-You will learn that the knowledge that determines the following approach is real! It's predictive!!

If we act from knowledge, our outcomes will always be predictable, consistent and successful

You will learn that there are only 2 functions that matter for occlusion.

1. swallowing--we should check habitual closure (HC)

2. chewing--we should check lateral excursions

You will learn the 3 criteria for establishing healthy, functional occlusion for your restorations in HC.

1. cusp/fossa, cusp/marginal ridge point contacts establishing exclusively vertical loading

2. no premature contacts, no lateral interferences, that is: nothing in the vertical or horizontal planes that will create an imbalance

3. specific vertical support through the muscle pull--that is, ideally, the palatal cusps of the upper 1st molars contact into the long axis--the fossas--of the lower 1st molars

You will learn why thin marking materials, hard acrylic splints and computer sensors will not always give you reliable, accurate occlusal information for patients with occlusal dysfunction or parafunction.

Important principle: If there is any inadequate support, any imbalance or interference in the dentition, there will often be unconscious compensating or protective muscle activity that will shift the bite into a parafunctional or dysfunctional position that does not reflect a healthy, comfortable, functional joint position. This position is the least uncomfortable position that the patient can unconsciously find but this protected, compensated, least uncomfortable position

can create destructive forces and even act as a 'trigger' for night-time clenching or grinding.

Important principle: the underlying, fundamental etiology for parafunction is almost always a malocclusion--not "stress". Stress can exacerbate or even initiate short-term parafunction but the real etiology is almost always a malocclusion. This goes against the conventional view but it is absolutely true and if ignored will keep dentistry from ever getting a handle on occlusion

You will learn of the 3 specific areas affected by the unhealthy, destructive forces generated by dental malocclusions/occlusal dysfunction that can create such varied, disconnected and confusing symptoms

1. teeth: sensitivity to temperatures, brushing, chewing; fractures, wear, open contacts, mobility

2. attachment tissues: promotes or exacerbates periodontal disease, promotes gingival recession

3. muscles of the head, neck and joints (that may also create symptoms in the joints): tension in head, face and neck; headaches, tinnitus; and even very sore, painful muscles or joints

You will learn how to use a short questionnaire to identify parafunctional and dysfunctional patients so that you might avoid treatment failures or aggravating a pre-existing situation that you'll be blamed for.

You will learn how to use a quick, 3-minute, 3-step, dynamic, 3-dimensional diagnostic approach to reliably and accurately diagnose occlusal dysfunction and/or helpfully confirm healthy function.

1. index finger palpation of the patients' upper front teeth

2. assessment with special base-plate wax

3. assessment with special marking paper and silk

Important principle: the assessment must be done 3-dimensionally and dynamically diagnosing with the conventional static or 2-dimensional approach doesn't always work!

You will usually just end up recording / marking the compensated, parafunctional bite position Very Important principle: the wax and thick paper obscure the malocclusions so that the patient's proprioception is changed--you get a truer joint hinge axis because now the muscles don't have to protect or compensate, this gives you the bite that you need to treat or restore to

You will learn the 2 "keys" to occlusion that will remove the uncertainty and confusion in locating the true, fundamental occlusal issues.

1. DON'T CHASE SYMPTOMS!! The symptoms are almost always secondary symptoms! They are the result of the patient unconsciously shifting off of the primary malocclusion.

Important principle: if you chase symptoms, you will be playing endless 'Whack a Mole' with the patient's malocclusion and dentition, and usually without ever resolving the problem 

DON'T CHASE OR FOCUS ON SYMPTOMS, FOCUS ON MALOCCLUSIONS!!

2. I can't--and neither can you--consistently, actively, directly "deprogram" over-active muscles! Important principle: the muscles have to be calmed passively, indirectly by removing causes!! Again, this goes against the conventional view but clinically, it's always predictably true

You will learn what are the only 3 dental malocclusions.

1. lack of specific vertical support against the muscle pull in the area of the 1st molar

2. premature contacts anywhere creating imbalances in the vertical plane

3. unwanted forces in the horizontal plane that create imbalances or dysfunction in habitual closure (HC) or chewing

You will learn that focusing on the joints is usually not very helpful

Important principle: jaw joints don't like to be pushed, pulled or twisted--if they are, then very often, the muscles around the joints have to over-actively compensate or protect against these unhealthy forces. Any clicking, popping, locking, restricted or uneven opening of the jaw are usually just symptoms of over-active, protective muscles trying to cope with a malocclusion

You will learn how to screen parafunctional patients or patients with joint symptoms so that you identify occlusal dysfunction as the correct etiology as opposed to patients with TMD.

Assessment using a specific, lower, soft, dynamic, 3-dimensional diagnostic splint is often helpful, and even mandatory when there are joint symptoms Important principle: this diagnostic tool will screen out truly TMD situations that I never want

to treat--it confirms the etiology to be occlusal, not neurological. It reassures the diagnosis.

You will learn a quick, superficial, non-invasive, 4-step treatment sequence to treat occlusal dysfunction.

- first, in patient's habitual, closed position:

1. allow for any 'joint decompensation' by thoroughly removing any anterior prematurities and any lateral- or distal-driving contacts or smears on the slopes

2. add specific vertical support through the lower 1st molars if required

3. exclusively vertically-loading 'point' contacts confirmed or re-established

then, but only after a functional, comfortable, habitual closed position is established, in lateral shifts:

4. healthy chewing function confirmed or established

You will learn the only 3 criteria for making any adjustments on your restorations or your patients' dentitions in a predictable, safe manner--only remove what you don't want!

1. do not remove supportive, point contacts from the cusp tips, fossas or marginal ridges-- especially, never remove or fail to provide support for the palatal cusps of upper 1st molars through the fossas--through the long axis--of the lower 1st molars

2. reduce all smears from slopes but leave a part of every smear as the appropriate,vertically- loading point contact to contact and support the opposing tooth

3. after dealing with the slopes, reduce any excessive point contacts but only on cusp tips!-- never deepen the fossas or reduce marginal ridges--while always retaining the necessary point contact

You will learn that 3 points of vertical contact on a posterior tooth will create huge stability for our restorative and orthodontic treatments 

Important principle: triangles are very stabilizing

You will learn that correct canine or group guidance is essential for healthy chewing function.

Important principle: when chewing, the jaw should be guided laterally of course, but also slightly forward

You will learn how to easily and accurately find/identify any working and non-working interferences.

1. working interferences are found on the same side of the dentition that the patient is shifting to and are always distal-driving to the mandible--the jaw is directed, pushed toward the joint space--which is never good

2. non-working or balancing interferences are found on the opposite side of the dentition that the patient is shifting to and always generate lateral interferences which are also never good-- they act like a longer 4th leg on what should be a 3-legged stool (the 3 'legs' being the 2 joints and the canine guidance) during chewing

You will learn of the potential very negative consequences to your dentistry of not finding/identifying and then eliminating these working and non-working interferences.

You will learn how focusing on healthy occlusion will make your dentistry more efficient, easier and more successful and satisfying.