Reducing Chairside Adjustments.
Adjustment at delivery is treated as a normal cost of restorative dentistry. A good deal of it is avoidable, and a surprising proportion of it is caused by checking things in the wrong order.
What adjustment actually costs
The obvious cost is chair time, and on a busy list twenty minutes spent adjusting a crown displaces something else. The less obvious costs matter more.
Every adjustment removes glaze and leaves a rougher ceramic surface than the one that left the laboratory. Unless it is properly repolished, that surface abrades the opposing dentition for the life of the restoration. Heavy adjustment also thins the restoration at exactly the point it was designed to be strongest.
And the patient is watching. A restoration that goes in, comes out, is ground, goes back in and comes out again reads as a problem, regardless of how ordinary the process is clinically. Confidence is part of what is being delivered.
Check the fit before anything else
The single most useful change most practices can make is to verify seating before assessing anything else, and to verify it on the model first.
If the restoration seats fully on the die or model and not in the mouth, the obstruction is clinical — a proximal contact, residual cement, a temporary cement remnant, tissue, or a preparation that has been altered since the record. If it does not seat on the model either, it is a laboratory matter and the case should come back.
That distinction takes thirty seconds and it prevents the most common diagnostic error at delivery: adjusting the occlusion of a restoration that is not fully seated. A crown held up by a tight contact reads as high in occlusion, and grinding the occlusal surface to fix it produces a restoration that is both under-contoured and still not seated.
Then contacts, then occlusion
The order is fit, contacts, occlusion, and it is not interchangeable. Each step depends on the one before being correct.
Assess contacts with floss rather than by eye, and compare against the patient's own contacts elsewhere in the arch. A contact that shreds floss is too tight; one that offers no resistance is too loose. Adjust the restoration rather than the adjacent tooth wherever possible, and adjust in small increments — a contact removed cannot be replaced.
Only once the restoration is fully seated with acceptable contacts does occlusal assessment mean anything.
Occlusal technique
Dry the teeth. Articulating paper transfers poorly onto a wet surface, and wet marks are broad and misleading. Use thin paper — thick paper produces marks substantially larger than the actual contact and leads to over-adjustment.
Mark the patient's existing contacts on adjacent teeth first, in one colour, so you can see what normal looks like for this patient. Then place the restoration and mark in a second colour. What you are looking for is a restoration contacting comparably to its neighbours, not a restoration contacting at all.
Then check excursions. A restoration correct in intercuspation and interfering in lateral or protrusive movement will be the source of sensitivity, fracture or wear, and it is the check most often skipped when time is short.
Where the contacts problem originates
Persistent contact problems usually trace back to the record rather than to the laboratory. Adjacent teeth captured incompletely give the technician a partial surface to build a contact against. Distortion in the impression, or a scan where the interproximal region was reconstructed rather than captured, does the same.
There is also genuine tooth movement. A tooth that has lost its contact — through the preparation itself, or through a provisional that was under-contoured — will drift, sometimes measurably within a fortnight. A restoration made to the position recorded at preparation is then correct for a situation that no longer exists.
Well-contoured provisionals that maintain contact are the defence, and they are worth the extra minutes for exactly this reason.
Always repolish
This is the step most often omitted and the one with the longest consequences. Glaze does not survive grinding, and a ground ceramic surface is considerably rougher than a polished one.
Use a ceramic polishing sequence appropriate to the material, working through the grits rather than jumping to the finest. A silicone polisher used alone on a coarsely ground surface smooths it visually without producing the finish that protects the antagonist.
It takes a couple of minutes and it is the difference between a restoration that is kind to the opposing dentition and one that quietly wears it for years.
Anaesthesia changes what the patient can tell you
A patient who is profoundly anaesthetized cannot report occlusal contact reliably, and proprioception through the periodontal ligament is exactly what you are asking them to use when you ask whether it feels high.
Where a restoration is being cemented under anaesthetic, rely on articulating paper and on your own assessment rather than on the patient's report, and consider reviewing the occlusion at a subsequent visit once sensation has returned fully.
This matters most on implant restorations, where there is no ligament to report through even when the patient is not anaesthetized, and where a persistently high contact does not announce itself the way it would on a natural tooth.
Close the loop
If a restoration needed adjustment, tell the laboratory what and where. Contacts consistently tight on the mesial, occlusion consistently high on one cusp, contours consistently full — these are calibration signals, and a laboratory that receives them can adjust how it builds for your practice.
Without that feedback, the same adjustment recurs indefinitely, and both sides assume it is normal.
In short
- Verify seating on the model before assessing anything in the mouth
- The order is fit, contacts, occlusion — and it is not interchangeable
- Dry the teeth and use thin paper; mark adjacent contacts first for reference
- Teeth drift when contact is lost, so well-contoured provisionals matter
- Repolish properly after any adjustment; glaze does not survive grinding
More on practice efficiency
Discuss a case
Where a case sits between options, a short conversation before preparation is usually quicker than resolving it afterwards.