Occlusal harmony: the final frontier in orthodontic excellence (Part 2)

Dr. Gregori M. Kurtzman offers ways to preserve orthodontic outcomes

Occlusion plays a pivotal role in determining the long-term success of orthodontic treatment. Unfortunately, the importance of occlusal refinement post-orthodontics is often overlooked. This article delves into the intricacies of occlusal adjustment, emphasizing its significance in preserving orthodontic outcomes.

The impact of occlusal forces

Optimal tooth function occurs when occlusal forces are directed along the long axis of the tooth (Figure 1). Contacts between posterior cusp tips and fossa optimally align with this axis. Conversely, contacts on inclined planes exert angular forces, potentially displacing teeth buccally or lingually (Figure 2). These orthodontic-like forces can counteract the achievements of orthodontic treatment. Consequently, meticulous occlusal adjustment is crucial for maintaining the desired esthetic and functional results.

Diagnosing occlusal issues

Articulating film is preferred over articulating paper for its thinner profile, which enables more precise identification of contact points. The patient is instructed to bite firmly without grinding, allowing the film to mark the occlusal surfaces. By gently tugging the film, clear contact marks are obtained. Grinding often creates misleading marks, hindering accurate diagnosis.

Occlusal adjustment techniques

The goal of occlusal adjustment is to eliminate contact points on inclined planes, preserving those on proximal marginal ridges which align with the tooth’s long axis. In the anterior maxilla, broad cervical-incisal contacts should be reduced to prevent labial tipping. Ideally, anterior contact points should be centered incisally to the cingulum. For the mandibular anterior, contact on canine cusp tips and incisor edges is optimal (Figures 3 and 4).

To adjust enamel, composite, or amalgam surfaces, a fine grit football diamond (Figure 5) is effective. For zirconia or ceramic restorations, a zirconia-specific diamond (Great White®Z FOOTBALL 368-023F, SS White) is recommended. When modifying buccal or lingual aspects of posterior cusps or anterior teeth, the previously mentioned diamonds and carbides can be used on enamel, composite, or amalgam. For zirconia or ceramic, a taper fine diamond (Great WhiteZ 850-018F, SS White) is suitable.

Polishing and finishing

Following occlusal adjustment and removal of orthodontic or aligner resin, polishing with Jazz® polishers (SS White) on a slow-speed handpiece is essential (Figure 6). These polishers are available in various grits, shapes (points, cups, disks), and as a comprehensive kit (Reliant Orthodontic Finishing Kit, SS White) for efficient treatment (Figure 7). The occlusal adjustment process can be visualized in four steps: marking with articulating film (Figure 8A), adjustment with a carbide or diamond (Figure 8B), polishing with a Jazz polisher (Figure 8C), and final occlusion (Figure 8D).

Conclusion

Occlusal harmony is the cornerstone of long-term orthodontic success. Interproximal recontouring, as discussed in Part 1 (Kurtzman GM. The science of stability: tooth modification and occlusal equilibration in orthodontics: a 2-part series. Orthodontic Practice US. Fall 2024;15(3):14-16), often complements occlusal adjustment. Both procedures require precision and attention to detail to achieve optimal esthetic and functional outcomes. By mastering these techniques, clinicians can elevate their orthodontic treatment to new heights.

Acknowledgement: The author would like to thank Robert Wojciechowski for his assistance with creation of the illustrations in the article.

This article was provided by SS White.