To begin: Most issues with reconstruction casework that is troublesome often begins right from the first appointment by often making classic mistakes from lack of understanding of a sound start procedure. Can that be avoided, the answer is yes.

Optimization is based on the formula above as a way to bring together protocols that connects the casework that has been made to the associations of the skeletal components of the patients masticatory system, so occlusion, function and the geometry becomes protected by harmonic free movement of the mandible and lower dentition that is not antagonistic to the opposing dentition.

An Understanding of the Structure:

The masticatory system is made up of eight major components that allows our dentition to function within a gimbal axis environment in all three planes.

The Five Principles of Occlusion then is made up on these eight major components; Maxilla (1), Glenoid-fosse (2) Upper dentition (1), Lower-dentition (1). Mandible (1), Condyles (2) - Totalling the eight major components (8)

There are twenty two associations that are interactive within the masticatory system that allows the mandible to translate from a single axis point. CR /RAP being home base and has symmetry being possible in Surtrusion, Detrusion, Retrusion and Protrusion. CO then has unpredictable asymmetric movements that are not repeatable even when engaging ICP. The arch of closure is never balanced or tracked either as it is an elliptical pathway not actually rotational and then has no repeatable pathway or location of rest in RAP. Often it is in CO, centric occlusion.

Optimization is how these eight components can be arranged and set by linking the associations together to create - The Five Principles of Occlusion, so the mandible can move harmonically within a three dimensional environment (x,y,z). Horizontally, Laterally, Vertically, motivated by muscles, tracked by geometry and protected by associations. The fine tuning, other associations we can use is the remaining associations no one talks about, but we understand and can apply when required.

It is a very simple process but is driven by a system of complex interactions as they are specific to each patients individual geometry. Averaging often leaves many patients out of the averaging parameters. Therefore the ICD of 110mm is often the wrong size. Try wearing the wrong size shoes for a couple of hours. When these association are not in sync, meaning correctly associated the components will be subject to dysfunction and no matter how small that dysfunction is, all eight components will suffer varying degrees of change over time by having the wrong settings. Often seen as tooth reduction (attrition), pain or tooth alignment changes and Bruxism.

When this is understood it is possible to build into our work safeguards that makes the casework fit for purpose. Without it you might face chipping, fractures and rapid wear on composite materials, patients suffering from headaches or TMJ issues. What that means is remakes, lost time and maybe complaints.

There are two levels of optimization we can apply to casework at OSS DENTAL. Anterior optimization, is the minimal approach when no restorative treatment is being applied to the posterior quadrants, the second approach is when complete arch/s are being restored.

“Model free casework is a ticket to remakes, as free uncharted space becomes a demolition derby and we will not undertake model free dental work.”

Trouble begins at the beginning of a case by not collecting information so a case can be approached correctly from its starting point. It will take thirty to forty minutes of your time on the first appointment and long term could save you hours, maybe days and will avoid a lot of patient disappointment that is now quite common. we have a paper to explain it all.

We need a face-bow record, a centric bite and a protrusive bite and one picture.

An upper and lower set of impressions or STL files so we can cast or print models.

This is the starting point. The second appointment brings it to first stage approval.

The rest all happens in the laboratory and if we choose to use articulators, then be rest assured we have reason to do so.Depending on the case configuration, being cement retained classic or an implant rehabilitation we can guide you through our requirements to get reconstructions on track from the first appointment. I have been doing this and teaching the techniques for years and a video on our website presented by Prof. Paul Tipton explains the principles in a very clear and informative 12-minute video.

We add no extra charges for this being applied to our casework as our work is all packed as all pricing and 5PO is included in all our aesthetic cases and complete reconstructions. Eighty percent of this work is lab-side techniques not chair-side, so it is not too time consuming for the dental team, but more work for us and we do not try and avoid this protocol as it is a method of reaching the final quality control that makes the difference. On a reconstruction is takes us about six hours of extra work at the final optimization, but provides the protection to us and the patient that a remake that could take days to re-do with considerable expense will be avoided.

If you suffer open anterior bites, posterior occlusal inaccuracies, wandering mid-line instability then think about our 5PO case approach. It works.

With modern digital equipment and our developments in new articulator designs, it has given our work a 1% remake factor across the past twenty years base on the formula below and most of those remakes where not antagonistic related but due to other factors;

RCP=ICP=around RAP

(Latest version and teaching Prof. Paul Tipton | Tipton Training | England)

We can apply this to all case requirements if required, but it is mostly used on aesthetic anterior restorations so chipping and fractures can be avoided and also will reduce Bruxism and the damage caused by paranormal function. This is too complex to explain fully here in detail but a video we are developing will explain it far easier when taught visually. Then it will all makes sense.

We are constantly reviewing our techniques and we are always in development with innovative ideas and time saving solutions. Soon we will have a new CO-CR bite recorder ready soon to make the initial stages even easier to manage and more accurate and maybe by September a completely new articulator system to improve the ergonomics of case reconstructions.

When you work with laboratories that are trained in these techniques which are far and few between you will experiance dividends in time saving benefits. We are constantly reviewing our techniques and we are always in development with innovative ideas and time saving solutions. Soon we will have a new CO-CR bite recorder ready to make the initial stages even easier to manage and maybe by September a completely new articulator system to improve the ergonomics of case reconstructions.

If you are a client we will keep you up on techniques. Our ethos is to make dental work easier to manage and improve patient appreciation through professionalism and quality.