The effect of malocclusion on restorative success

02 February 2024

Stephen Claffey suggests digital solutions.

Patients’ occlusion should be considered in every aspect of dentistry. It is a key factor in planning any dental treatment, be it orthodontic, cosmetic, or restorative. Malocclusion can also have a significant impact on patients’ oral health. It can increase the prevalence of caries and periodontitis and the risk of trauma. Patients with malocclusion may also feel self-conscious about the appearance of their teeth, causing them to seek treatment which improves the aesthetics. When providing restorative treatment, special care should be taken in the planning stages to assess patients’ occlusion and provide them with the most appropriate solutions.

Occlusion and restorative design

Occlusion influences every area of dentistry, including restorative. When recommending restorative treatments to patients, it’s vital to consider their occlusal situation and take a prosthetically-driven approach to treatment. For example, when providing a patient with a dental bridge, it’s crucial to take a highly accurate bite registration because the supporting teeth will be required to absorb any occlusal forces to protect the longevity of the restoration.

Similar considerations must be made when providing dental implant supported prostheses. While this depends on its location, the design of the prosthesis may mean that it is load bearing, so special measures must be taken to avoid this where possible. Recontouring the opposing tooth, for example, or adjusting the prosthesis design may help reduce the implant system load and minimise occlusal contact. In doing so, the implant structure is protected against excessive force, and patients can chew comfortably.

Any restoration will be exposed to a certain level of force, depending on its location. Small forces exerted during chewing, for example, have the potential to lead to fatigue failure of the restoration over time. If the restorative design does not accurately account for malocclusion, it will likely be subjected to excessive force.

The limits of traditional techniques

Inadequate impression taking can significantly impact the success of restorative treatment. If an impression has been taken of a prepared tooth that has not accurately captured the situation, restoration failure is more likely, with poor results both aesthetically and functionally. It is important to identify areas that bear the most stress as, if not located and the pressure relieved, restorations placed in these areas will become stress-bearing zones.

Traditionally, recording areas of contact is completed using bite articulating paper. The patient bites down on the paper, which marks areas that come into contact with opposing teeth. However, it doesn’t take into account each patient’s unique chewing motion and the level of force exerted on these areas. This does allow clinicians to make adjustments to prostheses, but does not provide additional information which could help inform treatment plans, and allow clinicians to adjust the prosthetic accordingly.

Are current digital solutions enough?

While intraoral scanners are fast becoming a popular option for recording dental impressions, they are often not sufficient for accurate bite registration. The software used to process intraoral scans may allow the clinician to simulate the teeth meeting, but this cannot replicate force or chewing cycles. This factor is key when providing restorative treatment, as it can have a significant impact on long-term success. Intraoral scanners are also currently unable to record and simulate patients’ chewing patterns, meaning that clinicians are missing crucial information about their bite which would allow them to provide restorations which perform better, and for longer.

Digital revolutions for enhanced accuracy

As the technology to produce this recording is not currently available, many clinicians are continuing to use traditional methods to record occlusion and bite registration, creating physical models of the teeth to ensure accuracy. Digital dental solutions are being adopted in many other areas of dentistry, and a system which adequately replaces this would revolutionise bite registration and the way that restorations are designed. For the future, there is a clear need for digital solutions that record patients’ unique chewing patterns and the force exerted on any areas of contact to allow clinicians to produce restorations which limit occlusal forces and protect the life span of the finished product.

Investing in new digital solutions is a big decision for any dental practice. The opportunity to improve workflows and record information that enables the dental team to produce long-lasting restorations is exciting, so it’s important to understand and use the technology effectively. Even though digital dental solutions still have a way to go, progress is being made. Many clinicians understand the importance of providing their patients with holistic, personalised care which takes into account every aspect of their oral health and dental anatomy. By designing restorations that accommodate occlusion, many patients will get the most out of the investment they’ve made in their long-term oral health.


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