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

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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How to Get a Patient to Accept Dental Treatment

Sometimes it’s hard to get patients to understand and accept the need for treatment.

The first thing to understand when it comes to patient acceptance is that patients won’t accept any course of treatment if they don’t understand that they have a problem. Particularly with equilibration it is important during the context of the examination that you first have a basic discussion about what optimum health is.

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Webinar: How to Effectively Equilibrate the Natural Dentition

Following proper diagnosis and treatment planning, occlusal equilibration can provide selected patients with the most conservative, predictable and safest treatment possible.

Occlusal equilibration can often help avoid the need for more complex treatments. Dentists who have developed proficiency in equilibration universally agree it is one of the most practical skills they use routinely in practice. 

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When You Don’t Yet Know How to Comprehensively Treatment Plan

When you are still going through the Dawson curriculum, do you wait to treat or do you try anything immediately?

This is an important question for anyone still learning occlusion and smile design. When you look at the totality of what we're training you to do, there are still a lot of patients who need preliminary mouth preparation to get healthy. There’s still periodontal and biological work to be done, like fillings and build ups.  There are also going to be patients that don't have tremendous functional problems.

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How Do You Know If You Achieved Centric Relation?

When we talk about utilizing bimanual manipulation as a way to get centric relation, one of the biggest misunderstandings we see is the tendency for dentists to think CR is achieved by forcing the jaw back to seat the condyles. When we are in a situation where we have a ‘tight’ patient, or patients that are resisting, the worst thing we can do is force it. 

Bimanual manipulation provides verification of:

  • The correctness of the physiologic position

  • The alignment of the condyle-disk assembly

  • The integrity of the articular surfaces

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Webinar: Why Porcelain Chips and Breaks

In this webinar, Dr. Cranham discusses the elements involved in perfecting an occlusion to insure predictability in restorations. 

Topics Covered:

  • Insuring a Perfected Occlusion with centric stops
  • What to do when back teeth rub
  • Anterior Guidance
  • Tooth Preparation (under and over)
  • Proper coping design
  • Materials
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