Selective teeth grinding according to Jenkelson: what is it, the technique

Orthopedic treatment is considered one of the main methods in the complex therapy of periodontal lesions.

It includes the technique of selective grinding of teeth, which is used for occlusion disorders due to displacement or damage to the dental apparatus.

What it is?

Selective grinding is an effective treatment for periodontal disease. During the procedure, premature contacts are removed by cutting the top layer within the enamel.

The purpose of this procedure: correction occlusions and articulation, creating uniform contacts, relieving excessive loads and stress in dental tissues.

The therapeutic effect is achieved by eliminating the unwanted component of the chewing pressure. Such a step ensures a decrease in vascular damage, corrects the displacement of dental units, respectively, eliminating moments that adversely affect tissue trophism. As a result of reducing the effect on the periodontal tissues, blood circulation also returns to normal.

The procedure is started only after the diagnosis, analysis, taking into account the condition dentoalveolar system and surveys. Pre-grinding can be carried out on the models. Diagnostics provides data on the clinical picture, condition and mechanism of development of pathology.

The main indication for the procedure is traumatic occlusion - incorrect closure. In this condition, hyperfunctional tension of individual places occurs. This leads to pathologies such as muscle and mandibular dysfunction, violation of the structure of periodontal tissues.

The procedure is carried out most often in the first part of the day. Each visit takes no more than 30 minutes. Complete grinding is done in an average of 5 sessions, maintaining between each weekly interval. This is necessary in order for the neuromuscular system and the periodontium to fully adapt. After 14 days, the patient comes to check the results and possible correction of the occlusion. In the future, such a visit is carried out every six months.

Tools that can come in handy for selective grinding:

• waterproof abrasive discs;
• electric drill;
• water-cooled pipe drill;
• set of abrasives;
• diamond coated heads;
• carborubin heads of various shapes;
• hard / soft rubber polishers.

Main directions

All grinding techniques are based on two main lines.

The basic methods include Jenkelson and Schuyler's methods:

1. Selective grinding according to Jenkelson's method - occlusal relationships are performed in a convenient form by the patient himself without the efforts of a doctor. Premature contacts are removed directly in the central / distal occlusion, while the anterior / lateral adjustments cannot be made.
2. Schuyler method - with this technique, occlusal contacts are subject to correction, which interfered with the articulation of the rows. They are removed in the following sequence: first distal / central, then anterior, and lastly lateral occlusion. The specialist manually regulates the movement and position of the jaw.

According to Jenkelson, there are 3 classes of unwanted contacts, according to which the procedure takes place.

The surfaces of the slopes of the mounds are marked with symbols I, II, III, the surfaces of the antagonists - I a, II a, III a:

• I - vestibular slopes of the cervical tubercles of the lower 6-8 teeth, 4-5 teeth, the surface of the anterior ones, facing the vestibule of the oral cavity;
• I a - oral slopes of the cervical tubercles of the upper 6-8 teeth, 4-5 teeth, the surface of the anterior, which faces the vestibule of the oral cavity;
• II - oral slopes of the upper palatine tubercles of 6-8 teeth, 4-5 teeth;
• II a - vestibular slopes of the lower 6-8 teeth, 4-5 teeth (lingual tubercles);
• III - vestibular slopes of the upper 6-8 teeth, 4-5 teeth (palatine tubercles);
• III a - oral slopes of the lower 6-8 teeth, 4-5 teeth (buccal tubercles).

Indications for the procedure

The indications for grinding are the following points:

1. Disease of a complex of tissues (periodontitis) as a result of dental displacement. Therapeutic measures and grinding can be carried out at the same time. In cases of a pronounced inflammatory picture, treatment is first carried out, then grinding.
2. In the presence of pockets or in case of pathology of bone tissue, the procedure is performed before surgery. If pathological mobility of individual dental units or a whole series is observed, then grinding is carried out before / during therapeutic treatment.
3. In the absence of natural grinding of the chewing surfaces. The procedure is performed when an overload of the jaw is created.
4. Repeated preventive measures in the absence of severe symptoms and with intact dentition.
5. With slight exposure of the necks of some teeth.
6. Adjustment involving prostheses (removable / bridge), crowns, fillings.
7. Increased tone of the chewing muscles.
8. Pathological row change or displacement with loss of one.
9. Pathological processes / anomalies of the masticatory muscles and the entire dentoalveolar system.
10. Prevention after treatment of diseases of the dentoalveolar system.
11. Correction before implantation as needed. In this case, grinding is carried out with extreme care so as not to cause rejection of the implant.

When prescribing an orthopedic measure, the following factors should be taken into account:

• the patient's age;
• shape, material, size of crowns;
• the thickness of the hard tissue and its condition;
• the presence of anomalies - the position of the teeth, occlusion, dental arches;
• the presence of interdental contacts.

Video lecture from Professor Khvatova:

Contraindications for conducting

In some cases, grinding is contraindicated:

• the presence of acute inflammation of soft tissues, pathological processes of the TMJ - grinding is prescribed at the stage of remission;
• obvious deformation states of the dentition, which require different treatment tactics.

The most common mistakes made by periodontists:

• the readings and time of the test are incorrectly set;
• the volume of work and the sequence of actions are violated.

Diagnostic techniques for supracontacts

Determine the need for grinding, as a rule, during normal viewing.

The following techniques are used if necessary:

1. Occludogram - a technique in prosthetic dentistry that is used to identify and mark premature contacts on a wax plate. Used to monitor changes in treatment over the entire period. As a rule, the results of the first and the last method are saved.
2. Jaw model diagnostics - special impressions of the lower and upper jaw, which reproduce its movement. Thanks to this, the doctor receives information about the shape / deformation of the arches, the nature of the deformity, occlusal contacts of the tubercles, and dimensions. It is carried out before and after grinding to determine the correct result.
3. Carbon paper marking - is considered one of the most accurate and at the same time the simplest method for diagnosing supracontacts. A small piece of carbon paper (approximately 3 * 4 cm) is used, which is folded into 4 layers. The most suitable method for identifying contacts during the dynamics of the mandible.
4. Auscultation can be used as an adjunct - a technique for examining the oral cavity, with the help of which certain sound vibrations are determined. In such cases, a bifurcated, dull sound, click is determined.

How is selective grinding carried out?

After carrying out the diagnostics, they begin preliminary grinding. At this stage, the excess part of the chewing surfaces is erased. Grinding takes place while maintaining the original shape and contour of the tooth. If cardinal shortening is necessary, then carry out depulpation. The procedure starts with the upper teeth when removing the anterior occlusion. The cutting edge of the canines and incisors is removed. Those teeth that come out are shortened.

Pre-grinding:

• grinding the surface facing the adjacent teeth;
• shortening the longest molar to the positions of the occlusal surface;
• grinding of a long dental unit at the end of the row, which does not contact the chewing surface of the opposite jaw;
• reduction of the distal (lateral) upper tubercle of 4-5 teeth, which makes it possible for the lower ones to align;
• correction (reduction) of individual displaced units of the dentition.

The final grinding is carried out taking into account the classification of the supracontacts (Jenkelson method). At this stage, grinding begins with the elimination of contacts to classes III and III a, on which premature contacts are most common.

The next step is the removal of class II and III supracontacts. It is not necessary to wash the palatine / cervical tubercles and their antagonists too much when working with the upper jaw. It is they who maintain the inter-veolar height, which cannot be reduced.

At the end, proceed to the correction in the position of the anterior occlusion. Carried out with lateral. First, remove the contacts that interfere with the closing of the row (or individual units) on the working side. The lower lingual, upper buccal tubercles are subject to processing. In some cases, after the narrowing of the chewing is carried out.

In the zone of interdental contact, the enamel thickness is removed from each tooth by a maximum of 0.25 mm. It is important not to let it overheat. The surface to be treated is cooled with air or water. Smoothing of the vestibular and oral surfaces is also carried out in order to obtain a smooth transition.

In some cases, complex grinding is not required (only 1-2 positions). Before conducting, the subcontacts of the classes on the alleged teeth are determined. The moving units of the row are splinted with gypsum blocks or tires. You can also support them with your fingers.

The last step is smoothing and polishing using polishing tools. Abrasive discs are used first, then rubber discs. An important point is fluorization.

If the procedure was local, you should limit yourself to rubbing fluoride paste (3-4 times) into the treated areas. If the slugging was carried out in full, then fluorization is carried out by applying varnish on the surface or by electrophoresis with fluoride agents.