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Confirmative, re – organized or unorganized/ dental continuing education courses

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Confirmative, re – organized or unorganized/ dental continuing education courses

  1. 1. Confirmative, Re – organized or Unorganized Stephen Davies INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. INtroduction • Most restorative dentistry has the potential to cause a change in the patients occlusion. Denstists should avoid unplanned occlusal change, because it may lead to iatrogenic problems or restorative failure.
  3. 3. Examination How to examine occlusion
  4. 4. • Articulating paper – • Red – 009 • Blue 010 • Thickness – not more than 40 microns
  5. 5. Sequence of using articuating paper • Dynamic occlusion • Static occlusion • First mark the dynamic occlusion using the red articulating paper. • Next mark the static occlusion by using the blue articulating paper.
  6. 6. Why record the dynamic followed by static • If static occlusion marks are made first, when the dynamic occlusion marks are made it will rub off the static occlusion marks during excursive movements
  7. 7. Reasons to carry out examination before restortive procedures • Can restorations be given within the Confirmative approach, or the re – organized approach.
  8. 8. Confirmatory approach • The conformative approach is defined as the provision of restorations ‘in harmony with the existing jaw relationships’. In practice this means that the occlusion of the new restoration is provided in such a way that the occlusal contacts of the other teeth remain unaltered.
  9. 9. Re – organized approach • When pretreatment occlusal examination indicates that a sufficient number of occlusal contacts are going to be destroyed or changed, it may be impossible to keep the same occlusion; i.e we cannot comfirm. • The objective for re –organized approach is to provide an occlusion that is more ideal
  10. 10. • The tooth level An ideal occlusion will provide: • Multiple simultaneous contacts • No cuspal incline contacts • Occlusal contacts that are in line with the long axis of the tooth • Smooth and, wherever possible, shallow guidance contacts
  11. 11. • The articulatory system level An ideal occlusion will provide: • Centric Occlusion occurring in Centric Relation • Freedom in Centric Occlusion • No posterior interferences (anterior guidance at the front of the mouth).
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  13. 13. • The essential difference between the examination of the patient who is going to be restored to the re – organized approach and one to be restored to the confirmative approach is in ‘ Jaw Realtionship’.
  14. 14. Restoring a patient to re – organized approach • Examination – Examine all the elements of the articulatory system. To diagnose any preexisting TMD. – To determine the CR position
  15. 15. Records
  16. 16. Schottlander occlusal sketch
  17. 17. Steps to restoring to the re- organized approach • To find centric relation ( stabilization splint or lucia’s jig) • Equilibration of standing teeth • Diagnostic wax up • Preparation of teeth and construction of provisional restorations • Provisional restorations • Definitive restorations • The post operative stabilization splint
  18. 18. Re – organizing occlusion • EDEC principle E – examine the preoperative occlusion ( examination phase) D – design the restoration ( planning phase) E – execute the design (The pre-definitive restoration treatment phase) C – check the restoration ( the definitive treatment phase)
  19. 19. Good occlusal practice in advanced restorative dentistry BRITISH DENTAL JOURNAL, VOLUME 191, NO. 8, OCTOBER 27 2001
  20. 20. When confirmatory approach is not needed • An increase in vertical height is wanted or indicated • A tooth or teeth is/are significantly out of position (ie overerupted, tilted or rotated) • A significant change in appearance is wanted • There is a history of occlusally related failure or fracture of existing restorations • Reccurence of a temporomandibular disorder that has relapsed after a period of successful splint therapy
  21. 21. Planning the restoration
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  26. 26. Custom incisal guidance
  27. 27. The examination and recording of the occlusion: why and how BRITISH DENTAL JOURNAL, VOLUME 191, NO. 6, SEPTEMBER 22 2001
  28. 28. Recording cr
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  31. 31. Checking anterior guidance
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  34. 34. Thank you For more details please visit