The key to success in restoring anterior teeth is the precise location of the incisal edges; where those incisal edges are will determine many things regarding the anterior restoration (including long-term success). It’s important to understand that there is no norm that works for every patient. In fact, the anterior guidance on each case will differ notably.
In this video, we asked Dawson Faculty, "What are the signs of Occlusal Disease?" Here were their answers:
Occlusal harmony is a concept that sometimes gets forgotten. Sometimes, students get so involved with the process of complete dentistry that they forget the reason why they're doing this in the first place. So let's talk about occlusal harmony.
People always ask me about classifications of TMJ disorders and where I find somebody can be treated and where they cannot be treated, when we have to consider splint therapy and other avenues of treatment of the joint.
I'm going to talk about QuickSplint. It's the easy quick way to make a temporary custom fit bite guard in five minutes, chair-side.
I use it when I need to provide immediate pain relief for muscle related facial pain, especially when you have a limited opening and can't fit in an impression tray.
One of the biggest struggles that our students have, as we go through this curriculum, is how to find centric relation, and certainly when I was training, I had that struggle too.
We're going to answer some questions regarding the webinar that I did the other night on anterior guidance, and we have some very good questions.
What about group function? Is it only for dentures?
The answer to this is that group function is routinely, very applicable to dentures, but not typically for natural teeth, with the exception of patients who do not have an anterior guidance. If they don't have an anterior guidance to disclude the balancing side in excursions, then we have to use the working side in group function to disclude the balancing side. As long as we have an anterior guidance though, we do not want group function. We want just lines in front, dots in back with the anterior guidance separating all the posterior teeth in all excursions.
In this webinar, Dr. Dawson discusses in depth the often discussed and debated concepts of Anterior Guidance. This discussion includes understanding how the envelope of function, incisal edge position, and lingual contours work in harmony with the anatomy of the TMJ and muscles of mastication, which are concepts that must be mastered by the restorative dentist.
Hear him revisit timeless principles that he has spent a career and lifetime in understanding and teaching to our profession.
Inspiration for this article:
Recently we received the following comment on the blog article, "The Importance of Load Testing" by Dr. Leonard Hess.
I am a past attendee of the Pankey and Dawson curriculums ( long ago in the 1980's) and am flabbergasted that you still preach this anachronistic content which has long been disproven in the evidence based literature and debunked in dental education. I am a dental educator and long ago stopped teaching that every patient had to be in centric relation, that the TMJ bore the main load of occlusion and that anterior guidance and posterior interferences had a significant relationship to TMD. I see patients with harmful irreversible changes caused by excessive and unnecessary equilibration, and TMD patients grossly overtreated with unneeded prosthetics, orthodontics and orthognathic surgery. I am hoping that you will post this and respond. Although I have great respect for Dr. Dawson as a pioneer in dentistry the Dawson Academy needs to greatly modify its curriculum content to come into the 21st century. !
Harold F. Menchel DMD
You can find responses by both Dr. Hess and Dr. Dawson to Dr. Menchel's comments at the bottom of that article. Below is my response.
As dental educators, it is our duty to seek a total understanding of the foundational concepts and the associated clinical relevancy in order to teach our students and positively impact patients. Dr. Dawson’s very concept of complete dentistry, and what is taught by the Dawson Academy, is to identify any signs or symptoms that impede anatomic and functional harmony. It is our goal to provide the least invasive, most conservative treatment to help our patients achieve optimal health that is maintainably comfortable and beautiful. This we agree upon.
The “anachronistic content” you describe stems from an incomplete understanding of the anatomy and function of the masticatory system as well as the erroneous application of that misinformation. Much controversy and clinically skewed research stems from a lack of a common classification system for joint position, occlusion and temporomandibular disorder (TMD) diagnostic criteria. Sadly, such has perpetuated our profession and the opportunity to clarify is welcomed.
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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