and therefore a reorganised approach), it is considered appropriate to improve the occlusion from the starting position. This new occlusion is likely to be tolerated better by the patient and can be judged by the way the patient’s tissues react to it. Whether a patient’s occlusion is good or bad should be assessed in terms of whether it causes damage – this will depend on the magnitude, frequency, and direction of the forces that are applied to the dentition and tissues, as well as any resistance and the number of contact points. In any case, the aim of restorative treatment is to produce a functional outcome, which doesn’t cause any harm to the patient’s anatomy or improves the situation where suitable.
To ensure the clinician can confidently carry out restorative treatment, with consideration for the patient’s occlusion, it is important to undertake appropriate training. During the ‘Occlusion: Basics and beyond’ course from the IAS Academy, Jaz Gulati and Mahmoud Ibrahim will provide you with a tangible, real-world, comprehensive understanding of occlusion. The course provides delegates with a risk-based, structured approach to the assessment and management of occlusion, for use in daily practice. It focuses on the practical applications of occlusion, taking into account everything from very basic restorations to full-mouth ortho-restorative cases.
The ability to carry out restorative treatment confidently, while having the knowledge needed to conform to, idealise, or reorganise the patient’s occlusion is valuable in day-to-day dentistry. It is important to understand the effects that the patient’s occlusion can have on the treatment options available and the impact that some restorative treatments can have on the resulting occlusion. It is important to undertake a thorough occlusal assessment prior to treatment to maximise the predictability of treatment results. Should restorative treatment be carried out, without appropriate consideration of the patient’s occlusion, damage may be caused to the patient’s tissues.
For more information call 01932 336470 or visit www.iasortho.com