Providing occlusion that allows for efficient masticatory function is essential to sound dentistry. Unfortunately, it’s not uncommon for patients to experience occlusal dysfunction after dental restoration treatment. It’s important to understand the nuances of hard and soft tissue in order to create a protocol for predictable outcomes.
One way to achieve that goal is to verify occlusal contacts after treatment, but we should also think about occlusion even before we begin. Occlusal mistakes can be avoided by detecting problematic contact areas prior to prepping. Here are a few things to keep in mind before you start.
Conduct a clinical occlusal evaluation
The best way to prevent occlusal dysfunction or disharmony is to conduct a comprehensive occlusal evaluation prior to treatment. Examine the following:
- All contacts in centric occlusion
- Left and right working movements
- Left and right balancing
- Forward protrusion
- Lateral protrusive mandibular movements
If the goal is to keep the existing occlusion intact, it’s important to thoroughly examine the patient’s occlusal contacts before prepping.
Conform to the patient’s existing bite
Use occlusal indicating materials to check the patient’s existing bite pattern. It’s critical to make sure their occlusion won’t be disrupted by the new dental restoration (e.g., crown, veneer, implant crown, inlay, onlay). The conformative approach is commonly used for single-unit restorative cases and is particularly handy with patients who are sensitive to changes or suffer from occlusal hypervigilance. To further elevate the patient experience, consider using an isolation mouthpiece for restoration preps and seats. Single-use, flexible mouthpieces have an integrated bite block that reduces stress on the tempormandibular joint.
Use occlusal indicators
Use occlusal indicators to check how all the teeth come together before you begin treatment on a dental restoration. Articulating paper and occlusal foil are both effective ways to detect contact challenges. While articulating paper and sprays are good, they can be messy in a moist environment. Occlusal foil is much thinner and doesn’t mark up the teeth with a sea of red, white or blue. You can use the foil to see how it pulls through when the patient occludes.
Use appropriate insurance codes for dental restoration cases
The comprehensive periodontal evaluation (under ADA insurance code D0180) includes everything from soft tissue to occlusion. This exam involves a lot of diagnosis, so remember to charge appropriately for the time it takes. Fees should reflect your time, care, skill and judgment.
It’s not uncommon for patients to have a heightened awareness of their occlusion after a dental restoration. Do everything in your power to make your patient comfortable and elevate their dental experience when possible. Invest in a CE course and learn how to standardize a system for creating a nondisruptive restoration that allows for a smooth transition for your single-unit and full mouth reconstruction cases.