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Comprehensive Dentistry: Advanced Occlusion & Treatment Planning

8-day hands-on Course

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COURSE INFORMATION

The problem

“Do you know a good occlusion course?” is a question that we have been asked many times over the years. Unfortunately ‘occlusion’ is not a subject that can be discussed on its own. It is a part of every restorative or orthodontic treatment plan, but yet it is often taught in isolation. To add to the confusion, there are many different approaches that all achieve the same or similar results for the patient. Frequently there is more than one ‘right’ answer.

The solution

In order to master the combination of aesthetics and function it is necessary to consider occlusion in the context of the problems you are likely to face at the chairside in planning and delivering treatment.

This course is intended to allow practitioners who have a degree of prior knowledge to consolidate their diagnostic and treatment skills in order to treat more complex cases with confidence. We will draw on what has already been covered in the Cosmetic & Aesthetic Restorative Dentistry Year Course and build on some of the more advanced topics, supplemented with hands-on exercises.

In order to unravel some of the confusion that surrounds occlusion, we will adopt our usual comprehensive approach, identifying the similarities and significant differences between the occlusal philosophies of Gnathology, Pankey, Dawson, Kois, Spear, Bioaesthetics, and Neuromuscular (amongst others), together with the different joint positions and articulators associated with each.

Following on from this, we will consider a comprehensive clinical examination that can be used to screen all patients for occlusal problems and differentiate between the healthy and unhealthy occlusal systems. The emphasis will be on identification of the ‘high-risk’ patient or the patient who needs specific TMJ management before restorative treatment can be undertaken.

The rest of the course will cover management of problems in different parts of the occlusal system, whether this is the teeth, the TMJs or the muscles. We will look at appliance therapy, again adopting a comprehensive approach to compare and contrast different appliances. We will also look at the current state of knowledge on tooth wear and bruxism and relate this to restorative dental management, again with an emphasis on risk management for the ‘occlusally dangerous’ patient so that treatment can be sequenced correctly and the risks managed during its delivery.

Through practical exercises on comprehensive examination, equilibration, build-ups for the worn dentition and appliance therapy amongst others, we will show you how to build these techniques into your daily practice.

comprehensive dentistry

Lectures

  • Why occlusion is such a complicated topic
  • The healthy masticatory system
    • Normal function of the teeth, joints & muscles
    • Envelopes of motion and function
    • Symptoms of unhealthy joints, muscles & teeth
  • Occlusal philosophies & instrumentation
    • "It seemed like a good idea at the time" – the history of the study of occlusion
    • Modern philosophies of occlusion
    • An occlusal philosophy that can be applied to every patient in your daily practice
    • Treatment positions: intercuspal position vs. centric relation… which one and when?
    • Facebow transfer – when & how
    • Articulator selection for different situations
    • Adjusting the articulator: when & how
  • The "comprehensive screening" exam
    • "Red flags": identifying patients who require more detailed investigations
    • Comprehensive examination of teeth, joints & muscles
    • CR bite records
    • Load testing
    • Deprogramming at the chairside
  • Case records for treatment planning
  • Optimising the patient’s occlusion
    • Occlusal equilibration: what, why, when & how
    • Trial equilibration: when & how
  • Treatment sequencing & delivery for the occlusally simple case
  • Restorative update
    • Adhesion to natural tooth and other substrates
    • Selection, preparation & cementation guidelines for ceramic restorations

Practicals

  • Comprehensive clinical examination
  • Centric relation bite records
  • Trial equilibration on models

comprehensive dentistry

Lectures

  • Overview of the diseased system
  • Classification(s) of TMD signs and symptoms: Wilkes, Piper, RDC-TMD & others
  • Unhealthy muscles
    • Signs & symptoms
  • Unhealthy teeth
    • Mobility & fremitus; tooth wear
  • Unhealthy joints
    • Aetiology, staging of intracapsular TMJ pathology
    • Relating joint condition to restorative dentistry
  • Appliance therapy
    • Making sense of all the available appliances
    • Partial coverage appliances
      • Flat anterior appliances (B splint, deprogrammer)
      • The Kois deprogrammer
      • Other partial coverage appliances & their role in dentistry
    • Role of full coverage appliances (hard & soft): Michigan, Tanner, full soft
    • Appliances for unhealthy joints
    • Appliances for the bruxist patient
    • Managing the patient’s expectations for appliance therapy
  • The acutely symptomatic patient who presents at the practice: diagnosis & management
  • The chronic pain patient: options for management or onward referral
  • Fitting the comprehensive exam into your practice
  • Presentation of exam findings to the patient
  • Talking about occlusion and occlusal disease with your patients
  • Fee setting for equilibration and appliance therapy

Practicals

  • Fit & adjust flat plane appliance / deprogrammer appliance
  • Fit & adjust soft bite guard
  • Fit & equilibrate hard upper full coverage splint and soft bite guard

comprehensive dentistry

Lectures

  • Implementation of the diagnostic & treatment planning process for occlusally complex cases
  • Treatment sequencing for complex cases
  • Creating space for restorations
  • The role of provisional restorations
  • The worn dentition
    • Aetiology & prevalence of tooth wear
    • Common presentations: attrition, erosion, abrasion, abfraction
    • Erosion: confirmation of diagnosis & risk management
    • Attrition: Parafunction vs. bruxism, confirmation of diagnosis & risk management
    • Management of the patient who will continue to brux
    • Case finishing for force distribution
  • Guidance and vertical dimension
    • Guidance patterns
    • Changing anterior guidance – effects on teeth, muscles & joints
    • Vertical dimension: when to change it & when not to
    • Current evidence behind concerns on alteration of OVD
    • Changing vertical dimension – effects on teeth, muscles & joints

Practicals

  • Complex equilibration
  • Direct addition technique for provisionals
  • Overlay technique for provisionals

comprehensive dentistry

Lectures

  • Lectures Review of the diagnostic and treatment process
    • Sequencing the full-mouth case in the healthy masticatory system
    • Sequencing the full-mouth case in the unhealthy masticatory system
    • Bite records for different restorative situations
  • Complex equilibrations: The patient who cannot be easily equilibrated
  • Maintenance protocols for conformative and reorganised cases

Practicals

  • Treatment planning & sequencing

The emphasis in this final session is on application of the diagnostic and treatment planning principles discussed in parts 1 to 3 as well as how we can assemble our repertoire of clinical techniques into the treatment plan for the patient. You will be given the records and models for a number of patients who have already been treated at our practice and will work in small groups to develop the treatment plan (or plans).

 

This programme is open to everyone but we strongly recommend 3-5 years of experience working as a dentist.

The course is run on 8 days over 4 months. Two back to back sessions a month, with roughly 3-4 weeks between them.

 

Course fee includes:

The ADS Occlusion Tool Box, a complete starter kit of the consumable items needed for bite records and comprehensive examination will be given enabling you to implement what has been learned immediately on return to your practice.

Reading folders to complement the teaching days. As with other ADS courses this has relevant articles from the literature to give you an appreciation of the current research which is applicable to the topics being discussed, as well as classic articles on the subject.

Comprehensive lecture handouts and practical worksheets with step by step clinical protocols you can follow to implement at your own practice, as well as a selection of custom made appliances which you will fit and adjust on each other, plus all materials for the hands-on sessions.

Catering throughout the sessions.