occlusal management

Let’s take an example of a crown, after the crown is perfectly seated’ 1. Dawson’s bimanual manipulation while head in neutral position: This is the foundation of detection of occlusal interference ( initial contact). If you manipulate correctly, very often, the initial contact would be located on the very distal part of last molar. .If your new restoration doesn’t introduce new occlusal interference, leave the preexisting occlusal interference alone. Don’t touch it. If your new restoration does introduce new occlusal interference, it must be eliminated. Keep on proceeding the procedure until you can’t find new occlusal interference. Remember, we are not doing full mouth equilibrationon. We are trying to deliver a new restoration which patient can 100% comfortably chew without any problem. 2. Dawson’s bimanual manipulation while head hyperextended position Proceed as step1. Remember head position may influence tmj position or motion, and vice versa .New occlusal interference detected must be eliminated, too. 3. Dawson’s bimanual manipulation while head hyperflexed position. Proceed as step 1. 4. Voluntary closure while head neutral position If there is occlusal marking different from previous markings , the new marking must be eliminated. Remember, we only want to preserve centric stops. Proceed occlusal adjustment until voluntary c7. Empty mouth clenching while head neutral position Proceed as step 4 8. Empty mouth clenching while head hyperextended position Proceed as step4 9. Empty mouth clenching while head hyperflexed position Proceed as step4 10.Jaw closure and bimanual manipulation with posteriosuperior direction while head neutral position Proceed as step 4 11 Jaw closure and bimanual manipulation with posteriosuperior direction while head hyperextended position. Proceed as step 4 12. Jaw closure and bimanual manipulation with posteriosuperior direction while head hyperflexed position Proceed as step4 13 Cotton roll clenching test Place cotton roll between restoration and opposinining tooth and ask patient to clench his or her jaw as hard as he or she can. If the tooth is healthy and there is no occlusal interference, patient almost always can comfortably clench on cotton roll. If patient have minute discomfort or soreness upon cotton roll clenching, there is almost occlusal interference present. At this stage, you may meticulously grind centric stops until satisfactory results achieved. 14. Remove all eccentric contacts as written in Dawson’s book. Finally, if a patient