Occlusion in Restorative Dentistry – Off the Cusp

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Do Your Patients Know?

Malocclusion can be caused by a high restoration, but it also can be caused by untreated decay or gaps left by missing teeth.

Did You Know?

Successful occlusal adjustment may require collaboration with experts in other dental disciplines including – but not necessarily limited to – periodontists, TMJ specialists, oral surgeons, and orthodontists.

Potential Complications of Malocclusion:

Tooth damage, loss of intra-alveolar bone tissue, and neuromuscular damage.

10 Minutes? Or 2 Years?

Correcting a malocclusion could be as simple as a 10-minute adjustment appointment, or it could require orthodontics, surgery, and restorative treatment plans that span 2 years or more.


The prevalence of malocclusion in America, according to one recent study.

Key Differences Between Using Electric and Air-Driven High-Speed Handpieces

·       Slower, 200,000 rpm

·       Stronger torque with consistent cutting power

·       Lower noise levels; often preferred by patients for this reason

·       Heavier and more fatiguing

·       Some newer models can be sterilized

·       Easier to learn and master since the handpiece stops spinning as soon as the activation pedal is released

·       Provides a more reliable and smooth cutting experience • May be too large for some very small mouths

·       Faster, 250,000–420,000 rpm

·       Cutting strength can weaken and slow speed when met with resistance

·       Louder than electric, but newer models are quieter

·       Lighter and more ergonomic

·       More likely to be autoclavable

·       Can take time for new clinicians to get used to the way air driven handpieces come to a gradual stop

·       Can skip or judder when cutting into certain materials

·       Smaller size makes them ideal for small mouths


Occlusal Adjustment vs. Wearing In

Tempted to tell patients that the filling that feels too high right now will wear down with time? This is more true for amalgam restorations that continue to harden over the course of hours after placement. Composite restorations, on the other hand, are as hard as they will ever be from the moment they are cured. If a composite filling is too high, it will take many years for the excess to wear down, doing damage to the occlusion in the meantime.

Did You Know?

Restorations can still end up being too high even after you’ve checked them because the patient’s jaw muscles have fatigued after they had to hold their mouth open for the restorative procedure, making it difficult to determine the actual position of their natural occlusion.

Details Matter

The finishing and polishing stage is an important part of preserving occlusion in restorative dental procedures. A filling must be polished to a smooth finish to avoid collecting plaque bacteria that can then move into the surrounding tooth tissue, weakening the restoration.

Minimize the Need for Occlusal Adjustments!

Save time and spare your patients the extra visit.

  • Take note of the patient’s occlusion prior to beginning the restorative treatment.
  • Use restorative materials and working techniques that improve tooth isolation and working field visibility and that reduce the possibility of saliva contamination to ensure the restoration comes out well on the first try.
  • Make sure your patient is seated upright and has had ample opportunity to relax and stretch their jaw back into its normal position.
  • Use multiple assessment tools to check occlusion after placing a restoration.


It is very common for dentists to have to adjust restorations they place, so there is no shame in doing so. Help your patients set realistic expectations about their treatment outcomes, explain the benefits of adjusting their occlusion, and be prepared with the tools you need to work quickly when making adjustments.

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Patterson Dental

At Patterson Dental, we are committed to partnering with dental practices of all sizes to help oral health professionals practice extraordinary dentistry. We do this by living up to our promise of Trusted Expertise, Unrivaled Support every day.

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