Comprehensive Occlusal Concepts in Clinical Practice E-Book

Irwin M. Becker

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 371

Veröffentlichungsjahr: 2011

Beschreibung

Comprehensive Occlusal Concepts in Clinical Practice aims to provide a clear and thorough guide to the understanding and application of occlusal concepts in the dental practice, enabling dentists to gain a straightforward understanding of widely recognized occlusal principles and practices to engender longevity, predictability, and professional confidence in everyday dental procedures. Comprehensive Occlusal Concepts in Clinical Practice also features a comprehensive review of occlusal and periodontal literature, establishes occlusal principles and practice protocols as routine, and aids in developing the reader’s critical ability to know when and when not to perform occlusal therapy. This is a unique book in its scope, thoroughness, and practicality, making occlusal concepts easily understood, yet also demonstrating the specific skills needed to perform the details of a physiologic occlusal scheme.

Leseprobe

Table of Contents

Cover

Table of Contents

Half title page

Title page

Copyright page

Preface

Contributors

1 Introduction to Occlusal Disease and Rationale for Occlusal Therapy

INTRODUCTORY DISCUSSION OF PARAFUNCTIONAL WEAR

RATIONALE FOR COMPREHENSIVE OCCLUSAL EXAMINATION

CATEGORIES OF PARAFUNCTIONAL ACTIVITY

ENGAGING THE PATIENT IN THE COMPREHENSIVE OCCLUSAL EXAM

RATIONALE FOR OCCLUSAL THERAPY

THE COMPREHENSIVE OCCCLUSAL EXAMINATION

SAMPLE OCCLUSAL EXAMINATION FORM

THE PATIENT’S UNDERSTANDING

2 Occlusal Parafunction and Temporomandibular Disorders: Neurobiological Considerations

3 The Masticatory System: Orthopedic Considerations in Function and Pathofunction

THE TOOTH-TO-TOOTH INTERFACE

DENTIN-TO-PULP INTERFACE

THE TOOTH-TO–SUPPORTING STRUCTURE INTERFACE

THE TOOTH-TO-NEUROMUSCULAR INTERFACE

THE TOOTH-TO-TM JOINT INTERFACE

BONY DEGENERATIVE CHANGES

GENERAL TREATMENT CONSIDERATIONS

SUMMARY

4 The Anatomical Basis of Occlusion

MANDIBLE POSITION

USE OF ANTERIOR DEPROGRAMMERS

PHYSIOLOGIC IMPLICATIONS

THE DEFINITION AND REQUIREMENTS OF CENTRIC RELATION

AUTHOR’S PROCEDURE FOR EVALUATING THE JOINTS AND MUSCLES

MANDIBLE GUIDANCE TECHNIQUES

THE BIMANUAL GUIDANCE TECHNIQUE

FUNCTIONAL AND PARAFUNCTIONAL MOVEMENTS

LOCATION OF CONDYLE LOADING

THE ENVELOPE OF PARAFUNCTION

THE IMPORTANCE OF TIMING OF THE SEATED CONDYLE DISC ASSEMBLY

5 Accepted Occlusal Principles Involved in Physiologic Occlusion

ANTERIOR GUIDANCE AND ITS ROLE IN EVERYDAY DENTISTRY

EXCEPTIONS AND COMPROMISES

NEGATIVE EFFECTS OF DISTALIZING INCLINES

CENTRIC STABILITY

PLACEMENT OF CONTACTS

FREEDOM IN AND OUT OF CENTRIC

THE POWER WIGGLE

REORGANIZING OCCLUSIONS FOR BOTH FUNCTION AND ESTHETICS

6 Evaluating the Muscles of the Stomatognathic System and Their Role in Understanding Occlusal Disharmony and TMD

OCCLUSAL CONNECTION

THE INITIAL INTERVIEW

OBSERVATIONS TO MAKE DURING THE INITIAL INTERVIEW

THE INITIAL PHYSICAL EXAMINATION OF THE MUSCLES

THE TEMPORALIS MUSCLE

THE MASSETER MUSCLE

THE LATERAL PTERYGOID MUSCLE

THE MEDIAL PTERYGOID MUSCLE

THE STERNOCLEIDOMASTOID MUSCLE

THE DIGASTRIC MUSCLE

THE DANCE OF THE DIGASTRIC MUSCLE

THE POSTERIOR NECK MUSCLES

THE UPPER TRAPEZIUS MUSCLE

THE SPLENIUS CAPITIS MUSCLE

OTHER FACTORS THAT INFLUENCE MUSCLE FUNCTION

THE DENTAL ASSISTANT CAN PLAY AN IMPORTANT ROLE

AUTHOR’S COMMENT ON USE OF AN ANTERIOR DEPROGRAMMER

7 The Effect of Occlusal Forces on the Progression of Periodontal Disease

HISTORICAL PERSPECTIVE

AUTOPSY STUDIES

ANIMAL STUDIES

HUMAN STUDIES

OCCLUSAL FINDINGS AS A PART OF PERIODONTAL DIAGNOSIS

OCCLUSION AS A FACTOR IN TREATMENT PLANNING OF PERIODONTAL THERAPY

OCCLUSAL THERAPY FOR THE PERIODONTAL PATIENT—TEETH WITH A POOR PROGNOSIS

OCCLUSAL THERAPY FOR THE PERIODONTAL PATIENT—TEETH TO BE RETAINED

OCCLUSAL THERAPY FOR THE PERIODONTAL PATIENT—REMOVABLE APPLIANCES

PERIODONTAL MAINTENANCE

SUMMARY

8 An Occlusal Basis of Treatment Planning

CONDYLAR INCLINATION

ANTERIOR GUIDANCE

ENVELOPE OF PARAFUNCTION

PLANE OF OCCLUSION

AXIAL INCLINATION OF EACH TOOTH

CUSP-FOSSA INCLINATION

THE OCCLUSAL TREATMENT PLANNING CHECKLIST

DIAGNOSTIC TREE

PIECING THE TREATMENT PLANNING PUZZLE TOGETHER

EXAMPLES OF COMPLEX CASES AND THEIR TREATMENT PLANNING PROCESS

9 Occlusal Bite Splint Therapy

PHILOSOPHY OF PATIENT CARE WITH OCCLUSAL BITE SPLINT THERAPY

GOALS OF OCCLUSAL BITE SPLINT THERAPY

OCCLUSAL BITE SPLINT DESIGN

OCCLUSAL BITE SPLINT FABRICATION

THE CLINICAL RESEARCH BASIS FOR OCCLUSAL BITE SPLINT THERAPY

OCCLUSAL BITE SPLINT THERAPY AND THE TEETH

OCCLUSAL BITE SPLINT THERAPY EFFECT ON MASTICATORY MUSCLE

MASTICATORY MUSCLE ACTIVITY AND OBS GUIDANCE CONTACTS

OCCLUSAL BITE SPLINT THERAPY EFFECT ON THE TMJ

WHY DOES OCCLUSAL BITE SPLINT THERAPY WORK?

OCCLUSAL BITE SPLINT THERAPY AND SLEEP BRUXISM

ANTERIOR REPOSITIONING APPLIANCES

CONCLUSION

10 Occlusal Equilibration and the Diagnostic Workup

THE FALLACY OF INSTANT ORTHODONTIC THERAPY

RATIONALE OF THE TRIAL EQUILIBRATION

THE TEN STEPS OF THE TRIAL EQUILIBRATION

SUMMARY OF THE TEN STEPS OF EQUILIBRATION

11 Dentist-Ceramist Communication, the Foundation of Successful Treatment

THE LAB COMMUNICATION PROTOCOL SUMMARIZED

Index

Comprehensive Occlusal Concepts in Clinical Practice

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Library of Congress Cataloging-in-Publication Data

Comprehensive occlusal concepts in clinical practice [edited by] Irwin M. Becker.

p. ; cm.

 Includes bibliographical references and index.

 ISBN 978-0-8138-0584-9 (pbk. : alk. paper) 1. Malocclusion. I. Becker, Irwin, 1943-

 [DNLM: 1. Malocclusion–therapy. 2. Malocclusion–physiopathology. WU 440]

 RK523.C66 2011

 617.6'43–dc22

2010028088

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: eBook 9780470958643; ePub 9780470958650

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Preface

In order to encapsulate and organize the body of occlusal knowledge that I have been learning, attempting to apply for the benefit of my patients, and teaching over the past 40 years, I committed to write this text. I hope it will help those who struggle to understand the seemingly complex subject of dental occlusion. I still meet dentists from all over the world who tell me that the subject remains confusing and is somewhat of an illusion. Many articles that I read question the role of occlusion in everyday dentistry. There are research articles that attempt to demonstrate evidence that occlusion simply doesn’t matter. Lastly, some of the most talented and educated clinicians still make presentations of beautiful maxillary ceramic restorations that do not come close to matching their opposing mandibular incisal edges.

Because these examples are still common and yet puzzling to those of us who have come to appreciate the clinical importance of the role of occlusion, this text is really dedicated to all the giants of our profession who have influenced and motivated many of us to seek out the clinical significance of this topic. In reality, this is my way of thanking those who have taught and challenged me and caused me to question what I thought I understood about how the masticatory system functions. These same mentors taught me and many others that the success of our profession is dependent on the classical process of examination, diagnosis, reasonable verification of diagnosis, and appropriate treatment planning.

In dental school I had several professors who made significant impact on my thinking about occlusion and comprehensive care. Most notable was Dr. Richard Wilson of Maynard and Wilson fame relative to modern understanding of biologic width. I had the privilege to work closely with Dr. Marvin Reynolds, who taught me the basics of gnathology and helped me with my first occlusal reconstruction. My journey toward comprehensive care continued with my studies and work in the Prosthodontic Residency Program at Boston University. My greatest influences came from Drs. Gerry Kramer, Ron Nevins, Don Mori, Leo Talkov, and Howard Skurow. When I began my practice in Miami, my journey benefited from giants in restorative dentistry such as Dr. Peter Dawson and Dr. Robert Kaplan, who really began the process of organizing the concepts of occlusion. Of course, it was also at this time that I had the opportunity to learn from Dr. L. D. Pankey. I would be remiss to not mention the influence Dr. Lloyd Miller had on me in developing the thoughts of combining function and esthetics as one comprehensive subject.

However, I have come to understand that my raging passion for comprehensive, optimal care and my insatiable search for occlusal truth actually began with a dental appointment when I was 16 years old. The dentist who performed a comprehensive examination and subsequently restored my lower right first molar with a gold onlay sparked a lifelong quest to understand how and why his restoration has been successful for over 50 years. You see, Dr. David Seitlin not only placed an exquisite restoration, he also equilibrated my bite at that time. And perhaps most important, the manner in which he did the co-discovery led to an immediate change in my appreciation of dentistry, Dr. Seitlin’s style practice, and my understanding of my own dental condition. Although I didn’t understand at that time why he was doing certain things such as utilizing a face bow registration, the way he did things comprehensively changed my viewpoint of dentistry, and I began to consider a career in dentistry. I will be forever grateful for his manner of treating patients.

My goal for this text is to appropriately represent the knowledge base that has been shared with me over these many decades. I hope the knowledge I have will never get in the way of new learning and new methods of application. Today, I am working hard to blend the newest digital technologies with classical comprehensive approaches to restorative dentistry in order to ensure longevity, comfort, predictability, function, and natural beauty.

I would not have been able to be in the position to write this text if it were not for the love and support of my wife of 46 years. Susie has always realized what my dedication to optimal dentistry has meant to me, and her personal sacrifices and encouragement have made it possible for me to have a wonderful and fulfilling career in practicing and teaching the subjects that I hold most precious.

Acknowledgement goes to my personal editor, Deb Bush, who spent countless hours turning my thoughts into readable text material. Her expertise as not only an editor but someone who understands the goals of comprehensive care as well as any dentist I have ever been associated with surely makes a significant difference in the clarity of this text. All of my associates at the Pankey Institute have taught me and shared with me their own learning journey, so much so that I am convinced that no one has learned more studying there than me. And clearly all my students who have challenged my beliefs and asked the right questions surely taught me the most. I lastly recognize the input of my son, Daren Becker, whose comments over this text helped make it more understandable and useful as a representative of my years of teaching.

Contributors

Irwin M. Becker, DDS Chairman of the Department of Education The Pankey Institute for Advanced Dental Education 1 Crandon Boulevard Key Biscayne, FL 33142

Herbert E. Blumenthal, DDS Visiting Faculty, The Pankey Institute, Key Biscayne, FL Private Practice, Cordova, TN 280 German Oak Drive Cordova, TN 38018

Henry A. Gremillion, DDS, MAGD Professor, Department of Orthodontics Dean, Louisiana State University Health Sciences Center School of Dentistry LSU School of Dentistry 1100 Florida Avenue New Orleans, LA 70119

Stephen K. Harrel, DDS Professor of Periodontology, Baylor College of Dentistry, Dallas, TX Private Practice, Dallas, TX 10246 Midway Road, #101 Dallas, Texas 75229

Martha E. Nunn, DDS, PhD Director, Center for Oral Health Research Associate Professor, Periodontics School of Dentistry Creighton University 2500 California Plaza Omaha, NE 68178

Matthew R. Roberts, CDT Founder of CRM Dental Laboratory and Team Aesthetics Seminars Team Aesthetics 185 South Capital Ave. Idaho Falls, ID 83402

Roger A. Solow, DDS Visiting Faculty, The Pankey Institute, Key Biscayne, FL Private Practice, Mill Valley, CA 655 Redwood Highway #251 Mill Valley, CA, 94941

Christopher J. Spencer, DDS Clinical Assistant Professor Department of Restorative Dental Sciences Department of Comprehensive Dentistry University of Florida College of Dentistry 1600 SW Archer Road Gainesville, FL 32610

1

Introduction to Occlusal Disease and Rationale for Occlusal Therapy

Irwin M. Becker, DDS

To understand the reasoning and general purpose of entering into any therapy that may change or modify a patient’s occlusal scheme, it is important to first realize that most signs and symptoms of occlusal causation occur mainly in individuals who demonstrate some degree of parafunctional activity. That is to say, a sign such as attrition rarely occurs from normal mastication (Belser and Hannam, 1985; MacDonald and Hannam, 1984; Moss et al., 1987; Silvestri, Cohen, and Connolly, 1980).

INTRODUCTORY DISCUSSION OF PARAFUNCTIONAL WEAR

Almost no one spends sufficient time with their teeth in contact during normal chewing function to cause observable wear patterns. These common wear patterns come from those times of clenching and or bruxing during either nocturnal or diurnal time frames. The potential etiologies of these activities will be discussed in chapter 2.

Of course, there are exceptions to the statement that parafunctional habits are the overriding, most common cause of signs and symptoms of occlusal disease. Conditions such as iatrogenic changes or dual bites, where a patient holds his or her teeth in a position other than some acquired closing pattern, could be considered additional causes of signs of occlusal disease (Attanasio, 1991; Kampe, 1987).

It is also essential for the modern dental clinician to understand that there exists a clear clinical ability to reduce muscle activity during these parafunctionally destructive times, but no clear evidence exists that the clinician can reduce or stop the actual parafunctional habits. The total body of evidence indicates that by providing a physiologic occlusion, a therapist can realistically reduce the muscle activity during bruxing and clenching. The therapist can greatly reduce the results of a destructive habit, realizing that the habit itself remains; only the muscle activity is reduced (Ash, 2006; Baba, 1991; Geering, 1974).