This week I spoke at the Greater New York Dental Meeting on Occusal Equilibration. One of the topic areas that created a great number of questions was the intensity of contacts on the anterior teeth. Most of my patients do not like the sensation of equal intensity anterior contacts or feeling “trapped” behind their front teeth. In the days before I did a final adjustment with the patient sitting up it was common to have patients come back in complaining of sore front teeth or bothered by their bite.
The concept of having lighter anterior tooth contacts has several sources. One reason can be the postural shift in mandibular position between a reclined and an upright position. As a convenience I complete my occlusal adjustments with patients in a reclined position. This allows me better access to the lingual of the maxillary anterior teeth, better visualization and better ergonomics. Because of this I need to verify the intensity of the anterior tooth contacts after I have had the patient sit up and lean forward. There are also patients who simply need extra room or freedom in the anterior to feel comfortable or accommodate a habitual movement of their mandible.
There are several different ways to accomplish the final adjustment. With the patient sitting up I place my fingernails on the anterior teeth and have the patient tap together. I am checking for fremitus, and adjust the anterior contacts with a rubber wheel until I have removed it. You can also use shim stock (6-8 microns) and adjust so it pulls through in the anterior and holds between the posterior contacts. I know other dentists who do this same technique but use Accufilm that is 24 microns thick to create additional freedom. Lastly, you may want to use different colors of articulating paper to mark the anterior contacts in the two positions.