🦷 Occlusion: The Unsung Hero (or Villain) of Restorative Dentistry

Why we need to stop pretending it’s not a big deal..

This post is a detailed, clinician-to-clinician style summary of a lecture by Dr. Michael Melkers—“Restorative • Posterior • Occlusion in Quadrant Dentistry”—presented as part of my RipeGlobal Fellowship in Restorative Dentistry.

Let’s be honest: occlusion has a bit of an image problem. In dental school, it was treated like an academic obstacle course—dry, abstract, and impossible to visualize unless you were a literal articulator. Most of us crammed it in before finals, then promptly relegated it to the back burner while we learned how to pack composites and impress with CAD/CAM.

But here’s the kicker: if you do restorative dentistry—and I mean anything from a simple onlay to a full mouth rehab—occlusion isn’t just a side note. It’s everything. It determines whether your work succeeds beautifully or fails spectacularly.

So let’s unpack it. Not with dry dogma or esoteric terminology, but with the real-world stuff that makes you better at what you do.

🧠 A Philosophical Framework: The Three Essential Questions

This lecture distilled occlusal thinking into a beautifully simple set of questions. I loved this:

1. How do you want it to look?

   That’s your esthetic vision. Tooth form, symmetry, shade—the art of dentistry.

2. How do you make it fit?

   That’s occlusion at its simplest: how the teeth come together. You’d be shocked how often we skip this.

3. How do you mitigate threats?

   Ah. Now we’re getting into the juicy stuff—force dynamics, muscle activity, parafunction, and the unsaid reality that restorations break not because of materials, but because of load.

💥 Occlusion as a Threat: What They Didn’t Teach Us in School

Here’s what most of us weren’t taught: occlusal failure doesn’t look dramatic until it does. A little porcelain chip here, a fractured cusp there… maybe a random hole in your zirconia crown. Wait, a hole? Yep. Repeated force and friction can literally wear through “indestructible” materials. Zirconia, lithium disilicate—strong in theory, but porcelain veneering remains the weak link.

We weren’t shown failure enough.

And failure teaches.

What do these failures have in common? Force. And specifically, force applied where it shouldn’t be. Which brings us to the main antagonist in our story:

🐘 Meet the Monster Elephant: Parafunction

Parafunction isn’t some vague night grinding habit. It’s a full-blown muscular disorder in disguise. It’s cyclic loading. It’s clenching at 3 a.m. with 300 pounds of muscle force directed at your beautiful indirect restoration. It’s the patient who fractures a crown and the adjacent tooth and then says, “I wasn’t doing anything.”

Managing parafunction is arguably the greatest challenge in restorative dentistry. And yet we often just hand the patient a nightguard and hope for the best.

The lecture was blunt: in high-risk patients, sometimes your goal isn’t to stop the destruction—it’s to help them break things more slowly.

🦷 Posterior Occlusion: More Than “Dots on Teeth”

You know the drill: traditional occlusion classes emphasized centric contacts—tripod contacts, “dots not lines,” all that. But those dots, when placed on inclines, can become splitting wedges under load. That’s how you get cracked teeth, fractured restorations, and that dreaded “it felt fine at the insert” moment.

Instead, we want to design restorations that compress, not shear. Why?

🔧 Dental materials (and natural teeth) are strongest in compression

❌ They’re weakest in shear and flexure

Here’s how we get there:

✈️ Landing Pads

Imagine a flat mini-helipad on your restoration—a surface that says, “Land here!” That’s a landing pad. It’s a flat, slightly elevated surface designed to receive the opposing cusp tip under axial load.

It gives you a target, it’s adjustable, and best of all—it doesn’t redirect force off-axis like a sloped incline would. Elevating it slightly gives you control during adjustment without weakening adjacent anatomy.

🧽 Reshape Opposing Cusps

Don’t be afraid to flatten or slightly reshape the opposing cusp to make contact more axial. A little smoothing goes a long way in getting away from shear-heavy inclines.

🎯 One Contact per Tooth (Two Max)

This one’s a game-changer. Forget about trying to recreate every cusp contact. Aim for one strong, axially loaded contact on each posterior tooth (two if the shape demands). It simplifies your delivery, reduces adjustments, and decreases the risk of fracture—especially on second molars, which are already loaded like workhorses and positioned far from the TMJs (aka the “nutcracker zone”).

😬 Anterior Occlusion: Where Guidance Happens

Posterior teeth aren’t meant to handle load during movement. That’s the job of the anterior teeth—and how we design that guidance makes or breaks your long-term outcome.

Here’s the breakdown:

🧭 Anterior Guidance

When the lower jaw moves forward or to the side, anterior guidance should lift the posteriors out of contact. This spares them from damaging lateral forces.

But there’s nuance. We’re not just talking about canine rise. Even with canine guidance, muscle activity can remain high.

🔩 The Nutcracker Analogy

Think physics: the closer a contact point is to the TMJ fulcrum, the more force it delivers. That’s why a second molar gets obliterated while an incisor barely takes a scratch.

So if you guide excursive movements with the centrals, not just canines, you reduce force. This is called protrusive guidance and it’s often overlooked.

✨ Custom Incisal Guide Tables

These are the unsung heroes of anterior restorations. They allow you (and the lab) to copy existing guidance or design new guidance that’s functional, elegant, and minimally destructive.

🧘 Outstroke Equilibration

Start at edge-to-edge. Work your way back to MIP. This method respects the patient’s anatomy and creates smoother anterior guidance transitions.

🔍 The Tools That (Actually) Tell the Truth

You can’t treat what you can’t see. And unfortunately, a lot of us are still using tools that lie.

📏 Articulating Paper Thickness Matters

• 88-micron paper: too thick. Shows false positives where there’s no real contact.

• 19-micron dry articulating film: now that’s what we want. It tells the truth.

Key tip: always mark on dry teeth. Moisture creates smears and phantom marks.

🦷 Triple Trays vs Full Arch Mounts

• Triple trays are great for single units in MIP—they’re surprisingly accurate.

• But for excursive movements or multiple units, use full arch impressions mounted on a semi-adjustable articulator. Condylar position matters, and you can’t replicate that with a quadrant tray.

🧠 Treatment Planning: Respect What’s Already There

You know those cases where you want to “fix the bite” by bringing a Class II or III into a textbook Class I? Be careful. That kind of forced occlusal makeover often ends in heartbreak.

Patients adapt. Their anatomy is their baseline. Unless you’re doing full-mouth rehab with orthotic deprogramming, forcing new occlusion onto an adapted system can wreck your dentistry.

Especially with parafunctional patients, the key is managing force—not achieving idealized occlusion. Sometimes, survival is success.

💡 Orthotics & Restorative Space: Unlocking Centric Relation

A well-made orthotic can:

• Reduce muscle activity

• Allow the condyle to seat into Centric Relation (CR)

• Reveal hidden restorative space (especially anteriorly)

This opens the door to vertical dimension changes, which are safer when guided by CR and anterior guidance. An orthotic becomes a testing ground—like a clinical rehearsal.

📏 Posterior Support & Vertical Dimension

Posterior teeth do more than chew—they hold up the vertical.

When restoring vertical dimension:

• Support posterior teeth with axially loaded contacts

• Use landing pads on marginal ridges

• Avoid inclines—they flex and fail

Remember: form follows force. Beautiful shapes will crumble under the wrong forces. Ugly, bulky anatomy will hold if it’s well-distributed and well-compressed.

🧩 Final Thoughts: Be a Pedantic Realist

This lecture didn’t just teach theory—it was a call to think better. To observe failure. To simplify what we teach. To chase not just beauty, but durability.

There’s no universal “occlusion school” that gives you all the answers. But you can build your own mental toolkit by watching, trying, adjusting, and learning from your failures (and your mentors’ failures too).

If I had to distill the whole thing into a mantra, it’s this:

“Distribution and load. Reduction in shear.”

And when it comes to checking occlusion?

✔️ Dots on flat landing pads

✔️ Dots on cusp tips

❌ Dots nowhere else

Slow down. Look at wear facets. They’re nature’s way of showing you where the body wants to land. Respect that. Work with it. And your dentistry will last longer, look better, and cause far fewer 3 a.m. panic texts from patients.