The Occlusion of Dental Restorations
It’s hard to over-emphasize the ill effects that an imbalanced bite has on periodontal tissues.
Several decades ago an old colleague, Dr. Leo, the Wizard of Gold Crowns, taught how restorations in a heavy bite are destructive. Over years of use perfectly good restorations or appliances may come into occlusion slowly and gracefully as the teeth wear. And yet, this normal process needs supervision.
Two practical aspects of this are directly related to periodontal disease.
1. “We know more than Nature.”
It seems many popular approaches assume that our dental work can handle 100%, even 120% of what natural teeth can handle. That is to say, our silver, porcelain, and composite fillings; our gorgeous crowns, bridges, and partial or full dentures; even our implants……can look better, and function better than natural dental structures. Likewise, we assume that natural enamel, dentin, and root structure, along with the natural periodontal ligament support, the gingivae and bone are not as perfect as our modern dental restorations.
This is a dubious, if not arrogant, posture to take. What we see is cute, flawless, excessive restorations CAUSE periodontal disease because the teeth and the structures around them respond to biting forces quite differently when conducted through dental work than through the natural teeth and tissues.
We ask patients to think of it this way. “The patient should not have to accommodate to our dentistry, but rather, our dentistry is best when it accommodates the patient’s situation.”
They say, “Yes, that feels good, natural.” If it doesn’t, we’ve got to figure out how to fix it, because anything else will lead to periodontal disease and tooth loss, sooner than later."
2. “Creeping Occlusion.”
Occlusal imbalance of dental restorations creeps up on the dentist as well as the patient. We try to watch for it routinely. We put in a crown here, a filling in there, a partial back there, a few more fillings, a root canal or two, and the minuscule changes in the bite accumulate. Soon, the patient reminds us: “Wait a second, doc, that feels a little high. It rocks my bite.”
Patients’ “feelings” are an important part of the diagnosis and solution. It’s evident that if they feel things are not quite right, then either they have a very alert sense of their correct bite, or the bite has been off for so long they are unaware of it. Then, something is done on another tooth, and the “malocclusion” makes itself apparent. It doesn’t feel right. By this time the imbalance has caused their periodontal problem.
Academic dental research rarely allows for patients’ feelings like: “It really has felt great all these ten years.” Or, “The pain’s gone and the tooth is tighter.” These are important factors.
No, we do not adjust enamel to balance the bite. This natural enamel is intricately designed to carry the powerful occlusal forces. We do not cut away enamel to solve periodontal problems.
A patient in Nebraska stated, “I am amazed at the difference adjusting my fillings made. I now bite instead of tapping my crown. I am certain that this has contributed to my gums being healthier! I love what CTI has done in improving the health of my teeth!”
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