QUESTION

How can I best ensure the long-term predictability and function of my newly placed restorations?

ANSWER

The key to success with all of your restorations, but especially the esthetic restorations, lies in one word - occlusion. Simply stated, failure to apply the underlying principles of occlusion in placing restorations will decrease the longevity of that restoration.

These principles begin with proper evaluation of the patient's occlusion, and it is necessary to place the casts in an articulator in approximately the same relationship as the temporomandibular joints exist in the patient. A facebow registration may be used to mount the maxillary cast on the articulator so that it is properly located both anteroposteriorly and mediolaterally.

When the full-arch casts are properly mounted with the bite registration, it is more possible to accurately reproduce tooth contacts and note occlusal discrepancies. Providing this information to a technician, especially on more complex cases, allows the technician to better build the restorations to the patient's true occlusion, not some arbitrary average. The more closely the laboratory's working model simulates the patient's centric occlusion and its protrusive and lateral excursives, the more accurate the final restorations will be in function.

Likewise, care and attention must be given to the try-in and cementation of the restoration. No longer can "checking the occlusion" involve merely asking the patient to open and close to see how it feels, and making adjustments on intercuspal position only. Dentists must ensure the presence of anterior and balancing side disclusion during laterotrusive movement. Any shearing forces from interferences in excursives will increase the risk of fracture to the restoration - a potentially costly proposition if you are dealing with multiple restorations.

As patients seek improved cosmetics in dentistry, the use of all-ceramic restorations in complex rehabilitations will increase as well. Now is the time to brush up on the principles of proper occlusion, because it will contribute to restoration longevity and success.