B I T E RE G I S T R A T I O N

PRESENTED
BY:

DR.M.SWATHI
MDS 2ND YEAR
DEPARTMENT OF ORTHODONTICS
 MIDS

CONTENTS
 Introduction
 Theories
-functional matrix theory
-growth relativity theory
-lateral pterygoid hyperactivity hypothesis
 Construction bite technique
- Study model analysis
- Functional analysis
-Cephalometric analysis
 Fabrication of construction bite
 Construction bite
 In various malocclusions –
-Class II division 1
-Class II division 2
-Anterior open bite
-Class III malocclusion
-Arch length discrepancy
 In various appliances
-Activator -Bionator
-Frankel
- Twin block
 Controversies in bite registration  Conclusion
 references
INTRODUCTION:

 Bite registration is a crucial factor in the design and construction of a functional appliance.

 The construction bite determines the saggital and vertical displacements of the mandible and therefore the
degree and direction of appliance activation.

 Probably the most important aspect is the assessment of optimal horizontal and vertical displacement before
construction of the appliance.

no cookbook exists for determining the relationships.

SO HOW MUCH BITE REGISTERED?

 Acc to woodside(1977) in construction of activator as described by anderson (1910)

A bite registration commonly used througthout the world registers mandible in a position protruded approximately
3mm distal to the most protrusive position that the patient can achieve while vertically the bite is registered within
the limits of patients freeway space.
 In north america, similar protrusive bite is made,except that the vertical activation is 4mm beyond the rest
position.
 Roccabado, quantifies normal physiological tmj joint movement as 70% of total joint displacement .beyond
this point the medial capsular ligament begins to displace the disc medially and distally off the condyle
.
THEORIES:

 Functional matrix theory

 Growth relativity/ viscoelastic theory
 Lateral pterygioid hyperactivity hypothesis

ANDERSONS CONCEPT(FUNCTIONAL MATRIX HYPOTHESIS)

He developed mobile,loose fitting appliance modification that transferred functioning muscle stimuli to the
jaws,teeth and supporting tissues which he called Biomechanical working retainer.
According to Andersen and Haupl,(1955),myotactic reflex activity and isometric contractions induce
musculoskeletal adaptation by introducing a new mandibular closing pattern.
Functional matrix theory –form follows function

 The theoretical basis of functional treatment in general is the principle that a “new pattern of function,”
dictated by the appliance, leads to the development of a correspondingly “new morphologic pattern.”

 The “new pattern of function” can refer to different functional components of the orofacial system-for
example,the tongue, the lips, the facial and masticatory muscles, the ligaments,

 The “new morphologic pattern” includes a different arrangement of the teeth within the jaws, an improvement
of the occlusion, and an altered relation of the jaws4
.
Effective in exploiting interrelationship between function and changes in internal bone structure.
Musculoskeletal adaptation by introducing new pattern of mandibular closure.
Reeducating the orofacial musculature need neuromuscular adaptation and change in
direction ,increased distance.
Condylar adaptation to the anterior positioning of the mandible consists of growth in the upward and backward
direction to maintain the integrityof TMJ.
Construction bite do not open beyond postural rest position

Thus it works using kinetic energy

 Drawback of anderson and haupl concept:3

 GRUDE(1952) explaination,If mandible opened beyond postural rest position(4mm) andersons concept
doesn’t work.
 Instead works by stretching soft tissues or viscoelastic properities of the muscles.
Mc namara (1973) in his experiments,found progressive disappearance of neuromuscular
adaptations.
 Stimuli from activator,muscle receptors,periodontal receptors promote mandible displacement.3
 Superior heads of LPM has most important role in skeletal adaptations

 McNamara and his colleagues pointed out from their experimentsin Mucaca muluttu primates that
anterior displacement of the mandible was capable of inducing altered postural activity in the pterygoid
muscle,which consecutively induced additional condylar growth.
 The change in the activity of the pterygoid muscle is indeed a “new pattern of function,” which in
experimental animals leads to a “new morphologic pattern.”

 McNamara and colleagues, who observed an interval of 2 weeks between the onset of the muscular
response and the morphologic changes in histologic preparations of the
mandibular condyle of Macaca mulafra.3

 The hypothesis was proposed that during the first phase of functional treatment, reflexes in jaw
muscles are transiently brought into a state of imbalance.

 This phase of imbalance could act as a trigger for the mandible to attain a new functional position, which
subsequently leads to morphologic changes3.
Petrovic(1984),based on his studies,fundamental requirement for condylar growth is activation of LPM
From their experiments on rats, Petrovic and his colleagues also claimed that the enhanced activity in the
pterygoid muscle during mandibular hyperpropulsion induced supplementary growth in the mandibular condylar
cartilage.(growth relativity hypothesis)
Selmer-olsen,herren(1953),harvold (1974),woodside(1973) do not accept that myotactic reflex and isometric
contractions cause skeletal adaptations.
Viscoelastic properities of muscle and stretching of soft tissues are decisive for activator action.
During each application of force,secondary forces arises in tissues introducing a bioelastic process3

Based on magnitude and duration of applied forced,,

Stages of viscoelastic reaction:

Emptying of vessels

Pressing out of interstitial fluid

Stretching of fibers

Elastic deformation of bone

Bioplastic adaptation
Woodside opens mandible beyond 4 to 5 mm postural rest position(10 to 15mm)

Wide open mandible- Potential energy3

Schmuth(1994),witt(1981),witt and komposch(1979),

his experiences opening up to 4 to 6mm below intercuspal position to be ideal.

Observed long periods of continuous pressure from mandibular teeth against activator.

Hence vertical opening beyond 4mm is not considered.

Eschler(1952),considered opening beyond 4mm as MUSCLE STRETCHING METHOD, alternative
isotonic(elevating mandible) and isometric muscle contractions(biting appliance)
AHLGRENS ELECTROMYOGRAPHIC RESEARCH(1970),
activator acts as interference producing new contraction patterns in the jaw muscles3

STEPS IN BITE REGISTRATION:3

 Before taking construction bite.clinician must prepare by making a detailed study of the plaster
casts,cephalometric and panoramic head films,and patients functional pattern3

 Diagnostic preparation:
 Patient compliance
 Patient motivation by instant correction(VTO)
 Clinical maneveur

 Study model analysis:3

 The first permanent molar relationship in habitual occlusion is determined.

 The nature of the midline discrepancy, if any, is determined. If the midlines are not coincident, a functional
analysis should be made on the patient to determine the path of closure from postural rest to occlusion

 The symmetry of dental arches is determined.

Curve of spee
Crowding and any dental discrepancies are checked and measured.3

 Functional analysis:3
The precise registration of the rest position is made. Thevertical opening of the construction bite depends
on this.
 The path of closure from postural rest to habitual occlusion is analyzed. Any sagittal or transverse
deviations are recorded.
 Prematurities, point of initial contact, occlusal interferences, and resultant mandibular displacement, if any,
are checked. Some of the dysfunctions can be eliminated with the activator, but some require other therapeutic
measures.
The TMJ is carefully palpated for clicking, crepitus, and so forth,which might be characteristic of a functional
abnormality orindicative of the need for some modification of the design of the appliance.
The interocclusal clearance or freeway space is checked severaltimes, and the mean amount is recorded.
 Respiration. With disturbed nasal respiration or enlarged tonsilsthe patient cannot wear a bulky appliance; the
respiratory abnormalities should be eliminated first3

 Cephalometric analysis:3
 The most important information required for planning for the construction bite includes the following:-
The direction of growth
 The differentiation between the position and the size of the jaw bases
The morphological characteristics
The axial inclination and the position of maxillary and mandibular incisors.3
TREATMENT PLANNING:
 Anterior Positioning of the Mandible:3

The usual intermaxillary relationship for the average Class II problem is that of an end to end incisal
relationship. However, it should not exceed 7 mm to 8mm or three quarters of the mesiodistal dimension of
the first permanent molar.
 Anterior positioning of this magnitude is contraindicated in following instances.
1. If there is severe labial tipping of the maxillary incisors.

2. If overjet is too large

3. If one of the incisor usually the lateral incisor erupted markedly to the lingual

 Midline shift during habitual occlusion-bite changed only one side and noted at molars area.

 Pseudo class II- most retruded posture of mandible due to tooth prematurities,tooth guidance,-minimum
forward positioning and maximum vertical opening for differential eruption of upper and lower posteriors.3
 Class I with deep bite-vertical correction leads to class II tendency due to autorotation of mandible.hence
1-2mm forward movement3

 Opening of the Bite:3

There are some guiding principles in maintaining the proper horizontal and vertical relationship in
determining the height of the bite.
 The mandible must be dislocated from the resting position in at least one direction sagitally or
vertically.
 If the magnitude of forward position is great 7 to 8mm, the vertical opening should be minimal.
 If the vertical opening must be extensive, the mandible must not be anteriorly positioned.
 If the bite opening is more than 6mm, the mandibular protraction must be very slight.

 IN CLASS II DIV 2 WITH DEEP BITE/ CLASS I WITH CROSS BITE3

 Initial overbite is measured and to determine how much bite can be opened.
 In permanent dentition-1.5-3mm interincisal up to 9mm molars
 In mixed dentition, 4 to 7mm interincisal
 Reason: palatal plane tipped downwards and increased curve of spee
CLASS II DIV 1

1)Less discrepancy in saggital relationship –more vertical bite opening

2)More discrepancy in saggittal reationship-less vertical bite opening and more anterior posturing favour
horizontal growth pattern
 Because larger bite cause downward and backward rotation of palatal plane .
3) If saggital discrepancy is premolar width,increased curve of spee,overeruption of incisors and retroclined—
edge to edge incisal relation
7mm at molars due to infraocclusion of molars
4)moderate curve of spee,no infraocclusion of molars3,

 General Rules for Construction Bite:3

1. If the forward positioning of the mandible is 7mm to 8mm, the

vertical opening must be slight to moderate (2mm- 4mm).

2. If the forward positioning is no more than 3mm to 5mm, the

vertical opening should be 4mm to 6mm.

3. Lower midline shifts3

 Execution of the Construction Bite3

 A horseshoe-shaped wax rim is prepared for insertion between the maxillary and mandibular teeth.

 It should have proper arch form and size and adequate width and be 2–3mm thicker than the planned
construction bite.

If the rim is placed on the lower arch, the mandible can be guided into the desired anterior position
required for the treatment of the Class II malocclusion.
If the wax rim is placed on the upper arch, the mandible can be moved into a retruded position required for the
construction of a

Class III activator3.

 During the closing movement, the operator controls the edge-to- edge incisor relationship and the midline
registration.
 The wax is carefully removed from the mouth and checked on the upper and lower models.
 The construction bite should always be taken on the patient and not on the models.
 Types of Construction Bites:3

1. Low construction bite with forward positioning of the mandible.

Corresponds to the “H” activator with mode I of action.

2. High construction bite with slight forward posturing.

Corresponds to the “V” activator with mode II of action

3. Bite without forward posturing

– Moderate, high

indication: open bite, deep bite

– Low

indication: crowding, appliance with screws

4. Construction bite with retrusion of the mandible.

For treatment of Class III malocclusion3

 Technique for the Low Construction with a Marked Forward Positioning of the Mandible:3

If mandibular repositioning is posterior when mandible moves from postural rest position to habitual
occlusion ,we suggest greater forward positioning or edge to edge relationship.

A general rule is mandibular positioning should be 3mm less of maximum protrusive
movement.

Vertical opening should be in limits of interocclusal clearance in postural rest position.

This type of construction bite seen in H- activator

Labial incisors cant be tipped labially.
 Additional indication of H-activator3:

 Class II DIV 1 malocclusion with posterior positioning of mandible caused by growth

deficiency with future horizontal growth pattern are suitable for H activator

 Vertical growth pattern does not allow this type of therapy3

TECHNIQUE FOR A HIGH CONSTRUCTION BITE WITH SLIGHT ANTERIOR

MANDIBULAR POSITIONING:3

 Depending on the magnitude of the interocclusal space, the vertical dimension is opened
4 to 6mm, a maximum of 4mm beyond the postural resting vertical dimension registered.
Anteriorly -3 to 5 mm

 The appliance induces activation of myotactic reflex in the muscles of mastication and soft tissues
remain even during sleep due to excess vertical opening.

 This construction bite is used in V –activator with vertical growth patterns.

 The stretch reflex activation
withincreasedvertical dimension may well
influence the inclination of maxillary base. .

 The Class II, Division I malocclusion with a

vertical growth direction cannot be significantly
improved sagitally by anterior positioning of the
mandible.
There is danger of dual bite3

THE TECHNIQUE FOR CONSTRUCTION BITE WITHOUT FORWARD POSITIONING OF THE

MANDIBLE3:

 Such appliances are primarily used in vertical dimension problems (deep overbite and open bite) and in
selected cases of crowding.
 Dentoalveolar overbite problems
 Deep overbite cases caused by supraocclusion of the incisors or infraocclusion of molars
 Infraocclusion of molars:
 Moderate or high construction bite
 Supraocclusion of incisors:

 Small interocclusal space

 High construction bite is contraindicated
 Relative intrusion due to eruption of molars
 Skeletal deep bite:
 Due to horizontal growth pattern maxilla base inclination can compensate.
 Construction bite should be high to exceed patients postural rest vertical dimension3.

 Acc to woodside(1984), bite is beyond 5 to 6mm freeway space

 Incisors are capped at incisal edges to allow eruption of molars and slight forward inclination of maxillary
base
 A dentoalveolar compensation by extrusion of lower molars and distal driving of upper molars with
stabilizing wires.3

 Open bite:
 The bite is opened 4 to 5mm to develop a sufficient elastic depressing force and load the molars that are in
premature contact for depressing posterior maxillary segments analoguous to orthognathic surgery.
 It also restricts vertical growth pattern3

Arch Length Deficiency Problem:

 The malocclusions with crowding can sometimes be treated with activators.
In these cases, low construction bite is used since jaw positioning and growth guidance by selective
eruption of teeth are not considered.3
 The appliace works in a manner similar to that of two active plates with jackscrews in upper and lower .

 Reciprocal forces cause anterior proclination and molar distalisation using stabilizing wires

CONSTRUCTING BITE WITH OPENING AND POSTERIOR POSITIONING OF THE MANDIBLE

FOR CLASS III MALOCCLUSIONS:

 The construction bite is taken by retruding the lower jaw. The extent of the vertical opening depends on the
amount of retrusion that is possible
 Pseudo class III/tooth guidance or functional protrusion
 Mandibular incisors approximate for edge to edge relation by proclination

 Mandible slides anteriorly to complete occlusal relationships

 So construction bite is taken to clear incisal guidance.
 If therapy begins in early mixed dentition stage,prognosis is good3
 In this age,malocclusion is not severe,so guiding maxilla anteriorly holding mandible clears
it.
 Construction bite is only 3mm to retrude mandible for edge to edge incisor guidance.
 Mandible held in posterior position with labial bow and acrylic removed lingually and placed labially.
 Skeletal class III malocclusion with normal path of closure from postural rest to habitual occlusion/true
class III:
 Not desirable or possible.
 If overjet is large,vertical opening should be more but is limited.

 Hence combined fixed and removable therapy is adviced.

 Orthognathic surgery is adviced
 However if therapy started in mixed dentition period,bite opening to get incisal guidance will further
prevent protrusion of mandible due to overlapping of incisors.3
 The vertical opening of the mandible is dependent on three major considerations

1) The kind of dysgnathic or dysplastic problem(saggittal and vertical relationships)

2) Developmental stage ,sex,age(potential incremental change)
3) Type of activator to be used.4

BIONATOR:

 Balters in 1950, said that tongue is the essential factor in the development dentition.

 Unlike activator,no allowances are made in case of facial pattern by variations in vertical opening as the
mandible is postured forward.

 The bite cant be opened and positioned in, an edge to edge relationship

 Two step procedure can be done.3

 Balters reasoned that high construction bite could impair tongue function and patient could actually acquire
tongue thrusting habit as mandible dropped open and tongue moves forward to maintain open airway.
He said this will provide the maximum functional space for the tongue and is also convenient for the patient

 Balter followed step by step protraction procedure in case where overjet is too large, to allow an edge to edge
incisal bite.3,

STANDARD APPLIANCE3

Lower extends from last erupted molars on one side to other side
Upper arch from premolars to molars,anterior region is open for tongue functioning,however

if edge to edge incisor relationship is maintained it prevents tongue thrusting.

It extends 2mm above and below gingival margins

Acrylic capping done for lower incisors to avoid proclination in 2 step procedure3.
OPEN BITE APPLIANCE

 Only to inhibit tongue posture

 Construction bite is as low as possible,but a slight opening allows the interposition of acrylic bite
blocks for posterior teeth to prevent their extrusion.
 To prevent tongue movement ,acrylic portion of lower lingual part extends in to upper incisor region
as a lingual shield,closing anterior space without touching upper teeth.3
CLASS III OR REVERSED BIONATOR

 Constructionbite is taken in most retruded position possible,to allow labial movement of the maxillary
incisors and simultaneously exert a slight restrictive effect on lower arch

 Bite is slightly opened creating about 2mm interincisal space for this purpose
 The lower acrylic portion is extended incisally from canine to canine.

 This extension is positioned behind upper incisorswhich are stimulated to guide anteriorly along the resultant
inclined plane3

FRANKEL REGULATOR APPLIANCE

 For minor sagittal relationships(2 to 4mm),edge to edge ,incisor guidance can be taken for
construction bite.
 Taking in to consideration excessive muscle strain should be avoided,both retrusive and
protrusive forcesshould be balanced(2.5 to 3.5mm)
 Interoclusal clearance should be such that crosswires should pass without touching teeth
 Or anteriors edge to edge relationship.
 Up to 6mm(forward)---2.5 to 3.5mm interocclusal clearance
 6mm—3mm
 Acc to petrovic,correctin the saggital discrepancy by two or three stages is effective for both tissue
response and pt compliance3.

 FRIII:
 Frankel recognises the probable maxillary deficiency and anterioposterior discrepancy in class III fact that a
combined mandibular excess and accomadative forward posturing of lower jaw may occur.
 Construction bite procedure involves posterior positioning of mandible with posterior position of
condyle.
 Vertical dimension is opened only enough to allow the maxillary incisors for crossbite correction.
 Bite opening is kept minimal to allow lip closure with minimal lip strain3.

TECHNIQUE

 To obtain maximal posterior condylar position,the clinician gently taps on mandiblewith flexed knuckles of
dominant hand when pt opnes bite app 1cm

 He continues tapping by the thumb against the symphysis and forefinger under chin.

 Before taking wax registration ,clinician must make sure that pt maintains this position for 1 or 2 min.so that
proprioceptive learning process and feedback to the muscles and tendons will be strong enough to overcme the
natural tendency to protrude the mandible when closing in to the construction bite wax wafer3.
 The posterior guidance is essential during the actual bite taking procedure.
 This position is easier for the patient to hold while wax rests.
 Deep bite problems require a wider opening of the vertical dimension for the construction bite by
posterior tooth eruption.3

TWIN BLOCK

 The Exactobite or Projet bite Gauge is used to record bite in wax for construction.of twin block.

 Bite registration for twin blocks orginally aimed for a single activation to an edge to edge incisor
relationship with 2mm intercisal clearance for an overjet of .10mm
 If overjet beyond 10mm,two step activation with 7 to 8mm forward movement.

 In early stages of using twin blocks,it was noted that some patients had difficulty in maintaining the
forward posture and occluding correctly on the inclined planes.
 This problem can be overcomed during bite registration by registering bite within limits of protrusive
path of mandible1
 The total protrusive movement
The total protrusive movement is calculated by first measuring the overjet in centric occlusion and in the
position of maximum protrusion.1
The protrusive path maximum protrusion.
 The protrusive path of the mandible is the difference between the two measurements.
the George bite is used to measure the distance.
 So functional activation should be within 70% of physiological limit.1

IN CLASS II DIV 1 MALOCCLUSION-

 In class II div 1 malocclusion- A protrusive bite is registered to reduce the overjet and the distal occlusion
on average by 5 to 10mm and 2mm vertical clearance between the incisal edges of the upper and lower
incisors and 3mm at molar region are registered.

 First blue bite guaze is placed and rehearsed for comfortable mandible position

 Then wax rim is added bite registered with accurate midlines coincidence.1
Class II div 2 malocclusion:

 Incisors in edge to edge occlusion.

As these patients require more vertical development, the occlusal bite blocks, should be thicker in
the premolar region to allow clearance of the upper and lower molars
 The amount of mandibular advancement is limited here.1

 Class III malocclusion

The blue exactobite is used to register bite with the teeth closed to the position of maximum retrusion,
leaving sufficient clearance between the posterior teeth for the occlusal bite blocks.
This is achieved by recording a construction bite with 2mm interincisal construction in the fully retruded
position.
The treatment of brachyfacial class III,yellow exactobite for 4mm interincisal clearance for further
increasing bite.1

CONCLUSION:

 The determination of proper construction bite is crucial for a functional appliance to succeed
 More failures can be avoided by correct posturing of mandible in three planes of space-vertical,horizontal
and transverse.
 And practical experience will master in this technique more than a theoritical point.2
REFERENCES

1) Clark William J., , Twin block Functional Therapy, Applications in dentofacial orthopedics, 2nd
Ed., Mosby; Pgs.12,25,26,161,193,218,90
2) Graber T.M., Neumann B. , Removable orthodontic appliances, Ed.2,1984, W.B.orthodontic
appliances, EPgs.310-314,364,365,411, 521.Saunders,
3) Graber Petrovic Rakosi, Removable orthodontic appliances, Ed.3 Pgs. 41, 42, 81, 82, 87.82,
87.
4)Carels and van der Linden : Functional appliances' ' mode of action; Am J Orthod Dentofac Orthop
:1987: 10:162 - 168.
5)John C. Voudouris,Improved clinical use of Twin-block and Herbst as a resultuse of radiating
viscoelastic tissue forces onof radiating viscoelastic tissue forces on the condyle and fossa in
treatment and in treatment and long-term retention: : Growth relativity; Am J Orthod Dentofac Orthop:
2000:3:157-J .