Congratulations to Dr. Frank Spear for writing and to JADA for publishing a well-thought-out column on occlusion ("The business of occlusion,"
JADA 2006;137:666–7[Free Full Text]
). As the previous director of the graduate prosthodontic program and director of occlusion at our university, I find that several of us have been saying the same thing for years. I find that many recent dental school graduates, and experienced clinicians, are taken in by the "esthetic orgy," and the resulting lack of attention to basic occlusion principles.
Dr. Spear echoes many of the thoughts and comments some of us have expressed over the past several years in our lectures, but we are usually drowned out due to lack of interest and the de-emphasis of basic occlusion knowledge. It seems the recent graduate, out of frustration or lack of knowledge and experience, chooses to be what I characterize as a "cult lemming," saying: "I studied with so-and-so; therefore, the information must be right." Unfortunately, [such dentists] apparently didn’t learn the basics in dental school, and are frequently looking for a quick fix for a patient’s complex problems.
Our patients are individuals who cannot be treated with a singular treatment philosophy. A "bimanual-neuro-gnatho-equilibration" technique isn’t necessarily right for all patients. The practitioner must take the best from all philosophies, and modify them to fit the patient. Until the profession has more evidence-based research on occlusion, "one size does not fit all," and there will continue to be some controversy.
All-porcelain restorations have come a long way in their development, and they can appear very natural and function for a long period of time. However, ignorance of basic occlusion principles can lead to the early demise of the most meticulously prepared and placed restorations. As prosthodontists, it is imperative that we work with the patient and our laboratory technician in developing restorations that are not only esthetic but functional in the long run.
I believe Aristotle was the first to infer that form follows function. Our patients will have esthetically pleasing restorations if they are designed with proper function in mind.
Thanks to Dr. Spear for sharing his personal insight and philosophy. This "non-cult" approach is very refreshing and, I think, very good for the profession.
