Occlusal equilibration is a treatment modality that we can use to increase patient satisfaction and comfort. Prior to my training and education at The Dawson Academy, equilibration was the least understood and therefore the most underutilized procedure of all the things that I did.
Occlusal equilibration basically is balancing up the bite to where the jaw joint is seated properly.
We always start with a healthy joint, making sure that it's seated properly, in Centric Relation, and then we want all the teeth to come together with equal pressure, and then when the jaw moves at all, just the front teeth touch.
Equilibration is one of the most fun and valuable procedures I can do in my office for my patients. I tell my staff all the time that if you want to have me as happy as I can be, fill the day with equilibrations. But finalizing an equilibration is also very crucial.
It can take a little bit of time to do. But most of the time, I will set aside about an hour to hour and a half for my equilibration, and I follow that up about 2 weeks later with a 1/2 hour appointment and then another 2 weeks later, if necessary, for about a 15 to 20 minute appointment.
Fremitus is the perceived vibration of a tooth when it comes into contact with another tooth.
This is very important for a number of reasons. It is something we should look at in our new patient examinations and is something that we have to check and make sure that is not present when we are finishing occlusal equilibration.
Some of you already have the T-Scan in your practice from Tekscan. It's a computerized bite sensor that you can use in initial exams to show patients some of their malocclusion. And one of my favorite uses in our practice is to use it as part of our equilibration.
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.
Equilibration or reshaping of teeth is one of the procedures taught at the Dawson Academy. The equilibration process begins with step 7 in the 10 Step 3D Treatment planning Checklist (Provide Equal Intensity Stops). The goal of equilibration is to reshape both posterior and anterior teeth until equal intensity contacts are achieved in centric relation. Like all other procedures, the dental assistant’s (DA) role is vital to the success of the equilibration process.
Lucia jigs, NTI’s, Cranham deprogrammers, and Dawson B-Splints all fall into the broad category of temporomandibular joint disorder diagnosis appliances. There are specific reasons as to why you may want to use one type over another when diagnosing a possible TMJ problem, but at their core they all achieve the same goal, getting centric relation by eliminating muscle hyperactivity.
In the practice of complete dentistry the dentist is committed to an examination, diagnosis, and treatment planning process and has developed the skill of recognizing the signs of instability in a patient’s masticatory system.
It is our responsibility to offer the patient the most conservative treatment method to achieve the desired end result- a stable, comfortable, healthy dentition and supporting structures that matches their esthetic desires. The most critical skill to be developed in evaluating a patient’s occlusion is locating and verifying centric relation. If the examination reveals stable healthy TMJ’s and load testing is negative, Centric Relation serves as the starting point to determine the amount of discrepancy between CR and MIP.
Contributing to the ambiguity surrounding occlusal equilibration is the fact that some dental continuing education courses have trouble discussing this topic because of faulty research that views occlusal equilibration in a negative light. Therefore, it is of paramount importance that dental professionals choose dental continuing education programs that present an unbiased, scientific-based approach that concentrates on the fundamental principles of occlusion and proper protocols for incorporating occlusal equilibration into clinical practice.
Dentists who have developed proficiency in equilibration universally agree it is one of the most practical skills they use routinely in practice. Deflective tooth inclines force displacement of the TMJs to achieve complete closure into maximal intercuspation. This forced jaw displacement can lead to painful jaw muscle hyperactivity, excessive tooth wear, fractured cusps, and a myriad of other signs and symptoms from sore teeth to headaches. Occlusal equilibration is often the most conservative, time effective, cost effective way to achieve an occlusion free of deflective interferences. Dentists who have never experienced the predictable effects of equilibration, done correctly on properly selected patients may dismiss the importance of occlusal equilibration. But learning the fundamentals and developing some necessary skills can be a significant eye opener to the value of a deflective free occlusion.
It is a premise of The Dawson Academy that no dentist can practice intelligently and ethically to the highest level of patient care without the ability to achieve a perfected occlusion. Occlusal equilibration is a “must learn” requirement for achieving that ability.
Peter E. Dawson, DDS, founder of The Dawson Academy and an expert in dental continuing education, emphasizes that dental professionals require the knowledge and skills necessary to differentiate masticatory system disorders in order to fully understand the potential of, and incorporate--when appropriate, occlusal equilibration. He notes that currently available research fails to address this. For this reason, The Dawson Academy divides masticatory disorders into four categories: masticatory muscle, intracapsular (by structures), neurological, and dental.
In particular, Dawson Academy students develop a greater understanding of how successful and predictable occlusal equilibration cases can be achieved in the safest and most efficient manner based on an understanding of what constitutes a healthy and stable jaw position. Based on this knowledge, they are then instructed in the proper analysis of the TMJs, taking and mounting casts in centric relation, reshaping tooth structures, and achieving harmony between the dentition and TMJs.
According to Dr. Dawson, successful treatment when occlusal equilibration is indicated requires proper case selection, diagnostics, and treatment planning, skills that are taught comprehensively in courses at The Dawson Academy. By emphasizing the fundamental principles for successful dental treatments, as well as effective yet controversial approaches such as occlusal equilibration, The Dawson Academy ensures that its graduates are "Complete Dentists" capable of providing comprehensive dental care for more consistent, predictable, and healthy outcomes.