The Dawson Academy Blog

Dental Articles on Occlusion, Centric Relation, Restorative Dentistry & More

John C. Cranham, DDS has an esthetic oriented practice in Chesapeake, Virginia. An honors graduate of the Medical College of Virginia in 1988, Dr. Cranham maintains a strong relationship with his alma mater as an Associate Clinical Professor. He is an internationally recognized speaker on the Esthetic Principles of Dentistry, Contemporary Occlusal Concepts, Treatment Planning, Restoration Selection, Digital Photography, Laboratory Communication, and Happiness and Fulfillment in dentistry. As a published author, Dr. Cranham has a strong commitment to developing sound educational programs that exceed the needs of today’s dental professional. He is an active member of numerous professional organizations including the American Dental Association, The American Academy of Cosmetic Dentistry, The American Academy of Fixed Prosthodontics, and The American Equilibration Society. Dr. Cranham is co-chair of Advanstar Dental Media’s CE Advisory Board (Advanstar is the publisher of Dental Products Report). Dr. Cranham is the Clinical Director of The Dawson Academy where he is involved with many of the lecture and hands-on courses within the curriculum. As an active educator, he has provided over 650 days of continuing education for dental professionals throughout the world.

Recent Posts

Dawson Quick Tip: Increasing Case Acceptance with Mindset Shift

The first step in increasing case acceptance is to think optimum oral health and to talk optimum oral health.

All too often in our practices, we start listening to patient's complaints and we get focused on a single, solitary, individual problem. And while that may be very important to the patient, we have to be mindful that there's a bigger picture going on; a system that involves the temporomandibular joints, the muscles, the teeth, and all the supporting structures.

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Dawson Quick Tips: Creating Stable, Equal-Intensity Centric Stops

Hey everybody. Welcome to Quick Tips. Today I want to talk to you about creating stable, equal intensity stops when we're looking at occlusion.

5 Requirements of Occlusal Stability

We talk about five requirements of occlusal stability, and number one is making sure that when we close our mouth that we have as many teeth as possible, hopefully 14 teeth, hitting 14 teeth simultaneously with equal intensity contact.

And so when we think about how a jaw closes, we want to make sure that we are aligning the cusp tip into the appropriate fossa or marginal ridge. So when we look at this stable bite, we are visualizing that cusp tip landing on a flat surface. If it's landing on an incline, it's going to cause the tooth to shift positions, get loose, move out of the way, or not be optimally stable.

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Dawson Quick Tips: Esthetic Restorations with Dental Implants

Welcome to Quick Tips. Today I want to give you some guidance when you are planning an esthetic restoration in the front of the mouth that's going to involve an implant.

What to look at first

When we look at these type of cases, the first thing we've got to be considering is the precision of that maxillary incisal edge. The second thing we have to think about is once we get that maxillary incisal edge figured out, where that gingival plane is going to be because that is going to be determining the optimum length of the tooth.

And then from there we have to think about how far that free gingival margin has to be from the head of the implant. Remember the incisal edge to free gingival margin really determines the length of the tooth.

Now we can plan the precise placement of the implant. We have our incisal edge position and we have our free gingival margin. We also know from the biology of implants that if the head of that implant can be about 3 millimeters from our free gingival margin, that gives us the room to be able to shape the tissue, support those papillas and have a great result.

So at the Dawson Academy, if you have an implant we still do everything the same way.

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Dawson Quick Tips: Customizing The Envelope of Function

Hello, everybody. Welcome to Quick Tips. In this edition, we're going to be talking about customizing your patient's envelope of function, which is a very important part of getting the anterior guidance right for your patients.

As you're looking at the lingual contour of provisional restorations, hopefully you are developing lines on your provisionals that provide evidence of posterior disclusion or anterior guidance.

Remember, if you don't get anterior guidance or posterior disclusion, then that is going to allow the back teeth to rub.

And if the back teeth rub, then we know that increases muscle activity and can create damage to the teeth, either by working them loose or by causing the teeth to wear. And make no mistake, a lot of the fractures we see are related to not having good anterior guidance or posterior disclusion.

But the question is, can we make the guidance too steep? 

When the patient starts chewing and speaking and the mandible starts moving outside-in, is it possible to get those lines too steep so it's actually in the way of the functional path that the lower incisors travel outside-in?

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The Significance of Anterior Guidance in Obtaining a Stable Result

We believe that the primary goal of an occlusal scheme is first to make sure that we have good stability on closure so that the vertical loading of teeth is balanced all the way around the arch.

We also believe that the patient does not have the ability to rub on posterior teeth.

Rubbing on posterior teeth will increase muscle activity and will almost always lead to some kind of breakdown whether it’s:

  • Wear
  • Mobility
  • Migration
  • Sore musculature

This can lead to headaches and maybe even potentially damage to the joint. If the back teeth aren’t going to rub, then anterior guidance is only second to centric relation for making sure we have a stable seated joint.

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Vertical Dimension & Severely Worn Teeth: Where Do You Start?

“I’m not sure where to start when vertical dimension is over closed and the teeth are all severely worn.”

If you’ve ever thought something along these lines, there are a few things that need to be cleared up.

One of the things that Dr. Dawson teaches us is that if patients have all their teeth and the teeth are worn, they have not lost vertical dimension even if the teeth are halfway gone. We know that as teeth wear there is an elongation of the alveolar process and eruption occurs. So the distance between the chin and the nose does not in fact change even in the case of extreme wear.

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Why Do Patients Think Their Upper Anterior Teeth are Too Long?

Well, the short answer is probably because they are too long. They also might be too far out.

It’s important to remember that when you’re restoring maxillary anterior teeth, unless you give the laboratory very specific guidelines on where you want the maxillary incisal edge, their tendency is to make the teeth too long and to make them too far labially.The other thing that we have the tendency to do on maxillary anterior teeth is under-reduce, which sets up a lot of these problems.

One of the things that is extremely important to remember is that if all the lab has to go by is a nice model of the prepared teeth with good margins, they are simply guessing at where the maxillary incisal edges will be in space. We have to determine these things in the mouth and then give very specific communication to the lab on where that’s going to be, and then have some verification or protocols to make sure they do it.

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