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Selective carving of natural teeth
Wolfgang B. Freesmeyer, Prof. Dr. med. dent.
Selective carving of static and dynamic occlusion in
condylar centric relation in natural teeth is one of the
invasive procedures in dentistry by which healthy
dental hard tissue is removed. For this reason, it is
absolutely essential to establish exactly its indication
and method of implementation. Selective grinding of
natural teeth may be required after preliminary
treatment of craniomandibular dysfunction with
occlusal splints, or after orthodontic treatment or
orthognathic surgery, in order to create a
harmonious occlusal relationship in the condylar
centric relation position. This article presents some
guidelines for performing selective grinding, which
are naturally also valid for grinding dental
restorations.
(quintessence. 2007;58(5):517-27)
Introduction
Selective grinding of natural teeth to restore
balanced static and dynamic occlusion is an invasive
procedure in which dental hard tissue is removed.
For this reason, this treatment should always be
carried out with great caution. Unlike what happens
with restorative treatment with crown
Correspondence: Wolfgang B. Freesmeyer.
Institute of Prosthodontics, Gerodontology and Functional Analysis.
Charité 3 Center for Dentistry and Oral and Maxillofacial Medicine.
Benjamin Franklin Campus.
Charité University Clinic in Berlin. Assmannshauser
Strasse 4-6, 14197 Berlin. Germany. Email:
wolfgang.freesmeyer@charite.de
Occlusion
and bridges, through which the vertical dimension can
be preserved or reconstructed, in selective carving it is
always reduced. The extent of retouching depends on
the amount of hard tissue that must be removed to
achieve a stable cusp-fossa relationship in static
occlusion, as well as anterior guidance in dynamic
occlusion. For this reason, a clinical and instrumented
functional analysis should always be performed before
commencing milling to allow for a trial mill in the
articulator and to determine how far the vertical
dimension should be tapered.2.7. This is the only way to
decide whether or not to perform selective carving on
the patient.
The goal of all selective carving is to obtain a
secure cusp-fossa relationship and thus support in
the sagittal and transverse directions.4,7,8. Tooth
movements should be directed by the anterior guide
and create an overall uniform spread, both on the
working and non-working sides. Before undertaking
selective grinding, one must first ask whether this
objective could not be achieved with rehabilitation
measures, such as the reconstruction of anterior
teeth worn by abrasion (Figs. 1 and 2).
Selective grinding is basically divided into two parts,
namely trial grinding in the articulator and selective
grinding applied to the patient.7.
test cut
For the trial carving in the articulator, the upper and
lower casts are fabricated in hard stone and
mounted oriented to the skull in a non-arcon type
articulator (eg Artex-TR, Amann-Girrbach, Pforzheim,
Germany). . The placement of the lower model in the
articulator is done by means of a register that
reproduces the final position of the handle.
quintessence(eng. ed.) Volume 21, Number 5, 2008 299
occlusion
Figure 1.Abrasion-worn denture of a patient with
craniomandibular dysfunction.
Figure 3.Cusp-fossa relationship pursued on the right side.
dibula with respect to the maxilla, that is, the
position to be achieved by carving. This can be
either the condylar position in centric relation or
the functional one. The latter pursues a
positioning treatment.
Trial carving is divided into three steps:
• Analysis of cusp-fossa relationships
• Carving of static occlusion
• Dynamic occlusion carving
Analysis of the cusp-fossa relationship
Through this analysis, the position of the active cusps must
be determined and the direction of correction established.
The analysis is performed both on the cusps
300 quintessence(eng. ed.) Volume 21, Number 5, 2008
Figure 2.Reconstruction of a canine anterior guide using
veneers and composite.
Figure 4.Cusp-fossa relationship pursued on the left side.
upper active cusps, the palatal cusps, as in the lower active
cusps, that is, the buccal cusps. For the same, the
relationship one to two according to Lundeen can be used
as a concept.5in neutral occlusion, or the one-to-one
relationship according to Thomas9in distal or mesial
occlusion. The most important thing is to determine how to
achieve, with the existing cusp to fossa relationship, a
stable occlusion according to the anatomical shape of the
teeth.
With some pencil marks, the target positions of the
active cusps in which there is stable support with
respect to the opposing masticatory surfaces are
indicated (figs. 3 and 4). Analysis of the cusp-fossal
relationship is performed first on the lower active
cusps on the right and left sides, and then on the
upper active cusps. For this, one observes the
Figure 5.Horizontal view of the maxilla for analysis of the
cusps. Rotated premolars 14 and 24 are clearly visible.
Representation of the first contact on tooth 23.
cast pair in the articulator from front and side, and
also from dorsal, ie intraorally.
The analysis of the cusp-fossa relationship in the models
is necessary to establish the position of the cusps
according to their static requirements and to determine the
magnitude of the loss of dental hard tissue before carving
in the mouth.
The principle of preserving as much dental hard
tissue as possible should always be respected.
Once the cusp relationship has been determined
and marked with a pencil, the dynamic analysis is
performed for the sliding of the cusp without
interference when making laterality and protrusive
movements. To do this, the articulator is moved to a
position of right and left laterality, analyzing whether
the active cusps on the non-working side can slide
next to each other without interference. If it is
observed that the cusps collide in the established
position, then their position must be modified
according to the entry and exit trajectories.7. To do
this, the position of the cusps is slightly varied in a
mesiodistal direction. In the same way as on the non-
working side, slippage between the active and non-
active cusps on the working side is then checked in
the right and left lateral position. If interference is
noted from buccal between the upper non-active
cusps and lower active cusps, or from lingual
between the upper active cusps and lower non-active
cusps, then the position of the non-active cusp is
modified, or transverse fissures are carved7. The
ideal position of the non-active cusp tips is then fixed
and marked in pencil on the cast. The function of the
Figure 6.Horizontal view of the mandible for analysis of the
cusps. Representation of the first contact on tooth 33.
non-active cusps should be retained. If this cannot be
guaranteed, a milling of the active cusp can also be
performed.
Once this analysis of the cusps in the sagittal plane has
been performed, the horizontal position of the active and
non-active cusps in the upper and lower cast is determined
(Figs. 5 and 6). At this point, the following questions should
be answered:
1. Do all the cusp tips and mesiodistal slopes of
the cusps lie in a harmonious line, or do they
need to be reshaped by grinding to achieve a
uniform cusp position and shape?
2. Do all the active cusps have the same height or
do some cusps exceed the occlusion curve?
3. Are all the fissures and marginal ridges the
same depth and do they form a line running
parallel to the line of the cusps?
If there are deviations from these ideal
relationships, they are marked on the casts and
accounted for later during carving.
Carved on the model
Selective carving on the model is divided into three
steps:
• Static occlusion carving (maximum
intercuspation)
• Dynamic occlusion carving
• Verification
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occlusion
Figure 7.Elimination of premature contacts and remodeling
of the relief formed by cusps and fissures.
Static occlusion carving
(maximum intercuspation)
It begins by representing the prematurities with
articulating paper and then reshaping the cusps and
fissures so that the teeth are modified in the cusp-fossa
relationship established according to the concept of an
ideal masticatory surface (figs. 5 and 6). As a general rule, it
is necessary to take into account which concept of static
occlusion should be applied to the patient: the concept
according to the principles of punctual centricity (point
centric) or that of freedom in centricity (freedom in centric:
long centric, wide centric).
For carving the position of maximum intercuspation
in punctual centricity, the following guidelines are valid:
• Roughen the active cusps so that they assume a
hemispherical shape and the cusp tips meet on a
harmonious line that corresponds to the fissures
of the opposing arch. All the cusps will have
approximately the same height and their position
will correspond to the established cusp-fossa
relationship.
• Deepen the fissures so that prominences (triangular
prominences) are created that establish contact with the
slopes of the antagonist cusps. These prominences in
the fossae should have a convex shape as much as
possible and come together in the valley of the fossa.
The deepest point of the fossa corresponds to the
antagonistic cusp tip. In order to create the convex
shape, it is often necessary to machine
302 quintessence(eng. ed.) Volume 21, Number 5, 2008
Figure 8.Situation after removal of premature contacts
from the upper left posterior sector. The first dental
contacts appear in the anterior sector.
secondary cracks next to the main ones. These
secondary fissures allow the creation of convex
prominences (fig. 7) and provide freedom in dynamic
occlusion.
• Shape the marginal ridges so that they acquire a
convex shape and lie on a line, all of them with
the same height.
These rules refer to the selective grinding of
prematurities and the grinding of a stable support in
the teeth of the posterior sector. However, the latter is
only possible when there is no prior contact and the
vertical ratio can be lowered accordingly. If there are
premature contacts in the anterior sector, other rules
must be applied. The reshaping of the posterior teeth is
done in several steps. After each grinding operation, the
occlusal contact relationship is checked with articulating
paper and it is decided whether a stable contact
relationship has been created. The carving of the
position of maximum intercuspation in the posterior
sector is concluded, for the moment, as soon as a
contact appears in the anterior sector (figs. 8 and 9). A
decision must then be made whether the vertical
dimension of the anterior teeth can be further reduced
by selective grinding in order to maintain stable
relationships. In this context, the following questions
need to be answered:
1. Is further reduction of the vertical dimension
clinically indicated?
2. Does the position and contact relationship of the
anterior teeth allow for additional selective grinding?

Figure 9. Situation after removal of premature contacts
in the lower left posterior sector. The first dental
contacts appear in the anterior sector.
3. Do the anterior teeth allow selective grinding from
the point of view of their shape (buccoli-lingual
extension) and taking into account the expected loss
of substance?
If the answers to these questions are yes, then
grinding of the anterior teeth first, followed by the
posterior teeth, continues until stable cusp-fissure
relationships are achieved. This selective carving is
limited when more hard tissue is removed than the
enamel layer of the anterior and posterior teeth
allows. This corresponds to a drop in level of the
models fixed on the incisal stem of approx. 2 to 4
mm. For this reason, during the grinding operation,
the reduction of the vertical on the incisal stem must
be controlled.
Anterior teeth carving
In the presence of premature contacts in the anterior
sector, the anterior teeth should only be ground
when it has been ensured that such contacts are not
due to a loss of posterior bearing zones (iatrogenic
or acquired). To decide if the anterior teeth can be
ground, it is necessary to check the existing vertical
jaw relationship. If there is a large free interocclusal
space in the posterior sector (premolar region) the
anterior teeth should not be ground; otherwise the
vertical jaw relationship would be excessively
lowered. In these cases, it is necessary from the
therapeutic point of view and it is more appropriate
for the future to rebuild the posterior teeth or elon-
Occlusion
We use maxillary orthopedics to achieve
occlusal balance. Intrusion of the anterior teeth
can also be considered through orthodontic
treatment, both in young and old patients.6.
When the interocclusal clearance of the post sector
is small (1 to 2 cm), and the anterior teeth are in
contact when examining the minimum interoal
distance during speech, then selective grinding can
be performed in the anterior sector if the thickness of
the the enamel layer allows it.
Regarding the grinding of the anterior teeth, the
additional question arises as to which arch should be
ground: the lower or the upper? The lower anterior teeth
should only be ground when there is a dislocation in the
posterior teeth. When protrusion and laterality movements
do not produce a disclusion in the posterior sector, and it
cannot be created by grinding either, then a palatal
concavity should be carved in the maxillary anterior teeth.7.
In this area, the enamel layer is generally thin, which
makes it necessary to carry out a moderate selective
carving in the upper anterior sector.
Care must be taken not to eliminate the interincisal
clearance between the upper and lower anterior teeth.
In carving, the arch of the guide of the central and
lateral incisors must be preserved, as well as the
straight or convex guiding surface of the canine.
When grinding the lower anterior teeth, the
generation of flat contacts with the upper teeth
will be avoided at all times, since they may later
become parafunctionally generated wear facets.
Convex surfaces should be created with slightly
pinpoint contacts relative to the marginal
eminences of the maxillary anterior teeth.
Once the selective carving of the static occlusion
(maximum intercuspation) has been carried out, the
dynamic occlusion is verified and corrected, that is,
of the dental movements.
Selective carving of dynamic occlusion
work side
Checking and carving of laterotrusive trajectories are
aimed at creating anterior or canine guidance and a
simultaneous and balanced distribution in the posterior
sector, both on the working and non-working sides. On
the working side this includes movements between the
non-active buccal cusps of the maxilla and the active
buccal cusps of the mandible, as well as between the
active palatal cusps of the maxilla.
Quintessence (eng. ed.) Volume 21, Number 5, 2008 303
occlusion
Figure 10. Marking of contacts in the maxilla in
laterality and protrusive movements. The interferences
in mediotrusion of teeth 24 and 27 are clearly
appreciated.
xillary and non-active linguals of the mandible. On
the non-working side, movements between the
upper active palatal cusps and the lower active
buccal cusps are affected (Figs. 10 and 11).
The goal is to ensure that, when performing lateral
movements, the cusps slide against each other without
interference and static contacts are maintained.7.
On the articulator, lateral movements are
represented by a different colored articulating paper
(red paper) than protrusive movements (green
paper) and static contacts (black paper). If
interferences arise in the posterior sector, both on
the working and non-working sides, that annul
canine anterior guidance, these are removed in the
direction of cusp movement, carving around the
laterotrusive or mediotrusive facets. To preserve
static contacts, it is more advantageous to remove
interference from non-active cusps than to grind
down active cusps. However, this can only be done as
long as the function of the non-active cusps is
preserved (bite protection of buccal surfaces and
tongue).
In case the non-active cusps require extensive
grinding to eliminate laterality interference, it is more
convenient to include the active cusps in the selective
grinding. When carving laterality movements, it is
necessary to avoid increasing the area of the
masticatory surfaces on the working side. This is
achieved by carving in a lingual and buccal direction,
without altering the position of the cusp tips. In the
presence of interference on the working side, it is also
appropriate to slightly modify the position of the cusps.
304 Quintessence (eng. ed.) Volume 21, Number 5, 2008
Figure 11. Marking of contacts in the mandible in
laterality and protrusive movements. Interferences in
mediotrusion are clearly recognized in teeth 34 and 37.
superior vestibular in a distal direction, in order to
preserve static contacts. In the mandible, a fissure
can be carved on the distal slope, distal to the static
contact (Thomas's groove), through which the upper
buccal cusp can slide.7.
If interference arises between the active upper
cusps and the nonactive lower cusps, the
interference on the lower lingual cusp is corrected.
In isolated cases, especially if they have large
upper palatal cusps, it will be necessary to reduce
these cusps taking into account static contacts in
order to preserve the lower lingual cusps. The
position of the lingual cusp tips can also be
modified mesially and distally in the molar area to
allow the active cusp to slide across the lingual
transverse cleft. Consideration of the size and
shape of the cusps and the shape of the opposing
masticatory surface is decisive in determining
whether grinding can be performed on the active
cusp or only on the non-active cusps.
rocking side
If there is interference with lateral movements to the
right or left on the non-working side, a milling should
be performed on the medial slopes of the upper and
lower active cusps. At this point it is necessary to take
into account in any case the static contacts of the
active cusps7. To preserve them, it is necessary to
carve in the direction of movement (figs. 10 and 11).
Non-interference sliding of the mesiopalatal cusps of
the upper molars over the distobuccal cusps of the
lower molars often
can only be secured by carving a complementary
concave fissure (Stuart's groove) in the upper
mesiopalatal cusps7. Freedom of movement can
also be achieved by having the contact point lie on
a convex element (cusp slope, triangular
prominence) and the masticatory surface motion
path for the opposing active cusps running on a
concave surface (Figs. 10 and 11). If interferences
occur during mediotrusion between the palatal
cusps of the upper premolars and the opposing
mediotrusive facets of the lower premolars and
molars, these disturbing surfaces can only be
compensated by grinding the upper and lower
teeth. This may require that the tips of the upper
active cusps move mesially and those of the lower
active buccal cusps distally. In this carving, to
modify the position of the cusp tips, the
punctiform support must not be eliminated.
Checking and selective carving of the
mediotrusion movement to the right and left side
is repeated as many times as necessary until an
anterior guideline has been created.
protrusion movement
The grinding of dynamic interferences during protrusive
movements is carried out in order to create anterior
guidance up to the level of the incisal edges with
simultaneous balanced distribution in the posterior
sector.7. In the articulator, the interferences in the
protrusive movement of the posterior sector are
represented with an articulating paper of a different
color from that of the static contacts (green articulating
paper).
If interferences occur during protrusive movement in
the posterior sector that prevent the anterior guide
from acting, then these interferences are removed in
the direction of the protrusive facets in a postero-
anterior direction. The protrusive facets (distal in the
maxilla and mesial in the mandible) are flattened until
they no longer override anterior guidance with
repeated protrusive movements. Depending on the
relief of the masticatory surfaces, the correction can be
carried out both in the maxilla and in the mandible.
Care must be taken to avoid removing static contacts.
Many times this is only achieved by modeling the slopes
of the cusps in a protrusive direction by making slightly
concave depressions.
This carving operation is repeated as many times as
necessary until generating an anterior guide in the direction
Figure 12. Marked areas of the upper arch where
selective carving was performed.
protrusive tion. In the event that this cannot be achieved
due to the anticipated loss of dental hard tissue, before
continuing to carve it is always preferable to rebuild the
anterior guide with composite or veneers using adhesive
techniques (!).
The interferences in the movement of the protrusive
that can be established in the patient's mouth as a
consequence of the elasticity of the biological tissues
when supporting stress peaks can be recognized during
the analysis of the models in the articulator by reducing
the angle of the condylar trajectory by about 5 degrees7.
If, after reducing the angle, there is no interference with
the protrusion movement in the posterior sector in the
articulator, then the lateral movements to the right and
left are checked and carved again.
Control
To finalize the carving of the dynamic occlusion in
the exposed directions of movement, the static
contacts are rechecked and, if necessary, re-
carved following the guidelines described. Next,
all ground areas are marked on all teeth on which
selective grinding operations have been
performed. This can be done using different
colored markers or a similar method (figs. 12 and
13): red is used for static contacts, green is used
for protrusive movement, and blue is used for
lateral movements.
This marking facilitates visual control during the
clinical implementation of the corresponding grinding
operations on the patient.
Quintessence (eng. ed.) Volume 21, Number 5, 2008 305
occlusion

Figure 13.Marked areas of the lower arch where selective Figure 14.Representation of the occlusal contacts with
carving was performed. black articulating paper.

Selective carving on the patient Once the areas of the masticatory surfaces have dried, the
assistant holds the articulating paper between the arches
It must always be kept in mind that selective grinding
and the patient closes with light manual guidance until a
in the patient is an operation for the definitive
first contact. It is often helpful for the patient to open the
removal of dental hard tissue. For this reason it must
mouth about 20 to 30 mm and then quickly close it. This
be carried out with the greatest possible care. In
movement can be guided and controlled without problems.
addition, it is necessary that in the carving session
the patient is able to reproducibly adopt the desired
Once the contacts have been represented, they are
horizontal intermaxillary relationship. Therefore, you
compared with those of the ground model and, if they
should be relaxed. If the patient is wearing an
match, they are removed from the patient's mouth
occlusal splint, it is always recommended that they
according to the rules described in the section “Trial
wear it for at least 12 hours prior to the carving
grinding” (fig. 15). If there is no match, the masticatory
session. Appropriate relaxation exercises are also
surfaces are cleaned and the contacts are re-enacted. If
advised prior to carving, such as TENS
they now match those on the carved model, then you
(Transcutaneous Electrical Nerve Stimulation),
can p
massage, and/or biting on a cotton roll or water pad
(Äquiliser) placed between the anterior teeth.
Like the trial grinding on the model, the final
selective grinding on the patient is divided into
grinding for static occlusion and grinding for
dynamic occlusion.

Static occlusion carving

To represent the early contacts and thus the areas to be
carved, the patient must sit upright in the dental chair
with the head in a horizontal position. It is necessary to
check that he does not adopt a forced posture and that
he does not try to capture the articulation paper (when
it is used only on one of the sides) by moving the
mandible laterally (fig. 14). This can be avoided by the
Figure 15.Cutting of the premature contacts on teeth 23
dentist by stabilizing the patient's head with one hand and 24 after checking that they matched those of the
and slightly guiding the mandible with the other. Once model.

306 quintessence(eng. ed.) Volume 21, Number 5, 2008

If there is no coincidence, the causes must first be
found (stiffness, incorrect determination of the jaw
ratio for the trial grind, etc.) and, if necessary, a new
analysis in the articulator. In these circumstances,
selective carving in the patient's mouth will not be
carried out in any case.
Selective grinding can be performed with the
patient fully or partially recumbent and using
cylindrical, pear- or flame-shaped fine-grain diamond
burs. For each element of the masticatory surface
(cusp, marginal ridges and fissures) the
corresponding burs are selected. To avoid having to
constantly change drills, work with the contra-angle
and the turbine equipped with the most frequently Figure 16.Representation of the occlusal contact
used drills. Grinding is done with a medium amount relationship after the first grinding cycle in the maxilla
of cooling water in order to maintain good visibility, (mirror photography). The uniform contact ratio in the four
support areas can be seen clearly.
since grinding should not be done on dentin. First of
all, the cracks around the contact area are always
deepened, and the active parts are worked by
performing a convex movement. The carved model
must be taken as a reference at all times to mentally
transfer the position of the contact points, the
corresponding cusp-fossa relationship and the
contacts between the cusps and the marginal ridges.
It begins with an arcade and progresses by
quadrants until the corresponding basic shape has
been carved.
After this first grinding cycle, the patient is lifted up
and allowed to relax briefly. Next, as described
above, a new representation of the contacts is made
(figs. 16 and 17) and compared with the carved
model. The second cycle can then be carried out. If Figure
occlusal
there are dental contacts in all four support zones or bull (photo
each tooth has one or more contacts in the posterior tion of
sector, then one can start with the representation
and carving of the protrusion, laterotrusion and
retrusion movements.

Dynamic occlusion carving

First the dynamic contacts are represented with an
articulating paper of a different color (fig. 18) and
then again the static contacts. Subsequently, the
interferences that appear in the protrusive,
laterotrusive, mediotrusive and retrusive facets are
suppressed, preserving the static contacts. For this,
the entry and exit trajectories of the active cusp on
the masticatory surface of the opposing tooth must
be taken into account. To finish each carving cycle,
Figure 18.Representation of dynamic occlusion in laterality
the static contacts that have been marked with great and protrusive movements (red articulating paper).
intensity are carved.
quintessence(eng. ed.) Volume 21, Number 5, 2008 307
Occlusion

Figure 19.Contact list after dynamic occlusion carving in the Figure 20.Contact relationship after carving of dynamic
maxilla (mirror photography). The guide surfaces of the occlusion in the mandible (mirror photography). The guide
anterior sector (red areas) are clearly visualized. surfaces of the anterior sector (red areas) are clearly
visualized.

Then, with the patient back in a sitting position, the further corrections are needed. The carving in several
representation of the dynamic and static contacts is sessions is not only suitable from the neuromuscular
performed. Then the marked interferences are cut in point of view, but also protects the dental hard tissue.
the same way (figs. 19 and 20). To finish each session, the carved areas are smoothed
During the session, both in the first and in the with Shofu polishers, polishing gums and rubber cups.7.
following ones, no more than three grinding cycles
should be carried out, since often the patients do not
Control
relax and there is a muscular reaction caused by the
manipulations. It must also be taken into account In the last session of selective carving, the static
that, due to grinding, the teeth move into a new load contacts are checked with articulating paper and
situation and, therefore, the neuromuscular situation Shimstock paper. The Shimstock articulating paper
is modified. To allow adaptation to the new situation should be held by each posterior tooth group in the
created, after each carving session a minimum rest usual intercuspation position, and not by the anterior
interval of 8 to 14 days is maintained. Finally, the teeth.
occlusal relationship achieved in the anterior and
posterior sectors is checked using fine articulating
paper (10-m Shimstock) (fig. 21). The following rule
must be observed: grind the natural denture in at
least three sessions and in three grinding cycles per
session,
It has been shown in clinical practice that an
adaptation phase of 3 to 8 days is needed after
carving, so that the patient gets used to the new
situation. This has also been corroborated by
electromyographic studies, which have shown that
normalization of levator activity only occurs after this
adaptation phase.2. Another point in favor of this
procedure in steps is the fact that after grinding, due
to the change in the action of the loads, the teeth can
adopt a new position and, consequently, the
situation of the contacts can be subjected to Figure 21.Verification of the relationship of contacts in the anterior
changes. changes. For that reason they may be and posterior sector with Shimstock articulating paper.

308 quintessence(eng. ed.) Volume 21, Number 5, 2008


Figure 22.Representation of the relationship of occlusal
contacts in the maxilla four weeks after finishing selective
grinding (mirror photography). A uniform distribution of
contacts can be seen in the posterior sector.
The posterior teeth must have at least A and B
or B and C contacts in each piece. Closing stops
and stabilizing contacts must be distributed
throughout the arch, both on the right and left
sides. Protrusive and laterality movements should
be guided evenly over the anterior teeth, and
retrusive movements over the retrusion facets of
the first and/or second premolars on both sides.
During these movements there should be a slight
and uniform dislocation (approximately 0.5 to 1.0
mm) posteriorly. If these dynamic occlusion
conditions are not achieved by selective grinding,
an anterior guide build-up should always be
considered, as discussed above.
All selective carvings require a review
appointment after 8 to 12 weeks, in which the
contact relationship is rechecked using the
method described (figs. 22 and 23), and
corrections are made as necessary.
Discussion
The carving of natural teeth is an invasive dental
intervention associated with the loss of natural dental
hard tissue, which limits its indication and requires
special care on the part of the dentist. Despite these
limitations, selective grinding of natural teeth is justified
when there are occlusal interferences that contribute to
craniomandibular dysfunction and after orthodontic
treatment, if stable occlusal relationships have not been
achieved. This too
Occlusion
Figure 23.Representation of the relationship of occlusal
contacts in the mandible four weeks after completion of
selective grinding (mirror photography). A uniform
distribution of contacts can be seen in the posterior sector.
It is valid in cases of orthognathic surgery with
transposition osteotomies to correct dysgnathia. The
essential condition to carry out the treatment is
always the knowledge of the occlusal morphology
and the objective that should and can be achieved by
grinding natural teeth. However, after selective
grinding, it should always be taken into account that
the teeth are anchored in a biological system and
that their position can change due to the change in
incidence of the loads, that is, the static and dynamic
occlusion created will not be affected. remains stable
over time2(lifelong).
From this it is clearly derived that these treatments
have a temporary limitation to protect the dental hard
tissue.
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