Adjusting Occlusion After Restoration - Taught by Jose-Luis Ruiz, DDS — Transcript

Full transcript

1. 0:13hello my name is Dr Jose Luis Ree and
2. 0:16I'm the director of the Los Angeles
3. 0:17Institute of clinical dentistry and it
4. 0:20is my pleasure to share with you this
5. 0:22Dentistry today technique of the week
6. 0:24video and the subject couldn't be any
7. 0:27more important oclusal adjust ment of a
8. 0:30single tooth after a restorative
9. 0:33procedure there is no question about the
10. 0:36fact that if we miss the occlusal
11. 0:39adjustment we will without a doubt have
12. 0:43bad consequences one of them is poop
13. 0:46sensitivity a lot of our patients they
14. 0:49they have a filling or or a crown and we
15. 0:52think that maybe it was the bonding
16. 0:54system of the cement is in fact just a
17. 0:56simple lateral interference and they
18. 0:59could be what sensitivity for a long
19. 1:01time and of course we know that that
20. 1:03that's not good for our practice and for
21. 1:04our you know for our good relationship
22. 1:06with our
23. 1:07patients also if we don't adjust
24. 1:10correctly our onlay or our crown or
25. 1:12filling we could end up with a fracture
26. 1:15and that's also very bad and and of
27. 1:17course we know that the number one
28. 1:18reason why the teeth will fracture or
29. 1:20the filling will fracture the
30. 1:22restoration will fracture is the bite if
31. 1:25the patient didn't bite it wouldn't
32. 1:27break if the patient didn't grind or
33. 1:29didn't have parun function our
34. 1:30restoration wouldn't break so it's key
35. 1:32to success to make sure that we adjust
36. 1:35it correctly and by the way let's not
37. 1:37assume that because we're using sironia
38. 1:40or gold uh we don't have to worry as
39. 1:43much about proper oclusal adjustment
40. 1:46this is an excellent example on your
41. 1:48screen you can see a dentist who had two
42. 1:51gold onlays done by the head of Prost of
43. 1:53the local school and uh she had
44. 1:56sensitivity for a year and a half and it
45. 1:59got to the the point where where she had
46. 2:01already been referred for root canal on
47. 2:03the tooth and in fact when she came for
48. 2:05a second console we discovered that it
49. 2:08was just a lateral interference and it
50. 2:11didn't take me more than a few seconds
51. 2:13to adjust it and using the technique
52. 2:16that I will share with you next we were
53. 2:18able to get her completely out of pain
54. 2:20so this couldn't be any more important
55. 2:23now we're going to talk about the step
56. 2:26by step of the accusal adjustment the
57. 2:28first let's remember the patient is
58. 2:30already in a Supine position and a
59. 2:33properly trained dental assistant is
60. 2:35going to immediately give us cut and
61. 2:36roll so we can start isolating that
62. 2:38tooth isolation is very important
63. 2:41because we use thin articulating papers
64. 2:44art artifa from bow ACU film to from
65. 2:47parel and they require a dry environment
66. 2:51if we use those wax articulating papers
67. 2:54they're very
68. 2:55inaccurate the first step is going to be
69. 2:57to check for Centric contacts with a
70. 2:59blue articulating paper and the
71. 3:02instruction to the patient is going to
72. 3:03be tap your teeth together like this tap
73. 3:06to I want to make sure that that I show
74. 3:09them with my hand so they understand
75. 3:11what I'm talking about top top never say
76. 3:14bite because if they bite sometimes it
77. 3:17will activate the masss and they can
78. 3:21very easily break a high filling a high
79. 3:24composite a high piece of porcelain we
80. 3:26should see equal contacts on all the
81. 3:28teeth we should see that uh the contacts
82. 3:31are on the working CA on the central
83. 3:33Groove after that's done then we will
84. 3:35check for lateral interferences and we
85. 3:37will use a different color paper because
86. 3:40we know that the mandible moves in the
87. 3:42direction of the food when people is
88. 3:44chewing so we will ask the patient the
89. 3:47instruction to the patient is going to
90. 3:49be bite and grind your teeth I again I
91. 3:53show them with my hands and I show them
92. 3:55how I want them to grind their teeth and
93. 3:56I tell them right like you're biting a
94. 3:58piece of jerky and exaggerate your
95. 4:00grinding sideways forward if there's any
96. 4:04red outside of blue it's a it's an
97. 4:06excursive interference a lateral
98. 4:08interference is working not working it
99. 4:11doesn't matter has to be removed any red
100. 4:14outside of blue has to be remove so when
101. 4:16we're done with this adjustment we
102. 4:19should see blue and red right on top of
103. 4:21each other and it has to be with two
104. 4:23color papers if we only use one color
105. 4:25paper is not going to be possible the
106. 4:28last step is SE the patient straight up
107. 4:30and down and do this one last time very
108. 4:33quickly just to make sure that there's
109. 4:35not a slight difference because of a
110. 4:37postural difference and after that we'll
111. 4:40be done now this technique can be also
112. 4:43used for patients that have severe
113. 4:45sensitivity or even pain on a tooth like
114. 4:48the case that you see on your screen
115. 4:50this patient has severe sensitivity and
116. 4:52she had already been treatment planned
117. 4:53for a root kill at another office and
118. 4:55after I checked for oclusal trauma I
119. 4:57immediately discovered that she had a
120. 4:59lad interference and that pain went away
121. 5:02immediately occlusive disease is rampant
122. 5:05and our patients are destroying their
123. 5:06teeth where they with their occlusion as
124. 5:09you can see in this slide uh the patient
125. 5:11to your left has healthy occlusion and
126. 5:14the patient to the right has oclusal
127. 5:16disease and you can see the severe
128. 5:18destruction and the incredible thing is
129. 5:21both patients are the same age so it is
130. 5:25important that we diagnose predictably
131. 5:28consistently our patients have oclusal
132. 5:30disease and not wait until there's so
133. 5:32much destruction using the technique of
134. 5:35the seven signs and symptoms of oclusal
135. 5:37disease is is very valuable and there's
136. 5:40a lot of information out there uh
137. 5:42articles videos that I have published uh
138. 5:45and it's important to to treat our
139. 5:47patients and diagnose our patients uh
140. 5:51educating our patients is key to success
141. 5:53and for that reason I would like to
142. 5:54share with you a wonderful free video
143. 5:57that Los Angeles Institute had the
144. 5:59develop to educate patients and this
145. 6:02video will allow you to show them to
146. 6:04your patients and they will uh
147. 6:06understand osal disease and understand
148. 6:09why they should have some treatment
149. 6:11starting from a night guard and going up
150. 6:13to oclusal equilibration or or
151. 6:16rehabilitations uh this is a valuable
152. 6:18tool it's been my pleasure to share this
153. 6:21information with you and I hope you have
154. 6:23a good
155. 6:28day