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Planning For Success 2
Author: Jim Mason & David Dunlop
PLANNING FOR SUCCESS
By Jim Mason & David Dunlop
Too often it’s only when things fail that the need to organise presents itself. When faced with occlusal disease in which the natural dentition has all but destroyed itself by an unattractive wear pattern or head neck and shoulder pain, the dental profession has found itself reaching for an explanation and solution in the principles of occlusion.
By the same token, when the laboratory-dentist relationship is not all that it could be, people of maturity will strive forward towards better communication and clearer goals and objectives. By forming close dentist-technician knowledge based partnerships and to avoid breakdown of the newly installed smile by the same forces that laid waste the natural tissues. The dental team has to learn its lessons and plan for success. With an unprecedented unity dentists and technicians alike have been making the study of occlusion a hot topic for CPD. How else can one hope to take advantage of the exciting opportunities presented by extensive wear cases without the necessary knowledge and working partnerships that will make the restorative solution work comfortably and survive?
You don’t need to have a background in the military to know that good communication at work is essential to get you where you want to be. Good discipline at the laboratory and the surgery, faithfulness to agreed protocols and a stable relationship are key to delivering what every patient wants: a beautiful smile. It’s a cliché but true that a business that fails to plan, will plan to fail.
Dentists that understand occlusion are able to:
• Recognise occlusal dysfunction and treat their causes
• Diagnose study casts and prepare treatment plans with confidence
• Provide for the lab the accurate records that will eliminate any guesswork with their cases
• Test and equilibrate provisional restorations to establish a comfortable occlusion
• Provide for their patients functional restorations that will not introduce occlusal disharmony or disease
• Fit beautiful and functional restorations that should last a lifetime
• See more of the larger cases that they love to do
Technicians that understand occlusion are able to:
• Communicate to dentists the records they require to articulate and cross mount their working casts
• Diagnose study casts and prepare wax mock ups
• Produce equilibrated provisional restorations for patient approval
• Design and equilibrate extensive cosmetic and implants cases with confidence
• Design their crown and bridgework with no interferences
• Select the most appropriate materials for our cases
When we execute our plans we have to avoid building into our restorations interferences.
No one benefits when the beautiful morphology built into our crowns and bridges are ground away in an effort to save our restorations. Interferences could cause symptoms and reduce the long term prognosis for our restorations and surrounding dentition.
Understanding and integrating occlusal principles into our treatment plans would eliminate many of the failures we see in our cases. We all love creating beautiful smiles where great results can be so rewarding for all the team and life changing for the patient. By getting it right first time we gain the confidence of our patients who become our greatest sales force and we see more of the bigger cases we all love to do.
By observing the wear patterns of natural teeth on our casts, we can mount our less extensive cases on anatomical articulators and set to average plane. Centric relation records and accurate die model transfer allow us to closely mimic the path the teeth take when they move about in function. When we have them then we can use them to fabricate veneers and crowns that do not fracture and that are a credit to our experience and knowledge.
When we routinely use facebows to obtain centric relation records then we build on our knowledge of occlusion and this gives longevity to our work. This allows the technician to equilibrate the restorations before they leave the lab. These will need further equilibration in the mouth, but less so than those that are not mounted at all.
Dentists who regularly provide these records and work closely with the lab find they worry less about the larger cases and they build their cosmetic practice.
Every Friday is a training day at the lab and every stage described in this article forms the core of our CPD. Through National Health Education for Scotland we have made a commitment to train with both the technicians and the dentists for the future. It is not within the scope of this article to describe facebow mounting and fully anatomical articulators. This will form the basis of a future training session and article for review.
Hints and tips for centric occlusion records
Prior to injecting the patient, familiarize yourself with the patient’s intercuspal position. (Fig 1) Record this with a material that remains stable in thin sections. We find Blu-Mousse from Prestige works very well. Syringe the mousse onto the occlusal surfaces of the opposite arch from which you are working. Ask the patient to close down fully into their best bite and record this position. This record can be used later once you have prepared the teeth as an aid to guide the patient back into their intercuspal position (Fig 2) and record the post prepared situation (Fig 3). Of course softened wax can be used for your records if you use and handle them with extreme care. We feel the mousse allows the patient to close into tooth to tooth contact. Perforations in the mousse seem to confirm this.
Fig 1 - Occlusal record of the intercuspal position prior to preparation
Fig 2 - Prior to recording prepared teeth place preliminary record onto opposite quadrant as a locating aid
Fig 3 - Saddle area recorded to improve the stability of record onto the casts
Fig 4 - The pre-preparation record can be used to confirm and stabilise
the patient into the intercuspal position as you check
your occlusal clearances with a flexible clearance guide
Fig 5 - Mounted casts set to average plane. We can now design our restorations with appropriate centric stops free of major interferences in function. (Photo of completed case mounted on Denar)
By using flexible clearance guides (Prestige & Schottlander) you can confirm the occlusal clearances the technician requires for producing aesthetically pleasing restorations. (Fig 4) We can now mount our casts set to average values and design our restorations with appropriate centric stops free from major interferences in function. (Fig 5)
