Can you apply the Dahl technique to localised POSTERIOR wear?
Spoiler alert: hell yeah!
How can the Dahl Technique help when there is posterior wear and NO space to restore?
How predictable is building up posterior teeth (rather than the usual worn anteriors)?
In this episode, Jaz dives into the ‘Reverse Dahl Technique’, a twist on the classic method typically used for localized anterior wear. Dr. Hans Kristian Ognedal from Norway shares his insights, explaining how building up posterior teeth with composite can lead to occlusion magic!
If you’re curious about this technique and want to see a real-life case study, this episode breaks it all down, with a special visual breakdown for those watching on YouTube or Protrusive Guidance.
https://youtu.be/V8MTFfXmdlwWatch PDP235 on YoutubeProtrusive Dental Pearl: Jaz shares insights from Hold On to Your Kids by Dr. Gordon Neufeld & Dr. Gabor Maté, emphasizing how modern children lose parental attachment too soon, turning to peers for guidance. This shift can lead to anxiety and emotional disconnection.
Takeaway: Kids thrive when their primary attachment remains with parents, not peers. Strengthening this bond is crucial for healthy development.
Need to Read it? Check out the Full Episode Transcript below!
Key Takeaways
- The traditional Dahl principle focuses on creating occlusal space for anterior crowns.
- The reverse Dahl technique is a direct method for treating worn POSTERIOR teeth.
- Diet plays a significant role in tooth wear and dental health.
- Taking photographs of patients’ teeth can help track wear over time.
- Understanding the etiology of tooth wear is crucial for effective treatment.
- Building up dental anatomy is essential for successful restorations.
- Occlusion should be viewed as a dynamic system rather than a static one.
- Patients can adapt well to this treatment modality
- “Patients that wear their teeth, they don’t usually have TMJ problems.”
Highlights of this episode:
- 02:22 Protrusive Dental Pearl
- 04:50 Guest Introduction: Dr. Hans Kristian Ognedal
- 07:06 Understanding the Original Dahl Concept
- 09:31 Exploring Reverse Dahl Technique
- 13:30 Etiology and Patterns of Tooth Wear
- 23:46 Facial Patterns and Occlusal Traits Linked to Wear
- 24:44 Clinical Approach to Posterior Wear
- 30:26 Patient Comfort and Staging Treatments
- 32:11 Cuspal Planes and Guidance
- 34:21 Review Schedule and Observations
- 38:44 Longevity of Treatments
- 44:04 Contraindications and Patient Selection
- 45:24 Case Studies and Practical Tips
- 49:30 Night Guard Use
- 53:06 Final Thoughts and Education Opportunities
If you want to learn more about Dahl Technique, be sure to listen/watch:
- Why do some Dentists find Dahl Distasteful? – PDP016
- Dahl Part 2 (The Spicy Bit) – PDP017
- Dahl Technique and ‘Maryland Bridges’ – GF001
This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.
This episode meets GDC Outcomes B and C.
AGD Subject Code: 180 OCCLUSION (Occlusal functional concepts)
Aim: To explore and understand the Reverse Dahl Technique, focusing on its application for patients with localized posterior tooth wear. This technique provides a solution when posterior teeth are worn, and there is insufficient space for proper restoration.
Dentists will be able to –
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Understand the principles behind the Reverse Dahl Technique and how it differs from the traditional Dahl Technique.
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Identify the clinical scenarios where the Reverse Dahl Technique can be applied.
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Comprehend the role of composite build-up in restoring posterior wear and its impact on occlusal reestablishment.
Click below for full episode transcript:Teaser: I think it's a tooth where it's probably a modern disease of our own course. I think I disagree on that one. I think the patients that wear their teeth, they're able to load their teeth quite hard, much harder than I'm able to do. I have an interior open bite and the Class III, I've never been able to touch my front teeth.Teaser:I don’t wear my back teeth. I think I am not able to generate a type of forces that wears my teeth. But I think most patients who wear their teeth, they’re usually in full occlusion. I think having posterior where it’s more a function of consequence of how they function, how they chew, how they eat, how they swallow, how they process food when they take food into the mouth.
Jaz’s Introduction:So whether you use it or not, I’m sure we’ve all heard about the DAHL technique, right? This is when you have localized anterior tooth wear, and what you’re doing in this case is you are building up the anterior teeth even though you don’t have space. And so because you’re building these teeth up, when the patient bites together, now they’re prematurely hitting their front teeth, the back teeth all open.
There are like bilateral posterior open bites, and what happens over time is intrusion of the anteriors and you know, over eruption or Dento alveolar compensation of the posterior and the occlusion. Like magic reestablishes. So if you wanna go deep dive into that, check out our previous episodes on the DAHL technique.
Like these are some of the ones we did five years ago with Tiff Qureshi, and they are literally like Protrusive Wall of Fame. So do check out those and I’ll link them at the bottom. But today’s episode, my friends is on something quite different. It is same, same but different as they say in Asia, right?
It is the reverse DAHL technique. Now instead of having localized anterior tooth wear, we have localized. Posterior tooth wear. Think of that patient who when they bite together, their posterior teeth are just shot, right? There is exposed dentine, there is lots of erosion, and so you’ve got plenty of localized posterior wear.
And then the premolars, canines and anteriors are maybe a little bit worn, but not that worn. And the problem we have is that yes, the posteriors are worn, but when the patient bites together, the back teeth are all contacting, meaning you don’t have space.
So with the reverse DAHL technique or modified DAHL technique, what you do then is you build up the posteriors in composite, you leave the anteriors out of the bite, and then like magic, the posteriors will intrude and everything else over ups, if you like, and the context will reestablish.
Now, our guest today, Dr. Hans Kristian Ognedal from Norway, does a wonderful job of discussing this technique and his experiences, and at the end, he shares a case. So for those of you who are listening, while you’re jogging on a train, while you’re driving, don’t worry, I describe the caseand the exact scenario.
For those of you who are watching on Protrusive Guidance or on YouTube, you’ll actually get to see the images as well if you listen all the way to the end. I was quite excited to record this episode because it’s a, a new one, right? It’s a, it’s a new thing for me. I haven’t seen much published on the interweb about this technique, so hopefully you’ll learn something new.
Dental PearlTalking of learning something new, every PDP episode I give you a Protrusive Dental Pearl. Now, as you know, I’m a family man, and for those of you on our community Protrusive Guidance, I’m always talking about the books that I’m reading, or actually I’m listening to on Audible. The current one, I just feel compelled to talk about it.
It’s called Hold on to your Kids. Like I’ve got two boys, a 6-year-old and almost 2-year-old, and I think a lot about being a dad and being hopefully a good dad. I actually always wanted to be a parent. I actually love my role as a dad it’s my favorite title in the whole wide world. Quite often I’ll pick like, you know, parenthood books or relationship books because just like I’m interested in dentistry and I read their dental literature.
I’m interested in parenting and being the best parent I can be. So I kind of am attracted to these kind of titles. Now, the book, again is called Hold Onto Your Kid, it’s by Dr. Gordon Neufeld and Dr. Gabor Matè. And it essentially talks about how in modern society, children lose the attachment to their parents too soon.
And so what it talks about is that what children of modern society do is when they lose that attachment to their parent, they then gain the attachment from their peers. And then it’s like, you know, the blind following the blind and there’s a major cause of anxiety and disconnection from family. I’m actually now just getting into the really good parts of the book where it’s actually telling me solutions, right.
You know, the whole several first few hours are talking about the problem, right? The problem of losing attachment to a children and how you cannot serve two masters so they can’t be attached to their peers. And attached to you as their parent. At the same time, they have to pick one. And the way that we have the schooling system, the way that we have social media and phones, that they’re constantly now messaging each other and they’re gaining their attachment from their peers no longer from their parents.
Now we need that parent attachme...