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Perfecting Dental Occlusion Using Computerized Analysis

Perfecting Dental OcclusionEarlier this year, I had the opportunity to try out the T-scan computerized occlusal analysis system. I was familiar with the system which was available in my former group practice, however, I had not used it to any great extent.  I had received such good training that I rarely had any occlusal complications following a reconstruction or an equilibration and had not found a great need to evaluate my patients’ occlusions with the system. In 2011, I restored a patient that we have affectionately come to know as "the Princess and the Pea."  This patient is incredibly loyal and gracious; she is also the most occlusally aware patient I have ever treated.

The Dental Reconstruction Process

We did a textbook reconstruction of her upper arch and lower posterior teeth as well as some limited aligner movement of the lower anterior teeth. We followed every protocol with a comprehensive exam, occlusal analysis, 2 sets of mounted models, a full contour wax-up, intraoral mock-up, and patient approved provisionals before we completed her case.  She had beautiful canine guidance, no detectible posterior interferences, equal intensity stops on all of her teeth when the joints were in centric relation, and a beautiful esthetic result. But after we finished her reconstruction she was very concerned. She reported that her “bite was even more off than when she came in,” and a poor bite was what brought her to our office in the first place.

Looking for More Precision

We mounted a new set of models, and her completed case looked ideal. I was at a loss as to how to proceed. After attending the dental treatment planning course that Dr. Cranham teaches in Virginia and seeing his use of the system, I decided to contact Tekscan.  It seemed that the type of precision that he described in his lecture regarding how he could finish the occlusion on his cases to a much higher level with the T-scan might help my patient.

The system would be a big investment for my new one-year-old dental practice, and Jennifer Cullen was gracious enough to bring the T-scan in to my office to let us assess it. My experience was incredibly valuable. After an initial scan of my reconstruction patient, we found that her dental occlusion was indeed very good, but the software was able to shine a spotlight on the teeth that were hitting with more intensity than we could detect with articulating paper.  It also charted the timing of the occlusal contacts and the balance of bite force between the right and left sides.

The Result

After one appointment, using only rubber cups to fine tune this patient's occlusion, she left saying her bite felt "perfect."  My whole team was overjoyed.  I had personally lost a lot of sleep pondering the case of “the Princess and the Pea” and was so relieved that we were able to finally make her feel as good as she looked.

This positive experience using T-scan in my office has put this technology at the top of my Wish List for our practice. Regardless of how good our training is or how precise we try to be, this technology allows us to take our dentistry to a higher level. I can say with confidence that it will improve the care we give our patients, increase our productivity, and prevent breakage that we might see from adjusting occlusion by relying on articulating paper dots or the patient’s sense of touch or proprioception.  It certainly liberated us from a puzzling situation and prevented many sleepless nights fretting over the "Princess and the Pea".

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Dr. Angela Gribble Hedlund completed her undergraduate training at Baylor University in Waco, Texas, where she received her Bachelor of Science Degree. She received her DMD from the Medical College of Georgia School of Dentistry in Augusta Georgia, and has completed an ADA-accredited program in Advanced General Dentistry at Baylor College of Dentistry in Dallas, Texas. Dr. Hedlund practiced with Goldstein, Garber, & Salama for 16 years, and have recently opened a private practice in North Atlanta. She has practiced dentistry in Atlanta since 1994. Dr. Hedlund has also received extensive training in esthetic dentistry. She has received her certificate in the Postgraduate Program in Esthetic Dentistry from Baylor, as well as completing the Comprehensive Esthetic Restorative Continuum at the same institution. During her postgraduate studies at the Medical College of Georgia, she was awarded the Goldstein Esthetic Dentistry Award, presented yearly to a senior student who has shown exceptional interest and talent in the area of esthetic dentistry. She is an active member in the Georgia Academy of Cosmetic Dentistry and the American Academy of Cosmetic Dentistry where she is currently an accreditation candidate. Dr. Hedlund is an active contributor to organized dentistry. This began when she served as the first female president of an MCG dental class, and a representative to the American Student Dental Association executive council. She is currently a member of the American Academy of Cosmetic Dentistry, American Dental Association, Georgia Dental Association, the Hinman Dental Society, and the Academy of General Dentistry, where she has completed over 1,500 hours of continuing education in dental studies. She has received her Fellowship in the Academy of General Dentistry; this is an honor held by fewer than 2% of dentists in the country. In July 2006 she became one of the youngest women ever to receive Mastership in this Academy. Dr. Gribble also is on the dental advisory council for the Christian Medical Dental Assocation. Dr. Gribble has published articles in the Journal of Esthetic Dentistry and the Journal of the American Dental Association. She has served as a contributing editor to the Dental Study Club Journal, which contains reviews from leading clinicians on articles from over seventy-five international dental journals. She also lectures on the subjects of restorative and esthetic dentistry. Dr. Gribble paid for a large portion of her education and received lots of “smile practice” in the Miss America Scholarship programs. She was 2nd runner-up in Miss Augusta in 1991, and 2nd runner-up in Tennessee’s America Junior Miss Pageant in 1985. Dr. Angie Gribble Hedlund enjoys singing, scrapbooking, and is a master scuba diver. She is an active member of the Atlanta Women’s Medical Alliance and Bible Study Fellowship where she serves as the Substitute Teaching Leader for the Norcross Women’s class. She and her husband Richard are members of Roswell United Methodist Church. They volunteer regularly with the children’s program there with their 2 daughters Tori and Lexi.