Clinical Policy Bulletins

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Dental - Clinical Policy Bulletins

Number: 029
(Updated)

Subject: Occlusal Adjustment

Date: September 21, 2007

Important Note

This Clinical Policy Bulletin expresses Aetna's determination of whether certain services or supplies are medically necessary. We have reached these conclusions based on a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical and dental literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians and dentists practicing in relevant clinical areas, and other relevant factors). We expressly reserve the right to revise these conclusions as clinical information changes, and welcome further relevant information.

Each benefits plan defines which services are eligible, which are excluded and which are subject to dollar caps or other limits. Members and their dentists will need to consult the member's benefits plan to determine if there are any exclusions or other benefits limitations applicable to this service or supply. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (that is, will be paid for by Aetna) for a particular member. The member's benefits plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the federal government or CMS for Medicare and Medicaid members.

Policy

Aetna considers occlusal adjustment to be part of and inclusive to restorative, prosthodontic and endodontic services. Occlusal adjustment is appropriate during any phase of periodontal therapy, except in the case of acute conditions. Occlusal adjustment (limited and/or complete) is considered to be therapeutic for the treatment of etiologic factors of occlusal trauma to enable patients to maintain a comfortable and functional dentition when supported by diagnostics and other documentation. Aetna does not consider occlusal adjustment the sole treatment modality for the management or prevention of temporomandibular disorders (TMD). 

Background

Occlusal adjustment (odontoplasty) is the reshaping of occlusal surfaces of teeth to create harmonious contact relationship between maxillary and mandibular teeth. A primary objective of occlusal adjustment is improvement of the functional relations of the dentition in such a way that the teeth and the periodontium will receive uniform stimulation and the occlusal surfaces of the teeth will be exposed to an even physiologic wear.¹

The rationale for doing an occlusal adjustment can be grouped into the following categories:

(1) the improvement of functional relations and to induce physiologic stimulation of the entire masticatory system;
(2) the elimination of traumatic occlusion;
(3) the elimination of abnormal muscle tension, bruxism, and associated discomfort or pain;
(4) the elimination of dysfunctional temporomandibular joint discomfort or pain;
(5) the establishment of an optimal occlusal pattern prior to extensive restorative procedures;
(6) the reshaping and contouring of the teeth for masticatory efficiency and gingival protection;
(7) the stabilization of orthodontic results; and
(8) the reconditioning of some abnormal swallowing habits.¹

Complete (full-mouth) occlusal adjustments are performed to achieve functional relationships and improve masticatory efficiency. It may be necessary to perform odontoplasty to occlusal surfaces of numerous teeth to establish or maintain occlusal harmony. Treatment is directed toward the elimination or minimization of excessive force or stress placed on the teeth and/or tooth.

Occlusal adjustments are necessary when essential to reduce or eliminate traumatic occlusion or when teeth are compromised due to loss of periodontal support. Occlusal adjustments may be integral to a comprehensive restorative treatment or part of treatment to correct skeletal and occlusal disharmonies. A complete occlusal adjustment may require multiple visits, is considered part of comprehensive orthodontic treatment and is integral to orthognathic surgery.

Occlusal adjustments are of limited value as the sole treatment modality for the management or prevention of TMD. There has been a long history of using occlusal adjustments in the management of TMD. Experimental evidence does not support the performance of occlusal adjustment as a general method for treating a nonacute TMD, bruxism or headaches.  Literature suggests that temporary reversible measures be attempted prior to permanent irreversible disengagement procedures. 

Any mounting of diagnostic casts, analysis or diagnosis is considered integral to the complete adjustment.

Codes²

D9951 -- occlusal adjustment -- limited
D9952 -- occlusal adjustment -- complete

Revision Dates

Original policy:  January 17, 2006
Updated: September 21, 2007
Revised:

The above policy is based on the following references:

¹Ramfjord SP, Ash MM. Occlusion. Philadelphia:W.B. Saunders Company; 1966: 249.  

²American Dental Association. Current dental terminology, CDT-2007-2008: 70.*

³American Academy of Periodontology.  Parameter on occlusal traumatism in patients with chronic periodontitis. J Periodontol. 2000 May;71 (5 Suppl): 873-5.

⁴Koh H, Robinson PG.  Occlusal adjustments for treating and preventing temporomandibular joint disorders. The Cochrane Database of Systemic Review. 2003; Issue 1.  Art. No.: CD003812.  DO1:  10.1002/14651858.CD003812.

⁵Tsukiyama Y, Baba K, Clark GT.  An evidence-based assessment of occlusal adjustment as a treatment for temporomandibular disorders.  J Prosthet Dent. 2001;86(1): 57-66.

⁶Ziebert GJ, Donegan SJ.  Tooth contacts and stability before and after occlusal adjustment.  J Prosthet Dent.  1979 Sep;42(3):276-81.

⁷Bell WE. Clinical Management of Temporomandibular Disorders. Chicago: Year Book Medical Publishers, Inc; 1982: 194-195.

*Current Dental Terminology. Copyright 2006 American Dental Association.  All rights reserved.

Property of Aetna. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating health care professionals are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating health care professionals are solely responsible for medical advice and treatment of members.