SELECTIVE GRINDING

IN
PROSTHODONTICS

S elective grinding is defined as the, “any change in the occlusion intended to alter the
occlusal surfaces of the
teeth or restorations to change their form.” 2 -- GPT -9.

Goals of selective grinding –

This procedure should accomplish the following requirements. It should:
1. Develop a stable intercuspal position in CO, so that all possible posterior teeth centric
cusp tips contact opposing flat surfaces evenly and simultaneously with the occlusal
forces directed along the long axis of teeth.
2. Develop a plane of occlusion with adequate inter-arch space for prostheses replacing
missing teeth.
3. Provide laterotrusive contacts to disocclude the posterior teeth when the mandible
moves laterally.
4. Provide anterior contacts to disocclude the posterior teeth, when the mandible is
protruded.
5. In the upright head position, provide for heavier contacts of the posterior teeth than of
the anterior teeth. [1]

Selective grinding Guidelines

With respect to the removal of vertical interferences, the rule of thirds can be used to
determine if selective grinding should be attempted. Accordingly, if the occlusal interference
represents a cusp tip occluding against the opposing cusp incline close to the opposing fossa,
selective grinding is likely to eliminate the interference without exposing dentin. If, however,
the cusp tip occludes against the opposing cusp incline closest to the opposing cusp tip,
selective grinding would likely expose dentin, and restorative procedures would be,
eventually, required.
With respect to the removal of horizontal, lateral or anterior-posterior interferences, it
may be expected that slides of less than 2mm can be eliminated by selective grinding. [2]

CAUSES OF OCCLUSAL DISHARMONY:

1) Incorrect registration of re-truded contact position (RCP)
2) Irregularities in setting the teeth.
3) Tooth movement when flasking and packing
4) Incomplete flask closure.
Indications for Occlusal Adjustment:
1. To eliminate isolated occlusal interferences, when a tooth becomes symptomatic after
the placement of a new, hyper-occluding restoration or following orthodontic
treatment (In rare cases, therapeutically-induced changes in occlusion can be
associated with the onset of TMD-like symptoms. In these uncommon instances,
adjustment of the occlusion may be warranted, as it will decrease the pain and
mobility and it will improve function, but it should be undertaken with as little
invasiveness as possible.
2. When it is determined that a periodontally involved tooth has increased mobility
which is due to traumatic occlusion rather than solely to attachment loss.
3. In the management of symptomatic fractured teeth or of prosthetically restored teeth
which fracture repeatedly.
4. Occasionally, prior to procedures which will result in major occlusal changes, such as
prosthetic reconstructions.
5. Following orthodontic treatment to correct minor interferences that cannot be
corrected solely by tooth movement.
6. As a form of limited supportive therapy, e.g. when a tooth in para-function becomes
hypermobile and hypersensitive, keeping in mind that selective grinding does not
replace treatment aimed at decreasing para-function (In these cases the occlusal
contact should be reduced, but not eliminated altogether.
7. Following occlusal splint therapy, selective grinding is indicated, once occlusal
appliance therapy has eliminated the TMD symptoms, and only if it is determined that
the symptoms would disappear permanently, if the occlusal contacts and jaw position
provided by the appliance were permanently reproduced in the patient's occlusion.
8. Following the placement of implant-supported crowns, in order to decrease the
incidence of biomechanical complications, such as crown-screw loosening or denture
tooth fracture. [3]

Contraindications to Occlusal Adjustment:

1. The absence of signs and symptoms of TMD.
2. The presence of acute oro-facial pain and /or dysfunction unrelated to occlusion
3. When the occlusal adjustment would require grinding beyond the enamel (e.g. slides
greater than 2mm).[4]

SELECTIVE GRINDING OF ANATOMIC TEETH:

Articulating paper of minimum thickness is used for marking the actual contacts of
the teeth. The diagnostic adjustment was first made on the casts and then on the patient using
four differently colored ribbons:
1. Red: centric stops
2. Black: protrusive interferences
3. Green: working side interferences
4. Blue: balancing side interferences[5]
The techniques are as follows:
1. Adjust the horizontal and lateral condylar inclinations of the articulator to the settings
dictated by the protrusive inter-occlusal maxilla-mandibular relationship record.

2. Release the horizontal condylar elements to allow freedom of the articulator movements in
the eccentric
positions.

3. Raise the incisal guide pin from the guide table and secure it above the height of the table.

4. Evaluate the areas of the tooth contact in the centric and eccentric positions prior to
selection of the point or area to be reduced or altered.

5. With the condylar elements against the centric relation stops, close the articulator until the
posterior teeth are in contact. the anterior teeth should not be in contact. examine the lingual
cusps of the maxillary posterior teeth and the buccal cusps of the mandibular posterior teeth.
premature contact appears when the remainder of the teeth fail to make maximum inter-
cuspation. record the area or areas of premature contact. The contacts may be in varying
amounts and may involve more than one cusp or tooth. These varying situations make
necessary critical evaluation prior to grinding procedures in the centric position; however
further evaluation in the eccentric positions is necessary before one starts any grinding.

6. Secure the right condylar element in the centric position and place the lingual cusps of the
maxillary posterior teeth in balancing relation with the buccal cusps of the mandibular
posterior teeth and the cuspids in their working position on the opposite side. The teeth are
placed in these positions and not shifted from the centric to the eccentric position with the
teeth in contact. This procedure often results in breaking or chipping teeth. when the teeth in
the balancing side is not in correct relation, the error appears on either the balancing or
working side. If the balancing contact is excessive, the working side teeth will not be in
contact. if the working side contact is excessive, the excess prevents contact on the balancing
side. if the teeth on the working side are too long, there will be no contact on the balancing
side. if a single tooth is high on the working side , there will be contact neither on the
balancing side nor on the working side .

7. Record the premature contacts. repeat the procedure with the left side as the working side
and record the premature contacts. Use articulating tape to mark the areas of premature
contact for selective grinding. when using tape, exercise care to prevent the tape from
wrinkling or doubling, as this will result in an error in marking. place the tape on occlusal
surfaces and the incisal edges of all the mandibular teeth. when the teeth are brought together,
this position assures that the same force is exerted on all the teeth.

8. Return the incisal guide pin to the table and use the following grinding procedures to
ensure balanced occlusion in the centric and eccentric position.
a. If the cusp is high in centric or eccentric position, reduce the cusp.
b. If the cusp is high in centric and not in the eccentric position, deepen the fossae or the
marginal ridges. after all interceptive contacts have been removed in the centric and eccentric
positions,
(1) Do not reduce the maxillary lingual cusp or the mandibular buccal cusp and
(2) Do not deepen the fossa or marginal ridge of any tooth.
9. When one wishes to refine the teeth to retain contact when the articulator is being moved
to and from centric and eccentric position – balanced gliding occlusion - use the following
selective grinding procedures: on the working side reduce the inner inclines of (a) the buccal
cusps of the maxillary teeth and (b) the lingual cusps of the mandibular teeth.

ELIMINATING OCCLUSAL ERRORS IN NON ANATOMIC TEETH:

An Inter-occlusal Centric Relation record is made in a bite registration material with the
opposing teeth just out of contact. Dentures are mounted on articulators and the following
procedures are undertaken.
1. After being detected by articulating paper between the teeth, gross premature contact
in Centric Relation are removed by grinding. Same procedures are used to locate and
remove all occlusal interferences lateral and protrusive movements. The grinding is
done that appear to have been ripped or elongated in processing. In Centric Occlusion
no grinding is done on the disto-buccal portion of the lower second molar. All
balancing- side grinding is done on the lingual position of the occlusal surfaces of the
upper second molar.
2. Abrasive paste is placed on the teeth on the articulator. These teeth are milled when
the upper member of the articulator moves in and out of protrusive and right and left
lateral excursions. When the teeth slide smoothly through all excursions, the dentures
are removed from the articulators and washed. Seldom is any correction necessary to
attain a bilaterally balanced occlusion.
3. Spot grinding is done to correct any small discrepancies in Centric Relation that
remain after the grinding with abrasive paste. The dentist adjust them after identifying
the discrepancies with articulating paper – using a light tapping motion with the
articulator and grinding the marks to ensure even occlusal contact in Centric
Occlusion.[6]

References:
1. Okeson J.P., Management of Temporomandibular Disorders and Occlusion. 7th
edition Elsevier, Mosby 2013.
2. Manfredini D., Favero L., et al., Natural course of temporomandibular disorders with
low pain-related
3. impairment: a 2-to- 3 year follow-up study. Journal of Oral Rehabilitation
2013;40:436-442.
4. List T., Axelsson S., Management of TMD: evidence from systematic reviews and
meta-analyses. Journal of Oral Rehabilitation 2010;37:430-451.
5. Rollman A., Visscher C.M., Gorter R.C., Naeije M., Improvement in patients with a
TMD-pain report. A 6-
6. month follow-up study. Journal of Oral Rehabilitation 2013;40:5-14.
7. Tetsuo saito et al : Quintessence international , vol. 21, number 11/1990.
8. Heartwell C M and Rahn A R . Denture insertion . 4th edition . Bombay; Varghese
publishers 1992; 402-404.