Equilibration Seminars with Norm Culver, DDS

Course Outline: Equilibration Seminar Content

two tooth sketches

EQUILIBRATION SEMINAR

For more information phone Dr. Culver at 360-378-7145 or visit
www.equilibrationseminars.com

INDICATIONS FOR EQUILIBRATION - controversial

  1. Bruxing, clenching, TMJ, myofacial symptoms?
  2. Mobile teeth, with heavy wear?
  3. With restorative?
  4. Post-ortho? - for rebound? - before and/or after band removal?
  5. If significant perio? - if traumatic occlusion? - if mobility and vert bone loss?
  6. Some endos? - fracture prevention?
  7. Neuromuscular vs. occlusal etiology? - noxious proprioception?

NEED FOR OBRTAINING CENTRIC RELATION OCCLUSION (CRO)

  1. Comparison and definitions of CO, MIP, CR and CRO - demos
  2. Rationale for obtaining CRO - or for doing any equilibrating - expert opinions
  3. Common objectives: elimination of eccentric prematurities and excusive interences - demos
  4. Importance of centric - in chewing, swallowing and parafunction
  5. Prophylactic equilibration - if only an anterior slide present?
  6. Reasonable indication: combination of prematurities, heavy facets and needed restorative - even if no present symptoms
  7. Consequences of not equilibrating: perpetuation, lost opportunity, future equil compromises
  8. Harm from equilibration? - expert opinions
  9. Reversibility of appliances vs. equilibration
  10. Freeing mandible and long centric - VD change?
  11. Usually nothing to lose and often something to gain
  12. Significance of changes in centric over time
  13. Prematurities - unnatural and vicious cycle
  14. Significance of heavy eccentric facets
  15. Expert quotes

WHY EQUILIBRATIONS ARE NOT MORE COMMONLY DONE

  1. Little taught in schools
  2. Equilibration, a secondary part of related post-grad classes
  3. Taught equilibration methods - complicated, vary greatly and confusing
  4. Case presentation - considered difficult
  5. Questionable isnurance coverage and profitability
  6. Conflicting expert opinions

EXACTLY WHAT AN EQUILIBRATION IS

  1. Making CO and CR match - demo
    Mandibular position - most retruded, most superior or lightly guided?
    Deprogramming - discussed later
    Main objective - no slide
    Anterior slide - and anterior constriction
  2. Adjusting working side
    Cuspid rise and group function
    Rule concerning change
  3. Adjusting balancing side
    Rule concerning balancing contacts
    Comparison to full denture occlusion
  4. Anterior adjustment - guidance and cosmetics
  5. Widened occlusal areas
    All discussed more later

CONTRADICTIONS, COMPLICATIONS, APPLIANCES AND REFERRALS

  1. True TMJ problems - load testing for pain - by manipulation or deprogramming
  2. Use of an orthotic
    Permissive orthotic construction
    Upper vs lower
    Soft vs hard material
  3. Severe Bruxing, nocturnal parafunction - signs, etiology and prognosis - appliance usage
  4. Lost vertical dimension - splint test - treatment vs referral
  5. Muscle disorders - appliance, equil or refer
  6. Class III, cross bite, etc.
  7. Anterior constriction - cause: ortho or restorative
  8. Limited opening and movements
  9. Significant emotional problems - and visa versa
  10. Usual options - splint, equil, refer

EXAMINATION FOR THE NEED FOR AN EQUILIBRATION

  1. A few minutes and impressionable to patient
  2. Questions to ask patients
  3. Things to examine for

ARMAMENTARIUM - SIMPLIFIED

  1. Type marking material and holder
  2. Stones and burs
  3. Finishing

DETERMINATION OF DESIRED CENTRIC

  1. Hand manipulation
    One or two handed
    Amount of pressure
    Demonstration
    Patient instructions
    Muscle resistance - resting - need for N2O, valium, TENS - vs deprogramming
  2. Deprogramming - muscle relaxation but appliance needed etc.
  3. Deprogramming requires no manipulation - but manipulation right now
  4. Relative amount of distilization with the two methods

THE EQUILIBRATION PROCEDURE

  1. Techniques vary and unnecessarily complicated
  2. Need for and use of mounted models
  3. Dental chair position
  4. Minute interferences
  5. Prophylactic equilibration and occlusal awareness
  6. Informing patients - tooth damage, decay and sensitivity
  7. Drying and marking teeth
  8. If heavy salivation
  9. Order of centric adjustments
  10. Grinding - stones vs. burs - cooling
  11. Sensitivity during and following adjusting
  12. Finishing - finishing burs and disks - after each appointment

Corrections of eccentric prematurities

  1. Specific adjustments not covered well in classes
  2. Rule concerning adjustment of inclines vs. cusp tips
  3. Usual first area of contact
  4. Adjusting upper vs. lower teeth
  5. If a cusp tip needs adjusting?
  6. "Stamp cusps"
  7. "Warping" and "walking" contacts
  8. End point of adjusting - no slide, even contact, cusps to flat areas
  9. If uneven contact
  10. Effect of arch flare in adjustments
  11. Specific adjustments and exactly how to do them
  12. Light tapping - for mobile teeth
  13. Then "chop" and finger check for mobility
  14. Mobile, depressed and displaced teeth and muscle discomfort
  15. Number, length and amount of treatment on appointments
  16. Resultant degree of long centric
  17. Demonstrations
  18. Occluding of subsequent crowns - to new vs. long centric
  19. Adjusting teeth in partial end-to-end and cross-bite
  20. Adjusting when lateral slide - and its cause

Correction of excursive interferences

  1. Manipulation vs. patient grinding movements - for recording full range of movements
  2. Adjusting balancing side first - then back and forth, as needed
  3. Location of balancing interferences
  4. Adjusting uppers vs. lowers - or both
  5. Hollow-grinding - but plenty
  6. Amount of excursive adjusting with cuspid rise vs. group function - theoretical vs. practical
  7. BULL rule for working interferences
  8. Additional adjustments of lower lingual cusps
  9. End point of working adjustments
  10. Adjusting working contacts progressively more posteriorly
  11. "Chop-chop" and patient grinding movements - for tooth discomfort

General points

  1. How much overall adjusting on upper vs. lower teeth - why - lower lingual exceptions
  2. Reduced cuspid rise, with bruxing
  3. "Wide centric" as well as long centric, with bruxing
  4. Decreased amount of equilibrating when doing much restorative
  5. Recurrence of slide - possible causes - dynamics of centric - tripodization?
  6. Third molars
  7. Pure vs real mandibular movements

Anterior adjustments

  1. Anterior guidance - adjusting uppers vs. lowers - the guidance rule
  2. Adjustment for heavy lower anterior wear
  3. Adjustment for heavy upper cingulum wear
  4. Wear from anterior constriction
  5. Adjusting subsequent posterior interferences
  6. Simplification of overall adjustments - from patient grinding movements
  7. Anterior end-to-end bite cases - leave or correct?
  8. Cosmetic adjustments for sharp cuspids, parafunction crossover and smile line

Broadened areas of occlusal wear

  1. Locations
  2. From excessive wear
  3. Rarely Addressed
  4. Where to adjust - demo
  5. To reduce food table and create vertical forces
  6. Partial equilibration? - for broad areas? - balancing contacts? lower ling cusps? for centric?

Implant equilibration

  1. Osseointegrated - immobile - axial loading
  2. Same as for original construction
  3. One contact - axial center, b-l and m-d
  4. Excursive contacts?
  5. "Centric platform"
  6. Cuspid rise vs. group function

DEPROGRAMMERS, T-SCAN AND OTHER DEVICES

  1. Lucia jig, Leaf gage, cotton role, tongue position
  2. Kois deprogrammer - good- but takes construction, monitoring and adjustments
  3. T-scan (TEK) - records contacts, relative pressure, timing - its value?
  4. TENS - for centric and muscle relaxation
  5. Myo-monitor - low frequency TENS - LVI - its value?
  6. Need for equil technique vs tech devices

PATIENT ACCEPTANCE, FEES AND INSURANCE COVERAGE

  1. Acceptance = understanding
  2. First appointment freshness - like with referrals
  3. Example case presentation - when no symptoms - and with symptoms
  4. A consideration: appliance first, then equilibrate
  5. Use of staff having had an equil
  6. More equilibration = greater acceptance
  7. More equilibration = greater proficiency = greater profitability - like fillings
  8. Manipulation - less time - so more equilibrating will be done
  9. Specific fee examples - $250 for 1/2 hr routine - say $800 if symptoms, more appointments and time involved
  10. Gratification - burnout - Culver example
  11. Insurance coverage - four codes - Culver example before coverage

Culver's equilibration follow-up services: consultation, in-house visits, retreats - and practice sales services

EVALUATION

  1. Was the information pertinent and useful for your needs?
  2. What subjects would you have wanted covered more--or less?
  3. Was the information too basic--or advanced?
  4. Would you recommend the course to others?
  5. Are you interested in more information or services?
  6. Your name please.


Register for a class online today or phone (206) 623-8632 for more information.