Occlusal Equilibration

Extracts from:The major part of dentistry you may be neglecting”  Gordon J. Christensen, D.D.S., M.S.D., Ph.D.
JADA, Vol. 136 April2005 
  • Occlusal equilibration as a part of treatment for bruxism or clenching.A significant percentage of patients seeking dental care experience bruxism or clenching.2 Although removal of occlusal prematurities is controversial, most practitioners agree that the procedure reduces patients’ tendency to aggressively continue their destructive habit. At the least, worn-in chewing patterns can be disrupted by occlusal equilibration, thus potentially reducing the possibility that further atypical wear patterns will continue to be accentuated. (…) 
  • Occlusal equilibration as a part of temporomandibular dysfunction.The most frequently used procedures for treatment of temporomandibular dysfunction (TMD) are occlusal splints and occlusal equilibration.3 The frustrating aspect of this statement is that many practitioners will not treat simple muscular TMD, and they do not accomplish occlusal equilibration in their practices. I suggest that dentists become competent in simple occlusal equilibration and that they treat simple cases of muscular TMD. 
  • Occlusal equilibration as a part of periodontal therapy. This subject is genuinely controversial. The opinion commonly expressed by many periodontists and general dentists treating periodontal disease is that there is not a relationship between occlusion and periodontal breakdown. This belief is written as a near-axiom is dental texts. A further challenge in that most general dentists do not treat periodontal disease or have much interest in it.4This problem has been verified strongly by my experience when I ask large groups of practitioners about their involvement with periodontics. 
At the risk of having to respond to the critiques of some readers, I will express my clinical observations on the relationship of occlusal trauma to periodontal conditions. I have formed these opinions after placing thousands of units of crowns, fixed prostheses and removable partial dentures. If I inadvertently leave occlusal prematurities on restorations, it is just a matter of time until I see periodontal manifestations of the occlusal trauma. The most common sign will be widened periodontal ligament space, and the most frequently occurring symptoms will be pain in the affected tooth or teeth and eventual pulpal death if the occlusal trauma is allowed to continue. If the prematurities have existed for months or years, the bone support will be reduced, as observed on radiographs. 
In a recent in-depth discussion with Dr. Alfred Seltman, a practicing periodontist for many years, I was interested to see radiographic images from many cases he has treated over several decades in which the original periodontal bony support of teeth was nearly terminal at the origin of treatment. By frequent minimal occlusal equilibration for these patients, not only was the original bone level preserved but, astonishingly, the bone increased over the years, the teeth became less mobile, and tooth extraction was avoided. Such statements as the preceding ones are contrary to popular belief in the profession. 
Because of the controversy, I encourage additional long-term investigations on the relationship of occlusion to periodontal health. In the meantime, I will continue to consider occlusal equilibration to be a significant factor in preserving and improving periodontal health and bone support. 
Observation of occlusion, providing patient education about occlusion and treatment of occlusal conditions sadly are neglected in the profession. Occlusal equilibration is one of the major treatments for occlusally oriented diseases, and I estimate that this procedure is not accomplished frequently by many practitioners. I have discussed the conditions needing occlusal equilibration and suggested procedures for the conditions. I encourage practitioners needing education in occlusion to seek it.

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