This book adopts a clinical approach to understanding occlusion and demystifies it for dentists and students. An accompanying narrated DVD provides stunning three-dimensional animations that clarity the effects of jaw movement. Comprehensive clinical videos demonstrate the process of investigating and managing real life occlusal problems.
By Robert Wassell, Amar Naru, Jimmy Steele, Francis Nohl
1. The Intercuspal Position and Dentistry
2. Normal Function and Occlusal Damage to Restorations
3. Damage from Parafunction, Deflective Contacts and Interferences
4. Conformative and Reorganised Occlusions
5. Occlusion, the Periodontium and Soft Tissues
6. Occlusion and Fixed Osseointegrated Implant Restorations
7. Occlusion and Temporomandibular Disorders
8. Occlusal Diagnosis, Tools and Techniques
DVD Contents - *videos included in epub*
* Understanding Jaw Movement Animations
* Clinical and Laboratory Sequences
This book acknowledges the importance of adopting a clinical approach to understanding occlusion, and that it can be a difficult subject to understand. We all know it is there and important, but, as it is difficult to visualise, it can sometimes be hard to appreciate this importance. Dentists whatever their background, will have different perspectives as to how occlusion affects their clinical practice. The authors, a general practitioner (AN) a restorative consultant (FSN) and two senior academics (JGS and RWW) have integrated their knowledge and experience to emphasise the common ground.
Rather than start with some dry definitions, we have considered a number of situations in which the occlusion causes damage to teeth or restorations; damage that is invariably caused by occlusal instability, parafunction or both. For all of the theoretical occlusal concepts that have been written about over the years, damage from occlusion is what actually matters. In many cases this is iatrogenic. A good dentist needs to know how to detect, treat and avoid such problems.
To describe how the occlusion is associated with day-to-day problems, we have explained and illustrated the possible underlying mechanisms, gradually introducing the reader to important occlusal concepts and definitions. Dr Naru's 3D computer animations, together with the narrated clinical movie sequences bring these to life.
We often think of occlusal damage affecting restorations, teeth, supporting tissues and the masticatory system, but, as described in Chapter 1, occlusion can also damage a practice. Think of the situation which happens all too commonly when a crown takes hours, or what seems like hours, to fit. Attention to detail with impressions, jaw records, articulation and provisional restorations is needed to prevent such frustration. The development of good practice in all of these areas will benefit any dentist wanting to expand their clinical knowledge and expertise in occlusion.
Chapters 2 and 3 focus on the effects of function and parafunction respectively. Normal function can damage vulnerable restorations but poorly contoured restorations can interfere with function, which further increases the risk of damage. Parafunction involves large forces that can wreak havoc with both teeth and restorations. Chapter 4 gives advice on conforming with, or reorganising an occlusion.
Chapters 5, 6 and 7 explores special considerations of occlusion relating to the periodontium, the provision of implant restorations and temporomandibular disorders (TMD). It is widely recognised that the majority of TMDs do not have an occlusal aetiology. Nevertheless, there are times when occlusal factors are very relevant and dentists need to know how to identify and manage them.
The final chapter, Chapter 8, is the longest in the book. It contains details of various occlusal techniques, including occlusal examination, recording jaw relationships, articulator choice, diagnostic waxing, copying anterior guidance, occlusal splints and occlusal adjustment.
About the DVD
How many occlusion students have been baffled by two-dimensional diagrams of mandibular positions and movements? With software used to create blockbusting films, Dr Naru has skilfully provided an animated three-dimensional perspective. In conjunction with Chapter 2, he illustrates the importance of anterior guidance both in terms of normal movement and what can happen when restorations interfere with guidance. With Chapter 3, he demonstrates the problems associated with deflective contacts and interferences.
We have also filmed a number of clinical sequences, beginning with Chapter 7, where we show a structured examination for diagnosing TMDs in Chapter 8, we use a clinical case of occlusal derangement to illustrate all the clinical and laboratory stages involved in occlusal analysis and occlusal adjustment. This section includes details of how to carry out an occlusal examination, tips on recording accurate impressions, centric jaw and facebow registrations. After considering semiadjustable and average value articulators, we move onto mounting casts, trial adjustment and clinical occlusal adjustment. Many of these procedures are common to the management of patients needing extensive restorations, or suffering from occlusally related problems.
The clinical case of occlusal derangement shown in the DVD is somewhat unusual in its aetiology, apparently resulting from tooth movements during pregnancy. It is also relatively challenging. Nevertheless, it usefully illustrates the sequence of events common to the management of many occlusal problems.