Occlusal Management of Everyday Practice
Firstly and critically,, I would like to urge you all to thoroughly review or study the textbook titled “Functional Occlusion, from TMJ to Smile Design” , by Dr. Peter Dawson, although this book may not be universally accepted by TMJ profession, and indeed there may be some controversial issues and/or inaccuracies, it’s still an excellent resource which provides you basic knowledge and clinical skill to manage your patient’s occlusal problem. However, many of you may not be able to solve all of occlusal problems of your patients after thoroughly studying this book. My lecture is not intended to replace or refute this excellent textbook; instead,d, the purpose of my lecture is to supplement the shortage of book.
When a patient comes into your office, he or she may ask for a filling or a crown. After routine clinical exam, we suggest comprehensive occlusal analysis as suggested by Dr. Dawson, which starts from transfer of diagnostic casts to semi-adjustable articulator. We demonstrate and explain the existing and potential occlusal problem to our patient. A comprehensive treatment plan is accordingly formulated. We all know very few patients can or are willing to pay for the services. Not to mention even the charge of occlusal analysis. Dawson’s practice is not likely to hapappen in the real world. I am not saying that his practice is wrong. On the contrary, his practice is an idealized model. It’s the issue of cost. The real world practice is that most of us do a few units of restoration on the patient. Under such compromised condition, we generally can not establish a perfected occlusion by delivering one or two units of restoration; we certainly don’t want to create more occlusal problems by new restorationKeep in mind that the theory of muscle engram tells us that jaw muscles have a memory to function in a repeated pattern, which is similar to the theory of preferred motion path within orthopedic profession. Each synovial joint has a preferred motion path which is under delicate control of central nervous system. I believe tm joints are no exception. If there is minute occlusal interference introduced by a new restoration, the established existing preferred motion path would be disturbed. Some patients may adapt and establish a new pattern of muscle function, and no significant consequences result. However, some patients may not adapt well, and disastrous consequences result, which may vary frfrfrom pulpitis to head, neck, shoulder, orofacial .as well as tmj pain. We all probably have encountered this condition, if you have practiced long enough.
It’s my consistent observation that a sound tooth can almost always tolerate the cotton roll clenching test, if the occlusion is managed correctly. If there is soreness or discomfort upon clenching a cotton roll, there must be occlusal interference. You have to believe this, otherwise the patient’s problem may never be solved. Our job is to dappen in the real world. I am not saying that his practice is wrong. On the contrary, his practice is an idealized model. It’s the issue of cost. The real world practice is that most of us do a few units of restoration on the patient. Under such compromised condition, we generally can not establish a perfected occlusion by delivering one or two units of restoration; we certainly don’t want to create more occlusal problems by new restoration web66