Dr Manrina Rhode explains why addressing TMJ issues is essential before restoring worn anterior teeth
Occlusion may be dentistry’s least glamorous topic, but according to Dr Manrina Rhode, it’s fundamental to successful smile makeovers, and ignoring it can lead to failed restorations and unhappy patients.
Understanding Anterior Wear
When patients present with aesthetic concerns, the presence of anterior wear should immediately raise questions about occlusion. Whilst gaps or discolouration may not warrant occlusal analysis, significant wear on incisors demands investigation.
“If you don’t consider why that wear is there in the first place, you’re going to have problems,” Manrina warns. “If a habit is bad enough to override the proprioceptors and shorten the front teeth, it will destroy your restorations too.”
The TMJ Connection
Patients don’t naturally grind on single-rooted anterior teeth, they’re designed to grind on posterior teeth with multiple roots and substantial bony support. When anterior grinding occurs, it typically indicates the condyle isn’t properly seated when the patient achieves maximum intercuspation.
This discrepancy between centric relation (CR) and maximum intercuspation (MI) causes discomfort when grinding on posterior teeth, so patients compensate by bringing the condyle out of the joint and grinding anteriorly instead.
Treatment Strategy
Manrina emphasises that TMJ alignment must be addressed before restoring worn anterior teeth if caused by grinding. For patients whose CR and MI are coincident, a traditional soft night guard may suffice. However, when anterior grinding persists, a deprogrammer such as an anterior jig or NTI splint may be indicated.
Once TMJ alignment and occlusal alignment is achieved, anterior restoration can proceed confidently, if anterior grinding was the issue. In cases where anterior wear has caused bite collapse, Manrina recommends opening the bite with composite edge bonding, allowing the occlusion to settle before progressing to definitive veneers.
“We need to solve the occlusal problem first,” she stresses. “It will help with TMJ alignment, neck alignment, and even back problems, many patients see osteopaths for issues that actually originate in the TMJ joint.”
Dr Manrina Rhode covers occlusion and predictable smile makeover protocols within her mentorship programme and on her three-day porcelain veneer course. For more information, contact Laura at academy@drmr.co.uk
