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“Well-I never!…and so should you!” The Occlusal Instrumentation Holy Wars

It seems that whenever discussion of occlusion & instrumentation comes up, dentists get quite polarized into two groups. On one side of the spectrum, there is the “Occlusion is way too complex and overrated-I just use a triple tray every time and those who don’t are dumb. I sold my articulator for beer money the day I graduated!” On the other side of the spectrum, there is the “If you don’t use a fully adjustable articulator on every case, every time… at every opportunity-you are not a quality dentist!”

Funny thing is-both opinions are extremist while neither side seems to think so. As is generally the case, the extremes define the norm and the truth lies somewhere in the middle.

If we can stop thinking about occlusal instrumentation the way some discuss sports teams, politics and/or religion, perhaps we can look at the subject a little bit more logically. The instruments that we use, whether it be an articulator or a triple tray, they should simply be regarded as what they are: tools to help us accomplish a goal and outcome. How long will it take us to take the full arch impressions, facebow and articulator? How quickly can we simply take a triple tray impression? Those questions of course must be balanced with how much time it will take us to insert and adjust the restorations.

When we’re making a decision on which tool to use, wouldn’t it make sense to choose the tool that is the easiest, quickest and least expensive-as long as we can achieve an excellent result? We shouldn’t let the dogma of the extremes hold us back from being logical, efficient and productive in our restorative care.

As always-we would love to hear your comments & please feel free to share using the link buttons below!

Second Molar Headaches & Leaf Gauge

Have you ever had “that call” from your technician? You know-that one where he or she wanted to touch base, complement you on your excellent impression… & Oh yes:

“Would it be okay if I sent you a reduction coping?”

“Um-sure… How much room do you need?”

“Oh-about 2 mm…”

“WHAT?!?!!?” How could this be?? You KNOW that you had enough reduction! You KNOW that you prepped enough! You KNOW…you think you know…do you know?! Let’s think about that. Have you ever gotten a crown back from the lab, tried it in… & adjusted…& adjusted…& checked…& adjusted. Oh-there’s the coping! Have you ever cut off “someone else’s crown” only to find a 1/4mm of porcelain and-being generous, a 1/4mm of metal coping? Or how about this: have you had the patient come back with a hole in the occlusal of the temporary crown…& they are occluding on the prep? But you KNOW that you reduced enough? How could this have happened? Was it “second molar rebound”? Was there some sort of supra eruption following relief of traumatic occlusion? Perhaps-distortion from those pesky triple trays!

Whether we realize it or not or are aware of the causes, this is happened to all of us… & will continue to do so. In many if not all cases however, this can be foreseen and avoided. The use of a simple leaf gauge screen prior to preparing 2nd molar crowns can give great insight into the possible or likely loss of occlusal clearance.

1) Use a leaf gauge to screen to determine the 1st contact

2) Count the number of leafs. 8 leafs at the incisors equals 1mm. 1mm at the incisors equals about 1/3rd of a mm at the second molar.

This means you could possibly take 1/3rd of a mm off of the second molar and still be in contact! 16 leafs at the incisors = 2mm…which could equal a loss of 2/3rd’s of a mm of reduction!

The leaf gauge screen is a great tool to help us realize when the occlusion may change during our preparation…and allow us to be PREpared to compensate with just a bit more reduction.
I hope that is helpful. I think that posting an article or a video of the concept may be even more so. Please let me know and I would love to hear your feedback!

As always-we would love to hear your comments & please feel free to share using the link buttons below!