After uncovering a clinically relevant CR-CO discrepancy in Part 7, the natural next step is deciding what to do with this information. When do we grind? When do we refer? When do we leave it alone? In Part 8 of the TMJ Series, we’ll walk through the clinical process of occlusal equilibration—why, when, and how to adjust the bite for long-term stability.
Occlusal Adjustment: What It Really Means
Occlusal adjustment (also called “occlusal equilibration”) refers to the reshaping of enamel surfaces to improve contact balance and eliminate interferences. It aims to align centric relation (CR) with centric occlusion (CO) and redistribute occlusal forces evenly across the dentition. It is precise, minimally invasive, and best reserved for cases with clear diagnostic indicators.
When Is Occlusal Adjustment Indicated?
Before touching a bur to enamel, clinicians should verify all of the following:
- Stable CR mounting after muscle deprogramming (e.g., leaf gauge or deprogrammer use)
- Repeatable CR bite records confirmed over multiple sessions
- Significant CR-CO slide (>1.5–2.0mm)
- Functional symptoms like joint pain, muscular fatigue, or occlusal awareness
- No current orthodontic or prosthodontic plans that would make grinding premature
Adjustment is not cosmetic—it is functional correction. It should not be used to fix esthetic or alignment issues.
Tools You Need
- Articulator (semi- or fully adjustable)
- Mounted casts in CR
- Shimstock and articulating film
- Leaf gauge or Lucia jig
- Diamond finishing burs and polishing discs
- Intraoral photos or occlusal mapping tools (T-Scan optional)
Step-by-Step Guide to Occlusal Adjustment
- Verify CR Position Again
Have the patient bite in CR using a deprogrammer or leaf gauge. Confirm that this position is stable, repeatable, and symptom-free. - Mount Accurate Casts
Take CR records and mount maxillary and mandibular casts on a semi-adjustable articulator. Label areas of CR-CO discrepancy. - Mark CO Contacts
Use articulating paper intraorally to mark initial CO contacts. Document premature contacts and their relation to CR stops. - Determine Interferences
Is the interference causing deflection? Does it lead to unilateral contact? Mark guiding vs. non-supporting cusps. - Selectively Grind
Use the BULL rule (Buccal of Upper, Lingual of Lower) for supporting cusps. Remove enamel only where necessary to harmonize occlusion. - Check Excursive Movements
Assess canine guidance, protrusive guidance, and any group function that may need refinement. - Polish & Reassess
After each grinding step, polish thoroughly to reduce plaque retention. Re-evaluate with articulating paper and shimstock. - Follow-Up Visits
Recheck the patient after 1 week, 1 month, and 3 months. Muscle adaptation may reveal new compensations.
Risks of Over-adjustment
- Enamel loss beyond the intended zone
- Creation of flat spots leading to loss of guidance
- Increased sensitivity if dentin is exposed
- Changes in mandibular posture that destabilize the joint
Always remember: grind in the lab first, not the patient’s mouth.
Case Snapshot: Equilibration After CR Slide
A 36-year-old female presented with post-splint therapy CR-CO discrepancy of 2mm to the left. Premature contact on tooth #26 deflected closure path. CR mounting showed broad contacts on #16 and #36. After selective adjustment of #26, #16, and minor reshaping of incisal edges, the CR and CO aligned within <0.5mm. Patient reported improved chewing and resolution of chronic temple tension.
Internal & External Links
After summarizing clinical foundations of TMJ dysfunction in Parts 1 through 6—ranging from joint dislocation and muscle imbalance to splint therapy and follow-up—we now transition into the biomechanical and occlusal reconstruction phase. Starting in Part 7, this series shifts to a deeper, anatomy-based analysis of occlusal relationships, centric discrepancies, and their role in long-term stability.
- Part 1: TMJ Dislocation Case Study
- Part 2: Muscle Dysfunction in TMD
- Part 5: Splint Therapy Principles
- Part 6: Post-Splint Evaluation
- Part 7: CR vs CO Explained
Further Reading:
In Part 9, we’ll explore how to identify parafunctional risk zones and map out occlusal rehab that lasts.
