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Here’s a common scenario that far too many restorative dentists have encountered:Â
A patient comes into the practice requesting cosmetic work on their two front teeth. Upon analyzing the patient, the fractures are obvious, and their aesthetic concern is valid.Â
The solution seems straightforward – composite restorations or veneers on teeth #8 and #9.
You complete the work, and all goes well. The patient leaves happy.
But two weeks later? They’re back at your practice, and they’re no longer thrilled. The restorations have fractured. You follow protocol and redo them. They fracture again.
What’s going wrong?
Dr. Neeraj Khanna recently taught exactly why this pattern repeats itself in practices across the country, and how dentists can break the cycle with one fundamental principle: form follows function.
“Before I met Pete Dawson, my practice was very efficient,” Dr. Khanna admits. “I tried to do an exam, a consultation, and present a treatment plan all in one visit. And that led to my struggles in my practice. It led me to realize that I was creating more problems for my patients.”
For Dr. Khanna, the issue wasn’t efficiency. It was a failure to diagnose the functional problems that were underlying the aesthetic complaints of the patient.
When patients present with fractured anterior teeth, worn dentition, or repeatedly failing restorations, it’s important to remember that they are showing you symptoms – not the disease.Â
Traditional dental education teaches most dentists to identify and treat bacterial problems. The focus is on addressing issues of decay, periodontal disease, and infections.Â
But what about the patient whose occlusion is destroying their teeth? Or what about those who present with unstable TMJs?
There’s an important caveat here: These problems don’t reveal themselves in a single-visit exam. For most, it’s necessary to complete a much more comprehensive analysis and diagnosis.
To make this shift in thinking, it’s important to go back to the masticatory system. This system involves three interconnected components: joints, muscles, and teeth.Â
All three work in harmony with the brain and create quite a remarkable and sensitive feedback system. As Dr. Khanna explains:Â
“A great example of this is if you’re eating a bolus of food and you find a small fragment within that bolus.”The masticatory system works in harmony with the brain to dissect that small fragment. We’ve all experienced this. That is how sensitive the system is.”
When we don’t respect this vital system, we can risk inducing stress that leads to complications. Pain and eventual procedure failure can quickly follow when we make aesthetic changes without understanding functional requirements.
That’s why it’s important to conduct a comprehensive examination. Even a straightforward three-type categorization of the masticatory system’s stability can help:
These patients present stable joints, comfortable muscles, and no signs of instability in their teeth. They can be treated in their habitual occlusion.
These show some signs of instability and may need treatment in a stable joint position (centric relation).
Red patients show degeneration and significant problems – requiring more extensive intervention.
With this framework in mind, you can move forward. But before addressing aesthetics, it’s important to establish functional stability. Fortunately, Dr. Dawson’s framework provides the roadmap:
That last requirement – the envelope of function – is where aesthetics and function intersect.
The envelope of motion represents the full range of mandibular movement, limited only by joint anatomy.Â
Within that envelope exists the envelope of function. This is the actual space where the lower teeth interact with the upper teeth during normal function.
“We all have the same envelope of motion,” Dr. Khanna notes. “What’s important is that we all have different levels of envelope of function.”
For instance, three patients can have identical incisal edge positions vertically, but vastly different envelopes of function based on incisal edge angulation and lingual contour design. Some patients have very open envelopes; others have extremely restricted ones.
Patients with restricted envelopes of function typically present with tight anterior bites and significant wear on their anterior teeth. These are the patients whose composites keep fracturing because the restorations don’t meet their functional requirements.
Dr. Khanna turned philosophy into practice with a story about Ashley, a patient who requested a simple fix: her two fractured front teeth (numbers 8 and 9).Â
According to Dr. Khanna, Ashley had a history of failed anterior composites and wanted a permanent, natural-looking solution within her budget.
But the comprehensive examination told a different story. Ashley presented as a yellow patient – one with stable joints, but showing evidence of extensive tooth wear and very uncomfortable muscles.Â
Based on the occlusion, it was clear that Ashley had working-side interferences and protrusive interferences. Her teeth didn’t contact evenly in centric relation.
The shift in the treatment process made all the difference:
The result? Two anterior veneers that remained stable—not because they were exceptional restorations, but because they were built on a foundation of functional stability.
For most dental professionals, the “easy” path would have been to restore only those two teeth.Â
But without addressing the underlying functional deficits, the restorations likely would have fractured like previous ones.Â
By treating Ashley as a yellow patient who required centric relation treatment, the aesthetic outcome became much more predictable – and potentially, life-changing for the patient.
“If we think about all the procedures that we do for our patients, isn’t the occlusion the very last thing we check?” Dr. Khanna asks. “Whether you’re doing an occlusal composite, cementing a crown, doing anything related to dentistry, the occlusion is usually the last thing we check for, and rightfully so.”
Dr. Khanna encourages dental professionals to shift their mindset. Take the step to check a patient’s occlusion before you begin so you can make the necessary modifications that lead to predictable results.
This shift – from treating occlusion as the final checkpoint to making it the diagnostic foundation – can completely change and enhance a patient’s aesthetic outcomes.
Beautiful dentistry that doesn’t function properly isn’t beautiful for long. Fractures, sensitivity, discomfort, and patient dissatisfaction are likely to follow when form ignores function.Â
According to Dr. Khanna, when dental professionals understand that occlusion starts at the joint position, building and ensuring lasting, stable occlusion becomes predictable. And when that occlusion is stable, those incredibly important aesthetic restorations can finally last.
Remember – form follows function. It’s not just a principle – it’s the prerequisite for aesthetic dentistry that actually works.
Want to transform your approach to aesthetic dentistry? Learn the comprehensive examination techniques and functional principles that create predictable outcomes. Start with Core 1: Occlusion and Smile Design, the foundational course of The Dawson Academy’s curriculum.
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