So much attention is placed on the esthetics of the anterior teeth and not as much on the posterior teeth. But when you are looking at beautiful smiles, the posterior teeth do come into view and can either enhance the smile or distract from it. That’s where occlusal anatomy becomes so important.
Cusp anatomy, contours, and color all play into the harmony of a smile. As dentists, we spend the majority of the day working on posterior teeth. I am sure it also makes up the bulk of most dental lab businesses. Often we get into a routine of doing posterior dentistry and esthetics get pushed aside.
If you want to enhance the esthetics of your posterior work, there are ways to communicate this to the lab:
Clinical Tips for Occlusal Anatomy and Posterior Restorations
1. You must have adequate clearance for the lab to create proper cusp height and central groove depth. Often labs are left with under-reduced teeth and have to make crowns flat so as not to compromise strength. The opposing tooth can also play into the shape of your anatomy.
2. Occlusal photographs can relay information to the ceramist. I recommend the Buccal Mirrors #1 or #2 by Photomed. You essentially use one cheek retractor and place the occlusal mirror on that side to capture the occlusal image. You can indicate what kind of stain (Occlusal Halo and Pit) or lack of stain you want for that restoration.
3. Full arch impressions can provide information about the contralateral tooth. Beautiful smiles are balanced left to right, so if the tooth has a certain angulation, prominence, and length, or if the cusp shape is unique, communicating this with a full arch impression shows the contralateral tooth for the ceramist to copy. Quadrant impressions don’t provide the same view for the ceramist.
4. Pre-op scan or impression: With new digital technology, labs will someday be able to replicate the exact tooth. For now, these records give them an accurate picture of the original tooth shape.
How do you handle occlusal anatomy? We’d love to hear from you in the comments!