06 January 2023

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Top tips for occlusion in primary care

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A research team from Peninsula Dental School at the University of Plymouth recently shared tips for occlusion, highlighting that this contact between teeth should be at the forefront to improve patient outcomes. The paper was published Dec. 9, 2022, in the British Dental Journal. 

The research team said that daily, primary care clinicians may impact occlusion, whether placing a single restoration or more complex multiples in fixed prosthodontics. Neglecting to analyze the occlusion and the effect interventions may have on it can significantly affect successful outcomes and accelerate failure if not managed carefully.

Simple occlusal analysis

Researchers said that terminology alone can be confusing in occlusion due to a plethora of different terminologies for the same positional or occlusal concepts.

They advised that clinicians think or approach the issue differently depending upon whether patients have teeth or are without teeth. 

For those with teeth, there are three key occlusal positions that are relevant to the clinician: the intercuspal position (ICP) - also known as maximal intercuspation position (MIP), retruded axis position (RAP) - also known as centric relation (CR) and retruded contact position (RCP) - the first tooth contact on closure of the mandible when in RAP and may or may not be coincident with ICP. 

Occlusion and restorations

If conforming, a simple tip is to check the occlusal contacts (ICP) on other teeth are the same before and after the restoration is placed.

According to the paper, it is important that any restoration has contact in the intercuspal position, as teeth may move if not in contact. Shearing forces are damaging for posterior restorations and to prevent fracture, dynamic tooth guided movement should not involve posterior restorations where possible.

Researchers said it is important to identify where the slide from RCP to ICP is located prior to restoration. If the tooth to be restored is involved in producing that slide, you may unknowingly alter the slide between RCP and ICP. This unplanned occlusal adjustment may result in the created space for the restoration being lost.

Conclusions

Understanding of occlusion and the effect clinical interventions have on occlusion is an essential element of daily clinical practice affecting all disciplines in dentistry. In this short paper, researchers presented tips and observations that they have found to help in managing occlusion to avoid occlusal disharmony and the complications this may bring. The team expressed hope that these tips will be useful in allowing clinicians to not only think about occlusion but to also dispel some of the confusion that often exists around discussions in this area.

Harris, A., Tredwin, C. & McColl, E. "Top tips for occlusion in primary care." Br Dent J 233, 908–909 (2022). https://doi.org/10.1038/s41415-022-5321-4