Occlusal Corrections for Full Mouth Cases

occlusalcorrection

Occlusal corrections on multiple crowns can be a daunting task.  Even with the most meticulous technique, there are times when you have to do more than “just a little” adjustment to your full mouth cases or you may just want to really detail the occlusal scheme of your masterpiece.  Do you make these adjustments in the mouth on what some call the “final articulator”?  I think everyone would agree that it can be difficult and sometimes impossible to make final adjustments of multiple crowns intra-orally, so how can one utilize an indirect approach to the tedious task of perfecting the occlusion?  In a classic article published in a 1981 issue of the Journal of Prosthetic Dentistry, David Eggleston describes a remount procedure for fixed prosthodontics where one makes a pick-up impression of crowns and adjusts the occlusion in the laboratory. The first step in my cases is to fabricate an acrylic wafer approximately 3mm thick with no palate for the maxillary.  I like to use Bosworth’s FastTray for this because this filled acrylic is stable after it sets for 24 hours.  Drill 2mm holes in this wafer to retain an impression plaster such as Bosworth’s Plastogum. In the operatory,  it is important to verify the interproximal contacts on every crown.  Floss should have a resounding pop when its perfectly adjusted.  Any open contacts can be corrected later but its important that you eliminate those that would interfere with complete seating of the crowns.  Once this contact adjustment procedure is completed, seat the crowns in place with bit of glycerin to prevent dislodgment during your next step which is to mix the plaster and apply it to your wafer.  Seat this pick up tray with enough pressure to record the occlusal/incisal one-third of the crowns. After the plaster sets, carefully remove the tray and make sure each crown has an accurate seat. You can add wax on the margins of each crown before you pour the remount cast to protect these thin areas. Mount the casts with your preference of bite registration material but make this record as thin as possible to improve accuracy in your mounting. Proceed with your laboratory adjustments and look forward to a short visit focused on careful cementation procedures.

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