The occlusal carving, or also called occlusal adjustment, it is a technique by which occlusal surfaces are modified to improve the contact pattern, selectively eliminating tooth structure. It is an irreversible technique, that is, once carried out, you cannot go back.
Occlusal adjustment must begin with locating the stable musculoskeletal position, the centric relationship, using the bimanual manipulation technique. If there are doubts about the position of the condyles, the adjustment should not be started until a reproducible stable position has been reached.
The treatment goals in occlusal adjustment They are:
- Contact all posterior teeth in centric relation and they must present a uniform and simultaneous contact.
- The laterality contacts of the anterior teeth must dislodge the posterior teeth
- The contacts of the anterior teeth must dislodge the posterior teeth when protruding the jaw.
- In the preparatory eating position, the posterior teeth must contact with greater force than the anterior teeth.
Once the adjustment has been indicated and the results have been predicted, the patient is explained that there are very small areas that interfere with the correct function of the jaw and that the objective is to eliminate them to restore normal function.
What are the indications for selective grinding?
There are two main indications for selective carving:
- Facilitate treatment of certain temporomandibular disorders (TMD). There is sufficient evidence that a permanent change in occlusal status will reduce or eliminate the symptoms associated with a TMD. Evidence of the need to permanently modify occlusal conditions is obtained from reversible occlusal treatment. Thus, occlusal adjustment will be indicated if: the occlusal appliance has suppressed the symptoms of TMD or if it is confirmed that the occlusal contact or the mandibular position are characteristics of the appliance that influence the symptoms.
- Supplement treatment associated with major occlusal modifications, is the most frequent reason, it does not have to be associated with TTM. It may simply be a restoration or reorganization of the occlusal state. When major occlusal modifications are planned, if extensive procedures with crowns and fixed prosthodontics are required, an occlusal adjustment is indicated before starting treatment in order to establish a stable functional mandibular position.
At present it is not scientifically proven that a prophylactic occlusal adjustment is beneficial to the patient.
