Title: Restorative management of a deranged occlusion: A reductive and additive approach – case series
Abstract:
The management of occlusion remains a significant clinical challenge in dentistry. Conditions such as lateral open bites, anterior bite discrepancies, and occlusal disharmony can arise due to various factors, including post-traumatic changes to occlusion, differential over-eruption resulting from prolonged anterior partial-coverage splint therapy, and parafunctional habits. This can lead to functional and aesthetic complications, with the potential for progressive deterioration, necessitating a tailored management approach. These occlusal discrepancies can be classified based on their location, aetiology, and extent, influencing the management approach. Patients often present with reduced masticatory efficiency and function, speech difficulties, occlusal instability, compromised aesthetics and an increased risk of temporomandibular joint (TMJ) dysfunction. These challenges highlight the need for a comprehensive and structured approach to occlusal management. While non-restorative management options, including orthodontic therapy and surgical intervention are often required for severe occlusal discrepancies, restorative solutions provide a minimally invasive and practical alternative in select cases. A reductive restorative approach can be taken in the form of occlusal equilibration, which involves trial adjustment on models mounted on a semi-adjustable articulator to guide occlusal reduction in the form of enameloplasty, thereby optimising occlusal contacts and improving stability. An additive approach, on the other hand, includes the use of direct and/or indirect occlusal restorations based on diagnostic wax ups to restore lost tooth structure and improve function, either in isolation or in conjunction with reductive management. In some cases, a multidisciplinary approach combining orthodontic, surgical, and restorative treatment may be necessary for long-term success. This case series outlines the diagnostic process, occlusal analysis, treatment planning, challenges, and clinical outcomes associated with both reductive and additive approaches across three case reports. Two case reports will be presented demonstrating a reductive strategy for managing post-traumatic occlusal challenges, including occlusal adjustment, mounted cast analysis, and model surgery to assess and execute necessary tooth modifications. A third case will illustrate an additive approach to occlusal management, utilising direct and indirect restorations to re-establish occlusal stability and function. The role of minimally invasive adhesive techniques and digital workflows in achieving predictable outcomes is also discussed. By highlighting these three cases, this case series aims to provide clinical insights into the decision-making process for managing occlusal derangement, demonstrating practical, evidence-based strategies to restore function, stability, and aesthetics with a conservative restorative approach.
