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OCCLUSAL ADJUSTMENT
Occlusal interferences occurring
during mandibular movement may Figure 2. (a) Articulated casts covered in indicator varnish. (b) Trial adjustments to show the
require adjustment before restorative effect of the procedure on the next point of contact.
procedures are contemplated. Once
a b
RESTORATION OF
POSTERIOR TEETH
The posterior teeth provide stable
vertical and horizontal relationships
between the mandible and maxilla.
When planning any posterior
restoration, the practitioner must
consider the following questions:
Figure 4. (a) Self-curing acrylic copings on distal abutments to verify occlusal contacts on the
cast. (b) Ensuring contact and assessing available space for correct thickness of material for
l Is ICP stable?
crown.
l What are the anterior tooth
contacts?
l What design of tooth preparation? a b
l How even is the occlusal plane?
l Occlusal vertical dimension –
adequate or reduced?
l What type of occlusal scheme is
desirable – conformative or
reorganized?
The objectives are: Figure 5. (a) Single-quadrant interocclusal record and (b) self-curing acrylic copings. The over-
erupted first molar has been prepared and waxed-up to produce an even occlusal plane.
l To leave stable occlusal contacts
RESTORATION OF
ANTERIOR TEETH
Figure 7. The replacement of a maxillary denture and crowns. (a) The displaced maxillary Preoperative considerations:
denture. (b) Palatal view of the restorations and edentulous space. (c) Complete arch diagnostic
wax-up in RCP. (d) Temporary bridge replacing all the maxillary restorations. The missing teeth l stability of ICP;
were replaced by single tooth implants and the remaining teeth crowned. l reproduction of correct palatal
contours;
l tooth preparation;
determinants of occlusion be developed stable ICP contacts. The wear l metal coping design;
in unison. It is advisable to provide characteristics of direct composite l protrusive and working guidance;
long-term temporary restorations in resins are less favourable and more l incisor relationship;
such cases as the patient’s tolerance abrasive to the opposing dentition: l phonetics and appearance.
to changes in ICP, RCP, excursive this material should not be used when
movements and possibly the OVD restoring large cavities where tooth Objectives (in addition to the
must be monitored over a long time. contact is solely on the material. Small posterior objectives):
The proposed changes can be Class II restorations can be restored
gradually introduced on the temporary with composite, providing that the l even distribution of forces in
restorations, which are easier to adjust occlusal contacts are primarily on the incisal guidance;
or add to. Such restorations should tooth and not the material. l immediate posterior disclusion
have a metal substructure overlaid with (except in Class III occlusions).
acrylic or composite resin. The Porcelain versus Gold
principles of a reconstruction are no Porcelain occlusal surfaces offer
different from those already described. improved posterior aesthetics but the Anterior Guidance
The treatment plan is divided into technique for developing them is more The anterior teeth are in a balanced
four stages: difficult than in gold and the highly position determined by the lips,
polished surface does not readily mark tongue, occlusal relationship and
1. Occlusal splint therapy.
2. Occlusal equilibration so that ICP
= RCP.
3. Restoration of the anterior teeth. a b
4. Restoration of the posterior teeth,
either by opposing quadrants or
all at one time.
is made using the premolars, group occlusion requires a high level of skill
function should be developed. and knowledge from both technician ACKNOWLEDGEMENT
The author thanks Mr Stephen Davies for his
The occlusal contacts on a simple and clinician to ensure a good result. constructive comments on these two articles.
cantilever bridge must be in ICP on A functional dynamic approach to
both units but the pontic must be free occlusion based on theoretical
of any lateral contacts. This reduces principles is a useful concept in
the lateral forces on the pontic that restorative dentistry. Most patients REFERENCES
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