THE EDITOR'S CORNER

Opinions vary concerning the wisdom of occlusal equilibration for orthodontic patients. The spectrum of opinion runs from no equilibration at all to constant equilibration beginning as a diagnostic aid.

It is difficult to justify occlusal equilibration of an untreated malocclusion to confirm centric relation. It is also difficult to justify equilibration during active treatment when the therapy itself may eliminate the interference. There may be some orthodontists who are so intuitive about occlusion that they can assist treatment by equilibration, but it would be difficult for the average one of us to remove occlusal tooth structure in anticipation of the finished result. I doubt that the average one of us would know whether he was favoring or impeding tooth movement, if that were possible to do by equilibration.

With regard to post-treatment equilibration there is the question of should it be done at all; if so, to what extent and at what time. In trying to make such a choice, we are hampered by a lack of knowledge of the long term effects of equilibrating and of not equilibrating. If there is good and poor equilibration technique, we don't know the long range benefits of good equilibration or the long range detriments of poor equilibration. One can make a theoretical case for eliminating occlusal interferences in terms of prematurities producing adverse tooth movements, slides, plunger cusps, bruxism or non-functional grinding, TMJ problems. Yet, periodontists as a rule are opposed to prophylactic equilibration.

I think, on the basis of possibilities, there is a stronger case for doing some equilibrating than for doing none. As with other therapy, it brings with it a prerequisite of competence. Training in equilibration and competence in its execution have been an influential factor in deciding whether an orthodontist did or did not equilibrate and how much. Many of us are untrained in techniques of equilibration. If you have no expertise in it, it is easy to establish a rule not to do any. It is also wise. However, that doesn't mean that it is good. To the contrary, if one were able to equilibrate without harming the teeth, the potential gain in possibly avoiding periodontal and TMJ problems, plus a factor of occlusal comfort, would make equilibration a justifiable procedure.

Within a framework of competent performance of harmless equilibration procedures, how much equilibration is done might depend on how competent one may be, how much time one feels is warranted to invest in the procedure, and on patient selection. If one has a fearful patient, a patient with unusually sensitive teeth, or a patient with psychological problems, one would do well to join the periodontists and do no prophylactic equilibration. If one has a limited competence, one can perform equilibration to eliminate the gross interferences in centric, working side and balancing side occlusion. If one is fully conversant with equilibration theory and technique, one can tailor his equilibration to his competence.

With regard to when post-treatment equilibration should be done, one guide might be to do gross equilibration relatively early in retention and finer equilibration following retention.

We orthodontists have probably been too content to let the other dental specialties be the keepers of the keys to occlusion. It seems apparent by now that each of them has interpreted occlusion in terms of the problems allied to their special approach to dental occlusion. Prosthodontists are concerned with the occlusal requirements of restorative dentistry. It seems obvious that one cannot apply the same rules to teeth that are unattached, as in full dentures, and teeth that are embedded in bone, as in the natural dentition. Nor can one apply the same rules to an artificial occlusal surface, as in full-mouth rehabilitation, and the occlusal surface of the natural dentition.

Periodontists evaluate occlusion from the point of view of periodontal health. This seems closer to a standard that orthodontists can use. But, it may not be so wise to lump orthodontic patients with the rest of the population. We are often making changes in what may be a relatively stable malocclusion. Attention to the possible equilibration needs would at least cause us to study more closely the changes that we are making. It surely would be a service to our patients if we were able, by equilibration, to make our results more stable and more comfortable, and prevent some periodontal damage and TMJ problems. It is not to our credit that we do not know whether we can or we can't accomplish these things. In the absence of knowing, we may be erring on the side of caution to do no equilibration. On the other hand, there would be no error if equilibration were accomplished without harming the teeth and to an extent commensurate with the judgment and competence of the orthodontist. Proper training and awareness could make prophylactic equilibration as acceptable as any other prophylactic procedure and prevention is better part of cure.