CAD/CAM Magazine

I case report _ occlusal force management puter-guided occlusal analysis affords the opera- tor precision, occlusal force isolation and pre- dictablecontrolofrestorativeocclusalerror,which aids in prolonging the longevity of the all-ceramic restorations. _Conclusion For MICD, computer-guided occlusal analysis systems offer data on quantifiable pressure, force and contact time sequence that can be employed toguidetheocclusaladjustmentoftherestoration to precise measurable endpoints.2, 3 These end- points establish uniform force distribution, bi- lateral simultaneity and measurable immediate disclusion, and minimise the damaging effect of concentrated, excessive, isolated occlusal force. Avoidingpotentiallydestructiveintra-oraluse,the overall prosthetic occlusal scheme preserves the ceramic materials utilised in the procedure, ensur- ing long-term survival. Lastly, occlusal adjustments that are guided by T-Scan III technology represent the essence of MICDbecauseacliniciantreatsonlywhatneedsto be treated and does not perform random subjec- tiveocclusaladjustmentbasedonmerejudgement of paper markings with the naked eye. Measured occlusal force and timing data direct the MI clini- cian to adjust only the locations of excessive force, while leaving the areas of measured low occlusal force untouched. Cosmetic restorations and tooth structure are therefore preserved and overtreat- ment is minimised. The clinical implementation of this technology mirrors the core message of the “Do No Harm” philosophy._ _References 1. Yamaga R, Nishino M, Yoshida S, Yokomizo I. Di- ammine silver fluoride and its clinical application. J Osaka Univ Dent Sch 1972;12:1–20. 2. Houpt M, Fukus A, Eidelman E. The preventive resin (composite resin/sealant) restoration: nine-year re- sults. Quintessence Int 1994;25(3):155–9. 3. Smales RJ. Yip HK. The atraumatic restorative treat- ment (ART) approach for the management of dental caries. Quintessence Int 2002;33(6):427–32. 4. Munshi AK, Hegde AM, Shetty PK. Clinical evaluation of Carisolv in the chemico-mechanical removal of carious dentin. J Clin Pediatric Dent 2001;26:49–54. 5. World Dental Federation. Minimal Intervention in the managementofdentalcaries.FDIpolicystatement2002. 6. Koirala S. Minimally invasive cosmetic dentistry— Concept and treatment protocol. Cosmetic Dentistry 2009(4):28–33. 7. Carey JP, Craig M, Kerstein RB, Radke J. Determining a relationship between applied occlusal load and articulation paper mark area. The Open Dentistry Journal 2007;1:1–7. 8. Saad MN, Weiner G, Ehrenberg D, Weiner S. Effects of load and indicator type upon occlusal contact mark- ings. J Biomed Mater Res B Appl Biomater 2008; 85(1):18–22. 9. Millstein P, Maya A. An evaluation of occlusal con- tact marking indicators. A descriptive quantitative method. J Am Dent Assoc 2001;132(9):1280–6. 10. Glickman I. Clinical Periodontics. Saunders and Co 1979(5):951. 11. ReiberT,FuhrK,HartmannH,LeicherD.Recordingpat- tern of occlusal indicators. I. Influence of indicator thickness, pressure, and surface morphology. Dtsch Zahnarztl Z 1989;44(2):90–3. 12. Dawson, PE. Functional occlusion: from TMJ to smile design. Mosby, Inc 2007(1):347. 13. McNeil, C. Science and practice of occlusion. Quint- essence Publishing 1997:421. 14. Okeson J. Management of temporomandibular disor- ders and occlusion. CV Mosby and Co 2003(5):416, 418, 605. 15. KleinbergI.Occlusionpracticeandassessment.Knight Publishing 1991:128. 16. Smukler, H. Equilibration in the natural and restored dentition. Quintessence Publishing 1991:110. 17. Maness WL. Force movie. A time and force view of oc- clusion. Compend Contin Educ Dent 1989(10):404–8. 18. Kerstein RB, Grundset K. Obtaining measurable bilat- eral simultaneous occlusal contacts with computer- analyzed and guided occlusal adjustments. Quin Int 2001;32(1):7–18. 19. KersteinRB.Tekscan-ComputerizedOcclusalAnalysis. In: Maciel RN. Bruxismo. Editora Artes Medicas Ltda. Sao Paolo, Brazil 2010. 20. Kerstein RB. Reducing chronic massetter and tempo- ralis muscular hyperactivity with computer-guided occlusal adjustments. Compendium of Contin Educ Dent 2010;31(7):530–43. 21. KersteinRB.Combiningtechnologies:Acomputerized occlusal analysis system synchronized with a com- puterized electromyography system. Cranio 2004; 22(2):96–109. 22. Kerstein RB, Chapman R, Klein M. A comparison of ICAGD(immediatecompleteanteriorguidancedevel- opment) to mock ICAGD for symptom reductions in chronic myofascial pain dysfunction patients. Cranio, 1997;15(1):21–37. CAD/CAM 2_201112 I Dr Robert Kerstein works in private practice in Boston, Massachusetts.He was Assistant Clinical Professor at the Department of Restorative Dentistry,Tufts University School of Dental Medicine from 1983 to 1998. CAD/CAM_about the author