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PubMed1990

Occlusal adjustment.

Occlusal adjustment is a misunderstood and underutilized procedure that is often indicated in the management of occlusion-related disorders. To clarify the confusion extant about occlusal adjustment and to encourage its use, when appropriate, this paper examines optimal, normal and abnormal occlusions, classifies abnormal occlusions according to morphological and functional characteristics and treatment needs, and presents a rationale for occlusal adjustment based on these concepts. Differences between occlusal adjustment, occlusal equilibration and selective grinding are discussed, occlusal interferences are defined and described and the indications and contraindications for occlusal adjustment are presented.

Dental Occlusion↗
PubMed1994

A new approach for accurate pre-planned occlusal adjustment.

Occlusal adjustment is important in prosthodontic pre-treatment procedures and in the management of some cases of craniomandibular disorders. This may involve tooth surface reduction and tooth surface addition with an appropriate restorative material. Occlusal adjustment must be distinguished from occlusal equilibration and selective grinding with clear indications and aims. A systematic pre-clinical and clinical protocol has clear advantages and the use of a thermoplastic vacuum-formed template greatly increases the clinical accuracy of a pre-planned adjustment.

Dental Occlusion, Balanced↗
PubMed1977

Occlusal adjustment for a physiologically balanced occlusion.

An investigation of the neuromuscular effects of dental contact at the physiologic median occlusal position was conducted before and after occlusal adjustments. Eighteen patients with histories of functional disturbances of the masticatory system, but whose painful symptoms had subsided, were analyzed before and after occlusal adjustments. Nine of the patients with missing teeth received fixed partial dentures and occlusal adjustments. Another group of nine subjects with normal occlusions were used as controls. Electromyographic recordings of the bilateral temporal and masseter muscles enabled quantification of two reflex parameters, the EMG silent period duration, and the mechanical latency of the jaw-opening reflex. Phase-plane traces of jaw-closing velocity as a function of position displayed the repeatability of the median occlusal position. The statistical analysis disclosed that the mean duration of EMG silent periods and latency of the jaw-opening reflex were significantly reduced following the treatment procedures. Within the limits of this study it was concluded that the described occlusal adjustments will reduce the masticatory reflexes evoked at median occlusal position to within the range of normal subjects. Furthermore these changes can be monitored by electrophysical methods.

Adolescent↗
PubMed2001

An evidence-based assessment of occlusal adjustment as a treatment for temporomandibular disorders.

STATEMENT OF PROBLEM: Occlusal adjustment therapy has been advocated as a treatment modality for temporomandibular disorders. In contrast to this position, a panel at the 1996 National Institute of Health technology assessment conference on TMD indicated that no clinical trials demonstrate that occlusal adjustment is superior to noninvasive therapies. PURPOSE: This article summarizes the published experimental studies on occlusal adjustments and temporomandibular disorders. MATERIAL AND METHODS: Eleven research experiments involving 413 subjects with either bruxism (n = 59), temporomandibular disorders (n = 219), headaches and temporomandibular disorders (n = 91), or chronic cervical pain (n = 40) were selected for critical review from the English dental literature. RESULTS: Three experiments evaluated the relationship between occlusal adjustment and bruxism. Six experiments evaluated occlusal adjustment therapy as a treatment for patients with primary temporomandibular disorders. One experiment looked at occlusal adjustment effect on headache/temporomandibular disorder symptoms; another looked at its effect on chronic neck pain. Most of these experiments used a mock adjustment or a comparison treatment as the control condition in adults who had an existing nonacute general temporomandibular disorder. Overall, the data from these experiments did not demonstrate elevated therapeutic efficacy for occlusal adjustment over the control or the contrasting therapy. CONCLUSION: The experimental evidence reviewed was neither convincing nor powerful enough to support the performance of occlusal therapy as a general method for treating a nonacute temporomandibular disorder, bruxism, or headache.

Adult↗
PubMed2004

Occlusal pressure pattern analysis of complete dentures for evaluation of occlusal adjustment.

The purpose of this study was to investigate occlusal pressure patterns of complete denture wearers to evaluate progress of occlusal adjustment of dentures. Thirty three edentulous subjects volunteered to participate in this study. A computer-based device was used to measure occlusal pressure sequence while tapping with their new dentures. The following variables obtained from each occlusal pressure pattern were assessed: Peak Time; Duration from the onset of pressure to the maximum pressure, Unloading Time; Duration from the maximum pressure to the end of pressure, Contacting Duration; Duration from the onset of pressure to the end of pressure, Tapping Cycle; Duration from the onset of pressure to the next onset, Peak Ratio; ratio of Peak Time to Unloading Time. Recordings were performed after the occlusal adjustment at each appointment and continued until denture adjustments were completed. Variables were analyzed using ANOVA and Bonferroni. A significant decrease was seen in Peak Ratio as the occlusal adjustments progressed (p<0.05). Its coefficient of variation was constantly the lowest among variables. The coefficient of variation of Peak Ratio was significantly lower than others at the completion of the adjustment (p<0.05). It was suggested that Peak Ratio was useful for evaluation of occlusal adjustment.

Aged↗
PubMed2003

Occlusal adjustment for treating and preventing temporomandibular joint disorders.

BACKGROUND: There has been a long history of using occlusal adjustment in the management of temporomandibular disorders (TMD). It is not clear if occlusal adjustment is effective in treating TMD. OBJECTIVES: To assess the effectiveness of occlusal adjustment for treating TMD in adults and preventing TMD. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (April 2002); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2002); MEDLINE (1966 to 8th April 2002); EMBASE (1980 to 8th April 2002) and handsearched journals of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from review articles of treating TMD. There were no language restrictions. Unpublished reports or abstracts were considered from the SIGLE database. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials (RCTs) comparing occlusal adjustment to placebo, reassurance or no treatment in adults with TMD. The outcomes were global measures of symptoms, pain, headache and limitation of movement. DATA COLLECTION AND ANALYSIS: Data were independently extracted, in duplicate, by two reviewers, Holy Koh (HK) and Peter G Robinson (PR). Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Oral Health Group's statistical guidelines were followed and relative risk values calculated using random effects models where significant heterogeneity was detected (P<0.1). MAIN RESULTS: Over 660 trials were identified by the initial search. Six of these trials, which reported results from a total of 392 patients, were suitable for inclusion in the review. From the data provided in the published reports, symptom-based outcomes were extracted from trials on treatment. Data on incidence of symptoms were extracted from trials on prevention. Neither showed any difference between occlusal adjustment and control group. REVIEWER'S CONCLUSIONS: There is an absence of evidence, from RCTs, that occlusal adjustment treats or prevents TMD. Occlusal adjustment cannot be recommended for the management or prevention of TMD. Future trials should use standardised diagnostic criteria and outcome measures when evaluating TMD.

Adult↗
PubMed1976

Occlusal adjustment by grinding of teeth; indications and techniques.

Occlusal adjustment by grinding of teeth is a therapy that all dentist can master, provided they base it on a knowledge of what constitutes an acceptable occlusion. There is hardly use for intricate or difficult rules and prescriptions for occlusal adjustment. After having diagnosed the occlusal condition in the patient, the dentist has to decide how to attain the goal : an acceptable occlusion without interferences, that is tooth substance that is in the way of harmonious function. Very often simple grinding of teeth can improve the occlusion of our patients. And in combination with other corrective measures, e.g. prosthetic rehabilitation and orthodontic treatment, occlusal adjustment by grinding deserves to be used much more frequently in clinical dentistry than it is today. It is a cheap and simple procedure that can improve our patient's occlusal hygiene. And occlusal hygiene is a concept that now should be incorporated in odontology as oral hygiene seems to have been universally accepted. And we dentists are even more responsible for increasing the quality of occlusion in our patients than we are for the standard of their oral hygiene.

Dental Occlusion, Balanced↗
PubMed1994

Occlusal adjustment: principles and practice.

Occlusal adjustment is an invasive and irreversible therapy. It is not a prophylactic procedure to be undertaken lightly. The occlusal surfaces of teeth are selectively reshaped so that the dentition will achieve the criteria of an optimum and mutually protected occlusion, at least in a Class I occlusion. The procedure, promoted some 50 years ago and modified slightly over the years, is rational and practical. However, because of the dynamic nature of the masticatory system, occlusal stability is seldom permanent and should be reviewed.

Clinical Protocols↗
PubMed1979

Tooth contacts and stability before and after occlusal adjustment.

A study was undertaken to analyze the possible relationship between the number and type of tooth contacts before, immediately after and 16 weeks after occlusal adjustment and their influence upon occlusal stability. The data collected from 10 adult subjects who required an occlusal adjustment indicated the following: 1. Six of the ten subjects had no clinically perceptible "slide from centric relation" 6 weeks after occlusal adjustment, and the number of teeth and number of contacts were virtually the same immediately after 6 weeks after occlusal adjustment. 2. The remaining four subjects, whose occlusions had relapsed after adjustment, had one dental arch that included a missing tooth. It would seem that dental arches interrupted with extraction spaces do not remain stable with occlusal adjustment alone. 3. The type of tooth contacts that are the most stable are those of a cup against a flat plane (e.g., bottom of a fossa or marginal ridge) or those of a combination of a cup against a flat plane and one or more inclined planes.

Adult↗
PubMed1997

The role of occlusal adjustment in the management of temporomandibular disorders.

The use of occlusal adjustment as a treatment for temporomandibular disorders has been questioned because of lack of evidence that occlusal factors play an etiologic role; lack of evidence that this irreversible treatment modality has sufficient efficacy, when reversible modalities are available; the self-limiting character of the disorders; and the possibility of adverse effects. However, controlled clinical trials have yielded results that are difficult to explain unless occlusal factors have a causal role in temporomandibular disorders. Controlled clinical trials also suggest an effect for occlusal adjustment on chronic headaches and on chronic neck and shoulder pain in comparison with conventional treatments. Moreover, no adverse effects of properly conducted occlusal adjustments have been reported. In view of the possibility that occlusal factors have a causal role in temporomandibular disorders, research efforts on the role of occlusion should be intensified, and teaching should be revised accordingly.

Dental Occlusion, Traumatic↗
PubMed1999

Occlusal refinement of mounted casts before crown fabrication to decrease clinical time required to adjust occlusion.

STATEMENT OF PROBLEM: An inordinate amount of time is often required to adjust the occlusion of a newly fabricated crown. PURPOSE: This study determined whether the procedure of "cast adjustment" significantly decreases the time necessary to clinically adjust the occlusion of a newly fabricated crown. MATERIAL AND METHODS: Thirty-eight crowns were fabricated by a commercial dental laboratory for patients of senior dental students at the University of the Pacific School of Dentistry. After master casts were returned from the laboratory and then mounted on semiadjustable articulators by the students, the cases were divided randomly into 2 groups: (1) the control group, for which no further work was performed before fabrication of the restoration; and (2) the experimental group, in which casts were occlusally adjusted by a certified laboratory technician until there was at least 1 cusp tip to flat surface centric contact on each posterior tooth in maximum intercuspation position. After the crowns were delivered, the students filled out a survey. One question on the survey asked the student for the time required to adjust the occlusion on the crown. RESULTS: Of the 19 crowns in the control group, 6 crowns required more than 1 hour for occlusal adjustment. Of the 19 crowns in the experimental group, 1 crown required more than 1 hour for occlusal adjustment. CONCLUSION: Performing a "cast adjustment" before fabricating a single unit casting can significantly decrease the chance of a lengthy clinical occlusal adjustment.

Centric Relation↗
PubMed1987

Response to occlusal treatment in headache patients previously treated by mock occlusal adjustment.

Headache patients who had received mock occlusal adjustment and who, after the placebo treatment, were judged to have moderate to severe mandibular dysfunction were offered further treatment. The present study reports the results of occlusal treatment in 19 patients who were willing to undergo further treatment. Statistically significant reduction after occlusal treatment (occlusal adjustment, aided in some cases by temporary use of occlusal splints) was observed in clinical signs (P less than 0.05) and subjective symptoms (P less than 0.01) of mandibular dysfunction and in the frequency of headache (P less than 0.05). The results are complementary to our earlier clinical studies and corroborate the conclusion that improvements after occlusal treatment exceed those after placebo treatment.

Dental Occlusion, Balanced↗
PubMed1979

Short term evaluation of counselling and occlusal adjustment in patients with mandibular dysfunction involving the temporomandibular joint.

The effect of counselling and occlusal adjustment was investigated in thirty patients with mandibular dysfunction involving the temporomandibular joint (TMJ). The patients were examined at three visits 6 weeks apart. At the first visit all patients received counselling. At the second visit they were divided into two groups, one receiving occlusal adjustment and the other not receiving treatment. The degree of mandibular dysfunction was assessed by the patients according to a five grade scale and by the clinical dysfunction index according to Helkimo (1974a). The score of subjective dysfunction was reduced significantly during the period following counselling and 60% of the patients improved. No effect was found on the clinical dysfunction score. The score of clinical dysfunction was reduced significantly during the period following occlusal adjustment and 67% of the patients improved. No further effect could be detected on the subjective dysfunction score. The correlation between changes in subjective and clinical dysfunction was poor, but changes in the subjective score were generally associated with changes in the clinical score. It was concluded that counselling may reduce the subjective symptoms; and occlusal adjustment the clinical signs of mandibular dysfunction involving the TMJ, but that the individual variation in response is substantial.

Adolescent↗