I learned a lesson again this week that I have learned over and over in twenty plus years of practicing, limited occlusal equilibrations are a journey into uncharted waters.
There are many pieces of altering a patient’s bite that can be challenging if they are unknown. The first question that comes up for me, is why is the patient experiencing a change in their occlusion. The answer could be related to a change at the level of the joints, muscles or teeth, but having an understanding of the cause allows the patient and I to understand the risks and benefits. If the underlying condition is an instability in the joints due to inflammation or a loss of the disc then until the joints are stabilized the bite will continue to change, and we could be chasing a moving target. A similar scenario is present when the existing occlusion is a learned muscle position, or has changed due to a change in the musculature.
Creating a reproducible starting point from which to alter the occlusion is critical in being able to understand the outcome. Otherwise as the bite is changed, the muscles adjust and the occlusion wanders, and we are left trying to chase it with a high-speed handpiece. The last piece of uncertainty can be summed up in one question, ” When I adjust this tooth, which one will hit next?” An occlusal equilibration is done in order to improve or optimize the occlusal contacts. If we are unclear where the contacts will move to and what the extent of the treatment will be in order to reach this outcome, the treatment is inherently unpredictable.
So the lesson of adjusting a contact the patient requests, to have them than notice it is heavy someplace else, and randomly chase the contacts around the arch at the patients direction hoping that they will say it feels good quickly, I learned again this week. One more time I am clear that equilibration is a process that requires understanding and planning.