High dental restorations are common but often overlooked issues that can lead to discomfort for patients and frustration for dentists. While many patients may tolerate a high restoration or adapt over time, others experience pain, headaches, TMJ discomfort, or even fractured restorations. Understanding the causes and solutions for high restorations can save both time and money, while improving patient satisfaction.

Why High Restorations Cause Problems

When a restoration is left too high, it can lead to various issues:

1. Discomfort and Pain: Patients may report tenderness to percussion or even broader symptoms like headaches and muscle soreness.
2. Structural Issues: High restorations can cause fractures in the restoration or cusps, and sometimes lead to tooth mobility.
3. Patient Satisfaction: These problems can lead to complaints and decreased trust, which can negatively impact a dental practice.

Accurate restorations minimize these issues, but achieving this precision can be challenging due to several factors.

Key Factors Leading to High Restorations

1. The Working Impression

While unlikely to be a major source of occlusal error, a working impression must be made with precise materials and adhesives to ensure stability. Flexible trays and overly viscous materials can cause slight distortions, though their impact on occlusion is typically minimal.

read this intro about dental occlusion

2. The Opposing Impression

This is a frequent source of error. Distortions in the impression can cause casts that look correct but fail to articulate properly, leading to occlusal inaccuracies.

3. The Occlusal Record

A wax or silicone record is often used to capture occlusion, but it can prevent casts from coming into complete contact, especially if the patient’s inter-cuspal position (ICP) is unstable. In some cases, it’s best to avoid an occlusal record or to limit it to the preparations only.

4. Laboratory Handling of Casts

Casts may sometimes contain small “blebs” on the occlusal surfaces due to air bubbles in the impression. These blebs, even as small as 1 mm, can create significant gaps, requiring excessive grinding of the restoration. Both the laboratory and the dentist should inspect and correct these minor issues before the final fitting.

5. Mounting of the Casts

Casts must be mounted carefully to avoid slight movements that misalign the restoration. Accurate mounting, with attention to every detail, is essential to ensure a precise fit.

6. The Provisional Crown

An ill-fitting or lost provisional crown can lead to overeruption and drifting, resulting in a high and ill-fitting final restoration. This can also create tight proximal contacts, complicating the fit and comfort of the final restoration.

Preventing High Restorations with Attention to Detail

Each stage in the restoration process has its own potential pitfalls, but with attention to detail, these can be minimized. Here are some quick tips:

• Use high-quality, stable materials for impressions to minimize distortion.
• Carefully inspect casts for any minor errors or air bubbles that could cause issues later.
• Prioritize precise mounting techniques to ensure that the restoration fits within the ICP.
• Ensure that provisional crowns are well-placed and maintained to prevent tooth drifting.

Conclusion

Avoiding high restorations may seem complex, but with careful attention at each stage of the restoration process, dentists can prevent issues that lead to discomfort, additional adjustments, and patient dissatisfaction. Following these steps saves time and builds trust with patients, making the restoration process smoother for both parties.

Reference:

"Applied Occlusion" by Robert Wassell, Amar Naru, Jimmy Steele, and Francis Nohl.