Occlusion affects everything dental professionals do. It informs the treatment plans of areas from restorative dentistry and orthodontics, to implantology – with even the smallest procedures potentially having an impact on occlusion. In recent years, with the increased popularity of digital dental technology, some clinicians have begun to question the efficacy of impression materials when it comes to accuracy and manipulation. This has led to an increased uptake of intraoral scanners as a potential solution to improve impression quality, but this technology may not always produce the desired result.[i]
Achieving the correct occlusion remains a challenge for dentists and technicians. Even the smallest discrepancies in tooth height, measuring just a few microns, can lead to issues such as temporomandibular disorder which causes pain in the jaw joint. As such, it’s vital that clinicians carefully consider the techniques they use to measure occlusion, appreciate the impact it can have on treatment outcomes and overall health, and understand how to record the teeth in both static and dynamic occlusion.[ii]
Traditional materials vs digital solutions
Because occlusion can have such a profound impact on treatment success, it’s crucial that clinicians choose the most appropriate way to record their patient’s situation, and plan treatment accordingly. In a profession which is constantly evolving, seeking the digital solution to common problems, it can be easy to get swept along with the latest tech. Some have expressed their concerns about the use of traditional dental impression materials, with issues like surface contamination, poor margin details, bubbles, and tears[iii] cropping up every now and then, leading to delays at the dental lab. However, they are still a reliable option for recording patients’ dentition in most cases.
Research comparing the fidelity, accuracy, and detail reproduction of both conventional impression materials and digital scanning solutions found that digital models are similar to conventional ones in most aspects. However, in areas such as grooves and pits, conventional methods are actually able to produce a more precise outcome.[iv] With this in mind, clinicians should carefully consider the methods they use to record patients’ dentition prior to treatment, as inaccuracies and lack of detail may lead to issues when it comes to occlusion. In the future, this may mean that patients suffer the consequences in the form of fractured or chipped restorations and jaw pain, for example.
The use of AI to improve occlusal modelling
At current, digital solutions are unable to accurately depict patients’ dynamic occlusion, making it difficult for clinicians to reliably use the software for treatment planning. As such, presently, it is sensible for clinicians to use the time-tested techniques of conventional impression materials to create physical anatomical models on which to base their treatment plans. While they are subject to human error in some cases, flaws should be spotted prior to sending the impressions to the dental lab. Additionally, they are able to pick up small details which are likely to be missed using an intraoral scanner. This is important for recording the occlusal surfaces, as the smallest discrepancy could have big implications for the patient long term.
As technology continues to develop, however, the possibilities are expanding. Artificial intelligence (AI) is beginning to play a larger role in all of our lives, and is having a big impact on the dental profession. Research suggests that AI could be used to simulate occlusal relationships, identify interferences, and evaluate functional dynamics. This type of technology could aid in prosthetic treatment planning, ensure proper occlusal alignment, and optimise functional and aesthetic outcomes.[v]
While this is promising, there is still a way to go until clinicians can rely on this type of AI assisted technology in practice. For example, when analysing worn or destroyed dentition, researchers are uncertain as to whether existing AI programs can be applied in these scenarios – suggesting more research and development is required for this to be implemented in the future.[vi]
Looking to the future
Whilst current digital technologies are not capable of producing sufficiently accurate models of the dentition for use in planning occlusion, there is hope for the future of dental technology – enabling clinicians to more efficiently produce a model of a high enough quality to use in treatment planning. AI driven technology will be a particularly helpful area of development, changing the way clinicians work, and enabling a full digital workflow.
This technology is likely to become available in the coming years, furthering the progression of the dental profession, and providing clinicians with the tools they need to confidently provide their patients with the high-standards of care they need. In the meantime, however, clinicians should carefully consider the technology they adopt in the dental practice, and whether it is able to deliver the level of accuracy they need to offer their patients the best occlusal outcomes.
Author:
Stephen Claffey Managing Director of Dental Pathway™ and the Independent Dental Advisory Board™
[i] Sharma A, Rahul GR, Poduval ST, Shetty K, Gupta B, Rajora V. History of materials used for recording static and dynamic occlusal contact marks: a literature review. J Clin Exp Dent. 2013 Feb 1;5(1):e48-53. doi: 10.4317/jced.50680. PMID: 24455051; PMCID: PMC3892230.
[ii] Sharma A, Rahul GR, Poduval ST, Shetty K, Gupta B, Rajora V. History of materials used for recording static and dynamic occlusal contact marks: a literature review. J Clin Exp Dent. 2013 Feb 1;5(1):e48-53. doi: 10.4317/jced.50680. PMID: 24455051; PMCID: PMC3892230.
[iii] DDS Lab. Most common dental impression errors and how to avoid them. Accessed Mar 24. https://blog.ddslab.com/dental-impression-errors-and-how-to-avoid-them
[iv] Carvalho, Thaise Ferreira, et al. “Evaluation of the accuracy of conventional and digital methods of obtaining dental impressions.” Int J Odontostomatol 12.4 (2018): 368-375.
[v] Dhopte A, Bagde H. Smart Smile: Revolutionizing Dentistry With Artificial Intelligence. Cureus. 2023 Jun 30;15(6):e41227. doi: 10.7759/cureus.41227. PMID: 37529520; PMCID: PMC10387377.
[vi] Tabatabaian, Farhad, Siddharth R. Vora, and Shahriar Mirabbasi. “Applications, functions, and accuracy of artificial intelligence in restorative dentistry: A literature review.” Journal of Esthetic and Restorative Dentistry 35.6 (2023): 842-859.
