Ten Common Occlusion Traps (and How to Avoid Them)January 21, 2020 by Dana J. Murn, CAE
Many dentists fall into common traps that can cause cosmetic and restorative dentistry failures. By properly establishing a stable occlusion and being cognizant of these ten occlusal traps and solutions, dentists can mitigate risk and increase patient satisfaction.
Trap 1. Undiagnosed Etiology
Remember that not every patient that presents with wear suffers force-related destruction of tooth structure. It is imperative to diagnose the etiology of tooth wear prior to treating both cosmetically and functionally, in order to be sure the solution is tailored to a specific patient's needs.
Trap 2. Unidentified First Point of Contact
If you alter the tooth that serves as first point of contact, you may alter occlusion. Furthermore, knowing the first point of contact can explain a lot of things you see in the mouth; for example, a front tooth that keeps breaking might be the tooth the mandible crashes into at the end of a "hit and slide." To find first point of contact, use a leaf gauge. (Using a leaf gauge is illustrated in detail in the AACD Virtual Campus course, "Ten Common Occlusion Traps.")
Trap 3. Undiagnosed Joint Condition
33% of asymptomatic patients have a disc displacement in at least one joint. When you alter the occlusion, you are taking a risk of creating a problem like joint noise or pain. Be aware of the possibility of undiagnosed joint conditions.
Trap 4. Missing the Existing Wear Pattern
If you determine wear is caused by force, it is necessary to figure out how that wear pattern was created. Design the final occlusion with force-related wear in mind.
Trap 5. Canine Guidance for All
There are some situations that warrant premolar guidance or group function. Do what makes best sense for the clinical situation.
Trap 6. Mounting Models Without the Use of a Facebow or CR Bite
Mounting models allows us to evaluate the function of the mandible in all its occlusal positions. Take the necessary records to mount your models correctly so you can do an accurate functional analysis.
Trap 7. Balancing Side Interferences
Make sure you don't inadvertently have balancing side interferences on new restorations. Either use digital occlusal analysis technology such as the T scan, or intentionally look for both working and balancing side interferences.
Trap 8. Focusing on the Occlusion During the Start of Treatment Planning
When we focus on the occlusion at the beginning of treatment planning, we can get caught up in function over esthetics, when we really need to be mindful of both from the get-go. Focusing on occlusion at the start of treatment planning can end in designing a smile that doesn't work for the patient's face.
Trap 9. Cantilevering on Implants
Begin with the end in mind: Graft bone in the location you need to place the implant in order for your restorative treatment plan to be sound.
Trap 10. Believing Only One Occlusal Philosophy is Correct
There are many schools of thought on the right way to treat occlusal disease, and in different situations, they can all be successful philosophies. The bottom line: Don't get trapped into thinking you can only do things one way.
For a deep dive into the occlusal traps and their solutions, view Dr. Albatish's course, "Ten Common Occlusal Traps" and take the CE quiz that follows, or read her article in the Journal of Cosmetic Dentistry.
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