Pacific Coast Society of Orthodontists Bulletin Fall 2020 - 42

Clinical Practice

Let's Talk About That

Dr. Patrick Turley Interviews Drs.
Larry and Will Andrews: Part 2
In Part 1 of this interview (Spring 2020 issue of the
PCSO Bulletin), we discussed a broad spectrum of
subjects including treatment goals, landmarks,
referents, classification, arch form, growth modification, and the threshold for extraction versus
nonextraction. In Part 2, I'd like to focus more on
your day-to-day practice modalities.
Dr. Patrick K. Turley
PCSO Bulletin Section Editor
Manhattan Beach, CA

Patrick Turley (PT): How much emphasis do you
place on occlusion?
Will Andrews (WA): We place a very high priority
on occlusion for all of our patients. It can be argued
whether an optimal occlusion (static or functional)
is paramount in all patients. We don't know the
answer to that; however, we do believe it to be very
important for some patients, if not in the short term
then possibly in their future. Many individuals seem
to get along fine with a poor occlusion, whereas
in others it could be a trigger for temporomandibular disorder (TMD), gross occlusal wear, or other
sequelae. The dilemma is not knowing for whom a
good occlusion is critical. To hedge our bets, we try
to provide it to all patients, to err on the safe side.
The goals include a canine-rise scheme in laterotrusion with incisal guidance in protrusion, which
almost automatically manifest in the presence of
the six keys to optimal occlusion,1 with the mandible in centric relation (CR; Figure 1).

Canine rise isn't the only viable occlusal scheme;
group and balanced function have their places
but are probably most relevant in prosthodontics,
in which spreading excursive loads across several
teeth might prevent excessive stress on restored
teeth or prevent the dislodging of a removable
prosthesis. In natural dentitions, the canine-rise
scheme is defensible and is the easiest to produce
orthodontically.
The potential consequences associated with
poor occlusion are attributable to the inequitable
distribution of functional and/or parafunctional
forces on the teeth and supporting tissues, which
can predispose individuals to dental attrition,
periodontal breakdown, and in some cases TMD.
It's difficult to make the case that traumatic
occlusion causes periodontal disease, but a pretty
strong case can be made that it can exacerbate or
impair the healing of an existing problem.2 Some
evidence suggests that good occlusion contributes
to overall well-being in the sense that food particles are broken down into smaller pieces when
occlusal interfacing is more complete, improving
digestion and nutrition.3-9 This is an important
thing to consider, especially for our growing
patients. We look at it this way; if you were the
patient, wouldn't it be nice to know that your
orthodontist took occlusion seriously? Our young
patients will likely have a very long life span, and

Figure 1. (a) Centric relation; (b) canine guidance with posterior disclusion during laterotrusion

PCSO Bulletin Fall 2020

Pacific Coast Society of Orthodontists Bulletin Fall 2020

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Fall 2020