M

anagi ng a bi te rel ati onshi p i s one

of the most cri ti cal aspects of any
restor ati ve dental pr ocedur e. The
bi te r egi str ati on i s a key component i n
recordi ng i ntraoral rel ati onshi ps for effec-
ti ve r econstr ucti on of a si ngl e pr epar ed
tooth, a quadrant of prepared teeth, or a ful l
arch of teeth prepared for restorati ve aes-
theti c reconstructi on. Bi te regi strati ons are
used to hel p or i ent the maxi l l ar y and
mandi bul ar rel ati onshi p duri ng the mount-
i ng of study model s, pr ovi si onal r estor a-
ti ons, r emovabl e appl i ance constr ucti on,
and restorati ve denti stry.
The bi te r egi str ati on or i nter occl usal
record can be used for di agnosti c mounti ngs
i n a habi tual accommodated centri c posi ti on
or i n a physi ol ogi c maxi l l o-mandi bul ar rel a-
ti onshi p to assess jaw rel ati onshi ps. The
bi te regi strati on can assi st the cl i ni ci an and
l aboratory techni ci an to better understand
pathol ogi c and physi ol ogi c r el ati onshi ps
that exi st when di agnosti cal l y anal yzi ng
the mounted study cast. The bi te regi stra-
ti on or i nteroccl usal bi te record i s al so used
for treatment purposes. A bi te regi strati on
shoul d be easi l y and preci sel y transferred to
stone model s wi thout rocki ng or fl exi ng i n
order to reproduce an accurate, yet stabl e
upper and l ower jaw rel ati onshi p.
THREE TYPES
OF BITE REGISTRATIONS
I nteroccl usal regi strati ons or bi te records
can be di vi ded i nto 3 categori es: 1. bi te reg-
i strati ons for one to 2 teeth (l i mi ted treat-
ment segments), 2. bi te r egi str ati ons for a
group of teeth such as a quadrant of teeth,
and 3. bi te regi strati ons for a si ngl e arch or
both dental arches together for treatment
and transferri ng of i ntraoral i nformati on to
the l aboratory mounti ng.
When treati ng a l i mi ted segment of
teeth or a quadrant of teeth the i ntercuspal
posi ti on can be recorded to the habi tual cen-
tri c occl usi on accuratel y and preci sel y as l ong
as there i s suffi ci ent occl usal support from the
adjacent teeth i n that quadrant or dental arch
(no mandibular torque) (Figs. 1 and 2).
108
Bite-Management Considerations
for the Restorative Dentist
RESTORATIVE
DENTISTRY TODAY JANUARY 2008
Clayton A. Chan,
DDS
Figure 1. LuxaBite (Zenith Dental/ DMG) allows for
precise model mounting and orientation to accurately
fabricate the occlusal contacts of the upper right first
and second bicuspid all-ceramic crowns (Empress,
Ivoclar Vivadent).
Figure 2. The occlusal contacting marks immediately
after bonding the upper right first and second bicus-
pids before anyocclusal adjustments. Further refine-
ment was made to balance the bite with the
Myomonitor TENS.
a
b b
Figure 3. Note the detail in the thin areas (right quad-
rant vs. left quadrant) of the LuxaBite bite registra-
tion, indicating imbalances in the terminal contact of
this case. This rigid (nonflexing) intraoral bite record
allows for precise transfer to the models for accurate
mounting.
Figure 4. Using a rigid bite registration (LuxaBite)
avoids vertical compression transfer error during the
mounting of the master die models for precise crown
fabrication and occlusal management.
continued on page 110
a

RESTORATIVE
110
Regi steri ng the exi sti ng
habi tual bi te rel ati onshi p vi a
any bi te regi strati on materi al
rel i es on the abi l i ty of the
pati ent to cl ose reproduci bl y
i nto a centri c posi ti on.
Whether the bi te i s bal anced
preci sel y or not, a bi te regi s-
trati on can be made as l ong as
the pati ent i s abl e to propri o-
cepti vel y cl ose to a termi nal
contact posi ti on. Any prema-
ture contacti ng i ncl i ne that
goes unnoti ced duri ng habi tu-
al cl osure can i nduce an i n-
accurate bi te recordi ng during
the bite registration (Fi gure
3). I f the pati ent cl oses sl i ght-
l y i nto another posi ti on other
than the posi ti on i ntended for
treatment, an i naccurate
mounti ng of the opposi ng
casts wi l l reproduce unwant-
ed prematuri ti es on the new
restorati ons at the ti me of
crown del i very, resul ti ng i n
undesi r ed occl usal adjust-
ments. Most exper i enced
l abor ator y techni ci ans have
an abi l i ty to i denti fy these
bi te r egi str ati on i naccur a-
ci es dur i ng the mounti ng
and ar ti cul ati ng stages of
the dental casts, and wi l l
i mmedi atel y cor r ect for the
er r or and pr obl em by al ter -
i ng the mount of the casts
themsel ves wi thout any
bi te r ecor d.
BACKGROUND
Dental practi ti oners around
the worl d spend a consi der-
abl e amount of ti me adjust-
i ng the occl usi on, especi al l y
when del i ver i ng poster i or
cr owns.
1
Why? Some may
bl ame the l aboratory techni -
ci an for not mounti ng the
model s accur atel y. Other s
may say that the shri nkage
or expansi on rati os of stone,
mounti ng pl aster, and the
processi ng of the crown fab-
ri cati on l ends i tsel f to mi nor
occl usal changes. Other s
bl ame the pati ents poor
bi te. Some may bl ame the
i mpressi ons for thei r i naccu-
raci es. I nadvertent gri ndi ng
of the occl usi on due to sl i ght-
l y hi gh premature contacts
on the new cr own(s) or
bri dge(s) can be l ess than
desi rabl e and frustrati ng to
the denti st. Excessi ve ad-
justi ng of the occl usi on, even
at successi ve offi ce vi si ts,
can be an i ndi cator that
other underl yi ng probl ems
may exi st, compromi si ng the
functi onal i ntegr i ty, mor -
phol ogy, stabi l i ty, and aes-
theti cs of the restorati ons.
A ful l upper and l ower
set of dental casts can be
hand mounted to the exi st-
i ng habi tual bi te wi th rel a-
ti ve accuracy when one or
2 cr own pr epar ati ons ar e
done, as l ong as there exi st
good i nterdi gi tati on of the
teeth and supporti ve oppos-
i ng abutments. I f free ended
edentul ous r i dges exi st i n
poster i or r egi ons of the
mouth (eg, mi ssi ng fi rst and
second mol ar s), or mol ar s
that are severel y worn down
wi th no suppor ti ve occl u-
si on, i t i s i mperati ve that
judi ci ous care be taken to
determi ne a physi ol ogi c bi te
rel ati onshi p and re-establ i sh
a pr oper poster i or ver ti cal
r el ati onshi p of the jaw (Fi g-
ures 4 to 6).
2
Sequenci ng whi ch tooth
to prepare fi rst whi l e mai n-
tai ni ng a verti cal stop wi th a
fi rm bi te regi strati on i s cri t-
i cal when tr eati ng mul ti pl e
uni ts of teeth for cr own
preparati ons.
BITE-MANAGEMENT
CONSIDERATION OF THE
OCCLUSALLY
COMPROMISED
Bi te r ecor di ng er r or s and
mi smanagement of the bi te
can affect the central nerv-
ous systems feedback l oop,
r esul ti ng i n debi l i tati ng
pathol ogi c r eacti ons (myo-
pathy and TMD) at al l l ev-
el s of the cr ani omandi bu-
l ar /neur omuscul ar /cer vi cal
postur al compl ex.
The adapti ve and accom-
modati ng capaci ty of most
peopl es bi tes certai nl y can
be attri buted to hi gh l evel s
of tol erance of the muscl es
an d tempor oman di bu l ar
joi nts duri ng restorati ve pro-
cedures. Fortunatel y, not al l
pati ents present wi th masti -
catory dysfuncti on, pai n, and/
or joi nt derangement.
Denti sts tr eati ng the
compl ex ar ch type cases
i nvol vi ng sever el y wor n
denti ti on wi th accompany-
i ng muscul oskel etal occl u-
sal probl ems may need to
rehabi l i tate a compl ete den-
tal arch to a more physi ol og-
i c verti cal di mensi on. Estab-
l i shi ng a new bi te posi ti on
for these myogeni c or arthro-
geni c compromi sed cases i s
often requi red. The Counci l
on Dental Care of Ameri can
Dental Associ ati on (ADA)
Gui del i nes for i ni ti al TMJ
tr eatment r ecommends a
phase I (reversible) treatment
appr oach for those cases
that are not stabl e; provi ng
the jaw r el ati onshi p wi th
ti me and i mpl ementi ng a
reversi bl e appl i ance i s hi ghl y
recommended to prevent fur-
ther harm. A phase I I l evel of
necessary therapy may be
requi red after the pati ent i s
pai n free (3 to 6 months).
3
Many wi thi n our professi on
recogni ze that a majori ty of
i ndi vi dual s wi th i nter nal
derangement and associ ated
myofaci al pai n wi l l respond
favor abl y to or thoti c and
functi onal jaw or thopedi c
appl i ance therapy.
4,5
Managi ng a proven bi te
rel ati onshi p after pai n sym-
ptoms have been al l evi ated
shoul d not be a casual or
r outi ne pr ocedur e. I t r e-
qui r es an abi l i ty to manage
the i nteroccl usal space accu-
ratel y i n mul ti -di mensi ons,
whi ch i ncl udes the verti cal ,
antero-posteri or, frontal /l at-
eral , pi tch, yaw, and rol l as-
pects of the mandi bl e. The
maxi l l o-mandi bul ar verti cal
r el ati onshi p shoul d cor r e-
spond to the physi ol ogi c rest-
i ng tonus of the masti catory
muscl es to ensure adequate
i nteroccl usal freeway space.
The physi ol ogi c rel ati onshi p
shoul d be recorded and accu-
ratel y mai ntai ned wi th the
condyl es and di sc i n a physi -
ol ogi c posi ti on.
RELAX THE MUSCLES
BEFORE TAKING A BITE
Path ol ogi c mu s cl e en -
gr ammed movement pr o-
gr ammi ng and muscul ar
dysfuncti ons often prevent
an unstrai ned bi te regi stra-
ti on and opti mal condyl ar
posi ti on. A useful ti p for
these types of cases i s to
r el ax and depr ogr am the
muscul ature pri or to taki ng
a bi te by pl aci ng 2 moi st cot-
ton rol l s over the premol ar
regi on bi l ateral l y and ask
the pati ent to cl ose thei r jaw
wi th mi ni mal pressure for a
few mi nutes before actual
regi strati on.
Rel axi ng the muscl es
vi a l ow fr equency Myo-
moni tor TENS (Myotr on-
i cs) for 60 mi nutes has
been pr efer r ed by many cl i -
ni ci ans to assi st i n estab-
l i shi ng an opti mal jaw r e-
l ati onshi p 6-di mensi onal l y.
Low fr equency TENS has
been an effecti ve means to
assi st i n r emovi ng patho-
l ogi c engr ams, al l owi ng the
compl ete cr ani omandi bu-
l ar compl ex to better al i gn
i tsel f i n a physi ol ogi c r e-
l ati onshi p pr i or to bi te
r egi str ati on.
2,6
MANAGING THE BITE IN
THE LABORATORY
Techni ques used to i ndex the
i nter cuspal /accommodated
bi te posi ti on for restorati ve
and pr ostheti c denti str y
have hi stori cal l y used soft-
ened pi nk base pl ate wax
fol ded and posi ti oned be-
tween the bi te to capture the
i nter ar ch r el ati onshi p for
dental cast mounti ng and
eval uati on.
7
I t i s no l onger
recommended to use the tra-
di ti onal wax bi te method
when ful l arch model s can
be di rectl y hand arti cul ated
wi th maxi mum i ntercuspa-
ti on. Even i f the wax bi te
i s careful l y handl ed i n the
mouth, di stor ti ons of the
wax cannot be avoi ded when
reposi ti oni ng i t back to the
stone model . The same ap-
pl i es to wafer bi tes, whi ch
are often recommended and
cause defi ni te changes when
tryi ng to establ i sh a more
physi ol ogi c rel ati onshi p.
Other materi al s such as
acryl i c resi n-base, composi te
resi ns, pol yether, pol yvi nyl
si l oxane, and i r r ever si bl e
hydr ocol l oi ds have been
used.
8
Pol yvi nyl si l oxanes
continued from page 108
Bit e-Management ...
DENTISTRY TODAY JANUARY 2008
Figure 5. (A) The first molar was
prepared first and a bite registra-
tion was immediatelyrecorded to
hold the bite relationship (stage
1). (B) The second molar was then
prepared and LuxaBite was inject-
ed over the second molar prep
(stage 2) while the first molar bite
registration was held in position to
hold the vertical dimension (pre-
venting joint collapse). (C)
Empress (Ivoclar) crowns were fab-
ricated to the recorded bite
relationship.
Figure 6. Articulating paper mark-
ings (40 m, Bausch Thin) immedi-
atelyafter cementation of the first
and second molar before any
occlusal adjustments.
Figure 8. A preliminaryfabricated
acrylic matrix (Sapphire) is made
prior to tooth preparation to hold
the upper and lower bite relation-
ship. LuxaBite is injected over the
acrylic matrix to reline the pre-
pared teeth to capture the details
of the bite and hold the bite posi-
tion accurately. Note the visual
ease and control the hard bite reg-
istration offers during treatment.
Figure 7. Diagnostic wax-up of the
upper and lower posterior quad-
rants at the physiologic position
after 23 months of stabilization.
a
b
c
a
b
a
b
(al though seemi ngl y conven-
i ent to use) have been used
wi th l i mi ted success i n accu-
r atel y mai ntai ni ng the
r ecor ded maxi l l o-mandi bu-
l ar rel ati ons.
9
Most experi -
enced denti sts and l aborato-
ry techni ci ans val ue a good
sol i d bi te regi strati on, whi ch
mi ni mi zes compressi on and
fl exural characteri sti cs.
10-13
Extensi ve effort by experi -
enced l aboratory techni ci ans
has been gi ven to ensur e
successful seati ng of the new
restorati ons, not al ways to
the credi t of a good bi te reg-
i strati on by the doctor. Some
bi te regi strati ons are ren-
dered usel ess and not used
when the l aboratory techni -
ci an r ecogni zes di stor ti ons
and l ack of accuracy i n regi s-
teri ng a correct bi te rel ati on-
shi p. The abi l i ty to compress
or fl ex the recorded bi te reg-
i strati on wi th the softer bi te
r egi str ati on mater i al s has
been found to i ncrease chai r-
si de occl usal adjustments of
the new restorati ons at the
seati ng appoi ntment. Remov-
i ng unwanted bubbl es and
fl ash from vari ous bi te regi s-
trati ons i s often requi red to
mount the dental casts cor-
rectl y. Any smal l di screpancy
i n the mounti ng or di storti on
i n the i mpressi on can l ead to
l oss of ti me and i naccuraci es
duri ng occl usal waxi ng and
crown fabri cati on.
IMPORTANCE OF
MAINTAINING THE BITE
IN THE POSTERIOR
QUADRANT
Temporary crowns are i m-
portant not onl y to protect
the prepared tooth, but al so
to hol d the bi te and stabi l i ze
the condyl es and di sc wi thi n
the gl enoi d fossa. Few cl i ni -
ci ans recogni ze the i mpor-
tance of mai ntai ni ng an ac-
curate bi te rel ati onshi p be-
tween the maxi l l a and man-
di bl e duri ng the tempori za-
ti on phase. Many denti sts
bel i eve that the provi si onal
cr owns ar e just tempo-
raries and the fi nal restora-
ti ons wi l l be seated i n a cou-
pl e of weeks wi th l i ttl e
regard to the muscul ature
and jaw joi nt mai ntenance.
Tempor ar y cr owns ar e
routi nel y adjusted wi th l i ght
to no occl usal marks to avoi d
i nterferi ng contacts (eg, fi rst
and second mol ar regi ons).
Teeth that are prepared i n
the posteri or mol ar regi ons
may be pur poseful l y l eft
wi th sl i ght contacti ng occl u-
si on duri ng the provi si onal -
i zati on stage, resulting in an
unrealized loss of vertical
dimension in that quadrant.
Wi th the sl i ght l oss of verti -
cal change ther e wi l l al so
be a compensati ng verti cal
change i n the condyl e/di sc
RESTORATIVE
111
continued on page 112
FREEinfo, circle 77 on card
Extensive effort by
experienced laborato-
ry technicians has
been given to ensure
successful seating of
the new restorations,
not always to the
credit of a good bite
registration by the
doctor.
RESTORATIVE
112
rel ati onshi p wi thi n the gl e-
noi d fossa.
Accommodati on wi l l oc-
cur i n the bi te, joi nts, and
muscul ature duri ng the tem-
pori zati on peri od i f proper
attenti on i s not gi ven to the
occl usal i ssues. Whatever
occl usal rel ati onshi p exi sts,
i mmedi atel y after r estor a-
ti ve treatment the pati ents
bi te i s forced to rel y on the
exi sti ng occl usi on to support
the jaw posi ti on. Al though a
bi te regi strati on was taken
and recorded at a parti cul ar
rel ati onshi p for the l aborato-
ry to mount, the pati ents
tempori zed bi te rel ati onshi p
may have been unknowi ngl y
al tered and wi l l adapt to a
sl i ghtl y l ower verti cal posi -
ti on than what the l abor ato-
r y actual l y mounted usi ng
the bi te regi strati on gi ven
for crown fabri cati on. As a
r esul t of the human ar ti c-
ul ator changi ng ver ti cal
posi ti on over ti me, the new
r estor ati ons that wer e fab-
r i cated i n the l abor ator y
wi l l appear hi gh at the
ti me of cr own tr y-i n and
cementati on. Cr owns ar e
rarel y hi gh i n occl usi on due
to super -er upti on of the
tooth. Erupti on i n the mol ar
regi ons rarel y occurs i n 7 to
10 days.
4,14
Most denti sts do
not real i ze they have con-
tri buted to a subtl e verti cal
l oss i n occl usal di mensi on of
thei r pati ents bi te.
SIGNS AND SYMPTOMS
OF BITE PROBLEMS
Di agnosi s of the condi ti on of
the jaw joi nts i s often over-
l ooked i n our general dental
professi on. I t has been re-
ported that 82% to 90% of
TMJ di sorders comes from
muscl es.
15,16
Al though a ful l
seri es of peri api cal fi l ms and
panorami c i s a standard of
care to most cl i ni ci ans, we
must not overl ook the fact
that not al l tempor oman-
di bul ar joi nts are heal thy,
just as not al l masti catory
muscl es (tender muscl es) are
heal thy when eval uated. Jaw
joi nts that present wi th con-
dyl ar degenerati ve changes
(eg, flattening, beaking, scle-
rosing, bend in the neck of
the condyl e, hyper pl asti c)
and present wi th di spl aced
di scs shoul d be i denti fi ed as
contri buti ng to occl usal man-
agement bi te chal l enges.
Cl i cki ng and poppi ng joi nts,
restri cted mandi bul ar open-
i ng, joi nt pai n, muscul ar
pai n, and tooth sensi ti vi ti es
and aches i n other regi ons of
the mouth coul d be cl i ni cal
i ndi cators that somethi ng i s
wrong wi th the jaw joi nts
and muscl es. Compl ai nts by
the pati ent that thei r bi te
doesnt feel ri ght or that cer-
tai n contacts hi tti ng prema-
turel y i n the anteri or regi on
cause i rri tati on shoul d not
be taken l i ghtl y. Numerous
repeat fol l owup adjustment
vi si ts and pati ent com-
pl ai nts about thei r bi te not
feel i ng ri ght woul d be one of
those i ndi cator s. To hel p
assi st the r ecogni zed oc-
cl usal , joi nt, and muscl e
probl em type cases, stri ct oc-
cl usal management protocol s
shoul d be undertaken to fi rst
stabi l i ze the jaw joi nts and
supporti ng muscul ature.
INTEROCCLUSAL RECORDS
SHOULD BE UTILIZED
A comprehensi ve eval uati on
of not onl y the teeth and
exi sti ng condi ti on of the
restorati ons shoul d be made,
but al so the heal th of the
jaw joi nts and surroundi ng
muscul ature. The qual i ty of
the functi onal movements of
the head, neck, and man-
di bl e shoul d be consi der ed
as to how they wi l l i mpact
the denti str y per for med and
vi ce ver sa.
A record as to the pre-
exi sti ng bi te shoul d be docu-
mented, especi al l y when
mul ti pl e teeth are i nvol ved
i n restorati ve dental proce-
dures. Undi agnosed jaw joi nt
probl ems, unrecogni zed hy-
per toni c muscul atur e, and
poor i nterdi gi tati on of occl u-
si on wi l l undoubtedl y resul t
i n occl usal chal l enges and
pati ent management i ssues.
Di agnosti c fi ndi ngs shoul d
be di scussed and treatment
opti ons presented to the pa-
i ent. I nteroccl usal bi te re-
cord protocol s shoul d be uti -
l i zed to confi rm and docu-
ment an exi sti ng bi te rel a-
ti onshi p pr i or to any i n-
vol ved occl usal treatment.
PROPRIOCEPTIVE
DETAILS AND THE BITE
MANAGEMENT
Not onl y i s a preci se i mpres-
si on materi al necessary for
exact bi te r ecor di ngs, but
even at an el ementary basi s
a hi gh qual i ty hard bi te reg-
i strati on materi al i s neces-
sary to rel ate the upper and
l ower casts accur atel y to-
gether. El astomeri c i mpres-
si on materi al s are popul ar
for maki ng i nteroccl usal re-
cords to mount casts on den-
tal arti cul ators. The resi st-
ance of these materi al s to
compressi ve forces i s cri ti -
cal , because any deformati on
dur i ng the r ecor di ng or
mounti ng process coul d re-
sul t i n i naccurate arti cul a-
ti on of casts and faul ty fabri -
cati on of restorati ons.
12
When bi te r egi str ati on
materi al s do not accuratel y
i ndex the bi te rel ati onshi p of
both the opposi ng ar ches
and tooth preparati on al ong
wi th suppor ti ng abutment
teeth, i t opens the door to
guesswork on the part of the
l aboratory techni ci an. I t i s
far too common for the l abo-
ratory techni ci an to estab-
l i sh the bi te of the case,
r ather than the tr eati ng
denti st, due to faul ty bi te
regi strati ons. The l aboratory
techni ci an appr eci ates an
accurate, defi ni te hard bi te
regi strati on from the treat-
i ng denti st, maki ng thei r job
and responsi bi l i ti es easi er.
Removi ng al l tor que,
fl exure and unwanted com-
pressi on i n a bi te regi stra-
ti on materi al must be con-
si der ed i f tr eatment casts
are to be mounted accurate-
l y and preci sel y.
Pr eci si on and accur acy
i n any bi te/occl usi on r e-
qui r es an awar eness and
attenti on to detai l s. Most
denti sts demand preci si on i n
the fi t of the crown. They
al so expect the restorati ons
to not onl y accuratel y fi t the
prepared tooth, but al so fi t
the bi te accuratel y.
WHY NOT GIVE THE LABO-
RATORY AN ACCURATE
BITE REGISTRATION?
The human i nci sors can di s-
cri mi nate 14 m thi ckness
between the teeth.
17
Some
i nvesti gator s suggest di s-
cri mi nati on bel ow 10 m.
8
Pati ents who present wi th a
hi gh l evel of di scri mi nati on
may requi re a hi gh l evel of
pr eci si on and tr eatment
fr om thei r denti st. I f the
denti st uses 60 to 80 m
thi ck arti cul ati ng paper to
check the bi te and the
pati ent unknowi ngl y de-
mands a 10 m l evel of de-
tai l ed treatment, there may
be a mi smatch i n meeti ng
the pati ents expectati ons. I f
the denti st i s not aware of
these very real i ssues, espe-
ci al l y of the hi gh propri ocep-
ti ve detai l ed pati ent, frus-
trati on wi l l ensue.
MATERIALS
This Is What I UseTips
and Techniques t o
Managing t he Bit e
I personal l y l i ke to use a
har d bi te r egi str ati on ma-
ter i al LuxaBi te (Zeni th/
DMG)for whi ch my l abo-
ratory techni ci an does not
need to guess how to rel ate
the upper and l ower casts
together. I t i s the doctors
responsi bi l i ty to determi ne
and establ i sh the bi te rel a-
ti onshi p accuratel y so that
the l abor ator y techni ci an
can mount the case to the
same preci si on as what the
denti st observed and estab-
l i shed i n the pati ents mouth
at chai rsi de.
The l abor ator y techni -
ci ans r esponsi bi l i ty i s to
mai ntai n the bi te rel ati on-
shi p that was determi ned by
the doctor and to accuratel y
fabri cate the restorati on(s)
to match the pati ents bi te.
LuxaBi te i s the most
ri gi d of al l bi te regi strati on
materi al s that I have used
thanks to i ts i nnovati ve
bi sacryl chemi stry.
18
I ts hard-
ness (Shore D-69 or Barcol
25) el i mi nates compressi on
or fl exi ng when mounti ng the
model s. LuxaBi te ensur es
an exact and rel i abl e bi te re-
cor di ng. Dur i ng i mpl ant
pr ocedures many cl i ni ci ans
have found i t effecti ve to
assi st i n fi xati ng mul ti pl e
i mpressi on posts i n order to
obtai n torsi on-free i mpl ant
i mpressi ons.
LuxaBi te i s a bi te regi s-
trati on materi al that i s easy
to di spense from an automi x
cartri dge usi ng a standard
di spensi ng gun and fi ne sy-
ri nge ti ps for accuracy and
pl acement. Worki ng ti me i s
45 seconds for easy, qui ck de-
l i very and pl acement. Set-
ti ng ti me i s 2.0 to 2.5 mi n-
utes. LuxaBi te has a thi xo-
tropi c characteri sti c, whi ch
prevents i t from penetrati ng
i nto proxi mal areas. I ts bl ue
opaque col or makes i t easy
to see i n contrast to the sur-
roundi ng tooth structure. I t
has been shown to be very
stabl e, fi r m, and easy to
adjust wi th any dental bur
continued from page 111
Bit e-Management ...
DENTISTRY TODAY JANUARY 2008
Figure 9. The relined LuxaBite/
Sapphire acrylic arch matrix is
trimmed and transferred to the
master cast models for precise
mounting. Upper posterior
Empress crowns are fabricated to
a hard and rigid bite relationship,
increasing occlusal accuracy.
Figure 10. Before restorative treat-
ment of posterior teeth and after
restorative treatment. Occlusal
contact marks immediatelyafter
cementation before adjustments
were made, as a result of using a
hard rigid bite registration material
(LuxaBite/ Sapphire matrix) and a
qualitylab (Mike Milne, CDT,
Sunrise Dental Laboratory, Las
Vegas, Nev, [800] 933-6838).
a
b
a
b
It is the doctors
responsibility to deter-
mine and establish the
bite relationship accu-
rately so that the lab-
oratory technician
can mount the case to
the same precision as
what the dentist
observed and estab-
lished in the patients
mouth at chairside.
RESTORATIVE
113
or di amond.
The benefi ts of LuxaBi te
are:
Shortens occl usal ad-
justment time.
Reduces the need to
break the porcel ai n gl aze
(avoiding re-glazing and pol-
ishing steps).
Reduces surface failure
fatigue points from over-ad-
justing porcelain restorations.
Ease of crown seating
leads to happier patients and
dentists.
I ncreased confi dence
level of the dentist.
I ncreased recogni ti on
from the pati ents and peers
of the preci se and accurate
treatment.
Why a Rigid Bit e
Regist rat ion Is Import ant
A ri gi d ful l arch bi te regi s-
trati on i s a cri ti cal compo-
nent of accuratel y managi ng
the bi te i n both the posteri or
ver ti cal , anter i or ver ti cal ,
and anter o-poster i or do-
mai n, especi al l y for those
cases whi ch requi re atten-
ti on to detai l i n managi ng
the maxi l l o-mandi bul ar oc-
cl usal rel ati onshi ps. Losi ng
verti cal or antero-posteri or
(AP) di mensi ons dur i ng
tooth preparati on can l ead to
a rel apse of neuromuscul ar
occl usal symptoms i f careful
and methodi cal steps are not
i mpl emented.
I n cases that r equi r e
numerous teeth to be pre-
pared i n an arch, I prefer to
fabr i cate a foundati onal
acryl i c matri x, whi ch acts as
a r ei nfor ci ng stabl e bi te
matri x to hol d the jaw rel a-
ti onshi p. LuxaBi te i s i nject-
ed over the Sapphi re matri x
to rel i ne the bi te regi strati on
for further detai l and accu-
racy over the prepared teeth.
I make the foundati onal
acr yl i c matr i x usi ng Sap-
phi re (Bosworth Company),
an ethyl methacryl ate acryl -
i c, by mi xi ng i t i nto a doughy
r ope consi stency whi ch i s
for med (hands l ubr i cated
wi th Vasel i ne) and pl aced
over the l ower teeth duri ng
the uncured stage to form a
ri gi d i nteroccl usal arch ma-
tri x. The pati ent i s asked to
cl ose the bi te together and
wai t unti l the Sapphi re rope
fi rms up. Just before the ma-
tri x hardens i n the mouth i t
i s loosened with a hand in-
strument to make sure the
material does not lock inter-
proximally. The patient will
conti nue to bi te the teeth
together firmly until the Sap-
phire bite matrix hardens.
The Sapphi re i s mi xed to
a powder-l i qui d rati o of 2.5
vi al s of powder to 1 vi al of
l i qui d. Thi s combi ned r e-
l i ned ri gi d regi strati on be-
comes a cri ti cal transfer ma-
tri x that al l ows the master
di e model to be accuratel y
mounted for fi nal waxi ng
and cr own fabr i cati on. A
l i ght-cur ed r esi n adhesi ve
(Opti bond Sol o Pl us, Kerr)
i s pai nted over the hardened
Sapphi r e matr i x to bond
the LuxaBi te to the Sap-
phi re matri x.
CASE HISTORY
A 36-year-ol d femal e pati ent
presented wi th chroni c head-
aches (mi grai ne type), previ -
ous orthodonti c treatment,
awakeni ng wi th sore jaws,
ri ngi ng i n the l eft ear, tender-
ness i n the l eft joi nt, restri ct-
ed head movements (fl exi on
and extensi on), r estr i cted
head rotati on, and sore and
tender occi pi tal regi on.
Fol l owi ng a comprehen-
si ve eval uati on and a seri es
of thor ough di agnosti c r e-
cords, a physi ol ogi c bi te rel a-
ti onshi p was determi ned af-
ter usi ng l ow fr equency
TENS (J5 Myomoni tor) and
the K7 Ki neseograph (Myo-
tr oni cs-Nor amed) to tr ack
the jaw posi ti on.
6
After con-
sul tati on and di scussi on re-
gardi ng the pati ents TMJ
pai n and aestheti c needs,
a treatment pl an was de-
si gned to stabi l i ze her man-
di bl e and l ater restore the
upper and l ower posteri or
quadrants once the bi te was
proven and the jaw stabi -
l i zed. A l ower orthosi s was
fabr i cated and wor n 24/7.
Fi ve week s after i ni ti al
pl acement of the or thosi s
the pati ent r epor ted no
l onger havi ng symptoms
and pai n. Three fol l ow up
adjustment vi si ts were re-
qui red over a one-year peri -
od to fi ne tune the bi te. The
orthosi s was worn for a to-
tal of 23 months pri or to
restorati ve treatment.
Once stabi l i zati on of the
muscul atur e and pr eci si on
of the bi te were establ i shed,
new upper and l ower i m-
pr essi ons wer e taken and
model s were mounted to the
new determi ned centri c oc-
cl usi on. The upper posteri or
teeth were cl eaned and exca-
vated of al l decay. The fai l i ng
amal gam fi l l i ngs wer e r e-
moved and repl aced wi th al l -
cer ami c r estor ati ons whi l e
at the same ti me mai ntai n-
i ng the new stabi l i zed bi te
wi thout a rel apse of pai n
symptoms. A di agnosti c wax-
up (Fi gure 7) was compl eted
at the new physi ol ogi c posi -
ti on and a provi si onal i zati on
matr i x was pr epar ed and
used to tempori ze the pre-
pared upper posteri or teeth.
The Sapphi re/LuxaBi te bi te
matri x was used to regi ster
the physi ol ogi c bi te r el a-
ti onshi p i ntr aor al l y and
tr ansfer r ed to the upper
and l ower model s to hol d
the physi ol ogi c bi te posi ti on
(Fi gure 8).
The master casts and
dies were prepared for mount-
i ng usi ng the LuxaBi te/
Sapphi r e bi te r egi str ati on
arch matri x (Fi gure 9). The
fi nal al l -cer ami c r estor a-
ti ons (Empress, I vocl ar Vi va-
dent) wer e fabr i cated and
bonded wi th a l i ght-cur ed
resi n-base l uti ng mater i al
(Var i ol i nk Veneer, I vocl ar
Vi vadent [Low val ue mi nus
one]). Mi ni mal bi te adjust-
ments wer e r equi r ed, pr e-
servi ng the beauti ful ceram-
i c work done by the dedi cat-
ed l abor ator y techni ci ans
(Fi gures 10 and 11). The bi te
was careful l y moni tored for
stabi l i ty befor e pr oceedi ng
to the l ower posteri ors.
CONCLUSION
A fi r m and r i gi d bi te r egi s-
tr ati on i s a val uabl e means
to captur e the detai l s nec-
essar y to accur atel y man-
age si mpl e to compl ex jaw
r el ati onshi ps. Reduci ng the
chances of di storti on, fl ex-
ure, and compressi on from
the i ntraoral bi te regi stra-
ti on to the bi te regi strati on
transfer onto the stone mod-
el s for l aboratory mounti ng
i s cri ti cal i f preci si on res-
tor ati ve cr owns ar e to be
achi eved. LuxaBi te has been
shown to be a key bi te regi s-
trati on materi al that i s easy
to work wi th when accuracy
and preci si on are requi red i n
qual i ty r estor ati ve pr oce-
dur es. I mpl ementi ng good
bi te taki ng ski l l s and oc-
cl usal management aware-
ness, combi ned wi th an
understandi ng of the tem-
por omandi bul ar joi nt and
muscl e heal th, wi l l reduce
the needl ess occl usal adjust-
ments at the crown del i very
appoi ntment especi al l y wi th
compl ex cases. !
References
1. Christensen GJ. Making fixed pros-
theses that are not too high. J Am
Dent Assoc. 2006;137:96-98.
2. Chan CA, Thomas NT. Clinical and
scientific validation for optimizing the
neuromuscular trajectory using the
Chan protocol. International College
of Cranio-Mandibular Orthopedics
Anthology. Volume VII. 2005:2-16.
3. The Council on Dental Care of
American Dental Association (ADA).
Guidelines for TMJ Treatment (2004).
http://www.cda.org/library/cda_mem-
ber/ pol i cy/ qual i t y/ t mj _mpd. pdf.
Accessed: December 3, 2007.
4. Broadbent JM. TMJ in your practice.
Funct Orthod. 2006;23:38-45.
5. Simmons HC 3rd. Guidelines for
anterior repositioning appliance ther-
apy for the management of craniofa-
cial pain and TMD. Funct Orthod.
2006;23:22-31 [republished from
Cranio. 2005;23:300-305].
6. Cooper BC. The role of bioelectronic
instrumentation in the documentation
and management of temporo-
mandibular disorders. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod.
1997;83:91-100.
7. Shillingburg HT Jr, Hobo S, Whitsett
LD. Fundamentals of Fixed Prostho-
dontics. 2nd ed. Chicago, IL: Quin-
tessence; 1981:259-267.
8. Breeding LC, Dixon DL, Kinder-
knecht KE. Accuracy of three interoc-
clusal recording materials used to
mount a working cast. J Prosthet
Dent. 1994;71:265-270.
9. Campos AA, Nathanson D. Com-
pressibility of two polyvinyl siloxane
interocclusal record materials and its
effect on mounted cast relationships.
J Prosthet Dent. 1999;82:456-461.
10. Keyf F, Altunsoy S. Compressive
strength of interocclusal recording ma-
terials. Braz Dent J. 2001;12:43-46.
11. Michalakis KX, Pissiotis A, Anastasi-
adou V, et al. An experimental study
on particular physical properties of
several interocclusal recording me-
dia. Part III: resistance to compres-
sion after setting. J Prosthodont.
2004;13:233-237.
12. Breeding LC, Dixon DL. Com-pres-
sion resistance of four interocclusal
recording materials. J Prosthet Dent.
1992;68:876-878.
13. Small BW. Centric relation bite regis-
tration. Gen Dent. 2006;54:10-11.
14. Chan CA. Multi-dimensional diagno-
sis and treatment to avoid orthodon-
tic and surgical pitfalls. J Am Ortho-
dontic Soc. 2006;6:18-28.
15. Baker L. Tension headache, or not?
Study shows pain may be due to
TMJD. [Study by Ohrbach R., et al].
Buffalo Physician. Autumn, 2006;
41:32.
16. Garry JF. Telephone communication.
September 29, 2002.
17. Riis D, Giddon DB. Interdental discrim-
ination of small thickness differences.
J Prosthet Dent. 1970;24:324-334.
18. Miller MB. LuxaBite: bite registration
material. In: Reality. Volume 20,
Houston, TX: Reality Pub Co;
2006:31-39.
Dr. Chan is a dentist dedicated to
sharing his passion, and teaches the
neuromuscular principles that have
worked for him. He is an educator to
thousands of dentists around the
world as well as mentor, teacher, and
counselor to study clubs and organi-
zations. He is considered by many an
authority on neuromuscular dentistry
and occlusion. Dr. Chan focuses his
private practice on aesthetic cran-
iomandibular orthopedics, orthodon-
tics, TMJ, and full mouth rehabilita-
tion, implementing both the gnatho-
logic and neuromuscular principles.
He can be reached at clayton
@drclaytonchan.com or clayton-
chandds.com.
Disclosure: The author does not have
any financial interest in products or
companies mentioned in the article.
This includes a salaried position in
the company (including a consultant
position) or funding from the manu-
facturer for research studies.
JANUARY 2008 DENTISTRY TODAY
Figure 11. Final upper posterior restorations bonded to maintain a physi-
ologic relationship with minimal occlusal adjustments.
a
b