Clinical Application of a Digital Occlusal Analyzer in Occlusal Equilibration: A case report

MiCD

Vol. 1, No. 2 / Jul. - Dec. 2021

ISSN 2091-1483 eISSN 2091-1491

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Clinical Journal

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M CD 2021 2

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MiCD ISSN 2091-1483 eISSN 2091-1491

Vol. 1, No. 2 / Jul - Dec. 2021

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Clinical Journal

A Peer-Reviewed Journal of Minimally Invasive Comprehensive Dentistry

Editor-in-chief Dr. Sushil Koirala, Nepal Editorial Board Dr. Adrian Yap, Singapore Dr. Akira Senda, Japan Dr. Dinos Kountouras, Greece Dr. Jose Roberto S Moura Jr, Brazil Dr. Kazuyo Yamamoto, Japan Dr. Mabi L Singh, USA Dr. Mostaque H Sattar, Bangladesh Dr. Peter Tay, Singapore Dr. R Luxhmen Wijeyeweera, Sri Lanka Dr. Robert B Kerstein, USA Dr. Robert H Dharma, Indonesia Dr. Robert Supple, USA Dr. Ryuichi Kondo, Japan Dr. Samsul M Alam, Bangladesh Dr. Sonny H Burias, Philippines Dr. T C Phua, Singapore Dr. V Vijayakumaran, Sri Lanka

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MiCD Clinical Journal is a peer – reviewed online international journal published by Vedic Smile Academy (VSA) which appears two times a year. The special issues of the magazine sponsored by the related professional associations; may be available in printed version as well. The online access to the magazine is free of charge to all dental professionals, dental organizations, dental colleges, dental laboratories and dental suppliers. The journal, articles and illustrations therein are protected by copyright. Any utilization without prior consent of the publisher is inadmissible and liable to legal action. This applies to duplication of copies, microfilms, translation and procession in electronic systems. The views and opinions expressed in the articles appearing in the publication are those of the author(s) or advertiser(s) and do not necessarily reflect the views or opinions of the publisher or the editorial board. Any product, clinical technique, diagram or material appeared in this issue should not be taken as an endorsement of the publication.

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• Dental Occlusion & Force Finishing

case report

Clinical Application of a Digital Occlusal Analyzer in Occlusal Equilibration: A case report Dr. Minn Htet Aung, Dr. Myat Nyan, Myanmar

INTRODUCTION The normal masticatory function includes the characteristics in which there is no cuspal interference on the closing and gliding movements.

Occlusal load must be evenly distributed on both sides of the mandible during the intercuspal position and must comprise of a reasonable number of teeth contact in the retruded contact position. During mastication, the presence of premature contacts and cuspal interferences cannot be diagnosed easily because it may be reflexly avoided. These abnormal occlusal contacts cause strain to the neuromuscular system during each closing movement of the mandible. This may lead to severe occlusal disharmonies resulting in impaired masticatory function.1-3

Premature contacts and occlusal interferences can be corrected by occlusal equilibration attained by selective tooth contouring. This method aims to improve the masticatory function by creating a stable occlusal contact, even distribution of load and axial stress on the teeth by eliminating the premature contacts and cuspal interferences. To best perform the selective tooth contouring, the patient’s mandibular position must be recorded in centric relation (CR) position and transfer this position to an articulator for diagnostic purposes.4 Functional analysis and treatment planning are very important before starting the grinding in order to exactly localize the premature contacts and occlusal interferences. The various materials and methods used to detect the occlusal contact points

Fig. 1 OccluSense® with the handheld occlusal device and ipad

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Aung MH, Nyan M: Clinical Application of a Digital Occlusal Analyzer in Occlusal Equilibration: A case report

being: alginate impression material, mylar paper strip, Polyether rubber impression bites, silicone putty, typewriter ribbon, transparent acetate sheet, wax, wax articulation paper, silk strip, foil, black silicone, high spot indicator, occlusal spray, photo occlusion, occlusal sonography, pressure sensitive film and digital analyzers such as T-scan and OccluSense®.5

static and dynamic occlusion can be treated with the aid of the diagnostic data presented by the device.6 The aim of this case report is to illustrate the clinical applicability of the digital occlusal analyzer as an aid to traditional articulating paper in occlusal equilibration.

Articulating paper has been used to mark the occlusal contacts for both diagnostic and clinical purposes as a long-standing method. It is to be noted that the thickness and ink quality of articulating paper plays a key role in determining the occlusal harmony, because it relies on the subjective interpretation of the clinician based on the shape and color of the ink marks left on the tooth surfaces, and with the patient’s “feel or comfort” perception. If massive occlusal alteration without a proper diagnosis and treatment planning is made, it might be harmful to the patient.2

A 50 years old male patient with the chief complaint of discomfort in chewing and swallowing and fatigue jaw muscles for years presented to the Department of Prosthodontics, University of Dental Medicine, Mandalay, Myanmar. Clinical examination revealed deviation of the mandible to the right side on opening and limitation of maximum opening. On intraoral examination, there were marked attrition facets, especially on the anterior teeth having edge-to-edge relation. There were no periodontal problems. Premature contacts were discovered on 2nd molars on the left side of the dental arch during occlusal analysis using the OccluSense® (Fig.2a). These premature contacts were also seen during the articulator analysis using the OccluSense® (Fig.2b). The provisional diagnosis made was occlusal disharmony due to premature contacts in the working side and balancing side contact during unilateral chewing. Impression was taken for both jaws and diagnostic casts were poured with dental stone. Facebow registration was made and centric jaw relation was recorded using the bite registration silicone. Diagnostic casts were mounted on semi adjustable articulator with facebow transfer. Treatment planning was made to grind the occlusal surfaces of tooth numbers 37

With the advance in technology, digital occlusal analyzers were developed since the 1980s. The OccluSense® system is an advanced technology that identifies the occlusal contacts and analyzes the occlusal force with a thin, flexible, thin, self-ink coated digital pressure sensor. Occlusal contacts and forces are recorded with a handheld device and the obtained data is sent wirelessly to iPadApp (Fig.1) which allows the users to read the graphic information of occlusal contacts in color and occlusal forces in percentage. The device can record premature or missed occlusal contacts accurately. Furthermore, occlusal problems during

Fig. 2a

CASE PRESENTATION

Fig. 2b

Fig. 2a Graphic presentation of initial occlusal contact points and forces during baseline intraoral examination.

Fig. 2b Graphic presentation of occlusal contact points and forces during baseline articulator analysis using the OccluSense® .

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Aung MH, Nyan M: Clinical Application of a Digital Occlusal Analyzer in Occlusal Equilibration: A case report

Fig. 3a

Fig. 3b

Fig. 4a

Fig. 4b

Fig. 5a

Fig. 5b

Fig. 3a Upper cast occlusal contact points during articulator analysis. Fig. 3b Lower cast occlusal contact points during articulator analysis. Fig. 4a Upper arch occlusal contact points during intraoral examination. Fig. 4b Lower arch occlusal contact points during intraoral examination. Fig. 5a Selective reductive contouring of tooth number 37 according to the contouring list. Fig. 5b Selective reductive contouring of tooth number 27 according to the contouring list.

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Aung MH, Nyan M: Clinical Application of a Digital Occlusal Analyzer in Occlusal Equilibration: A case report

Fig. 6a

Fig. 6b

Fig. 7a

Fig. 7b

Fig. 6a Graphic presentation of occlusal contact points and forces after final adjustment on the mounted diagnostic cast. Fig. 6b Graphic presentation of occlusal contact points and forces after final adjustment intraorally using the OccluSense®. Fig. 7a Occlusal harmony was checked by the OccluSense® Fig. 7b Occlusal harmony was rechecked using articulating papers. and 27 according to the occlusal markings from articulating paper and data was recorded from the OccluSense® sensor. Firstly, the disto-lingual cusp tip of 37 was scraped on the cast and checked the occlusal contact with the OccluSense® and articulating paper. Secondly, the palatal cusp tip of tooth number 27 was reduced on the cast and checked the occlusion. Finally, the buccal incline of the palatal cusp of tooth number 27 was contoured and the occlusion was checked. Occlusal loads were evenly distributed after the contouring premature contacts on the casts (Fig.3a-b). After the articulator analysis of occlusion intraorally (Fig. 4a-b0 , a dental contouring list was noted down to proceed with clinical occlusal adjustment

at chair-side. Selective reductive contouring were performed intraorally with a diamond bur according to the contouring (Fig.5a-b) list with great care not to overgrind. Occlusal contacts and loads were checked by the OccluSense® between each contouring step. After completion of the selective contouring procedure, the occlusal loads were evenly distributed on both sides of the jaws and the premature contact points were observed to have disappeared (Fig.6a-b). After a week, during the follow-up visit, the occlusion was re-checked by the OccluSense® and articulating paper (Fig.7a-b) which confirmed the acquired occlusal harmony and the patient reported substantial relief of symptoms.

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Aung MH, Nyan M: Clinical Application of a Digital Occlusal Analyzer in Occlusal Equilibration: A case report

DISCUSSION Effective occlusal equilibration can be achieved only if the abnormal occlusal contacts are discovered precisely. Different materials and techniques have been used to locate the occlusal contact points but the traditional ones have flaws in detecting the accurate location and pressure4. In this case report, we have illustrated the applicability of OccluSense® in occlusal equilibration.

OccluSense® system uses the combination of traditional and digital methods of identifying the occlusal contacts and the occlusal force distribution. The OccluSense® sensor is relatively thin (60 microns) and flexible coated with red color. The color coating serves as the traditional articulating paper and aids in localizing and checking the exact occlusal contacts. Recorded data are sent to the OccluSense® iPad app through a wireless connection aiding the users to manipulate the handheld device freely without the problem of the cables tangling. The clinician can see the data in the graphic presentation in both 2D and 3D views and occlusal load distribution in percentage7.

The masticatory distribution can be checked with up to 150 images per second. The OccluSense®

system is affordable, simple to use, easy to locate accurate contact points with self- ink coated sensor, lesser hinge axis effects due to thinner sensor when compared to the T-Scan system.

CONCLUSION Occlusal equilibration by reductive tooth contouring using a digital occlusal analyzer as an aid provides excellent clinical outcomes. The OccluSense® system may be applicable in various dental procedures especially functional occlusal analysis, occlusal equilibration, restorative and prosthetic dentistry.

Author

Minn Htet Aung Myanmar drminnhtet@gmail.com

Myat Nyan Myanmar myatnyan@udmmandalay.edu.mm

References

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Redelberger H. The future of occlusion control. Dent Asia. 2020; 40-41.

Popa ST, Popescu SM, Constantinescu MV. Occlusal equilibration between option and clinical realty. Stoma Edu J. 2015;2(1): 57-63.

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Constantinescu FE. Gold standard in occlusion controlOcclusense® by Dr. Jean Bausch GmbH & Co. KG. Stoma Edu J. 2019;6(4). prodnews.1.

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Ash MM, Ramfjord SJ. Occlusion. Saunders: 1995.

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Posselt U. Physiology of occlusion and rehabilitation.

Blackwell Scientific: 1971.

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More and more dentists worldwide admit:

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Occlu Sense! ®

Innovative system for digital occlusion control.

Take advantage of the award-winning OccluSense® system: • 60 microns thin, flexible pressure sensors record both static and dynamic occlusion • Data transfer to OccluSense®-iPad-App via wireless network • Red colour coating marks the occlusal contacts on the patient’s teeth • Avoid incorrect loading of implant-supported supraconstructions and involved structures • Detect premature contacts during occlusal corrections as well as incorrect loading on the laterotrusion and mediotrusion side • Document occlusal changes during orthodontic treatments • Improve communication with your patients by visualizing the occlusion

WE MAKE OCCLUSION VISIBLE® Dr. Jean Bausch GmbH & Co. KG | Oskar-Schindler-Straße 4 | 50769 Köln | Germany Phone: +49-221-709360 | Fax: +49-221-70936-66 | info@ occlusense.com | www.occlusense.com Bausch and OccluSense are trademarks of Dr. Jean Bausch GmbH & Co. KG, registered in Germany and other countries.

Apple and iPad are trademarks of Apple Inc., registered in the U.S. and other countries.

More information: www.occlusense.com and YouTube

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