Treatment: Trauma from Occlusion - including occlusal adjustment and splinting

Question 1

What are the two working hypotheses?

Answer 1

1) Occlusal trauma may, under some circumstances accelerate attachment loss
2) Immobilization is essential for periodontal regeneration

Question 2

What will the PDL look like after TFL?

Answer 2

It will be widened

Question 3

What are reversible methods of occlusal therapy?

Answer 3

Night guard
Extracoronal splint
Muscle relaxants
Muscle exercises

Question 4

What are irreversible methods of occlusal therapy?

Answer 4

Intracoronal splints (require tooth prep)
Occlusal adjustments by selective grinding
Orthodontics
Orthognathic surgery

Question 5

What are the two principles of occlusal adjustment?

Answer 5

1) Occlusal adjustment by selective grinding is one of the most irreversible dental procedures
2) Knowing the contraindications to occlusal adjustments is more important than knowing the indictions to adjust

Question 6

What are the indications for occlusal adjustments by selective grinding?

Answer 6

Periodontal occlusal trauma
Post-ortho (fine-tuning)
Prior to extensive restorations
Certain types of TMD
Certain types of wear patterns

Question 7

What are the contraindications to occlusal adjustment by selective grinding?

Answer 7

Severe malocclusion
Non-ideal but well-tolerated occlusion
Severe wear or if occlusal adjustment would expose dentin
Patient in pain
If no suitable endpoint can be reached

Question 8

What are the goals for an occlusal adjustment?

Answer 8

Occlusal stability over time
Axial loading forces
Anterior guidance in excursions
Smooth gliding unrestrained

Question 9

What are important in comprehensive occlusal adjustments?

Answer 9

Centric Relation

Excursions

Question 10

What are we trying to eliminate in limited selective grinding?

Answer 10

Lateral “jiggling-type” forces

Question 11

What are the steps in comprehensive occlusal adjustment by selective grinding?

Answer 11

1) Eliminate or reduce CR-CO hit-and-slide
2) Eliminate non-working side interferences
3) Working contacts via canine guidance
4) Anterior protrusive guidance
5) Recontour sharp or irregular incisal edges
6) Polish all teeth that were adjusted

Question 12

Inner incline

Answer 12

Faces occlusal table

Question 13

Outer incline

Answer 13

Vestibular or palatal/lingual aspect of the cusp

Question 14

What is the ideal occlusal relationship?

Answer 14

Cusp-fossa

Question 15

What is an acceptable occlusal relationship?

Answer 15

Cusp-flat area

Question 16

What are not good occlusal relationships?

Answer 16

Cusp-incline

Cusp-embrasure

Question 17

What is a ‘worse’ occlusal relationship?

Answer 17

Incline-incline

Question 18

What is the worst occlusal relationship?

Answer 18

Cusp-cusp

Question 19

How do we establish a long centric?

Answer 19

Flatten incline

Question 20

What are the different centric relation interferences?

Answer 20

Mesial inclines maxillary

Distal inclines mandibular

Question 21

Problem: CR Mandibular cusp tip to incline
Solution: ?

Answer 21

Flatten maxillary mesial incline

Question 22

Problem: Incline-incline contact
Solution: ?

Answer 22

Recontour both the max mesial incline and mandibular distal incline

Question 23

Problem: Prematurity in Centric, working and non-working
Solution: ?

Answer 23

Spheroid he maxillary palatal cusp

Question 24

Problem: Premature contact in centric only
Solution: ?

Answer 24

Deepen the fossa

Question 25

Problem: CR incline-incline contact on both max and man holding cusps
Solution: ?

Answer 25

Recontour both cusp inner inclines

Question 26

Problem: Incline-incline premature contact on max palatal holding cusp
Solution: ?

Answer 26

Recontour both cusp inclines

Question 27

T/F - we want to adjust the holding cusp

Answer 27

False - adjust the inclines

Question 28

When’s the only time we flatten the cusp tip?

Answer 28

There is cusp-embrasure relationship: then place the contact on flat areas

Question 29

What are the different types of excursions?

Answer 29

Non-working
Working
Protrusive

Question 30

What cusps/inclines do we adjusts to eliminate non-working side contacts?

Answer 30

PUBL
Palatal upper (inner incline)
Buccal lower (inner incline)

Question 31

BULL Rule

Answer 31

Working side interference adjustment
Upper Buccal inner incline
Lower Lingual inner incline

Question 32

What do we want with protrusive contacts?

Answer 32

Anterior guidance

No posterior interferences

Question 33

What should we keep in mind when recontouring anterior teeth

Answer 33

Round off uneven incisal edge
Gain esthetic harmony
Limited amount of by the amount of wear

Question 34

What is the polishing sequence?

Answer 34

1) use green midgets
2) use brown midgets
3) use fine polish
4) make sure patient is comfortable

Question 35

Splint definition

Answer 35

Appliance for the immobilization or stabilization of injured or diseased parts

Question 36

What are indications for a splint?

Answer 36

To immobilize excessively mobile teeth by sharing forces with more stable teeth
To stabilize teeth in their new position after orthodontic movement

Question 37

What is the outcome of a periodontal splint?

Answer 37

While they stabilize teeth, they do not decrease individual tooth mobility once the splint is removed

Question 38

What are the different types of provisional extracoronal splints (without tooth prep)

Answer 38

Wire and acrylic/composit splints
Acid etch composite splints
Mesh splints attached by composites
Cast splints attached by composites

Question 39

What are the different types of provisional extracoronal splints (with a tooth prep)

Answer 39

Amalgan/composite reinforced splint

Provisional crowns splinted together

Question 40

What are the different types of permanent extracoronal splints

Answer 40

Swing-lock partial denture

Bite-plane