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Controlling Treatment Failures

The ways in which patients determine their satisfaction with a dentist rely largely on did the dentist hurt and how does it look and feel. If there is post operative pain it could be due to a nerve response or it could be that there were not careful considerations to someones bite.

If dentists don't evaluate their patients for wear facets (indicative of abnormal wear), cracks, defects, abfractions (notches in roots not caused by toothbrushes) then post operative pain can result.

Conformative Dentistry means if a tooth breaks-fix it. Don't pay attention to teeth that have shifted, don't rock the boat, just put something back. Restorative Dentists look for why something broke and try to fix the underlying pathology so future treatment won't result in premature fracture.

Occlusal studies can help a person choose a dentist by helping to identify philosophies based first on success, and long term comfort of the patient - not on a quick buck. Articulator Dentists aren't drill, fill, and bill dentists....

Studying Bite Dynamics

How do dentists make crowns and dentures fit together so well?

Dentists that do complex restorative and reconstructive dentistry use instruments similar to what is pictured here. The Articulator.

Articulators are instruments that allow a dentist to mount models of your teeth and orient them in space so nuances of your particular bite can be studied, reproduced and if need be changed.

Jaw Movement Study

The instrument on the right is a facebow. This is used to orient someones upper jaw (their study model of their jaw) to the horizontal plane.

Articulators Explained Dr Richard Winter The teeth are mounted so that the range of someones bite will be accurately recorded. This includes sliding your jaw to the left, right and straight forward. The dentist uses various settings to insure that all border movements can be reproduced and that any crowns, dentures and implants can be constructed within the parameters of a healthy bite.

If a tooth hits before all the others, a person can experience TMJ (temperomandibular joint) symptoms. Pain in the muscles of chewing, cracked teeth, jaws that lock open or closed can all be symptomatic of dental problems or joint problems or a combination of the above.

An articulator can detect occlusal prematurities, (hitting a tooth too hard or too early) to prevent pain, tooth loosening, muscular pain, ear pain associated with joint problems, as well as a host of other problems.

If a dentist uses their articulator for difficult cases or in situations where precision is essential for the fabrication of various components (crowns, bridges, veneers, overlays, build-ups, etc) they can achieve results that are more predictable than by "flying without a parachute."

The physics of the stomatognathic system -MOUTH- is complex and delicate. Understanding force factors, parafunctional habits such as grinding your teeth, clenching, etc. can all have a bearing on success or failure of occlusal rehabilitation.

The role of the dentist is to allow the muscles of mastication, like the cheeks, temples, and neck muscles to work synergistically with your teeth to keep the balance of proper biting in check. If the muscles are spasming and teeth are clenching, (especially in the presence of large fillings), cusps will fracture, people with develop cracked tooth syndrome.

Crowns that a dentist has to grind excessively on, teeth that feel high, bridges that don't fit, can sometimes be avoided by using this instrumentation.

Reasons for Including Articulation Studies in Your Treatment

Basically an articulator is a way to relate upper jaws to lower jaws, upper teeth to lower teeth in a way that closely mimics the way these arches match up in real life. They give dentists guides to develop treatment plans.

They are precision tools for mounting teeth during the fabrication of implants, dentures, partials, crowns and any other prosthetics or restorations that ends up in someones mouth. The dentist that uses these basic tools can often have advantages that out weigh all the high-tech stuff that marketers rely on. Lasers and cerec machines are great - but you need to start with an articulator.

Richard Winter, DDS MAGD

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