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During this Q and A of the 15 questions posed by the MiCD Global Academy, A dentists outside of this forum group asked me about the following: He stated….
Dear Clayton
Good morning
The more I ask questions and get your reply, I have found that you have similar views / and the approach that I am working in this part of the world. I being a clinician who respects Self Awareness and Natural Harmony, I trust on the component called ” Occlusal Awareness ” and use it in my practice. I focus on COMFORT, rather than the numbers.
I totally agree with you
““Even the size of the digital wafer effects the lips and surrounding musculature as one opens the mouth to accommodate the width of the digital wafer. When the obilcularis oris, buccinators and lip musculature have to accommodate around the digital wafer the mandible will naturally posteriorize, thus altering their occlusal relationship”. I believe biting with lip closing ( no foreign materials in between lips ) and biting with something in between the lip is different.”
As your interview reply is very comprehensive, if possible I would like to request you to elaborated little more on the effect of thickness of wafer of digital occlusal scanners. Because one of the author wrote it has not much effect in finishing of occlusion.
Regards
SXXXX
My Response:
Anytime you put something between the teeth the mandible will react and compensate positionally changing its jaw relationship. Even the size of the digital wafer effects the lips and surrounding musculature as one opens the mouth to accommodate the width of the digital wafer. When the obilcularis oris, buccinators and lip musculature have to accommodate around the digital wafer the mandible will naturally posteriorize, thus altering their occlusal relationship. The digital wafer will accurately record occluding high spots, but is only as accurate as to the compensated position of the mandible with its condyle/disc and surrounding musculature – think six dimensionally. When a sensor is bitten down on, many sensels are excited simultaneously and the combination of their responses produces the final response of the whole sensor. The system ultimately provides an indication of relative force, either the total digital level or the percentage of the total digital level. There are different levels of sensitivity adjustments to adapt its use to different patients. Once again, regardless of how sensitive or accurate the activation of these sensels, it is the clinical assumption that the patient with the unseen spastic hyper muscles that will be “accurately” occluding into the wafer. I don’t believe that occluding on a digitized wafer will actually record the correct and proper 6 dimensional closing contact position of a complete lower arch of teeth since there are posturing muscles and disc conditions that effect that closing position when occluding.
Some patients will habitually occlude more in the second molar regions during closure, while others may occluding in the bicuspid or anterior regions, but none of these closing patterns assures the clinician whether the patient is optimally closing on the isotonic mandibular path (myo-trajectory). If one doesn’t identify or determine the optimal physiologic closing path of the mandible that is free of muscle tension and disc derangement problems in 6 dimensions, the patient will give close into the digital wafer giving a bite force readings that would indicate certain premature contacts are occurring in certain spots or areas of that wafer, but in reality the actually prematurities are occurring in another location when the patient is TENSed to identify the involuntary closing path of the mandible.
As I indicated in my responses, most clinicians do not distinguish between habitual (voluntary) muscle closing paths vs physiologic (involuntary TENS) muscle closing paths…. They are different, thus the premature occluding contacts will show up different than what the digital wafer will identify. What occluding marks will the astute clinician rely on when deciding to adjust the occlusal surface of particular teeth? Does one rely on the “accurate” and precise digital wafer recordings that were driven by tight straining muscles that created that occluding relationship? Or does one learn how TENS produces an involuntary mandibular movement that will identify other occluding prematurities without the torquing, skewing and straining muscle influences.
One’s understanding of how the mandible and muscles close into a terminal contact (occluding) position does matter and effects the finishing of the occlusion. It also effects the end result of how the muscles respond to that occlusal finish.
If one doesn’t measure these muscular, position and occluding contact muscle responses in all dimensions, one will never know and just assume digital wafers are the end all tool to balance occlusion. It is not.
In our office we have T-scans and OccluSense. I am familiar with them and what they do. I don’t use or depend on them to finish my TMD pain patient cases who have had previously seen DTR doctors with T scan adjustments, and all the various occlusal equilibrating methods used on them. T scan and OccluSense are good at one level, but there is another level of awareness of occlusion that I am trying to convey to the profession that goes beyond the obvious.
Clayton A. Chan, D.D.S. – Founder/Director
Telephone: (702) 271-2950
Leader in Gneuromuscular Dentistry