I’m confused in cases when patients come in with canine incisal edges that have worn down severely and the patient is in group function. I’m wondering how to best restore or design an occlusion on these patients.

I’ve always thought getting them into canine guidance would be best because that will shut off the muscles. Dr. Spear’s recent class online occlusion course makes it seem that may not always be the case. He mentions using canine guidance to protect the back teeth mechanically even though it may not shut off muscles and to use group function to distribute the load.

Did the patient have canine guidance and severely wore down the canine because all of the forces were on that one tooth and the group function is now best protecting the teeth? Or did the patient have group function and that activated the muscles causing the canine to wear down and the patient would be better off in canine guidance?

It’s like the chicken or the egg, which came first? Or better, how do you know which scheme to put the patient in?

I see cases like this a lot in my practice with flat canine and group function. Below is one example. She came in with a fractured #12. She has severe wear on #11 and she likes to go into that end to end wear facet. She has group function. After I restored her implant I watched Dr. Spear’s class, it got my thinking about what’s best for her, canine guidance or group and how can I predictably help these patients. Yes, that’s a lovely heart tattoo on her #12 implant crown.

If this patient wanted to restore the canine, Dr. Spear recommends altering the occlusion to survive the muscle behavior. I’m trying to figure out if canine guidance or group function would be best in cases like this. Since this is where she likes to move into this end to end wear position, the two choices would be to either restore her canine flat like this or add length back to the worn canine and adjust the lower canine until I get even broad contact movements. Is my understanding correct for restoring end to end wear like this?

Thank you. Brian

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