Dental Tribune International

Inaccurate analysis of occlusal overload and its detrimental impact on dental restorations and implants.

Despite being in the era of digital dentistry with the accuracy it provides, many of us dentists are still highly attached to traditional tools in our daily practice. For occlusal analysis, the most common tool used is articulating paper. The correct physiological recovery of occlusion is always a challenge for every dentist and technician. Proper tools and proper knowledge enable us to overcome one of the most critical phases in dental restoration, increasing the success rate and longevity of the restoration and preventing any future damage.

Occlusal analysis is one of the most critical phases in crown delivery, as any undetected high occlusal point can lead to a range of consequences such as minimal cracks in the crown to TMJ pain and sometimes to failure of the implant in case of crown over implant. In some situations, minor errors can be self-adjusted, but this is not always the case. Based on Dahl concept dated from 1975, a 0.5mm bite-raising cap placed on the occlusal surface of a permanent molar in five human adult subjects can take 23 to 41 days to bring their teeth into occlusal contact with the cap in position. This proves that some degree of axial movement is naturally observed when placing restoration in supra occlusion in which teeth can adjust themselves by intrusion in high contact point and by extrusion in the open bite to reach the correct occlusion. The same thing applies during and after orthodontic treatment. However, this concept does not apply in all case scenario. For example, when two ceramic bridges are opposing each other there is neither intrusion nor extrusion movement to adjust the occlusion. The same thing applies when an implant supported crown is in occlusal contact with a ceramic bridge or when two implant supported crown are opposing each other. In such cases accurate analysis of occlusal overload is very critical, where the presence of undetected occlusal interference will lead to either early or long-term failure. Another factor that amplifies occlusal discrepancies is bruxism. Bruxism will affect the longevity of the restorative treatment due to the increased occlusal force and the extended time of maximal intercuspation. The sensitivity and reliability of the techniques currently applied for occlusal analysis when using articulating paper depends on its thickness, composition, ink substrate and plastic deformation.The oral environment (saliva, humidity) also plays an important role. Another factor that affects the readings when using articulating paper is the restorative material used. Conventionally, the material used in fixed and removable prosthodontics were either metal, composite, porcelain fused to metal, veneered zirconia or acrylic resin. The recent introduction of full contour zirconia, either manually polished or furnace glazed, can affect the interpretation of the reading of the articulating paper. Occlusal reading on the articulating paper is usually a time-consuming process and a very critical phase in restorative dentistry, however most dentists do not dedicate adequate time for this process. Studies show that around 95% of occlusal readings are incorrect. Misreading urges the dentist to remove from different occlusal spots which would lead to occlusal disturbance. With the introduction of advanced technology, we have access to computerized occlusal analysis devices which provide high accuracy to some point. However increased overhead costs and cross contamination issues make this technology unavailable in many cases. Therefore the urge to upgrade an easily accessible traditional technique, making articulating paper more reliable with less misreading and minimal cost for both the dentist and the patient. The objectives of this webinar are:
  • to guide the dentist in choosing the proper articulating paper in terms of thickness and material
  • to aid in more precise reading
  • to prevent occlusal discrepancy, restorative failure, implant failure and TMJ pain and disorders.

Watch the webinar

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