Root Reflections: When the Bite Tells a Deeper Story



Once, a female patient came to my clinic with a simple but nagging concern: mild pain while biting. I had previously performed a root canal for her, and following that, she had gone back to her general dentist for the final crown. A few weeks later, she was referred back to me. The dentist suspected the root canal might be failing. But when I looked at her X-ray, everything seemed perfect. The obturation was clean. No periapical radiolucency. CBCT was pristine.

Before diving deeper, I called the referring dentist. He confirmed that the crown had been placed properly, checked for high points, and cleared using articulating paper. The patient was reportedly satisfied when she left his clinic. Even now, she reported no perceptible discomfort—just a vague sense of something being “not quite right.”

I asked her one simple question: "Are you comfortable biting in your normal, centric position?" She answered yes, but just as she bit down, I carefully watched her face. Subtle—almost imperceptible—a fraction of a movement occurred. She was shifting slightly to find comfort. To the untrained eye, even among experienced dentists, this would have gone unnoticed. The articulating paper hadn’t revealed anything. Neither would a bite registration. I suspected an occlusal disharmony. But without access to digital occlusion tools like T-Scan, I had to go analog.


So I took photos. Lots of them. From multiple angles. And when I stitched the evidence together, it told a story: her habitual occlusion was slightly eccentric. What looked "normal" on paper wasn't her actual norm. A high point on the palatal side of the restored tooth was causing a cascade of micro-trauma with every bite.

What made it even more elusive was that this high point was on the lingual incline—a zone notoriously tricky to detect. Most conventional bite tests and articulating methods fail to mark these inner aspects effectively. Articulating paper may show the outer cusp-to-cusp contacts, but miss the deeper inner slopes and marginal ridges. The palatal inclines of maxillary teeth and lingual fossae of mandibular teeth often play a silent yet significant role in bite dynamics. They may seem insignificant, but even a minor interference here can shift the bite path, alter temporomandibular dynamics, or create chronic pain.

I carefully adjusted the palatal contours, reducing just enough to balance her occlusion. That’s when she looked at me and said the words we love to hear: “Now it feels perfect.” Pain—gone.         



Understanding the Bite: Centric vs Eccentric Contacts

Centric Occlusion (CO) is when the upper and lower teeth naturally come together. Functional cusps (maxillary lingual and mandibular buccal) should ideally nestle into central fossae or marginal ridges. But if even one cusp lands off-track, the result is unnatural pressure, leading to discomfort, tooth wear, or even root strain.

Eccentric Movements, like lateral excursions or protrusion, are where problems often hide. In ideal occlusion:

  • Working side: Only canines (or premolars in group function) should contact.

  • Non-working side: No contact should occur.

  • Protrusion: Only anterior teeth should guide the movement; posterior teeth must disclude.

Any deviation from this norm creates what we call "interferences"—invisible culprits that can lead to cracked restorations, periodontal inflammation, or lingering pain.

And often, these interferences arise not on the obvious cusp tips but on lingual inclines, internal fossae, or transverse ridges. They are elusive, and unfortunately, easily overlooked in a rushed or purely mechanical occlusal check.

The Pitfall of Conscious Biting

One of the trickiest challenges? A patient who’s trying too hard to help.

When patients become overly aware—especially if they're anticipating pain—they start subconsciously avoiding the very bite path that causes it. Their neuromuscular system adapts, masking the real issue. Repetitive bite tests can thus become misleading.

The solution? Random, passive observations. Ask them to talk, laugh, or simply close their mouth normally, and watch their natural movement. That’s when the real pattern shows up.

The Art of Building Restorations: It’s More Than Filling a Hole



Every restoration is a reconstruction of a finely tuned system:

  • Grooves guide movement.

  • Fossae house cusp tips.

  • Ridges and Margins direct food and stabilize occlusion.

One misplaced contact can collapse that harmony. As restorative dentists, we’ve all faced that heartbreak—meticulously layered composite, carefully sculpted anatomy, then… the patient bites and winces. And the only way out? Trim it down. Flatten it. Sometimes, destroy the very anatomy we worked so hard to build.

Tools and Techniques to Detect the Invisible

  • Tissue Pressure Test: Bite on cotton roll—see where the deepest indent forms.

  • Passive Closure: Gently guide the jaw to check for midline shifts or uneven stops.

  • Colored Wax Bites: Give more nuanced feedback than basic articulating paper.

  • Patient Reenactment: Ask them to mimic how they chew real food.

  • Thermal Rebound Test: Helps differentiate occlusal trauma from pulpal pathology.



Final Thought: Restoring More Than Teeth

Every bite we restore must fit seamlessly into a dynamic, ever-adapting system. It's not just about sealing a cavity or covering a prep. It’s about restoring equilibrium. When the opposing tooth no longer has a partner in harmony—when grooves don’t meet, and ridges misalign—we invite dysfunction.

So the next time you pick up your finishing bur to trim a high point, pause for a second. Maybe the contact isn’t the problem. Maybe it’s trying to tell you something deeper.

Root reflections don’t always come from roots. Sometimes, they echo from the occlusion above.


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