3 Paper Technique
Dr David Alleman commonly refers to the 3 Paper Technique for checking occlusion. Dr Alleman credits his teaching of this method to Dr Gary Unterbrink, and his occlusion training to Dr John Kois.
The occlusion is first checked using standard methods making use of one piece of articulating paper, and any necessary adjustments carried out.
The 3 Paper Technique is useful for detecting non-working/non-functional interferences. 1 piece of articulating paper is placed on the non-restored side, and 2 pieces of articulating paper are placed on the restored side to be checked. The patient is asked to chew on the non-restored side. The single piece of paper on the non-restored side is used to activate the functional chewing motion on this side, and the non-functional movement on the restored side. If the single piece of paper is not used then the functional movement will likely switch to the restored side and non-functional interferences will not be evident. Non-functional interferences should be removed by appropriately deepening the fossae or lowering cusps.
Reducing the Chance of Catastrophic Failure
The chance of catastrophic failure can be reduced by following the protocols set out in Lesson 3, Lesson 4 and Lesson 5 of the SLA to BRD.
The following points should be followed to reduce the chances of catastrophic failure, as per all of the previous lessons of the Six Lessons Approach to Biomimetic Dentistry.
- Resin Coating (RC) with 0.5 mm of microfilled, flowable composite
- Ribbond fibre placement in the central groove
- Onlay holding (functional) cusps <2 mm and tension (non-functional) cusps <3 mm (cusp thickness measured from the base of the cusp as per Lesson 5)
- Avoid reducing centric holding (functional) cusps where possible (Palatal cusps of Uppers and Buccal cusps of Lowers)
The risk of catastrophic failure can be increased if cusps which are too thick (>3.5 mm) are onlayed. As per the research paper by Fennis et al. in 2004, the placement of fibre in dentin replacement can help to reduce this risk. The 2005 paper by Fennis et al. also backs up the concept that fibre placement in the layer of dentin replacement underneath the indirect/semi-direct restoration can prevent catastrophic fractures in the tooth.
Relevant Literature
Fennis WM, Kuijs RH, Kreulen CM, Verdonschot N, Creugers NH. Fatigue resistance of teeth restored with cuspal-coverage composite restorations. Int J Prosthodont. 2004 May-Jun;17(3):313-7.
Fennis WM, Tezvergil A, Kuijs RH, Lassila LV, Kreulen CM, Creugers NH, Vallittu PK. In vitro fracture resistance of fiber reinforced cusp-replacing composite restorations. Dent Mater. 2005 Jun;21(6):565-72.
Geurtsen W, Schwarze T, Günay H. Diagnosis, therapy, and prevention of the cracked tooth syndrome. Quintessence Int. 2003 Jun;34(6):409-17.
