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Anterior aesthetics without dysfunction: a case report. Part 1: the operative dental procedure Raj Raja Rayan OBE Aesthetic Update 2025 1:3, 137-142.
Authors
Raj Raja RayanOBE
MA (ClinEd), MSc, FDSRCS(Ed), FFGDP(UK), MRDRCS(Eng), MGDSRCS(Eng), DRDRCS(Ed), BDS, LDSRCS(Eng), Former Dean, FGDP(UK), RCS (Eng), Former Associate Dean, London Deanery; Recently, Professor and Head of Restorative Dentistry, College of Medicine and Dentistry; Former restorative referral-only practice in Harley Street; Honorary Colonel of The Commonwealth of Kentucky. Now retired.
Marketing cosmetic dentistry is financially fashionable. Anterior aesthetic reconstructions are an artform showcasing the dental technician's skill. There is a perceived concern that anterior reconstructions that do not consider the functional features of the mutually protected occlusion, may, in susceptible patients, lead to dysfunction with its possible consequences. This series of three articles examines the restoration of worn upper anterior teeth with a plan for failure.
CPD/Clinical Relevance:
The mutually protected occlusion.
Article
Occlusion is a confusing subject. That is because, historically, occlusal philosophies were invented by well-intentioned, strong personalities and passionate operators promoting complicated and exacting prosthodontic procedures without any evidence based on science. The evolution of its understanding has been by philosophical experimentation, using sophisticated tools and unfortunate patients. Engineering concepts often superseded the physiological ability of such patients, often leading to pathological consequences. Occlusion has developed cult following with fixed ideologies of operating procedures and the potential for overtreatment of patients. Many eminent individuals in the field suffer from cognitive dissonance. If occlusion was the one important feature behind temporomandibular disorders, dentist would have, by now, cured this problem.
Today, the profession has moved away from the dogma of full mouth reconstructions, constructed to centric relation and balanced articulation, to one of the mutually protected occlusion. While the science for this later concept of anterior guidance and posterior stability is sparce, it is nevertheless, the current perceived wisdom. It is based on a biomechanical model that purports to reduce traumatic forces associated with the susceptible clenching parafunctionist.
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