Bite occlusion dentist Charlotte NC occlusion
North Carolina bite balancing
Occlusal analysis-mounted case (Bite exam)
Are you aware of the Occlusal Analysis-Mounted Case
procedure for analyzing an unbalanced bite?
Proper analysis of the bite or occlusion before treatment is completed will ensure optimal final results for each of my Charlotte North Carolina area patients. I accomplish this with an Occlusal Bite Analysis Mounted Case. It is important to understand that this is a very specific type of examination.
What is an Occlusal Analysis Mounted Case?
An Occlusal Analysis Mounted Case is the official American Dental Association description for a comprehensive procedure to analyze a patient’s bite.
Before describing an occlusal analysis-mounted case in more detail, I would like to discuss when it is indicated.
An Occlusal Bite Analysis-Mounted Case is indicated for the following cases:
- Before any complex cosmetic and oral reconstruction
- Before orthodontics (braces) for adults.
- If there is any of the following signs of Occlusal Disease :
* Pain or incorrect functioning of the jaw muscles/jaw joint (TMJ)
* Excessive wear of the teeth
* History of multiple crowns and/or bridges
* History of multiple root canals
* History of periodontal (gum and bone) disease
* Current periodontal disease
* History of teeth becoming more crowded and crooked over time
* History of teeth becoming more spaced or flared over time
* Loose teeth
* Fractured and chipped teeth
To best way to ensure that your jaw joint (TMJ), your jaw muscles and your teeth (bite) are functioning in harmony is to first start with an Occlusal Analysis, mounted case (ADA procedure code (D9950). After the Occlusal Analysis, mounted case is completed, a determination can be made for what procedures need to be performed to get the bite balanced. Among other procedures that might be recommended, an Occlusal Adjustment, complete (ADA procedure code D9952) is often necessary. Only a small number of dentists actually perform these procedures (ask them). Without these procedures I could not deliver the best holistic care and long term comfort, function and health for many cases. These procedures are recommended by prestigious dental academies.
The following pictures shows the basic steps in performing an Occlusal Analysis, Mounted Case. These steps ultimately result in the dentist analyzing the information to determine the best way to achieve a balanced bite for the patient.
An Occlusal Analysis Mounted Case requires that models of a patient's teeth are mounted on a tool called an articulator. The models are mounted or attached to the articulator using measurements and data taken from the patient's jaw structures. The mounted models are then analyzed to determine what is wrong with a patient's bite and what treatment needs to be completed to balance it.
You may find the following helpful in understanding how the bite or occlusion affects the position of the jaw in a joint. The jaw system is more complicated than this but it is a good starting point.
Think of the lower jaw (mandible) as an inverted tripod:
Like any tripod or three legged table, the lower jaw (mandible) is stable if all three "legs" are on stable "ground". The "ground" for the mandible is the base of the scull and upper teeth.
When the occlusion or bite is in sync with the correct and supported position of the mandible is stable.
When the bite is not in sync with the correct and supported position of the mandible in the joints the mandibular position is unstable.
Occlusal Bite Disease
Occlusal Bite Dentist Charlotte NC North Carolina
Strong foundations prevent problems.
As I continuously preach to my patients, if we do not treat the cause of dental disease then you are just treating the symptoms and you will never solve the problem. Often times the cause of dental disease is an unbalanced bite or Occluso-Muscle Disorder. Never do I have a patient present to my office without some sign or symptom of Occluso-Muscle Disorder. Any sign or symptom of Occluso-Muscle Disorder is considered Occlusal Disease. In some patients the symptoms are mild but most of the time the symptoms are moderate to severe. It is surprising that signs and symptoms are so obvious but rarely is it treated in a comprehensive manner which starts with an occlusal (bite) analysis, mounted case. As a Charlotte North Carolina dentist solving patient’s problems for over 25 years, I have become more and more convinced of the importance of comprehensive bite balancing therapy.
Note: Incorrectly designed or inadequately maintained bite guards and store-purchased soft guards will also result in damage to the TMJs (jaw joints), teeth, bone and gums as well. In other words, they can promote and worsen Occluso Muscle Disorder which will result in continued Occlusal Disease. Click on the following link to understand this:
Occlusal Bite Disease Includes:
Many of my Charlotte NC area patients and even health care providers including dentists will use the term “TMJ” to describe joint or jaw muscle pain or dysfunction of the jaw joints. TMJ simply means temporomandibular joint. The correct term to use is TMD which stands for Temporomandibular Disorder. TMD is associated with one or both of the following: TMJ (jaw joint) damage, dysfunction and/or TMJ and muscle pain
- Cracked, fractured and worn teeth
- Damaged dental treatment
- Tooth pain and hypermobile (loose) teeth
- Need for root canals
- Failure of previously completed root canal procedures
- Need for extensive dental treatment and missing teeth
- Instability of orthodontic retention
Occlusal Bite Adjustment
Charlotte TMJ dentist NC North Carolina
Bite Adjustment Dentist:
In my opinion a comprehensive occlusal adjustment or occlusal equilibration is one of the best services we can provide our Charlotte NC area patients. Done properly, along with other procedures will eliminate all the problems of occlusal (bite) disease. The official ADA term of a comprehensive occlusal adjustment is Occlusal Adjustment , Complete. In my Charlotte North Carolina office this procedure is completed on a patient only after an Occlusal (Bite) Analysis, Mounted Case is completed. As part of this analysis, the models of the teeth are adjusted before adjusting or equilibrating the teeth for the patient.
Mounted models from an Occlusal Analysis (top).Adjustment are made on the models before adjusting the teeth (bottom).
Close up of unbalanced and traumatic contacts on teeth.
Ideal contacts on teeth at initial closing.
Contacts on teeth after an occlusal adjustment
The following pictures shows a unbalanced contact (red spot) of a tooth being adjusted or equilibrated with a dental handpiece. This type of adjustment done delicately and does not damage the tooth:
Miscellaneous statements from text and research sources:
"Occlusal adjustment, the intentional mechanical grinding of selected biting surfaces of teeth to improve the contact of or relationship between opposing tooth surfaces, their supporting structures, the muscles of mastication, and the temporomandibular joints."
"equilibration: Reshaping of the occlusal surfaces of teeth to create harmonious contact relationships between the upper and lower teeth; also known as occlusal adjustment."
"Properly diagnosing an occlusal interference and correcting it with proper equilibration is one of the most valuable treatments you can perform for your patients."
"Occlusal adjustment, complete (D9952): Occlusal adjustment may require several appointments of varying length, and sedation may be necessary to attain adequate relaxation of the musculature. Study casts mounted on an articulating instrument may be utilized for analysis of occlusal disharmony. It is designed to achieve functional relationships and masticatory efficiency in conjunction with restorative treatment, orthodontics, orthognathic surgery, or jaw trauma when indicated. Occlusal adjustment enhances the healing potential of tissues affected by the lesions of occlusal trauma."
"Failure to detect and treat occlusal disharmony leads to an array of problem. A stitch in time saves nine. Occlusal equilibration is an excellent example to justify this proverb and for better understanding this concept it is very essential to know in detail about the development, gross anatomy and histology of temperomandibular joint. Together with the basic Knowledge of TMJ this book gives an in detail practical approach of occlusal equilibration of natural dentition."
"Temporomandibular dysfunction has been considered to have a multifactorial etiology, which seems to be related to: genetic, physiologic, traumatic, pathologic, environmental, and behavioral factors. Nonworking side contacts, slides between RP-IP, increased vertical or horizontal overlap and lost of occlusal stability due to missing posterior teeth are all occlusal factors related to signs and symptoms of TMD. Although some authors state that many individuals are capable to adapt to occlusal discrepancies within tolerable limits, without the presence of signs and/or symptoms or TMD, the clinical practice shows that it is not possible to predict whether the patient will adapt or not, and to establish the tolerance limits of each patient. Thus, the professional should always try to establish an harmonic occlusal relationship, avoiding the presence of prematurities and/or interferences that might possible cause any type of dysfunction. In the presence of muscular tenderness an occlusal cause should be suspected. Occlusal adjustment must be employed only when an occlusal disarrangement is noted because it should be considered preventive treatment and not a prophylactic one. Since TMD etiology is multifactorial a multidisciplinary treatment must be considered in other to better treat the patients, gathering the following areas: Dentistry, Physiotherapy, Psychology, and Medicine."
Criteria for a Balanced Bite
Charlotte NC Dentist North Carolina Occlusion
There are four criteria for a balanced bite. They are explained below. When performing an Occlusal (Bite) Analysis, Mounted Case I determine how far a patient’s bite or occlusion deviates from these criteria. The more deviation there is, the more therapy will be recommended to balance the bite. As a Charlotte North Carolina dentist working in the “real world”, there are times it is not possible to attain all the ideal criteria for a balanced bite. In these cases we make compromises in the therapy to accommodate the patient’s unique case or desires. Therapy to correct the bite may include one or more of the following therapies for my Charlotte NC area patients.
- Occlusal Bite Adjustment, Complete
- Orthodontic movement of teeth
- Crowns or porcelain veneers
- Orthognathic surgery (surgical repositioning of jaw bones)
- Bite Guard
Criteria for a Balanced Bite:
1) The condyles need to be in the most stable position in the jaw joints (TMJs):
2) The teeth must have balanced and simultaneous initial contact with each other so the condyles are not moved out of their stable positions in the TMJs (jaw joints) and no tooth is receive excessive or misdirected bite forces:
3) The upper and lower anterior teeth must have proper contacts with each other when the lower jaw slides forward. This will decrease the amount of activated jaw muscles and properly guide the condyles in the TMJs (jaw joints):
4) The upper and lower canine teeth have proper contacts when the jaw slides laterally. This will decrease the amount of activated jaw muscles and properly guide the the condyles in the jaw joints (TMJs).