Why does occlusion feel so confusing at dental school?
What if the problem is not that occlusion is too complex, but that it was taught in the wrong order?
How do you make sense of worn teeth, bite scans, shimstock, leaf gauges, provisionals and T-Scan without getting overwhelmed?
And which small ideas can genuinely change the way you diagnose, plan and restore?
In this episode, Jaz is joined by Dr. Mahmoud Ibrahim for a brilliant occlusion-focused conversation. They each bring five clinical “pearls” that helped occlusion finally click for them — from facially generated treatment planning to checking the contralateral side, muscle palpation, provisionals and digital occlusal data.
Create a PowerPoint or Keynote library of your clinical photos so you can quickly show patients relevant examples during consultations.
⚠️ Avoid hunting through random folders chairside — it feels clunky and breaks the flow of the conversation.
✅ Build a scrollable visual library of cracks, before-and-afters, complications, direct restorations, overlays, crowns and consent examples to support clearer patient communication.
Key Takeaways
Occlusion becomes easier when it is placed inside the treatment planning sequence, not treated as a separate subject.
Facially generated treatment planning starts with where the upper teeth need to be for aesthetics.
Once the central incisors are planned, the rest of the occlusion becomes easier to organise.
Worn teeth that are still in occlusion are often in the wrong position.
Anterior wear may be caused by tooth position, contact time, contact force, or a combination of all three.
Gingival levels can reveal whether worn lower incisors have over-erupted.
Digital bite scans are useful, but they are not always a perfect representation of the patient’s bite.
Shimstock remains one of the most valuable and inexpensive tools for checking true occlusal contacts.
After fitting a restoration, checking the contralateral side first can reveal whether the new restoration is high.
Anterior guidance should be steep enough to separate the back teeth, but shallow enough to allow the lower incisors room to move.
Muscle palpation should assess the quality and symmetry of contraction, not just whether the muscles exist.
Always assess the opposing tooth before placing composite, ceramic or an indirect restoration.
A leaf gauge can help create a more repeatable jaw position when planning more complex occlusal cases.
Provisionals are essential for testing aesthetics, function, vertical dimension and occlusion before committing to final restorations.
Highlights of the Episode:
00:00 Teaser
00:56 Introduction
03:36 Pearl: Build a Clinical Photo PowerPoint
12:48 Pearl 1: Facially Generated Treatment Planning
15:56 Pearl 2: Worn Teeth in Occlusion Are in the Wrong Position
18:05 Why Tooth Position Matters
18:22 Three Causes of Wear to Consider
19:34 Pearl 3: Digital Bite Scans Are Not Always Accurate
20:24 Why Shimstock Still Matters in Digital Dentistry
24:18 Pearl 4: Check the Contralateral Side After a Restoration
26:27 Pearl 5: The First Movement of Opening Is Not Pure Rotation
28:27 Midroll
33:10 Pearl 6: Healthy Occlusion Should Have Coordinated Muscle Contraction
35:22 Why Muscle Palpation Is a Useful Data Point
38:18 Practical Muscle Assessment Tip
38:58 Pearl 7: Always Look at the Opposing Tooth
39:33 What to Check Before an Indirect Restoration
39:44 Why the Opposing Tooth Matters
41:13 Pearl 8: Leaf Gauge for Finding a Repeatable Jaw Position
42:43 What a Leaf Gauge Is
44:33 Pearl 9: Provisionals Reduce the Fear of Complex Cases
47:49 Pearl 10: T-Scan Adds Objective Occlusal Data
Bulletproof is designed to take occlusion from abstract theory to real-world clinical application — covering posterior crowns, quadrant dentistry, PROPER conformative dentistry, occlusal risk assessment, shimstock, leaf gauges and daily protocols you can use straight away.
The next Bulletproof course takes place on 26th–27th June at London Heathrow (Radisson Blu Hotel)
This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance.
This episode meets GDC Outcomes C
AGD Subject Code: 180 Occlusion
Aim: To help dentists improve their understanding and clinical application of occlusion by recognising key diagnostic signs, using practical occlusal assessment tools, and applying occlusal principles to restorative treatment planning.
Dentists will be able to –
Apply facially generated treatment planning principles when assessing occlusal and restorative cases.
Identify how tooth position, contact time and contact force contribute to tooth wear and restoration risk.
Use practical occlusal assessment methods such as shimstock, contralateral checking, muscle palpation, leaf gauges, provisionals and T-Scan data.
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