When Your Occlusal Clearance Disappears

when your occlusal clearance disappears

By: Lee Ann Brady DMD
Topic Originally Appeared on PankeyGram.org

It can be an incredibly frustrating clinical situation when you have been meticulous about preparing a posterior tooth, (most commonly a molar) for a crown and things aren’t predictable.

Using your burs you created depth cuts to ensure adequate occlusal clearance. After the impression you allow your assistant to fabricate the temporary only to have them come get you.

Why? Because the temp is thin or perforated on the occlusal. When you go back to check, and have the patient bite, sure enough, the opposing tooth is touching your prep.

When Your Occlusal Clearance Disappears

Common Reason Your Occlusal Clearance Disappears

A common reason that this happens is because we just prepared away the patient’s first point of contact in centric relation.

The lateral pterygoid muscle in coordination with the elevator muscles has a learned pattern of firing that brings the mandibular teeth into maximum intercuspal position.

This “learned” position is programmed by the patient’s first point of contact when the condyles are seated.

For some patients when we remove this contact, and therefore the message that was programming the muscles to locate MIP, they release quickly.

When the muscles release and the condyles seat, the occlusion is now totally different than MIP was moments before.

Identifying Patients at Risk

One solution that I considered briefly was to no longer work on molars! Alas, not a great business strategy.

Removing this frustration is about understanding which patients are at risk. Identifying risk begins with the exam, whether we are discussing caries or occlusion.

There are several key factors that alert me to this potential issue.

I start by identifying the patient’s first point of contact and clarifying if it is on the tooth we are about to prepare.

If I am going to prepare FPC away, then I look at the magnitude and direction of the patient’s slide or the difference between this position and MIP.

If the difference is small (1-2mm), then even if their condyle does seat the occlusal difference will not cause an issue for clearance. So large slides (3mm or greater) could cost approximately 1mm of clearance on the prepared tooth.

Other factors include whether they have a history of occlusal changes or more than one MIP they can find.

In Conclusion

Understanding the risk still leaves us with the question of how to proceed. That is a longer conversation for another post.

However, if we proceed as we would before, at least knowing the risk we can explain this to the patient ahead of time, and help them understand how we would manage it if it happens.

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Rosie, RDH

Rosie, RDH

I had the pleasure of working with Candy as a dental hygiene consultant over the course of several months, and her...
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Rosie, RDH

I had the pleasure of working with Candy as a dental hygiene consultant over the course of several months, and her impact on both our hygiene department and overall practice was exceptional. Candy is highly knowledgeable, approachable, and genuinely invested in the success of the team. She is an excellent listener who takes the time to understand challenges and provide practical, effective solutions. One of the qualities I appreciated most was her accessibility, she was always available to answer questions, offer guidance, or return a call when needed. Her hands-on approach and commitment to helping our team succeed were evident in every interaction. Candy’s focus extends beyond productivity and practice growth; she truly cares about the people within the practice and works to create a supportive, collaborative environment. As a fellow dental hygienist, it was especially refreshing to work alongside someone who shares a similar philosophy and approach to patient care, team development, and practice success. We view many aspects of dentistry and hygiene through the same lens, which made collaboration seamless and productive. Having the opportunity to work with another hygienist who understands the challenges, opportunities, and importance of our role was invaluable. The hygiene modules she developed were incredibly valuable. They were well organized, easy to follow, and provided clear, actionable guidance. The accompanying handouts and resources gave our team the tools and confidence needed to implement new concepts successfully. Her training materials were practical, relevant, and tailored to the real-world needs of a busy dental practice. Candy’s expertise and dedication to excellence have made a lasting impact on our team. I would highly recommend her to any dental practice looking to strengthen its hygiene department, improve systems, and support the growth and success of its team. She is a true asset to any practice fortunate enough to work with her.
Rosie, RDH
Dr. Justin Elikofer

Dr. Justin Elikofer

Our story with IgniteDDS began almost five years ago when my wife and I purchased an established fee-for-service practice. At...

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Dr. Justin Elikofer

Our story with IgniteDDS began almost five years ago when my wife and I purchased an established fee-for-service practice. At the time, we promised the team that everything would stay the same. The practice was thriving, and from the outside it seemed clear they had found a successful recipe for success. Our goal wasn't to change it—we simply didn't want to mess it up.

What we discovered was that while everyone wanted the outcome of success, there wasn't alignment around how we achieved it or measured it. Success in room 1 wasn't the same as Room 2. It took us nearly four years to fully understand that because we were doing well. During that time, we also realized we weren't leading as effectively as we could have been. We weren't communicating a clear vision, establishing consistent standards, or implementing clear protocols. Instead, we allowed people to continue doing things their own way. Some team members appreciated that freedom, while others felt frustrated by the lack of consistency and direction.

After four years, we found ourselves at a crossroads. We felt stuck. Morale was low and we weren't sure we could get the practice where we wanted it to go on our own.

As owners who value relationships as much as results, David immediately stood out to us. His personality was authentic, approachable, and trustworthy. He was someone we could see ourselves learning from and building a genuine relationship with. Being local was a bonus, but what really resonated with us was that his vision for practice growth, demonstrated through his own private practice, closely mirrored our own. He had already built the type of practice we wanted to create.

This stood in contrast to many other consultants we spoke with, whose focus seemed to be on PPO models and increasing volume. David's experience aligned with the type of practice we wanted to build: a high-touch, high-end patient experience centered on quality rather than quantity.

The IgniteDDS team—David, Dawn, and Candy—started by helping us understand where we truly stood. Through discovery, data gathering, and DISC assessments, they helped us identify opportunities for improvement and build a foundation for long-term growth. Rather than jumping straight to solutions, they gave us clarity.

Candy's coaching was instrumental in aligning our hygiene department and our office as a whole with the hygiene department. With her help, we were able to improve the patient experience and new patient process.

We also tackled practical issues that had become major challenges, including an accounts receivable system that was largely out of control. IgniteDDS didn't just point out problems—they provided systems and processes to solve them.

One of the most valuable aspects of the relationship was having experienced coaches to help us navigate team conflict and leadership challenges. As practice owners, those situations can feel isolating. Having a trusted team to walk through difficult conversations and decisions was invaluable.

Another large impact came through our office managers' work with Dawn. Rather than relying on the doctors to drive every initiative, IgniteDDS empowered our office managers to take ownership of the process and lead from within the organization. They embraced that responsibility wholeheartedly. No challenge was too large or too small. Dawn consistently met them where they were and helped them develop the confidence and skills to lead. The answer was rarely, if ever, "no." Instead, it was, "Let's figure out how."

Today, our practice is more aligned, more accountable, and better equipped to deliver the experience we've always envisioned. We have clearly defined protocols, team agreements, and expectations that simply didn't exist before. Our collections have improved significantly, particularly through implementing systems that helped us address and recover outstanding balances.

If we could offer one piece of advice to another practice owner considering IgniteDDS, it would be to identify the team members who are willing to take ownership and invest in their growth. Share your vision with the IgniteDDS team, trust the process, and allow them to help shape your team into the organization you want to become.

Working with IgniteDDS has been one of the most impactful investments we've made in our practice, our team, and our own growth as leaders. Are things perfect? No. Are we closer? Absolutely, yes!

Dr. Justin Elikofer
Dr. Sanjie Jackson

Dr. Sanjie Jackson

I was running on empty, and honestly, everyday I thinking of my exit strategy when I met Dr David Rice. ...
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Dr. Sanjie Jackson

I was running on empty, and honestly, everyday I thinking of my exit strategy when I met Dr David Rice. As the sole owner of two dental practices, I knew I couldn't continue trying to do everything on my own. Not if I wanted to grow and lead at a higher level. Partnering with IgniteDDS has been, hands down, one of the best investments I've made for both my practices and my team. Just halfway through my first year with IgniteDDS, the impact has already been remarkable. The knowledge, systems, accountability, and leadership development they have provided have transformed the way we operate. Not only have I gained valuable tools and insights as an owner, but my entire team is getting empowered with skills and confidence that are helping us elevate every aspect of our patient experience and practice performance. What sets IgniteDDS apart is the genuine commitment they have to their clients' success. Their guidance is practical, actionable, and tailored to the everyday realities of me running two dental practices. I am incredibly grateful for Dr. David Rice, Dawn, Candy, and the entire IgniteDDS team. Their expertise, continuous encouragement, and unwavering support have made me feel like I am not alone on this journey. If you're a practice owner looking to strengthen your leadership, improve your systems, and create sustainable growth, I cannot recommend IgniteDDS highly enough. The value they provide is truly exceptional, and I am excited to see what the rest of this journey brings.
Dr. Sanjie Jackson
Alyse Berta

Alyse Berta

Dawn, thank you for the great advice and guidance you’ve shared as we work on improving our practice's efficiency. I...
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Alyse Berta

Dawn, thank you for the great advice and guidance you’ve shared as we work on improving our practice's efficiency. I truly appreciate your support and the time you’ve taken to help us move forward in a more streamlined and effective way. Your insight has been incredibly valuable and is helping us make meaningful progress.
Alyse Berta
Dani S.

Dani S.

IGNITEDDS has made a real difference in our practice and in my role as office manager. The support I’ve received has...
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Dani S.

IGNITEDDS has made a real difference in our practice and in my role as office manager. The support I’ve received has helped me grow with more confidence and clarity, and our systems and leadership have improved because of it. Dawn has been an incredible support to me personally, always present, approachable, and truly invested in our success. I never feel alone when challenges come up, and that level of guidance and encouragement has been invaluable. IGNITEDDS doesn’t just support practices; they support the people behind them.
Dani S.
Eva B.

Eva B.

Working with IGNITEDDS Coaching has been such a great experience! Having David as a dentist makes a huge difference. He truly...
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Eva B.

Working with IGNITEDDS Coaching has been such a great experience! Having David as a dentist makes a huge difference. He truly understands the day-to-day challenges we face in practice. His insight makes their guidance practical, relevant, and easy to implement. Working alongside Dawn has been such a gift! She’s always available to answer questions, talk through ideas, and help us find the right solutions. Her advice is thoughtful, effective, and supportive. It hasn’t just helped me, it’s positively impacted our entire team and elevated our patient experience. I’m incredibly grateful to partner with Ignite as we continue to grow, strengthen our team, and serve our patients at a higher level.
Eva B.
Kylinn Tucker, RDH

Kylinn Tucker, RDH

I had an amazing experience with the IGNITEDDS Coaching program. Especially since I am a new hygienist, everything...
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Kylinn Tucker, RDH

I had an amazing experience with the IGNITEDDS Coaching program. Especially since I am a new hygienist, everything you guys shared was so helpful. It’s evident that you guys prioritize each individual team member of a dental office and do everything you can to make the environment and schedule run as smoothly and efficiently as possible. I learned so much about treatment planning, Dentrix, scheduling, teamwork, and overall ways to continue improving as a new grad. I wish every dental office had the opportunity to complete this program.
Kylinn Tucker, RDH
Dr Ben Truong

Dr. Ben Truong

It was great working with a team to help bring out the best in each of us. Our team is ...
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Dr. Ben Truong

It was great working with a team to help bring out the best in each of us. Our team is small, but we work closely together to provide a great patient experience, while having fun at work as well! Your team was able to help us learn to work together, with each person having a vital role in providing care to the patient! Helping us all become streamlined and on the same page will help us become an even more successful practice!
Dr Ben Truong
Dr. Ronnetta Sartor

Dr. Ronnetta Sartor

The 90-Day Jump Start has been transformative for our office. Dawn and Dr. Rice guided us through implementing essential systems ...
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Dr. Ronnetta Sartor

The 90-Day Jump Start has been transformative for our office. Dawn and Dr. Rice guided us through implementing essential systems and processes, from new patient calls to treatment planning and case acceptance. Their focus on patient care and team accountability has helped us create better structure, improve work/life balance, and stay aligned with our goals. In a short time, our practice has grown tremendously.
Dr. Ronnetta Sartor
Dr. Chandler Oldenburg

Dr. Chandler Oldenburg

IGNITEDDS has been truly transformative for our practice. Within just a few months, our accounts receivable collections increased by $30K, ...
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Dr. Chandler Oldenburg

IGNITEDDS has been truly transformative for our practice. Within just a few months, our accounts receivable collections increased by $30K, and our operations became far more streamlined. Their clear procedures and policies gave our team structure and confidence, while their step-by-step ownership guidance addressed our specific challenges. Thanks to David and Dawn, we feel more organized, empowered, and aligned than ever before. I highly recommend IGNITEDDS to any practice ready to grow and strengthen its foundation.
Dr. Chandler Oldenburg

Dr. Lee Ann Brady

Dr. Lee Ann Brady lives in Phoenix, Arizona with her husband Kelly and three children Sarah, Jenna and Kyle. She owns Desert Sun Smiles Dental Care, a private restorative practice in Glendale, Arizona. Outside of her private practice, Dr. Brady is the Director of Education for The Pankey Institute, recognized for hands-on education programs focused on occlusion and restorative dentistry. She is the founder and lead curator of Restorative Nation, a supportive learning community for dentists.

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