Author’s response
Arthur A. Dugoni, D.D.S., M.S.D.
I appreciate Dr. Woods’ opinions on the subject of postorthodontic occlusal equilibration. Undoubtedly, he has a highly controlled practice and excellent results.
After observing thousands of "completed" orthodontic patients treated by many different orthodontists, I find that nearly all of them need a minor to a major amount of postorthodontic occlusal equilibration to stabilize their occlusion. I am pleased that Dr. Woods has overcome this challenge in his practice.
I am a prosthodontist, not an orthodontist. To aid in answering this question, I sent Dr. Woods’ letter to Dr. Arthur Dugoni, an orthodontist and dean of the Arthur Dugoni School of Dentistry at the University of the Pacific in San Francisco. Dr. Dugoni’s comments to me follow:
Dr. Woods brings to your attention his observations from treating 23,000 patients and his experience with respect to the completion of his orthodontic cases.
As you know, most orthodontists will check the occlusion at every visit during orthodontic treatment and, of course, especially after orthodontic treatment. This is because there are many things an experienced clinician would do as far as equilibration at various times during the treatment process, such as [the following]:
- [Treating a] painful tooth [resulting from] traumatic interferences. Sometimes, our appliances and mechanics may hold a tooth or teeth in a premature contact during or at the end of treatment and in retention. The correction of anterior and posterior cross bites is a frequent reason for this to happen.
The first choice is usually to adjust the appliances to eliminate this problem, but often an equilibration of the teeth is necessary to get the patient more comfortable. If this is ignored, a tooth in trauma could eventually develop a pulpal problem and require endodontic therapy.
- Esthetic recontouring of chipped or damaged teeth typically is done at the end of orthodontic treatment, after the most ideal tooth position is attained, as you suggest in your article.
- Many patients have large or uneven marginal ridges on their anterior teeth that will prevent the establishment of optimal overbite and overjet, which is another type of equilibration that frequently is done at the end of active treatment.
- Unworn teeth that are adjacent to worn cusps of other teeth frequently exist due to the initial malpositions of the teeth, especially in open-bite malocclusions. The most judicious time to equilibrate these teeth is at the end of treatment, when other general characteristics of normal occlusion have been attained.
- Periodontally compromised teeth, or teeth that have short roots, can become extremely mobile during treatment if prematurities are not removed during, and especially at the end of, treatment.
- Another common form of posttreatment equilibration is to do interproximal reduction as needed for matching the arches into a more optimum interocclusal relationship. This is because tooth mass discrepancies between the arches are common, with a high percentage variation in the widths of anterior and posterior teeth. Sometimes this also is accomplished during the orthodontic treatment process.
In my own practice experience, my initial occlusal adjustments immediately after debanding are limited to the above six observations. During the settling process, in the past I have used hinge-axis type positioners or other similar types of appliances to allow the teeth to settle into their final positions. The final detailed occlusal adjustment, in my hands, was usually accomplished during the three to six months after band removal.
I think there is reasonable agreement between Dr. Woods’ position and my position, and also your observations. I believe the essential message is that orthodontic cases will require appropriate occlusal adjustments in addition to the orthodontic repositioning of the teeth both during active treatment and after the removal of orthodontic appliances.
