The widespread use of durable restorative materials such as zirconia and lithium disilicate, coupled with the popularity of dental implants, has ushered in a new era of restorative excellence. However, many of these advancements have also introduced complex occlusal challenges that cannot be overlooked. Dentists today must prioritize occlusion in their clinical practice to ensure long-term success and patient satisfaction.
The Occlusal Puzzle in Modern Dentistry
Occlusion might be a forgotten era of dentistry, but the rigidity of implants and the hardness of modern materials create unique challenges that require a renewed focus on occlusal knowledge. Here are some occlusal basics to remember:
Teeth Move—Implants Don’t
Natural teeth, supported by the periodontal ligament, are inherently designed to absorb and adapt to occlusal forces. This flexibility allows for harmonious interdigitation even under varying loads. In contrast, implants are immovable anchors in bone. Their rigidity means they do not accommodate natural tooth movement, often leading to altered occlusion and a cascade of issues such as temporomandibular joint (TMJ) discomfort and headaches, to name a few.
The Problem of Mesial Drift
Throughout life, natural teeth drift mesially, maintaining tight proximal contacts. However, when implants are introduced, this natural movement is disrupted. Over time, mesial contact points adjacent to implant-supported crowns may open, causing food impaction and malocclusion. Dentists must interdigitate occlusal contacts and monitor mesial drift closely to mitigate these problems.
The Double-Edged Sword of Modern Materials
Zirconia and lithium disilicate are celebrated for their strength and aesthetics, but their wear-resistant properties pose a significant occlusal challenge: unlike gold or composite restorations, which wear at a rate similar to enamel, glazed zirconia often causes accelerated wear on opposing teeth. This imbalance can disrupt occlusal harmony, necessitating careful material selection and occlusal adjustments.
Practical Solutions for Today’s Challenges
Here’s a roadmap for addressing these occlusal dilemmas:
1. Upgrade Your Occlusion Knowledge:
Occlusion is an intricate discipline that deserves ongoing education. Dentists should seek out advanced courses and CE to refine their understanding of occlusal dynamics and learn practical techniques for prevention and treatment.
2. Prioritize Occlusal Exams:
A thorough occlusal evaluation should be part of every new patient exam and routine appointment. Look for signs of occlusal instability, such as TMJ pain, broken teeth, and open contacts. Assess occlusion in all functional positions, including centric relation, lateral excursions, and incisal guidance.
3. Use Conservative Restorative Approaches:
While zirconia and lithium disilicate crowns are often unavoidable, they should be reserved for cases where more conservative options are not viable. Treat early carious lesions proactively with minimally invasive composite restorations to preserve as much natural tooth structure—and occlusal harmony—as possible.
4. Be Strategic with Implant Placement:
Implants should be a last resort when treatment planning. They introduce rigidity into the dentition and often exacerbate occlusal challenges. When implants are necessary, meticulous planning and occlusal adjustments are essential to ensure a balanced bite.
5. Embrace Occlusal Splints and Equilibration:
Occlusal splints are invaluable for managing bruxism and protecting both natural dentition and restorations. Occlusal equilibration, although underutilized, can correct bite discrepancies and reduce occlusion-related complications.
Addressing occlusal challenges is not only critical for patient care but also a potential source of hidden revenue. Dr. Gordon Christensen, DDS, PhD, MSD notes that an estimated 35% of adults could benefit from occlusal splints, while many others require equilibration. Brushing up on your occlusal know-how and offering these services could potentially boost your practice’s bottom line
The modern restorative dentist faces a critical choice: to treat teeth in isolation or to treat the entire masticatory system. The rise of implants demands a shift in perspective that recognizes the profound impact of occlusion on overall oral health. Ignoring these foundational principles is not only a disservice to patients but also a potential source of future complications or even legal ramifications. In an era of advanced restorative dental materials, occlusion might be the missing piece that could make or break your long-term patient outcomes.
SOURCES: British Dental Journal, Dental Economics
