Great episode.. As a practicing dentist, occlusion has been, and continues to be one of my favourite topics ever since dental school. Apart from its role in our usual conformative dentistry to the complex cases, it's one of the most crucial factors that determines the life of our treatments, and is often overlooked. Loved the insights through clinical scenarios.🙌🏼 ✌🏼✨
we want an episode about how to precisely check the high spots during filling / indirect restoration. thanks in advance. looking forward to seeing the next episode of verti for plonker
Checking a patient’s bite to see if there is a discrepancy between the patient’s Centric Relation to their MIP is vital. If there is a discrepancy between habitual bite means all cases should be built in CR. Anterior Guidance is as important as CR. The use of a facebow transfer to a semi-adjustable articulator gives the dentist important information, as opposed to using the patient as the articulator, all dentists should get a view of the patient’s teeth from behind to see how the teeth come together. This can be done by looking at the backside of the articulator. It allows the dentist to see how the teeth come together. Rare cross-overs/crossbites and other malocclusion can be seen on the articular and repaired. It saves the patient and dentist time and frustration.
Dr Parker, thank you so much for your comment. I totally agree to how eye opening it can be to see the view of how the teeth come together from the back of the articulator (or a digital scan spun 180 degrees). The only statement I would content is the presence of a 'discrepancy between habitual bite means all cases should be built in CR' - my reason for disagreeing with this is because this means that 90-97% of the world population 'should' have this done (by equilibration, orthodontics etc). I would like to argue that there is a biological variability in that regard - and if someone's MIP is repeatable and comfortable, we should not be 'aiming' towards CR as a goal. I know that some camps will disagree (I am Dawson trained) but this is my real world conclusion. I think a discussion on this would be useful and I really appreciate your inspiration!
Hi Jaz! A question. Whenever I do full mouth rehabs, I usually order a set of pmma crowns and adjust the occlusion on these and then the patient wears them for a trial period. If everything is great I just scan these and send to the lab so they can copy the occlusal design when making the permanent crowns. Now to my question. Should I expect them to be able to accurately copy the scan? In my experience I've always had to make some adjustments (and it bothers me). Is it expected or is there something wrong with the dental lab work?
I also adopt this approach - usually there is a little adjustment to do, but not major. There will always be lab inaccuracies (often beyond control) to replicate the restorations exactly. Also the articulation on their articulator will not exactly mimic the patient, so there is some error here. I think a big issue is bite registration of prep vs prep - when the lab mount these, very often there is a discrepancy - even for a single crown, when the lab mount the models, they must be stringent to check that the wear facets match up - very often the wear facets will not be matching and some model work is required to get them to match (and hence OVD is now correct). I hope that a lab technician can give more insight in to the challenges and nuances of this approach
Great episode.. As a practicing dentist, occlusion has been, and continues to be one of my favourite topics ever since dental school. Apart from its role in our usual conformative dentistry to the complex cases, it's one of the most crucial factors that determines the life of our treatments, and is often overlooked. Loved the insights through clinical scenarios.🙌🏼 ✌🏼✨
thank you Mohit - glad to connect with another Occlusion geek!
we want an episode about how to precisely check the high spots during filling / indirect restoration.
thanks in advance.
looking forward to seeing the next episode of verti for plonker
thanks for the inspiration and I have content for this I can publish thank you!
Checking a patient’s bite to see if there is a discrepancy between the patient’s Centric Relation to their MIP is vital. If there is a discrepancy between habitual bite means all cases should be built in CR. Anterior Guidance is as important as CR. The use of a facebow transfer to a semi-adjustable articulator gives the dentist important information, as opposed to using the patient as the articulator, all dentists should get a view of the patient’s teeth from behind to see how the teeth come together. This can be done by looking at the backside of the articulator. It allows the dentist to see how the teeth come together. Rare cross-overs/crossbites and other malocclusion can be seen on the articular and repaired. It saves the patient and dentist time and frustration.
Dr Parker, thank you so much for your comment. I totally agree to how eye opening it can be to see the view of how the teeth come together from the back of the articulator (or a digital scan spun 180 degrees). The only statement I would content is the presence of a 'discrepancy between habitual bite means all cases should be built in CR' - my reason for disagreeing with this is because this means that 90-97% of the world population 'should' have this done (by equilibration, orthodontics etc). I would like to argue that there is a biological variability in that regard - and if someone's MIP is repeatable and comfortable, we should not be 'aiming' towards CR as a goal. I know that some camps will disagree (I am Dawson trained) but this is my real world conclusion. I think a discussion on this would be useful and I really appreciate your inspiration!
Hi Jaz! A question. Whenever I do full mouth rehabs, I usually order a set of pmma crowns and adjust the occlusion on these and then the patient wears them for a trial period. If everything is great I just scan these and send to the lab so they can copy the occlusal design when making the permanent crowns. Now to my question. Should I expect them to be able to accurately copy the scan? In my experience I've always had to make some adjustments (and it bothers me). Is it expected or is there something wrong with the dental lab work?
I also adopt this approach - usually there is a little adjustment to do, but not major.
There will always be lab inaccuracies (often beyond control) to replicate the restorations exactly. Also the articulation on their articulator will not exactly mimic the patient, so there is some error here.
I think a big issue is bite registration of prep vs prep - when the lab mount these, very often there is a discrepancy - even for a single crown, when the lab mount the models, they must be stringent to check that the wear facets match up - very often the wear facets will not be matching and some model work is required to get them to match (and hence OVD is now correct).
I hope that a lab technician can give more insight in to the challenges and nuances of this approach
@@protrusive thanks for the reply jaz! It helps to know that some adjustments are normal. Its all about managing expectations :)