Confirmative, re – organized or unorganized/ dental continuing education courses

Confirmative, Re – organized or
Unorganized
Stephen Davies
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

INtroduction
• Most restorative dentistry has the potential
to cause a change in the patients
occlusion. Denstists should avoid
unplanned occlusal change, because it
may lead to iatrogenic problems or
restorative failure.

Examination
How to examine occlusion

• Articulating paper –
• Red – 009
• Blue 010
• Thickness – not more than 40 microns

Sequence of using articuating
paper
• Dynamic occlusion
• Static occlusion
• First mark the dynamic occlusion using
the red articulating paper.
• Next mark the static occlusion by using
the blue articulating paper.

Why record the dynamic followed
by static
• If static occlusion marks are made first,
when the dynamic occlusion marks are
made it will rub off the static occlusion
marks during excursive movements

Reasons to carry out examination
before restortive procedures
• Can restorations be given within the
Confirmative approach, or the re –
organized approach.

Confirmatory approach
• The conformative approach is defined as
the provision of restorations ‘in harmony
with the existing jaw relationships’. In
practice this means that the occlusion of
the new restoration is provided in such a
way that the occlusal contacts of the other
teeth remain unaltered.

Re – organized approach
• When pretreatment occlusal examination
indicates that a sufficient number of occlusal
contacts are going to be destroyed or changed,
it may be impossible to keep the same
occlusion; i.e we cannot comfirm.
• The objective for re –organized approach is to
provide an occlusion that is more ideal

• The tooth level
An ideal occlusion will provide:
• Multiple simultaneous contacts
• No cuspal incline contacts
• Occlusal contacts that are in line with the
long axis of the tooth
• Smooth and, wherever possible, shallow
guidance contacts

• The articulatory system level
An ideal occlusion will provide:
• Centric Occlusion occurring in Centric
Relation
• Freedom in Centric Occlusion
• No posterior interferences (anterior
guidance at the front of the mouth).

• The essential difference between the
examination of the patient who is going to
be restored to the re – organized
approach and one to be restored to the
confirmative approach is in ‘ Jaw
Realtionship’.

Restoring a patient to re –
organized approach
• Examination
– Examine all the elements of the articulatory
system. To diagnose any preexisting TMD.
– To determine the CR position

Records

Schottlander occlusal sketch

Steps to restoring to the re-
organized approach
• To find centric relation ( stabilization splint or
lucia’s jig)
• Equilibration of standing teeth
• Diagnostic wax up
• Preparation of teeth and construction of
provisional restorations
• Provisional restorations
• Definitive restorations
• The post operative stabilization splint

Re – organizing occlusion
• EDEC principle
E – examine the preoperative occlusion
( examination phase)
D – design the restoration ( planning phase)
E – execute the design (The pre-definitive
restoration treatment phase)
C – check the restoration ( the definitive
treatment phase)

Good occlusal practice in
advanced restorative dentistry
BRITISH DENTAL JOURNAL, VOLUME 191, NO. 8,
OCTOBER 27 2001

When confirmatory approach is not
needed
• An increase in vertical height is wanted or
indicated
• A tooth or teeth is/are significantly out of
position (ie overerupted, tilted or rotated)
• A significant change in appearance is wanted
• There is a history of occlusally related failure
or fracture of existing restorations
• Reccurence of a temporomandibular disorder
that has relapsed after a period of successful
splint therapy

Planning the restoration

Custom incisal guidance

The examination and recording
of the occlusion: why and how
BRITISH DENTAL JOURNAL,
VOLUME 191, NO. 6,
SEPTEMBER 22 2001

Recording cr

Checking anterior guidance

Thank you
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Confirmative, re – organized or unorganized/ dental continuing education courses

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