Selective Grinding

Selective Grinding
Lorenzo M. Prats DMD MHA FAGD

Texas A&M Baylor College of Dentistry
Occlusion 8200
Selective Grinding Goals

Equilibration
With condyles in CR all possible posterior teeth contact

evenly and simultaneously between cusp tips and
opposing flat surfaces.
When the Md is moved laterally, laterotrusive contacts
on the anterior teeth disocclude the posterior teeth.
When the Md is protruded, contacts on the anterior
teeth disocclude the posterior teeth.
In the upright head position (alert feeding position) the
posterior teeth contact more heavily than the anterior
teeth.
JP Okeson Management of Temporomandibular Disorders and Occlusion 7th ed

Ch(19)p443
Indication: Assist managing certain

TMDs
Only when sufficient evidence from previous diagnostic work out

demonstrates that permanent alteration of the occlusal condition will
reduce/eliminate symptoms.
This evidence cannot be determined by the severity of the malocclusion.
Severity does not correlate with symptoms bc of the great variations in physiologic
tolerances
Malocclusion may not reflect orthopedic instability
Selective Grinding should not be initiated until a diagnostic equilibration has been
done in models (mounted in CR) .
The evidence for the need to permanently change the occlusal condition is
obtained through reversible occlusal therapy (Splint therapy)

Ch(19)p443
Indication: Complementing treatment

associated with major occlusal changes
Most common reason to consider selective grinding is as part of tx

plan that will result in a major change in the existing occlusal
condition. This is not associated with TMD but entails a significant
restoration or reorganization of the occlusal condition.
Extensive fixed prosthodontics may indicate the need of selective grinding

so that stable functional mandibular position is established prior to
restoring. Selective grinding first then restore..
There is no evidence at present that

prophylactic selective grinding is of benefit
to the patient!!!!

Ch(19)p443
Outcome Prediction: Misalignment
Extremely important that outcome must be predicted

before selective grinding
Selective grinding is appropriate only when
alterations of tooth surfaces are minimal so that all
corrections can be made within the enamel surface!!!
When misalignment present and there is a possibility
of dentin exposure then permanent restoration is
indicated. Degree of success will be determined by
the amount of misalignment!!!
Operator and patient in sequence with treatment. No
surprises!!!
JP Okeson Management of Temporomandibular Disorders and

Occlusion 7th ed Ch(19)p443
Rule of Thirds
To be determined in CR mounted models

Outcome Prediction: Direction and

amount of slide CR-ICP
Anterior posterior discrepancy must be analyzed by visualizing CR-ICP

slide.
Direction of slide in sagittal plane. Both horizontal and vertical components
of the slide must be analyzed.
Horizontal component more difficult to eliminate within the confines of
enamel than vertical component.
If slide is almost parallel to arc of closure it is easier to eliminate.
The shorter the slide the more likely selective grinding can be accomplished
within the confines of the enamel.
Generally a 2mm slide can be successfully eliminated by selective grinding.

CR-ICP slide
Vertical
Horizontal
AP slide: Mx distal incline w

Md mesial incline

AS slide: Mx mesial incline w

Md distal incline
Outcome Prediction: Anterior Guidance
After CR has been examined, the position of

the anterior teeth is evaluated.
While closing in CR before producing the slide,
evaluate future position of anterior teeth
This will predict adequacy and type of future
anterior guidance.
JP Okeson Management of Temporomandibular Disorders and Occlusion

7th ed Ch(19)p449
Selective Grinding Sequence
JP Okeson Management of Temporomandibular Disorders

and Occlusion 7th ed Ch(19)p447
A. Md buccal cusp premature contact, preventing contact of Mx cusp to fossa, B. No contact on

laterotrusive movement, C. No contact on mediotrusive movement, D. Reduce opposing fossa
allowing contact of Mx lingual cusp tip

A. Md buccal cusp makes contact prematurely, preventing contact of the

Mx lingual cusp. Contact also occurs (B) during a laterotrusive
movement and mediotrusive movement. (D) the Md buccal cusp is
shortened allowing contact of the Mx lingual cusp

Ch(19)p449

JP Okeson Management of Temporomandibular Disorders

and Occlusion 7th ed Ch(19)p448

1.
Developing an acceptable lateral and protrusive

guidance:
1.
2.
3.
4.
When the canines are properly aligned this goal can be

easily achieved.
When canines are not properly aligned forces may be evenly
distributed to premolars.
Selective grinding in anterior teeth can be done by removing
form both Mx and Md at the same time. It will also depend
on esthetic concerns.
All adjustments for eccentric contacts are established wo
altering CR contacts already established.

7th ed Ch(19)p450

Patient Instructions
After selective grinding pts muscles may feel

tired.
Advise pt. of some roughness in teeth that have
been adjusted that will disappear with time.
Pt does not have to be aware of maintaining
any specific jaw position.
Advise pt. Lips together teeth apart

7th ed Ch(19)p448

7th ed Ch(19)p447
Partial Selective Grinding
Heavy mediotrusive contact. To adjust or not to adjust?
1. Beware of consequence when deciding bc of possible loss of ICP contact.
2. Although orthopedically unstable pt. has no report of symptoms.

3. Ortho cases that end up with flat occlusal planes may manifest this type of interference.
4. (a) Mount case with CR records and (b) do DX selective grinding, (c) have pt. wear stabilization
appliance.
5. If pt. has no symptoms LEAVE ALONE!!
THE END

Selective Grinding

Uploaded by

Copyright:

Available Formats

Selective Grinding

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Selective Grinding

Uploaded by

Copyright:

Available Formats

Selective Grinding

Lorenzo M. Prats DMD MHA FAGD

Selective Grinding Goals

With condyles in CR all possible posterior teeth contact

JP Okeson Management of Temporomandibular Disorders and Occlusion 7th ed

Indication: Assist managing certain

Only when sufficient evidence from previous diagnostic work out

JP Okeson Management of Temporomandibular Disorders and Occlusion 7th ed

Indication: Complementing treatment

Most common reason to consider selective grinding is as part of tx

Extensive fixed prosthodontics may indicate the need of selective grinding

There is no evidence at present that

JP Okeson Management of Temporomandibular Disorders and Occlusion 7th ed

Outcome Prediction: Misalignment

Extremely important that outcome must be predicted

JP Okeson Management of Temporomandibular Disorders and

To be determined in CR mounted models

Outcome Prediction: Direction and

Anterior posterior discrepancy must be analyzed by visualizing CR-ICP

JP Okeson Management of Temporomandibular Disorders and

AP slide: Mx distal incline w

JP Okeson Management of Temporomandibular Disorders and

AS slide: Mx mesial incline w

Outcome Prediction: Anterior Guidance

After CR has been examined, the position of

JP Okeson Management of Temporomandibular Disorders and Occlusion

Selective Grinding Sequence

JP Okeson Management of Temporomandibular Disorders

Selective Grinding Sequence

A. Md buccal cusp premature contact, preventing contact of Mx cusp to fossa, B. No contact on

JP Okeson Management of Temporomandibular Disorders and

Selective Grinding Sequence

A. Md buccal cusp makes contact prematurely, preventing contact of the

JP Okeson Management of Temporomandibular Disorders and Occlusion 7th ed

Selective Grinding Sequence

JP Okeson Management of Temporomandibular Disorders and

Selective Grinding Sequence

JP Okeson Management of Temporomandibular Disorders

Selective Grinding Sequence

Developing an acceptable lateral and protrusive

When the canines are properly aligned this goal can be

JP Okeson Management of Temporomandibular Disorders and Occlusion

JP Okeson Management of Temporomandibular Disorders and

After selective grinding pts muscles may feel

Selective Grinding Sequence

JP Okeson Management of Temporomandibular Disorders and Occlusion

JP Okeson Management of Temporomandibular Disorders and Occlusion

Partial Selective Grinding

Heavy mediotrusive contact. To adjust or not to adjust?

1. Beware of consequence when deciding bc of possible loss of ICP contact.

2. Although orthopedically unstable pt. has no report of symptoms.

You might also like