Feb 242015
Equilibration Refinement Web

I’ll admit that for a portion of my professional career I didn’t think twice about occlusion. Today occlusion is as well integrated into my thought process as caries, perio or restorative considerations. What role does occlusion play in your practice? Is it part of your routine diagnostics? Is it fully integrated with your esthetic and restorative treatment planning? Or do you only wonder about it when a patient breaks something or you are concerned about moving forward with a severe wear case?

Early in my career occlusion would show up as a frustration. One example is when I would prepare a second molar being very careful about creating adequate occlusal clearance, using both depth cutting burs and checking the result with bite registration, just to have my assistant come and tell me she didn’t have enough clearance to make the provisional. It was a relief years later in my first CE course with a focus on occlusion to learn this was not rapid super-eruption, or a mistake on my part, but muscle release due to removal of a key occlusal contact and I could predict this before i prepped the tooth. How about the patient who would come into my office for a hygiene visit or a buccal pit restoration with no joint sounds and call the next day concerned that their jaw had been clicking ever since they left the office the day before. What a relief when I learned these patients had an underlying risk for disc displacement called ligament laxity and I could diagnose it quickly at an exam appointment.

An everyday occlusal issue I run into is the patient with a limited opening who needs posterior dentistry, or they can open at the beginning but rapidly fatigue and their jaw begins to shake and close as we work. What a gift today that I can identify this as a symptom of overuse of the elevator muscles, treat it easily and quickly at a restorative appointment with a deprogrammer, and offer the patient options for relaxing their muscles and allowing them to stay healthy.

The process of demystifying occlusion and having it become an everyday reality for me required committing to a series of hands on CE programs, being willing to manage my learning and taking it back to my patients and begin using what I was learning in small steady steps. The benefit has been less frustration, increased confidence with my patients, and an ability to help patients in new and profound ways I didn’t have before. My passion for occlusion didn’t stop with my practice, but has become a huge piece of the continuing education I teach with Clinical Mastery in our Occlusion Series.

Occlusion One: Mastering Functional Dentistry

Occlusion Two: Mastering Complex Cases

Occlusion Three: Mastering Full Mouth Reconstruction



Feb 172015
Futar On teeth-Resized

Capturing an accurate centric relation bite record can be challenging and sometimes frustrating. Simplifying this process, and doing it with confidence has been about two components in my practice. First having techniques at hand to deprogram the muscles and separate the teeth temporarily, which are the two things that make this unpredictable. Secondly I use multiple techniques to capture the record, depending on which one the patient responds best to ( muscles stay relaxed) and what I will be doing with the models and how this vertical corresponds to the vertical the record is captured at.  The last post demonstrated a great tool and technique for deprogramming muscles using a QuickSplint. In this video Dr. Michael Smith, one of faculty for Clinical Mastery, demonstrates capturing a centric relation bite record Using a QuickSplint to deprogram the muscles and composite to create an anterior stop. Continue reading »

Feb 142015

Now that I have Quicksplint’s in the office I am not sure how I practiced before them.  A QuickSplint is a plastic shell designed by Dr. Brad Eli, that fits over the anterior teeth from canine to canine and is customized using heavy body tray impression material to create an instant temporary anterior only appliance. My first thought was to use them for acute pain patient’s who get some relief on a lucia jig. I could send them home with an Quicksplint appliance immediately without the need to take an impression, and without the worry of giving them something lacking in retention that they could swallow or aspirate., as they are highly retentive.  As I began using them I found more and more clinical applications. One is as an easy inexpensive way to help patients experience that they grind or clench, and the value of an occlusal appliance, immediately after endo therapy to avoid having to cut down the occlusion on the tooth or crown, to deprogram the masticatory muscles and take accurate centric relation records, and many more. In our Ultimate Occlusion One Program at Clinical Mastery we teach fabricating a Quicksplint and using it for deprogramming.

In this short video I will demonstrate how to make a Quicksplint. Continue reading »

Dec 152014
Kois Web

Accurately transferring a maxillary model in three planes of space to an articulator is essential for predictability and accuracy whether we are using the models for diagnostic or restorative purposes. If we work with mounted models where the radius of the arc of rotation, or the position of the maxilla are different then the clinical reality all of the tooth contacts other then intercuspal will be different int he mouth than what we see on the bench top. Additionally we are looking to transfer esthetic information, incisal plane compared to the horizon, which can not be accomplished if the upper model is hand mounted. The Kois Dentofacial Analyzer is a quick, simple and predictable way to mount the maxillary model to ensure functional and esthetic predictability. This video demonstrates capturing the record. Continue reading »

Dec 022014

One of the things that I value about continuing dental education is the opportunity to spend time with other dentists, as I always learn something I can bring back to my office. Recently while lecturing at Midwestern Dental School to the faculty, on of the faculty members told me about a new way to stabilize lower models when mounting, and was even kind enough to give me some samples. Over the years I have tried about every idea possible to optimize mounting the lower model. If the model moves int he bite registration due to pressure during mounting, tipping or shrinkage of the stone it interferes with the accuracy of the mounting. To overcome this I have tried hot glue, compound, rubber bands, hanger wire bent into a V and probably many more. Continue reading »