Rehabilitation of occlusion - science or art?

The primary objective of rehabilitating occlusion is to improve stomatognathic function in patients experiencing dysfunction in mastication, speech, and swallowing as a consequence of tooth loss. The procedure of occlusal treatment involves improving the morphology and the stomatognathic function. Several practical methods and morphological endpoints have been described in occlusal rehabilitation. We made a selection of these (mandibular position, occlusal plane, occlusal guidance, occlusal contact, face-bow transfer, use of an adjustable articulator and occlusal support) and performed a literature review to verify the existence of compelling scientific evidence for each of these. A literature search was conducted using Medline/PubMed in March 2011. Over 400 abstracts were reviewed, and more than 50 manuscripts selected. An additional hand search was also conducted. Of the many studies investigating stomatognathic function in relation to specific occlusal schemes, most studies were poorly designed and of low quality, thus yielding ambiguous results. Overall, there is no scientific evidence that supports any specific occlusal scheme being superior to others in terms of improving stomatognathic function, nor that sophisticated methods are superior to simpler ones in terms of clinical outcomes. However, it is obvious that the art of occlusal rehabilitation requires accurate, reproducible, easy and quick procedures to reduce unnecessary technical failures and/or the requirement for compensatory adjustments. Therefore, despite the lack of scientific evidence for specific treatments, the acquisition of these general skills by dentists and attaining profound knowledge and skills in postgraduate training will be necessary for specialists in charge of complicated cases.