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12 I I MICD _ occlusal force management puter-guided occlusal analysis affords the opera- tor precision, occlusal force isolation and pre- dictablecontrolofrestorativeocclusalerror,which aids in prolonging the longevity of the all-ceramic restorations. _Conclusion For MICD, computer-guided occlusal analysis systems offer data on quantifiable pressure, force and contact time sequence that can be employed toguidetheocclusaladjustmentoftherestoration to precise measurable endpoints.2, 3 These end- points establish uniform force distribution, bi- lateral simultaneity and measurable immediate disclusion, and minimise the damaging effect of concentrated, excessive, isolated occlusal force. Avoidingpotentiallydestructiveintra-oraluse,the overall prosthetic occlusal scheme preserves the ceramic materials utilised in the procedure, ensur- ing long-term survival. Lastly, occlusal adjustments that are guided by T-Scan III technology represent the essence of MICDbecauseacliniciantreatsonlywhatneedsto be treated and does not perform random subjec- tiveocclusaladjustmentbasedonmerejudgement of paper markings with the naked eye. Measured occlusal force and timing data direct the MI clini- cian to adjust only the locations of excessive force, while leaving the areas of measured low occlusal force untouched. Cosmetic restorations and tooth structure are therefore preserved and overtreat- ment is minimised. The clinical implementation of this technology mirrors the core message of the “Do No Harm” philosophy._ _References 1. Yamaga R, Nishino M, Yoshida S, Yokomizo I. Di- ammine silver fluoride and its clinical application. J Osaka Univ Dent Sch 1972;12:1–20. 2. Houpt M, Fukus A, Eidelman E. The preventive resin (composite resin/sealant) restoration: nine-year re- sults. Quintessence Int 1994;25(3):155–9. 3. Smales RJ. Yip HK. The atraumatic restorative treat- ment (ART) approach for the management of dental caries. Quintessence Int 2002;33(6):427–32. 4. Munshi AK, Hegde AM, Shetty PK. Clinical evaluation of Carisolv in the chemico-mechanical removal of carious dentin. J Clin Pediatric Dent 2001;26:49–54. 5. World Dental Federation. Minimal Intervention in the managementofdentalcaries.FDIpolicystatement2002. 6. Koirala S. Minimally invasive cosmetic dentistry— Concept and treatment protocol. Cosmetic Dentistry 2009(4):28–33. 7. Carey JP, Craig M, Kerstein RB, Radke J. Determining a relationship between applied occlusal load and articulation paper mark area. The Open Dentistry Journal 2007;1:1–7. 8. Saad MN, Weiner G, Ehrenberg D, Weiner S. Effects of load and indicator type upon occlusal contact mark- ings. J Biomed Mater Res B Appl Biomater 2008; 85(1):18–22. 9. Millstein P, Maya A. An evaluation of occlusal con- tact marking indicators. A descriptive quantitative method. J Am Dent Assoc 2001;132(9):1280–6. 10. Glickman I. Clinical Periodontics. Saunders and Co 1979(5):951. 11. ReiberT,FuhrK,HartmannH,LeicherD.Recordingpat- tern of occlusal indicators. I. Influence of indicator thickness, pressure, and surface morphology. Dtsch Zahnarztl Z 1989;44(2):90–3. 12. Dawson, PE. Functional occlusion: from TMJ to smile design. Mosby, Inc 2007(1):347. 13. McNeil, C. Science and practice of occlusion. Quint- essence Publishing 1997:421. 14. Okeson J. Management of temporomandibular disor- ders and occlusion. CV Mosby and Co 2003(5):416, 418, 605. 15. KleinbergI.Occlusionpracticeandassessment.Knight Publishing 1991:128. 16. Smukler, H. Equilibration in the natural and restored dentition. Quintessence Publishing 1991:110. 17. Maness WL. Force movie. A time and force view of oc- clusion. Compend Contin Educ Dent 1989(10):404–8. 18. Kerstein RB, Grundset K. Obtaining measurable bilat- eral simultaneous occlusal contacts with computer- analyzed and guided occlusal adjustments. Quin Int 2001;32(1):7–18. 19. KersteinRB.Tekscan-ComputerizedOcclusalAnalysis. In: Maciel RN. Bruxismo. Editora Artes Medicas Ltda. Sao Paolo, Brazil 2010. 20. Kerstein RB. Reducing chronic massetter and tempo- ralis muscular hyperactivity with computer-guided occlusal adjustments. Compendium of Contin Educ Dent 2010;31(7):530–43. 21. KersteinRB.Combiningtechnologies:Acomputerized occlusal analysis system synchronized with a com- puterized electromyography system. Cranio 2004; 22(2):96–109. 22. Kerstein RB, Chapman R, Klein M. A comparison of ICAGD(immediatecompleteanteriorguidancedevel- opment) to mock ICAGD for symptom reductions in chronic myofascial pain dysfunction patients. Cranio, 1997;15(1):21–37. cosmeticdentistry 2_2011 Dr Robert Kerstein works in private practice in Boston, Massachusetts.He was Assistant Clinical Professor at the Department of Restorative Dentistry,Tufts University School of Dental Medicine from 1983 to 1998. cosmeticdentistry _about the author