Digital occlusal information has the potential to revolutionize the way we practice general dentistry. For the past 20 years, the T-scan system has recorded force scans to supplement the information given by ink marks. As we leave the 2-D world of articulating paper behind and enter the 3-D world of digital occlusion, both doctor and patient develop new knowledge, new attitudes, and a new appreciation for the human oral physiology.
Get acquainted with the T-Scan. Use the force sensor whenever you use articulating paper; the recording will yield information that ink marks alone could not give. Force scans offer dramatic diagnostic improvements over traditional articulating paper:
- Full arch of contacts
- Marks recorded independent of materials
- Multiple pinpoint locations of force intensity
- Recording of location and intensity that can be viewed in 2-D or in 3-D
- Permanent record that will not be ‘washed’ away
- Occlusion/disclusion timing
- Repetition of force cycles
- Sequencing of points of contact
- Direction of force transfer
- Bites that patients can see
When to use force scans During the past 20 years, we have found four application categories that may benefit every patient. Each patient has different concerns and unique anatomy. We listed 10 reasons why force scans are an improvement over what we think articulating paper is telling us, but Digital Occlusion is much more than computerized ink marks. The cumulative information recorded by force scans is powerful. Force recording has four primary applications:
- As a diagnostic tool during clinical exams.
- As a prevention tool.
- As an evaluation tool before, during, and after any treatment.
- As a tool for directing comprehensive occlusal/TMJ therapy.
Application #1: Force recording as a diagnostic tool during clinical exams
It is important to diagnose force transfer during any clinical exam. Dentists who are new to the T-Scan technology often choose to introduce force scans to new patients only. However, we have found that introducing force scans to returning hygiene patients is an effective motivational tool for co-diagnosis. Existing patients who already trust the practice are excited to see their bite on a monitor. Original scans establish a baseline record which coincides with the presence of:
- Periodontal pockets
- Recession areas
- Stressed fillings
- Sensitive teeth
- Fractures and/or cracks
- Over-worn dentition
- Cervical neck triggers
- Tender lateral TM ligaments
Digital images from an intraoral camera and a force scan recording effectively communicate what you see to patients who become more likely to comply with treatment plans you propose. Any exam during which you record force scans has the potential to change the way patients perceive dentistry and to increase the confidence they have in you. Consider recording force scans during the following exam appointments:
- New patient
- Returning patient
- TM joint/occlusal analysis
Application #2: Force recording as a prevention tool
Preventing the future decline of a dentition is the most powerful application of force technology. Force patterns predict the future of an occlusion. The pattern in an arch pinpoints the location of excessive stress on the anatomy. Habitual force patterns reveal how a bite will age, which teeth are involved in guiding, and how the bite force is absorbed. At any age and with any bite, a force scan can easily identify areas of immediate concern and accurately predict the development of future problems (see Habitual Force Pattern in the Articles section). The adult habitual force pattern is close to being established by age 13 and it is definite by age 15. The ideal age to record a baseline habitual force pattern scan occurs after wisdom teeth mature or are extracted. At that time, it is possible to identify the envelope of stress on the occlusion, years— if not decades—before the appearance of symptoms. Balancing the occlusion at this young age prevents future fatigue or failure of the anatomy. Patients easily grasp the analogy between balancing tires and balancing a bite to prevent uneven wear and tear.
Application #3: Force recording as an evaluation tool before, during, and after any treatment
Force technology improves the quality and precision of any procedure or any series of procedures. All restorative procedures impact occlusion as they have the potential of changing the bite. Implant prosthetics is a good example as it is considered prudent not to load the occluding surface for fear of implant failure. When an implant post and crown are taken out of occlusion, a clinician must ask: “Where did the force go?” Unloading one area implies that an extra load is added somewhere else, which may improve the system as a whole or may increase stress in another location and result in failure. Putting a crown on a lower second molar is another example of a restorative procedure that often challenges dentists. Over 50 percent of occlusions exhibit a heavy force in the posterior region. Preparing to crown a second molar which happens to be the anterior control (first point of contact when the condyle is seated) will change the bite because the condyle position will move up. Either the temporary or the new crown will be very “high” and will require adjustments. It is even possible that the preparation will touch the opposing upper tooth. Balancing an occlusion before performing restorations in high-force locations will save time, money, and patients’ confidence.
Application #4: Force recording as a tool for planning comprehensive occlusal/TMJ therapy
Articulators put models together but scans put together models, pictures, and radiographs and bring them to life. Pictures and radiographs tell a story. Force scans uncover the mysteries behind the story and, along with comprehensive care, help prevent unfortunate outcomes. Every patient has two TM joints and one occlusion. The treatment sequence is a critical part of the treatment plan. Excellent occlusal history records (see Expand Your Horizon: Make Occlusion Simple in this section) combined with current digital images make a comprehensive care sequence logical to both patient and doctor. The Application Card Deck and the Case Card Deck section present many examples of force patterns leading to comprehensive treatment planning. An occlusal interference can result in a pathologic adaptation (maladaptation) of the stomatognathic system. Interference management often will dictate the appropriate treatment sequence. Patients understand words like teeth, muscles, bones and joints.