DentaltownUK October 2017 - 44

Example case
Patient P in her late 40s attended, her goals were discussed and her occlusion was assessed.
Thin and chipped incisal edges were noted along with a chewing pattern with heavy contact across
the anterior segment.

Fig 6: Pre op presentation

Fig 10: Asking the patient to slide their lower
jaw to the right tests the right lateral excursion,
contacts on the right side are working contacts;
contacts on the left side are non-working
contacts. In this case we can see canine
guidance, which is preferred

Fig 7: Trial Smile - resin temp material and
flowable resin composite

Fig 8: Post Op - porcelain restorations fitted,
produced as a copy of the trial smile

Fig 11: Asking the patient to slide their lower
jaw to the left tests the left lateral excursion,
contacts on the left side are working contacts;
contacts on the right side are non-working
contacts. In this case we can see we are lacking
canine guidance due to mal-positioned teeth

Once we have cemented using our standardised
bonding protocols, we must then assess
excursions and guidance to ensure we are leaving
the patient with a functional, comfortable, and
balanced result.

Conclusion

Fig 12: Asking the patient to slide their lower jaw
forwards but left, and also forwards but right,
tests the inter-incisal guidance. This excursion
should be free of the incisal edge of the lateral
incisors in both forward and backward motions.

Fig 9: Asking the patient to slide their lower jaw
forwards tests protrusive guidance. More than a
single anterior tooth should be in contact

OCTOBER 2017 // dentaltownuk.com

anterior jig, or Kois Deprogrammer, will
allow us to determine the centric relation
bite - a reproducible position where the
mandible is fully seated in the condyle with
the muscles in a relaxed state.
This allows a construction of a trial
smile, to trial the new occlusal scheme
until the function has become balanced
enough to move to our final restorations. In
some cases this trial period can be a matter
of months, so it is paramount to ensure
interdental cleaning aids can be used despite
the temporary smile being splinted to limit
any gingival inflammation.
Regular review appointments, and regular
occlusal adjustments are made until a balanced
and stable scheme is identified. This can in
some cases involve building the patient's
dentition up to their first point of contact,
either in composite resin or porcelain.
These cases are mostly additive, and
therefore conservatively managed. Once
treated, we can expect a result where
restorations are mostly bonded to enamel,
and a balanced occlusal scheme has been
produced - predictability can be expected.
However educating our patients to appreciate
factors beyond our control is something we
must not ignore.
In some cases a laboratory hard splint can
be recommended for nightly wear.

If treatment planning is conducted with
the patient's main concerns in mind, and
existing occlusal issues are identified at an
early stage, we can then plan for functional,
and aesthetic success.
There will be inevitable failures long term,
for one of the multiple reasons outlined above,
however most we will be able to predict and
be able to pre warn our patients about, thus
allowing us to practice with more confidence,
and our clients to escape from the stress of
dentistry, and enjoy the rewards a beautiful,
healthy, smile can give. ■

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Table of Contents for the Digital Edition of DentaltownUK October 2017