Information for Dentists
- Prior to any/all restorative treatment, verify occlusion, periodontal probing, and tooth vitality.
- Prior to beginning the case, verify VDO and stable centric stops. Excluding endo mishaps and perio, most failures in major cases result from decreased VDO and improper occlusion that stress anterior teeth to breakage or leave insufficient room for restorative materials. Therefore, full mouth occlusal adjustment to stable centric and excursions prior to restorative is a must.
- Both neuromuscular and Dawson-type occlusions share many common factors. The initial point of contact is either on a neuromuscular arc (N.M.) or in a hinged-arc, condyle-superior manipulated position (Dawson) and many individuals can function from either. From this position, one needs good centric stops on the posterior teeth at a good VDO on the arc of closure, then anterior guidance on multiple teeth with immediate disclusion of the posteriors. Posteriors should not touch in protrusive or lateral excursions else the mandibular closing muscles will be activated, overstressing all teeth.
- In right (working) excursions: ideal is cuspid guidance or group function with no left side (balancing) interferences. In left (working) excursions: ideal is cuspid guidance or group function with no right side (balancing) interferences.
- With Dawson-type manipulated centric, use gentle condyle-seating pressure. The slope of the anterior fossa will distalize the condyle if excessive seating pressure is employed.
- With neuromuscular occlusion, employ the myomonitor (low frequency T.E.N.S.) to determine arc of closure, or use the standing Willie-May swallow technique.
- Establish proper vertical dimension of occlusion (VDO) initially. To allow room for C&B materials, partial clasps, partial frameworks, attachments, etc., a good starting guide is a Shimbashi number (max centrals CEJ to mandibular centrals CEJ) of 18 – 20mm.
- ERA attachments are good, simple, reliable attachments but require adequate clearance for the housing. If necessary, establish adequate VDO with occlusal buildups prior to initiating final restorative.
- For UCP/LCP cases, saddle-lock clasp designs can give the patient hidden clasps without the increased cost of crowns and precision attachments. The clasps must encircle greater than 180 degrees around the tooth. Giving an abutment tooth a mesial slice (hidden to the lingual) with a slight mesial groove is advantageous.
- Impressions: never use a triple tray. Up to 60% of all lab remakes result from triple-tray-related distortion. Few patients can hold a uni-lateral bite static; most will slide to the side of the impression while it is setting and cause distortion.
- To maximize impression accuracy and minimize distortion of pour-ups:
Impressions with posterior preps should be boxed up prior to being poured. Delicate margins and interproximal areas should be stabilized with light body impression material delicately painted on these areas. Thin, delicate, multiple layers should be applied as necessary; invert the impression while setting. The weight of the die-stone can distort the thin impression areas and they may not recover through the thickness and weight of the stone mix; look for and remove or stabilize thin marginal areas that can fold over.
- If retraction cord is required for the impression it will likely be needed for isolation prior to seating the restoration to avoid contamination of the cement.
- Chlorhexidene gluconate (peridex, etc.) should often be used prior to preparation; and usually between preparation and seating of crown and bridge.
- Not all patients lend themselves to full porcelain restorations; choose these cases carefully. Full gold and gold occlusals provide great durability and great forgiveness; they are the closest alternative to the natural occlusion. In any case, stable occlusion is the key.
- Take care of your patients first, the profession second, and yourself third. Your rewards will come.
Forms / Documents for Download:
- Appendix A: Esthtetic Crown Lengthening and Normal/High/Low Osseous Crest Patients
- Appendix B: Root Reshaping
- Appendix C: Treatment For Dry Mouth (Xerostomia) and Aggressive Cavities (Decay)
- Appendix D: Burning Mouth Syndrome
- Appendix E: Implant Selection Criteria
- Appendix F: Sleep Disordered Breathing Exam Form
- Appendix G: OSA Lab Slip Instructions
- Appendix H: Esthetics Case TX Routing Form
- Appendix I: Esthetics Case Delivery Supply List
- Appendix J: Esthetics Case Delivery Treatment Sequence
- Appendix K: TMJ Exam Forms
- Appendix L: Complex Case Protocol