Solow Roger A
a Private Practice , Mill Valley , CA , USA.
b Visiting Faculty , The Pankey Institute , Key Biscayne , FL , USA.
Cranio. 2018 May;36(3):195-206. doi: 10.1080/08869634.2017.1312199. Epub 2017 Apr 11.
Occlusal adjustment can optimize the result of orthodontics, orthognathic surgery, and comprehensive restoration, and resolve adverse forces to the dentition that affect the entire masticatory system. Mounted diagnostic casts and computerized occlusal analysis offer complementary advantages for evaluating occlusal problems. Predictable occlusal adjustment is facilitated by precise, measured documentation of occlusal force by computerized occlusal analysis.
A conservative, structural correction of a pronounced, chronic occlusal problem by additive and subtractive occlusal adjustment was performed after a previous failed occlusal adjustment. The patient's chief concerns were significant anterior teeth fremitus in maximum intercuspation and "pain in the teeth and a poor bite" after 30+ adjustments over 2.5 years.
Confirmation of specific criteria for a therapeutic occlusion resolved the anterior teeth fremitus and uneven bite. Traumatic occlusal contact on posterior teeth may elicit protective mandibular repositioning affecting anterior teeth relationships and should be considered during comprehensive diagnosis.
咬合调整可优化正畸、正颌外科手术及综合修复的效果，并消除影响整个咀嚼系统的牙列不良作用力。上架诊断模型和计算机化咬合分析在评估咬合问题方面具有互补优势。通过计算机化咬合分析精确测量记录咬合力，有助于实现可预测的咬合调整。
在之前的咬合调整失败后，通过增减性咬合调整对明显的慢性咬合问题进行了保守的结构性矫正。患者主要关注的是在最大牙尖交错位时前牙明显震颤，以及在2.5年中进行30多次调整后出现“牙齿疼痛和咬合不良”。
确定治疗性咬合的特定标准可解决前牙震颤和咬合不均问题。后牙的创伤性咬合接触可能引发保护性下颌重新定位，影响前牙关系，在综合诊断时应予以考虑。
