The Missing Data in Digital Dentistry: Jaw Motion Tracking Explained

In the virtual world, I can put stickers on a patient's teeth and I can record every single movement for every single boundary that the patient can move to. I can put that in Exocad as an example and I can mimic what the patient is going to do in every single scenario and say, okay, well now how will that inform me for how the patient is going to chew with these crowns or whatever that restoration is going to look like. Welcome to Austin, Texas, and welcome to the Phil Klein Dental Podcast. Most of us listening to this podcast have had crowns or bridges come back from the lab that require a fair amount of occlusal adjustment once they're cemented. And more than once, while making those adjustments chairside, the thought has probably crossed your mind, there has to be a better way. Our guest today, Dr. Mark Kleive, believes there is, and it starts with jaw motion tracking. By capturing a patient's real jaw movement and sending that data to his lab, Dr. Kleive is delivering final restorations that rarely need adjustment at all. Even more importantly, patients aren't just happy with how their new teeth look, they're noticing how comfortably they function, how efficiently they chew, and how natural their bite feels. In this episode, Dr. Kleive breaks down how jaw motion tracking works, why it matters. and how it can make your restorative dentistry more predictable, more efficient, and far less stressful. Dr. Kleive is a practicing general dentist. He's also on faculty at the Panky Institute. He lectures nationally on digital dentistry and business systems in private practice, and he's at the forefront of helping clinicians bridge the gap between advanced technology and everyday clinical success. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases and our entire production team will really appreciate it. Dr. Kleive, pleasure to have you on the show. Phil, I'm happy to be here. Yeah, we're really happy to have you. And I do want to recommend to our listeners before we get started that you have a webinar on VivaLearning.com, which is really fabulous. I watched it. It's called utilizing jaw motion tracking technology as a virtual articulator. That was delivered by Dr. Kleive on December 9th, 2025. Just go to VivaLearning.com, type in Dr. Kleive's last name. It's K-L-E-I-V-E. K-L-E-I-V-E in the search bar. You'll see it. He's done some other stuff with us in the past as well. Very, very well done. And it covered a lot of important points about a lot of things I think we don't really think about as general dentists. So to begin this episode, let me ask a foundational question. What is a virtual articulator and what data acquisition is needed to create one? So a virtual articulator today is basically... mimicking what the patient does in their jaw motion, mimicking that in a digital way so that you can, let's use the term duplicate, so that you could duplicate what a person does with their jaw in all ranges of motion, left, right, open, close, and so that we can actually mimic, duplicate a person's movements. so that we can more clearly define what type of restoration, what shape of the restoration, how does this restoration need to work with the patient. In the virtual world, we just now have the ability to way more closely manage what the patient actually does. Yeah, and I thought it was very interesting in your webinar, you put a quote up on the screen. and I'm going to repeat the quote, and then I'd love you to comment on it. I like my new teeth, but I find I don't chew as well with them. And that was from a patient. So that means the tooth-shaped form of the restoration was not really ideal for the patient's chewing, but it looked great. And this had a lot to do with the angle of eminence, which you talked about. Tell us about that quote. Tell us about what the patient was going through and how you kind of tried to ameliorate that concern of the patient. Well, I think what happens in most restorative scenarios in a virtual world, we could be just emulating how a person just opens and closes. Their jaw is a hinge and like an alligator and the person opens and closes and we can get that right. So the restoration is not too high. Let's use that as our quotes, too high. The reality is, is depending upon what their jaw does in motion and, you know, chewing is, is dynamic. I'm going to rub these surfaces of my teeth as closely as possible. And it's that closeness that creates a wonderful chewing surface for the patient. So depending upon, you know, you use the term angle of eminence, depending upon, you know, how steep their condo or inclination is, the shape of that restoration is going to influence whether those teeth... come in close contact and are great for chewing. And the example that I used is it's possible to create a restoration that if the patient only opened and closed like an alligator, the restoration is perfect. It's not high. But depending upon the shapes of the cusps and the locations of the cusps, the patient may say, oh my God, and I've had this happen. The patient says, you know. I just, I can't chew as good as I used to. Well, now I know that that's because of the shape of that restoration and how they work with that restoration over time and how it influences how they chew. Right. And most general dentists, basically when they deliver the crown, for instance, they say after it's cemented in, the cement is cleaned up. They say, okay, tap, tap, tap, move your teeth side to side. And there's an articulating. strip in there. You know, I'm talking as an endodontist. So, you know, this is what I heard from my colleagues over the last, you know, whatever. So, you know, that's what they're doing, right? I mean, that's their test of occlusion. And, you know, the patients try many times just wants to please the dentist and says, yeah, that feels great. And, you know, they're moving side to side. You know, what does that even mean when it comes to chewing? So we have the capability now with technology to go way beyond that. And that's what you're teaching, right? Absolutely. And I think it's your knowledge of the occlusion. You have a very thorough, comprehensive knowledge of the occlusion. I don't know whether you did the COIS program or Panky or both or whatever. And there's more programs that focus on occlusion. I think that's always been kind of a weak point for many dentists is really understanding the occlusion. So we used to do it with a face bow and an articulator. in the analog world, but tell us now how some of the technology that's available is so much better than that and how you actually do it. Talk about it from the standpoint of implementing this technology. Well, let's compare and contrast the analog world to the virtual world today. I'll certainly put in a plug for my education at Panky. I mean, it has been very thorough and there are lots of places to get a great education and Panky was my destination and super pleased about it. In the analog world and the facebow world and the articulator, semi-adjustable articulator world, there are still arbitrary measurements that are going to get you most of the way there. An articulator still has a straight path of condylar guidance. so there's no there's there's you know what the beginning point is you know what maybe the end point is but the the distance between those two points kind of mimicking how the person opens and closes and how that um that joint capsule works with the condyle and the disc and all that sort of stuff It's still a straight path in the analog world. In the virtual world, I can put stickers on a patient's teeth and I can record every single movement for every single boundary that the patient can move to. So now I can take that and I can put that in Exocad as an example, and I can mimic what the patient is going to do in every single scenario. and say, okay, well, now how will that inform me for how the patient is going to chew with these crowns or whatever that restoration is going to look like? So that movement that you're tracking goes into a software program. Capturing that tracking motion, is that from the facial scanner? Is that part of the facial scan? It is. It's the Metasmile MR. Okay, Metasmile MR. I think Shining 3D makes that. So that's used as an additional layer of information in that digital stack compiled by Exocad by the laboratory. Correct. We're used to fabricating a crown. I want an upper arch and I want a lower arch and one of those arches has a prep. Now you can animate those upper and lower arches to every possibility that the patient can already do. I mean, they've proved to you every single motion that they can do in every... from every single boundary, as far as they can open, as far as they can move to the left, as far as they can move to the right. All of this is recorded and you have that motion data. It's a file type, that motion file type, which then informs you for how you're going to... What is that file type called? It's not STL, it's not DICOM, it's obviously some... It's a JAW.motion file. Okay, so it's a proprietary file. When that's transferred to ExoCAD, Let's assume the laboratory is doing the design work here and not the dentist. So the dentist has to work with a laboratory that knows how to use this jaw tracking information. Tell us about that. Correct. Well, you know, I am fortunate. I work with somebody who can help me in the design process that is aware of the motion type files. The motion file type is a standard in the industry. There's more than one. It's not proprietary to Metasmile MR. There are other motion companies out there that provide the same file type. So as long as you're a designer that's helping you in your laboratory or the laboratory that you work with, As long as they're used to using these types of file types, it's an import feature just like importing an upper STL or a lower STL or a PLY or OBJ file. It's all in the same file type. Right. So you don't need an articulator anymore like we used to do with the Facebook transfer. That's over. You do not need that. So that must put a smile. We are to the point at which if you can take the three minutes to... to record what these motion parameters are for the patient, you can record that and save that and use that as part of your design feature with your laboratory. I mean, just think of all of the applications of times that you're going to use data, whether it's a single restoration or it's going to be a full arch restoration, all on X, whatever it is. You can record everything that the patient can do. So in your opinion, Dr. Kleive, do you think a general dentist who's doing the simple single crowns, three unit bridges, is this overkill? Do they need to get a facial scanner with jaw tracking software and so forth? Or should that be delegated to the more complex cases? Well, and I think, think about the patients that a general dentist is going to see on a regular basis. We have low risk patients who, if we're going to do a restoration, let's say it's a first molar on a low risk patient. They don't have excessive wear. They don't have TMD issues. They don't have muscle pain, joint pain. More than likely, we can fabricate a restoration that's going to be 99% effective for the patient without needing to do jaw motion study. Okay. So the reality is, is I think our job is to actually manage the risk factors that the patient has and say, what is going to likely give us the best outcome for this patient based upon the risk factors? And so when I have patients that are high risk patients, they have a history of TMD, they have a history of excessive wear. joint pain, muscle pain, and I'm going to do restorations, replace restorations on second molars or first and second molars. Those are, or arches. Those are the patients that absolutely positively, I'm going to do jaw motion studies on today to make sure I'm going to gather that data and make sure that I use that. That is a piece of implementation that I'm going to use that is going to help me get the best success for the treatment that I provide the patient. But to me, it's based upon risk factors. Right. Yeah. And I think that's the key. We have low-risk patients and we have high-risk patients. And I'm going to do this absolutely positively for high-risk patients. Now, for low-risk patients, you won't use it? For low-risk patients, there would likely be not much benefit for me to use them. Okay. So that's something in itself to determine whether or not the patient fits into the category of saying, we need to use this technology. Sure. Now, there's a whole thing about... early acceptance, early adopters of technology. And I think you talked about it in your webinar. And I think it's very interesting. If you would share that with our audience, tell us where we are on that timeline of technology adoption related to the various key technologies that are in our digital workflow, iOS, CBCT, facial scanners, jaw tracking, photogrammetry, and so forth. So the point that I made in my introduction was Everett Rogers talked about the diffusion of innovation. And it has to do with, you know, how is all technology implemented? It's the standard bell curve. And you start out with innovators and early adopters are the first part of the slope of the bell curve. early majority and late majority, and then you have the laggards. And I think all of us as dentists need to look at technology implementation and decide at what point are we going to step into this? Well, the thing that happens first, you know, intraoral scanners, I mean, they've been around for 20 plus years, you know, I guess that people who are thinking about, I think I might want to start, you know, internal scanning. I mean, they're 20 years behind the 20 or maybe 25 plus years behind the innovators. Let me guess, that's the laggard. Those are the laggards. You're kind of in the laggard stage. You might be using film x-rays in your office. So, I mean, these are the things to think about. As far as jaw motion tracking, you know, as you get from the innovation to the early adopters, you get complete solutions. And complete solutions, I think, are for most dentists, those are the times to say, okay, I'm ready to step into this space. And I... think that, that jaw motion has been around long enough that I would say we've worked a bunch of the kinks out. And I think that people can step into this space now with the confidence that, you know what, this stuff actually does work. Yeah. Now I've spoken to some very well-known educators. Dr. Tawil is one of them. And he does, he's actually a consultant for Shining 3D. And he says the facial scanner is one of his favorite tools. It's amazing. Yeah. And it's not that expensive when you think about it, because what you could spend $5,000. for a facial scanner and then right does that come with the jaw tracking part of it it does not not from shining 3d that's a software add-on that's approximately i think it's approximately five thousand dollars added on to that so to get the both it's it's around 10 i I think so. It could be less than that. I really hate to quote prices. Right. But I'm just the reason. Yeah, they change it in technology. Of course, you know, with the competition and more companies having it, it goes down. But my point is a lot of dentists look at things based on a return on investment. You know, it's a business. We do want to do the best dentistry we can. And you mentioned that. That is a big part of it. And you also made a really good point about, you know, when is it time to get in? When you start seeing all the tools. Yeah. When you start seeing all the tools that actually provide a full solution to something, and then you could make this virtual patient appear at the laboratory, the cases are going to come out better. Right. I mean, it's a, I mean, it's. No question. Right. No question. Right. So if you're a dentist and you want your cases to come out better and you care about the patient, I think it's a practice builder too. I think some of this technology is a huge practice builder through word of mouth, but that's a whole nother issue. But as far as. Well, and that's, and I did even. referenced that in closing of the webinar that I did, just talking about return on investment and how we oftentimes miss the patient experience return on investment, that patients are looking, and I use the Mayo Clinic as an example, that it's just, it's worldwide known for its... it's, um, high quality and you're not going to step into the Mayo Clinic and expect that, that you're not going to see technology pieces that, that aren't to the benefit of the patient. And this is no different than that, in my opinion. No, that's a very good point. Good comparison. And I totally agree with it. Um, getting back to the clinical stuff here, if a patient comes in and they're, and they have a broken tooth number 30 and they're not, it just cracked down. So there's very little left. It needs endo and then it needs to be restored. and you have a facial scanner with the tracking technology, when they're moving, when you put the markers on their teeth and you have them move through the motions, they're not going to move exactly the way you want them to because that molar isn't in occlusion. So how do you provide the acquisition information to the lab in which they're going to actually move their mandible when the teeth are actually restored? Here's what I believe, that if you record the patient's opening and closing and you record the patient's movements to their boundaries, so as far as they can move left and as far as they can move right, every place in between those areas, I've already got that covered then. So that's the benefit of this technology is that I don't need to record every possible movement that the patient could make. But I do need to record the boundaries that every patient can be. So the starting and end points on each of those motions, you need to record that. Correct. Okay. And then... And it's going to... The motion data is going to fill in every potential between those areas. I see. I see. That's interesting. Yeah. So I was curious about that. So if one was to purchase this facial scanner with the add-on of the motion, the jaw motion tracking technology, you would recommend that? at the same time, when you buy the facial scanner. I would say, I can't imagine not having the potential to record jaw motion if I was going to do, if I was going to invest $5,000 into a facial scanner, I'm going to invest the rest to be able to do jaw motion study. Now, do you just to have that capability? Yeah. So that information gets added on to the layers of information that gets sent out to the laboratory. So the patient just becomes incredibly realistic for the laboratory. And you think, Most labs are able to manage that data that's acquired through these technologies to actually emulate the mouth so closely that these restorations will come back at a level that this office couldn't reach otherwise. Well, the only part, Phil, of your question that I'm not sure of is how many labs have the capability of doing this. But I do believe that motion information, if... If a laboratory is using ExoCAD, they would have the ability to, I mean, know they have the ability to import this information. But whether or not they're used to using it or not, I have no idea about that, to be honest with you. So the software that they have, hopefully, will let them know that based on the motions that were recorded that they now have that they could duplicate, that will help determine the shape of the final restoration. Absolutely. And in your lecture, you talked about how important that shape is to chewing. It's not just, hey, that looks great. When we were in dental school and we waxed up our teeth, we had these beautiful cusps and the grooves and everything looked beautiful. And we had no idea what that had to do with form and function, at least in the beginning. In the analog world today, you're still putting in that articulating paper in and asking the patient to move left and right. And then you're making the adjustments on those restorations. Well, the reality is you can get 99% of the way there. Maybe 100% of the way there with jaw motion tracking so that you don't have to make those adjustments. I have the preview of everything that this person can do. So when you get these cases back, theoretically and possibly realistically, because you've done it, you do very little occlusal adjustment on these final restorations. Absolutely. So that's like joyful in the office not to have to deal with that. It is. It adds an extra level of... care, skill, and judgment to what we do. So as we wrap up this podcast, Dr. Kleive, it's been very interesting. Tell us about the conversation you have with a patient when doing the facial scan with the jaw tracking. What do you say to the patient? And how impactful is the wow factor in growing the practice? Well, I think the conversation that I want to have with each patient is helping them understand the value of what we're providing. So I tell patients and my team would tell patients the why behind what we're doing. Of course, patients haven't had this experience in an office before. So our job is to tell patients we have the ability to closely mimic or duplicate what you do with your jaw and make sure that we provide restorations for you. that are going to be in symmetry with what you do with your mouth. So we're going to preview what we're going to do. We're going to tell them why it adds value to the process because they haven't experienced it before. And we're going to tell them, this is going to take three to five minutes for us to do this. We're going to ask for your participation. And everything about the communication fill is all positive. We're just telling them, this is why we do it. And this is why it benefits the patient. I mean, those are the things that they continue to rave about and will tell other people about and will mention in Google reviews as an example of why this is a great place to be because they're taking extra special care of me. And again, I frequently use the terms care, skill, and judgment. I believe our job is to express our care, skill, and judgment because that is ultimately what people are paying for. Yeah. No, that's well said. That is well said. And I think there's so many advantages to this technology and it's all coming together. As you said, it's becoming a full solution that dentists that want to stay up to par and they want to provide what we consider a state-of-the-art practice has to take this seriously. And they need to go into CE courses and do the stuff that maybe you did. Go to Panky Institute or find... a mentor along with that continuing education. The information is out there. You're not going to get it in dental school like what you learn afterwards. I mean, not now anyway. The curriculum doesn't provide you with the expertise to do something like this, not only in the form of integrating all the technologies, but also... the practice management of it to help grow your practice with these technologies. So it's really important to stay in tune with all this continued education. And as I said in the beginning of the podcast, Dr. Kleive's webinar is fabulous, utilizing jaw motion tracking technology as a virtual articulator. It was really amazing stuff. And it's great to see how you think, Dr. Kleive, from the standpoint of really understanding the occlusion and how this technology helps you be a better dentist. Any closing remarks before we wrap it up? I guess what my final thought is, is there are lots of ways that each of us can differentiate ourselves from the rest of the profession. And I think our use of technology and utilization of technology is one of the ways that we can set ourselves apart from what people expect in dentistry. And the technology pieces is a way that we can help patients understand how we are different and how our service is exceptional. Yeah. And it makes you get out of bed with enthusiasm to start the day. Absolutely. Well, thank you very much, Dr. Kleive. Really appreciate your time. And I hope to have you on another program soon. Thanks, Bill. Have a great day.