(a letter from Tom and my reply) 

 

Dear Dr. Dawson
I am anticipating equilibrating a patient I examined this week who has molars that are depressible.  Perio and bone support is normal other than this mobility. I attribute the mobility to occlusal prematurities and aggressive clenching/bruxing.  Although I can locate gross interferences, it seems to me that marking all the interferences and adjusting them is going to be quite a challenge compared to doing this on teeth that are less mobile/depressible because the teeth move out of the way with the slightest pressure.  What do you recommend?
 
Sincerely,
Tom

Dear Tom,

 
It is definitely much more difficult to equilibrate mobile teeth.  Often several (2-4) short, touch up appointments may be needed to complete the equilibration, so plan accordingly.  
 
First, make sure you complete a trial equilibration on models.  As always, but especially, with mobile teeth you must verify your bite record. You remember that this is done by chilling the delar wax in ice cold water for a couple minutes so it is brittle hard.  Delar wax is great in helping to identify loose teeth, because as you verify your chilled record, any premature contacts on the bite record typically are the result of a mobile tooth.  Reheat the occluding surface of the bite record where the prematurity exists and retake the record.  Again chill and verify.  Do this until total verification of the record is completed.  When you mount your case as well, remember that a small slide in a mouth with mobile teeth can actually be quite large on the stone model once the teeth can no longer move.  The trial equilibration will give you a road map.
 
Now, in the mouth, equilibrate as usual, but when you get to the final stages have the patient close fast and hard while you hold them in cr.  This will result in marking the mobile tooth before it can be pushed out of the way.  As you adjust the interference, the tooth will gradually deflect less and less.  If the tooth is extremely mobile, you can try this technique initially as well, but I tend to use it as a finishing technique.  As I stated before, make the patient aware as that tooth tightens up, he/she will need to come in for a few touch up appointments.  At those appointments refine, then hard/fast “chomp-chomp.”

Shannon P Johnson, DMD
Academic Advisor