There is so much to think about when providing an effective restoration. A “simple” fix by placing composite at the incisal edge, requires thought about the technique used for placement, the material used for optimal wear resistance and polish retention, and how the restoration will ultimately fit within the existing dentition.
The last point is incredibly important for dental professionals. An aesthetic restoration that doesn’t conform functionally within the pre-existing smile is at risk of damage, which can compromise results. Without an appropriate assessment for occlusion, an aesthetic restoration can do more harm than good.
Clinicians need to be aware of the current consensus around occlusion, and how to analyse relationships amongst the dentition in order to inform their treatment plans.
Clinical understanding
Occlusion is a concept that has expanded to include mechanical, dynamic, functional and neuromuscular relationships between teeth, muscles and temporomandibular joints during function (such as chewing and speaking) and at rest.[i] A dental restoration is subject to continuous forces, and if it does not fit as a cohesive component in the larger dentition, restorative failure is inevitable.
It’s important to note that occlusion is still a somewhat controversial topic in some clinical circles. This is because of varying interpretations of clinical theories and observations, which inform different approaches to clinical studies.[ii] There is also limited consensus on optimal occlusal approaches to some forms of restorations, such as removable complete dentures.[iii] These occlusal schemes could include bilateral balanced occlusion, lingualised occlusion, buccal occlusion, monoplane occlusion, unilateral balanced occlusion and canine-guided occlusion[iv] – such a wide range means the best approach for a given restorative treatment is typically unestablished in the literature.
Some even state that in most cases the patient’s masticatory system can adapt to minor changes of occlusion,ii but clinicians must ensure that this adaption does not come at the cost of damage to the natural or restored dentition. To do so, they should be able to accurately assess the existing occlusal relationships of the upper and lower arches, and use this information effectively to plan an optimal restoration that works for the patient’s unique needs.
Assess with care
Performing accurate occlusal analyses in the practice requires effective equipment and practitioner knowledge. The latter is imperative. A clinician needs to know what they are looking for and why, and how to implement their findings. There are many ways to perform a detailed occlusal analysis. Mechanic articulators are still used by many, and computerised diagnostic solutions are entering the field more often as we move further into an age of digital dentistry, though there is little consensus on the ideal diagnostic approach.[v]
Many clinicians still use solutions such as articulating papers and shimstock foil. These can be used to assess the static and dynamic occlusal contacts by recording the biting contacts, enabling clinicians to view their position, distribution and intensity.ii It’s important to ensure that the oral cavity is prepared for an occlusal exam. Where there is a moist environment caused by saliva on the biting surfaces, the procedure may be deemed unreliable. The literature states that in a “dry working field,” shimstock foil of a thickness of 8-10 µm or articulating paper of 12-40 µm offer reliable results when used properly.ii
Digital solutions are growing in popularity and preferred by some, as they can account for human error that may affect a manual workflow.ii However, these are still developing and may not be accessible for all practices immediately.
Developing skill-sets
As seen in the General Dental Council’s “Standards for the Dental Team” dental professionals should only carry out tasks if they are appropriately trained and confident in their ability.[vi] This includes assessing occlusion, and implementing any findings into restorative care. Clinicians should consider the Occlusion: Basics & Beyond online course from IAS Academy to inform their workflows.
Led by Dr Jaz Gulati and Dr Mahmoud Ibrahim, the on-demand course features 34 hours of engaging, informative content packed into bite-sized modules, using real-world clinical scenarios to prepare you for effective care. Upon signing up to the course, which covers everything from risk assessments and planning, to conforming and reorganising the dentition, clinicians also receive the OBAB toolkit with an autoclavable Huffman leaf gauge and 8 µm Hanel shimstock foil. This allows you to put your studies into practice immediately.
Occlusion is a significant topic to tackle, and clinicians need an in-depth understanding of its importance within restorative workflows for predictable results. By seeking out educational resources, dental professionals can safely assess a patient’s occlusal relationships and work with these findings with ease.
For more information on upcoming IAS Academy training courses, please visit www.iasortho.com or call 01932 336470 (Press 1)
Dr Tif Qureshi; founder and a clinical director of IAS Academy, qualified from Kings College London in 1992. He is a Past President of the British Academy of Cosmetic Dentistry, an International faculty that provides mentored education for general dentists on a pathway from appropriate simple to comprehensive orthodontics. Tif has a special interest in simple orthodontics and truly minimally invasive dentistry. He has committed his life’s work to empowering dentists to provide important alternative techniques. He offers a wide variety of treatments to many more patients, while always respecting the fundamental precepts of orthodontics. Tif also pioneered the concept of Progressive Smile Design through Alignment, Bleaching, Bonding – a course that combines tooth alignment, composite bonding and teeth whitening to produce superior smiles using techniques with the absolute minimum of invasiveness available today. An experienced teacher in the Dahl concept, Tif shows how this technique is used to plan tooth alignment and minimise invasive dentistry in the development of a beautiful smile. Tif now lectures and published scientific articles internationally.
[i] Aldowish, A. F., Alsubaie, M. N., Alabdulrazzaq, S. S., Alsaykhan, D. B., Alamri, A. K., Alhatem, L. M., … & Alamari, A. (2024). Occlusion and Its Role in the Long-Term Success of Dental Restorations: A Literature Review. Cureus, 16(11).
[ii] Ćelić, R., Pezo, H., Senzel, S., & Ćelić, G. (2023). The Relationship between Dental Occlusion and “Prosthetic Occlusion” of Prosthetic Restorations Supported by Natural Teeth and Osseointegrated Dental Implants. In Human Teeth-From Function to Esthetics. IntechOpen.
[iii] Ahmed, N., Humayun, M. A., Abbasi, M. S., Jamayet, N. B., Habib, S. R., & Zafar, M. S. (2021). Comparison of canine-guided occlusion with other occlusal schemes in removable complete dentures: a systematic review. Prosthesis, 3(01).
[iv] Ahmed, N., Humayun, M. A., Abbasi, M. S., Jamayet, N. B., Habib, S. R., & Zafar, M. S. (2021). Comparison of canine-guided occlusion with other occlusal schemes in removable complete dentures: a systematic review. Prosthesis, 3(01).
[v] Buduru, S., Finta, E., Almasan, O., Fluerasu, M., Manziuc, M., Iacob, S., … & Negucioiu, M. (2020). Clinical occlusion analysis versus semi-adjustable articulator and virtual articulator occlusion analysis. Medicine and pharmacy reports, 93(3), 292.
[vi] General Dental Council, (2019). Standards for the dental team. (Online) Available at: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/standards-for-the-dental-team [Accessed May 2025]
