There is too often a lack of awareness and understanding of the need for occlusal therapy and it is subsequently neglected in diagnosis and treatment planning. The operator must be able to make the distinction between a physiological and a pathological occlusion. Basically stated, a physiological occlusion is one that is compatible with health and a pathological occlusion is one that is not compatible with health. Signs and symptoms of a pathological occlusion may include fremitus, mobility, flaring, drifting or tilting of teeth, radiographic evidence of widened periodontal ligament space, myofacial pain and clicking or popping sounds or crepitus in the temporomandibular joint. The presence of one or more of the above is not, however, a definite indication of existing pathological condition. For example, not all tilted teeth are associated with pathosis.
When occlusal pathology is identified it needs to be addressed. As the occlusion collapses, occlusal trauma increases. The initial approach to treating a pathological occlusion is controlling the occlusal trauma. This may include occlusal adjustment, temporary stabilization (splinting of teeth); bite plane therapy and tooth movements to align occlusal landmarks correctly. Much of this should be considered part of initial therapy.
There has been much speculation as to the origins and effects of occlusal trauma. Today it is widely recognized that occlusal trauma alone does not lead to the loss of periodontal attachment. Superimposed on an existing inflammatory condition in the attachment apparatus, however, an accelerated loss of attachment loss will occur as opposed to that caused by the inflammation alone.
Two types of occlusal trauma are recognized. Primary occlusal trauma is when larger than normal forces are applied to a tooth with adequate periodontal support (e.g., bruxing, clenching; orthodontic forces, high dental restorations). Secondary occlusal trauma is when the periodontal support is reduced to such an extent that even normal forces are not well tolerated.
This is the judicious grinding of certain aspects of the occlusal table, the aim of which is to create correct cusp fossa relationships in both centric and excentric positions.
The first step is to achieve the desired jaw to jaw relationship in the retracted centric relation posterior. Cusp slopes are then judiciously adjusted, eliminating interferences to maximum intercuspation at this jaw to jaw relationship. Supporting cusp tips and fossae are not ground as this would lead to a loss of vertical dimension. Then, interferences to smooth excursive movements from this position are eliminated. Balancing interferences are modified first followed by interferences in working and protrusion It must be stressed that not all cases require occlusal therapy or occlusal adjustment and that this mode of therapy should only be embarked on when knowledgeable professional opinion deems it necessary.
This is achieved by splinting one or more mobile teeth to one another and to other more stable teeth in a position that facilitates a more axial and even distribution of occlusal forces. This is generally performed on teeth with reduced periodontal support. The rationale for this is improved patient comfort, function and plaque control, better distribution of occlusal forces and improved tooth stability during clinical procedures.
A variety of means may be utilized to achieve temporary stabilization. What ever means are used, special attention should be paid to making the splint amenable to oral hygiene procedures and instructing the patient on plaque control around the splint.