Occlusal adjustment in periodontal therapy

Occlusion is the relationship of the teeth of the upper and lower jaw when they are joining. Occlusion adjustment is achieving the right relationship between the dental curves. This is one of the main objectives of any dental treatment, along with the correct occlusion (correct contact of the teeth).

At present, occlusion adjustment in adulthood is an absolutely normal practice, many patients over 50-60 years old successfully correct the occlusion.

Why it is necessary to correct the occlusion:

  1. When the absence of contact, the teeth tends to opposite teeth; when supercontact or improper joining, the teeth are destroyed, the abrasion of the teeth appears. Both cases lead to the gradual loss of teeth, and the process takes place over the years, and not towards old age as many people believe. The tooth sensitivity appears.
  2. Improper joining of teeth leads to an overload of the maxillo-temporal joint, the crunch, the clicks or discomfort are appears. Headaches are often added to them.
  3. In the modern world, even teeth are part of the image of a healthy, successful person. In addition, an malocclusion causes an abnormal, unnatural proportions of the face.

Contraindications for the occlusion adjustment

Absolute contraindications are quite rare, often talking about relative contraindications:

  • Serious periodontal diseases (gums and everything that holds a tooth in the jaw).
  • Mental illness.
  • Carious and other lesions of the teeth.
  • Pregnancy is not a direct contraindication. However, it should be borne in mind that the process of occlusion adjustment is long, requires visits to the doctor (usually once a month or every 2 months).
  • Other situations when visiting the doctor is difficult.
  • However strange it may sound, the reluctance to correct the occlusion is the main contraindication. After all, you must follow all the recommendations of the doctor, carefully monitor hygiene, etc.

Types of malocclusion

Normal, healthy is orthognathic occlusion. The classification, among other things, is based on the ratio of the location of the sixth teeth of the upper and lower jaws:

Class 1
Neutral occlusion, when the ratio of the teeth of the lower and upper jaw is normal, but there may be overcrowding or gaps and other deviations from the normal arrangement of the teeth.
Class 2
Distoclusion, when the lower jaw is too far back.
Class 3
Mesiocclusion, when the lower jaw is too far forward.

These types of occlusion can be combined with the following anomalies of the teeth location:

  • Deep occlusion – the upper incisors overlap the lower teeth too much.
  • Open occlusion – the incisors of upper and lower jaw do not joint due to the presence of a gap between them.
  • Cross occlusion – when the teeth of the upper and lower jaws intersect.
  • Overcrowding – the teeth are incorrectly located due to lack of space.
  • The gaps between the teeth are the anomaly opposite to the overcrowding. Including, diastema is a gap between the first incisors.
  • Center shift is a common anomaly, and sometimes the result of improper orthodontic treatment when there is no symmetry
  • Progeny is a more general concept than the mesiocclusion, when the front teeth of the lower jaw are in forward of the front teeth of the upper jaw.

Methods of occlusion adjustment

Occlusion adjustment is a complex task, the solution of which involves doctors of different specialties, and the orthodontist plays a leading role in planning and treatment.

  • Retainers are removable orthodontic appliances, usually installed in childhood (up to 11-12 years old).
  • Braces – most often used in the occlusion adjustment at the age of 11-12 years.
  • Splints – modern alternative to the braces. They are removable and made of transparent plastic individually for the patient.
  • Orthognathic surgery – it is resorted to in rare cases.
  • Installation of crowns, veneers – strictly speaking, occlusion – the teeth location ratio, but also when occlusion adjustment, they achieve the correct occlusion (proper joining of teeth).

Stages of occlusion adjustment during orthodontic treatment

Diagnostics, planning, preparation

  • Examination of the patient, determination of the correct occlusion. Determination of treatment necessity and possibility.
  • X-ray studies (CT, TRH, OPTG – if necessary).
  • Taking casts and making plaster models.
  • Photographing.

Orthodontic treatment

First stage

If the occlusion adjustment was chosen by braces, first of all, they are installed.

Contrary to the wishes of patients, even when the teeth are curved on one jaw only, most often, braces need to be installed on both, since there will be no proper closing of the teeth after the movement of the teeth only one of the jaws.

When treating with splints (transparent plastic aligners), the doctor sticks attachments to the teeth – small bumps that help the splint hold better, if necessary).

Continuation of treatment, scheduled visits to the doctor

Depending on the diagnosis, the treatment goes through different stages, such as jaw dilation, bodily movement of teeth, etc.

The frequency of visits to the doctor depends on the appliances chosen:

  • Ligature braces – about 1 time per month.
  • Self-ligating braces – about 1 time in 1.5-2 months.
  • Splints – depends on the stage of treatment and recommendations of the doctor – it’s possible 1 time per month or 1 time in 2 months.
End of treatment
They are removed during treatment on braces and residues of glue are removed from the teeth.
Retention period
A very important stage that goes right after orthodontic treatment is the retention period. It consolidates the achieved result. Neglect of them often leads to negative feedbacks of patients, such as “after treatment, all the teeth returned to the initial place, the treatment did not make sense.” Therefore, immediately at the end of treatment, wire retainers are usually installed and splints or retainers for the night.

Duration of the occlusion adjustment

Each stage of treatment takes a certain time:

  1. Diagnosis, planning, preparation – can take one day to several weeks
  2. When treating on splints or individual braces, for example Incognito, it takes some time to manufacture and deliver them – from one to two months.
  3. Installation of braces usually occurs at the next reception after diagnosis and preparation, and takes about one hour.
  4. Terms of wearing braces are highly dependent on the diagnosis. It can be generalized to say that in a large percentage of cases, this period is 1-1.5 years with an average degree of curvature of the teeth and irregular bite. In simpler cases, treatment on braces takes about 6 months, and in difficult cases it can be 2 years or more. Usually the teeth move 0.5-1 mm per month.
  5. The removal of braces (or attachments for splints) takes approximately one hour.
The retention period always lasts in different ways: approximately, we can say that the wire retainer should be worn 2 times longer than the patient wore braces or splints. Retainer does not cause inconvenience to the patient.


Postgraduate training (Aspirantura) supervised by DMSc Professor Elizarova. More than 35 advanced training courses.
More than 17 years experience in the best clinics.

More than 22 advanced training courses. More than 10 years experience in the best clinics. Treatment using multi-loop arch wires (MEAW) without extraction of premolar teeth.
Holder of Postgraduate Degree (Aspirantura) in Orthodontics awarded in the Russian Federation, attended advanced training courses in Malaysia and Spain. Actively participates in conferences and is an author of scientific works.
Treatment of TMJ dysfunction with splint therapy. FACE Certified Specialist. Internship in Spain.
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