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Medical Forum / General / Dentistry / August 2008

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Equilibration / Abfractions / Reality Check

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Chris - 17 May 2007 16:15 GMT
I posted some time ago about my dentist's recommendations regarding some
abfractions he was seeing and wanted to treat.

I received some good information from this group - but now that the
insurance company is denying the treatment he provided, I have come up with
more questions.

Abfractions - these I have. The dentist performed an occlusal equilibration
due to "interferences he discovered to centric and working side".

Beyond the equilibration, he restored the abfractions with composite. He
only did one side, and tooth sensitivity was immense after the procedure. I
took ibuprofen for two weeks or so, and the throbbing subsided, but
sensitivity still remains - and more so than before the procedure. I went in
for a check up last week, and he stated that my sensitivity where the
composites were was "atypical" - so he gave me flouride (previ-dent) and
asked that I come back in two weeks.

The insurance company has denied the equilibration claim twice. Initially,
because the narrative that my dentist provided was completely wrong. I
pointed that out to them, and they re-submitted the claim. The narrative
resubmitted states exactly as follows:

"A complete occlusal equilibration was required to remove deflective
intereferences to centric relation occlusion and balancing and working side
inteferences. These interferences led to the significant erosion of the
structure at the gingival area and required multiple composite restorations.
By removing these interferences, we are hoping that the restorations will
last much longer."

The insurance company decided that the explaination above was not a valid
reason to perform the procedure. The customer service rep stated that they
typically see equilibrations for orthodontic or periodontal reasons. Those
reasons did not exist in my case. My only option with the insurance company
is to appeal.

So - reality check time. What the hell is going on here? Sensitivity - is
this a result of him abrading the tooth surface for the composite? Could
this be the composite material?

Equilibration - did he sucker me here?

Im on the edge of switching dentists, but need one final push...

Any help or advice is certainly appreciated!

Chris
Amatus Cremona - 17 May 2007 16:43 GMT
As far as the insurance company is concerned,,,,, your treatment (as you
describe it) is simply not a covered benefit.  Not much that can be done
there.

Abfractions are due to bending of the teeth from heavy clenching with
isometric grinding forces.  Equilibrating, can "soften" this problem for a
while.  However, if you are still clenching with isometric grinding forces,
then you are continually creating microfractures of the tooth neck.  These
microfractures continually expose more sensitive tooth structure.

Is it normal for teeth to hurt?  no.  Is it expected in certain instances?
yes.  Would I expect it after treating abfractions?  only if the harmful
activity persists.   How do we control that activity?  NTI.

As far as equilibration is concerned,,,,,,,,,,,,, In my office,,,,, a full
equilibration requires I create a set of study models first which are
mounted using a face bow transfer.  The equilibration is then completed on
the models first.  The equilibration is then transferred to the patient
using a template made from the models.  The patient the returns for 2-4
follow-up adjustments in the equilibration, as it is impossible (in my view
of the world) to equilibrate properly in one appointment.  Using a template
helps make for less adjustments down the road.  Also, I refuse to do any
adjustments unless the patient has been wearing an NTI for at least 2-3
weeks.  In the dim days before the NTI, I would work the jaw position to
where I would equilibrate it with a horseshoe appliance, but this took
months to get right.

A one appointment equilibration of 4-8 teeth is a MINOR EQUILIBRATION and is
billed as such.  This is only designed to correct a discrepancy in one or
two teeth.  And, the patient must not have any jaw or joint problems.

Depending on how the composite restoration was placed, your dentist may have
cut into the exposed tooth for extra retention, or may have bonded directly
to what was there.

In my office,,,,,,,,,,,,,,,,,,,,, I refuse to restore abfraction lesions
unless the patient will wear an NTI appliance.  Otherwise, they bend the
teeth, and "pop" the restoration right out every 6-18 months.

Signature

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Amatus

/

>I posted some time ago about my dentist's recommendations regarding some
>abfractions he was seeing and wanted to treat.
[quoted text clipped - 44 lines]
>
> Chris
cleverboy - 29 Aug 2008 21:22 GMT
Chris-

I have experienced the irreversible procedure referred to as a 'bite
adjustment' or 'full mouth equilibration'.  

A procedure called 'bimanual manipulation' was used by the dentist to rotate
and  torque my jawbone into what the dentist determined was a Centric
Relation Position. This position, was a manually manipulated new jaw joint
position, created by the treating dentist, and had nothing to do with the
existing position and relationship of my teeth. As a patient, I can only
communicate to anyone reading this- I wish I had never had this done, that I
had not trusted the dentist, and that I had gotten a second opinion. or a
third or a fourth!!!!

As for reality checks-  my dentist told me it was a 'bite adjustment'-  can I
ever be adjusted back? No. It is a permanent, irreversible procedure, and
change, to the position of the jaw joint.. You can adjust your car radio, you
can adjust the height of your chair, you cannot 'adjust' your teeth-or jaw
joint position, once changed,  it is permanent!  You cannot go back to that
same exact position-

Because of the procedure, I have a new jaw joint position. My dentist told me
I needed a bite adjustment because my 'bite' was off, and was the cause of my
only complaint and symptom- " wanting to rip out tooth #19'  

My dentist did not tell me that he planned to create a new joint position,
using bimanual manipulation-  (or that bimanual manipulation is the position
of the joint, independent of the teeth)  I have read in multiple places that
the dentists who 'teach' , 'use', and 'believe" in this technique- now refer
to it as 'bimanual guidance'  the explained reason for the new term is that
it is " a softer term to describe the process'  does it change the process-NO!
It is still the process of the dentists grabbing the patient by the chin in a
suppine position and rotating a person's  jawbone/mandible, upward, and back,
sing light torque, around an 'imaginary axis of rotation' to 'seat the
condyles' and 'place/record' the patient in 'Centric Relation'.

Without going into great detail, I am sharing that I am a patient, I
experienced this, and I did not have insurance- I WISH I HAD, because it
might well have prevented me from having the 'bite adjustment' and I might
have received an accurate diagnosis for why I 'wanted to rip out tooth #19'.
BEFORE having the 'bite adjustment' 'equilibration' or what the procedure
truly is- a man made intentionally induced, permanent change, to the position
of the jaw joint. Imagine if I had been told that- 'I plan to change the
position, geometry, function and neuromuscular dynamics of your jaw, and the
position has nothing to do with your teeth'

1 week after having a  'bite adjustment' and what was recorded by the
dentists as a 'full mouth equilibration', I had to go to the ER because of
new, week long , unremitting, jaw joint pain, muslcle spasms, and an
inability to open and close my mouth properly, a deviating jaw to one side-
all of which presented only after the procedure.

13 days after seeing the dentist who permanetly, created a new jaw joint
position using bimanual manipulation, and 3 days after going to the ER
because of  jaw joint pain, I was diagnosed that the reason I complained of
'wanting to rip out tooth #19' was because tooth #19 was infected.

After #19 was treated, all of my original symptoms and complaints of
'wanting to rip out #19' went completely away. Unfortunately,  my new
symptoms created by the new jaw joint position only got worse.  

I wish I had gotten a second opinion.

CB

>As far as the insurance company is concerned,,,,, your treatment (as you
>describe it) is simply not a covered benefit.  Not much that can be done
[quoted text clipped - 40 lines]
>>
>> Chris
 
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