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4-page article: word version with pics (5.7 Mbytes)

  1. 1. BITEMGeneral info in boldClinical text in regular fontTechnical text in italicsNot often does a new idea spring up and immediately finds itsrole in almost every facet of the dental field. Such versatilitycan only be attributed to a material with both controllable andadjustable properties: BITEM.BITEM is the trade name for a new acrylic and it is theacronym for Biocompatible Intra-oral Thermo ElasticMaterial.The initial concept, an invention of Bob Huybrechts, an RDTfrom Newmarket, Ontario, is quite simple and yet yields somany unprecedented applications, they are hard to ignore:Critical parts of dental appliances are created to soften in hotwater and can be fashioned to the contours of the oral cavity.The innovation to this patented technology, lies in controllingthe mixture of the two liquid monomers. Their proportiondetermines an infinite range of BITEM consistencies: fromcushiony soft, to as hard as denture base. 1
  2. 2. Beyond that, after polymerization, BITEM always remains“thermo-elastic”, which means it may be heated in water tosoften, in order to be adapted to soft tissues and teeth, over andover again.As mentioned, BITEM has dual qualities: its rigidity iscontrollable during mixing and it remains thermo-adjustableever after.Each appliance therefore should be tailored exactly to theprerequisites of the case.Following are some examples of BITEM applications ofvarious rigidities, incorporated into important areas of anacrylic appliance, serving different purposes:- to adapt to tissues or teeth (postdam / ortho spring retainers)- to utilize existing undercuts (submandibular fossa / over large maxillary tuberosity)- to replace clasps or gasket clasps on partials or ortho appliances- as a heat adjustable reline on partials or difficult lowers- utilized to install pre-manufactured BITEM-LOCK sublingual stabilizer wings.- multiple applications to simplify orthodontics.- as an absorbent stressbreaker on rigid attachments- “thermo-grip” retention for overdentures. 2
  3. 3. These are just a few examples of the more than 50 (fifty)applications, presently listed for BITEM.Unfortunately, we are so accustomed to “single purpose”products, it takes some exploring to grasp all the potentialadvantages of BITEM. Its multi-purpose functions,simultaneous with its thermo-flexible properties open up awhole new world for the creative mind. FULL DENTURESPostdamConsider full upper and lower dentures: postdams are alwaysarbitrary; would it have any merit to create an adjustablepostdam?Once added to an upper denture, the postdam can be heated in hotwater and massaged upwards out of the mouth, then, while stillwarm, inserted and pressed in place to conform to the palatal bone.There isn’t a better way to establish a perfect palatal seal and if notdone right the first time, it can be done over again.a BITEM postdam 3
  4. 4. This adjustability can be extended to include the Hamularnotch regions, where stretched muscles sometimes cause openareas on the finished denture.Lingual FlangesAny “undercut” can now be utilized rather than avoided andoften become part of the solution instead of the problem.Not least on a full lower denture, where the lingual posteriorflange has never properly utilized the submandibular undercutto mechanically stabilize the denture. BITEM gives thepatient this option.Simply immerse the extended flanges in warm water for about 10seconds, then, freehand, quickly open both flanges towards eachother, insert the denture and with both index fingers, press thelingual flanges into the submandibular undercuts, as far ascomfortably possible.a lower denture with BITEM flangesFor the same reason as on the upper, the adjustable portioncan include the pterygo mandibular notch region. 4
  5. 5. Other useful undercuts sometimes occur in the alveolar ridgeor in the buccal region of the upper tuberosities.BITEM, on the other hand, can also be used to fit over a taurusor any other anomaly of the soft tissues and it makes fittingimmediate dentures, or post-operative appliances so mucheasier.By warming the adjustable portion, the practitioner can shorten theperiphery, where necessary, by cutting with small scissors.Relines“Thermo Relines” are a major component of this new idea:can you imagine having the luxury to simply heat the dentureand re-adjust the fit in seconds? And if not satisfactory, it canbe done again. The proportion of the two liquids controls therigidity of the reline, from soft to hard and the operator has todetermine the appropriate consistency needed for the case athand.On upper dentures, only the ridges would be relined, not thepalatal area. 5
  6. 6. Thermo-relining the saddle areas on a partial denture, wouldassist in adjusting the fit of the appliance as it “settles in”.Sublingual WingsOn lower dentures, where there is lots of bone resorption andinsufficient undercut below the mylohyoid eminence, anothersolution is possible: BITEM-LOCK sublingual stabilizer wings,horizontally attached to the lingual aspects.These wings are pre-manufactured, easy to install and provideunsurpassed comfort, again because of their inherent thermo-adjustable properties.The BITEM-LOCK wings, are installed in 7mm wide verticalslots, on the lingual flanges of a lower denture, which allows thepractitioner to heat the denture and with a dull instrument, movethe wings up or down by 2mm either way.The final thermo-adjustments for the patient can now be done at alower temperature, by closing the mouth and swallowing with thetongue down three or four times. This procedure can be repeateduntil the desired level of comfort is reached. 6
  7. 7. Polishing BITEM-LOCKS is a lot easier when the wings areheated and flattened completely against the lingual wall, thencooled in cold water. By soaking the denture in hot waterafterwards, the wings will return to their original position.Wings can be easily made smaller, by heating and curving thelarger end inward and then cutting off the excess.Patient management is the primary practitioner’s responsibility: itis up to the practitioner to instruct the patient and to delegate onlythose functions, deemed necessary for the well-being of thepatient.All BITEM applications can be performed in either heat cure orself cure. To achieve the best results, same as for acrylics ingeneral, heat cure is always recommended over self cure, becauseit produces a more complete and stable polymerization, giving theappliance a more impervious surface and therefore a longerlifespan. PARTIAL DENTURESPartial dentures are all acrylic using the “double packing”method. They require a very different design: we are notlooking for the conventional buccal undercuts to accommodatespringy metal clasps, instead, BITEM buccal clasps are to bekept short, just to brace the abutments, while a softer mix ofBITEM is used to create mesial and distal retention in theinterproximal undercuts. 7
  8. 8. This new method of retention uses invisible friction. Internalclasps are incorporated into the major connector and becomean integral part of the partial denture.Less breakage, superior esthetics and no metal required arethree great advantages.Since there is usually more interproximal than buccal undercut,the ideal amount of retention can be established. Sometimeslingual retention can be engaged to keep the design as simple andas effective as possibleAs an option, the softer interproximal material could be addedafter the denture base and the buccal clasps are processed, usingthe self cure BITEM and a duplicate model to establish the idealamount of retention.Buccal clasps are used in the posterior regions, only whennecessary, which immediately increases the esthetics of anypartial denture.Lingual aprons can also be thermo-adjustable and this isparticularly desirable when lingual retention is gained in the same 8
  9. 9. area with a softer consistency, adding another option to control fitand retention.A great advantage is that all along, the patient can fine-tunethe pressure of the clasp on the tooth, simply by warming andmanipulating the clasp. Such control, directly affecting theirown level of comfort, has never been extended to patientsbefore..(drawing or photograph of a BITEM clasp)On the topic of clasps, it is always more esthetical to keep themhidden, but in cases where they are visible, carefully roughen orlightly pencilblast the inside of the BITEM clasps, so the lightrefraction through the clear acrylic will not result in a “black lineeffect”, while still picking up the tooth colour.Free-standing teeth are excellent candidates to receive BITEMgasket clasps. These clasps, surrounding the tooth entirely, arevery strength-effective, particularly when the bonding to thedenture base is chemically cross-linked.To increase the adjustability it is possible to layer BITEM gasketclasps in more than one rigidity, going from the softest round layeragainst the tooth, gradually to harder ones, joining the denturebase. This can be done in one “double-packing” session. 9
  10. 10. a BITEM gasket claspLayering BITEM in different rigidities is advantageous in otherapplications as well: for example on the lingual flanges of a lowerdenture, the inside portion could be softer, while the outside shellremains harder and highly polishable.It is of paramount clinical importance that in the design of allacrylic partial dentures, sufficient relief is given to all the gumsadjacent to or surrounding the teeth, to avoid impingement andfuture periodontal problems.The all-acrylic partial can be designed to have a continuousperipheral roll, similar to a full denture, consisting of 3mmBITEM straps connecting the pink partial flanges.Such partial denture is very strong and seldom needs clasps orany other retention, as it gains suction and friction by design.(Drawing or photograph of a continuous strap partial denture)A new and interesting concept lies in the thermo-adjustabilityof partial denture BITEM rests. Whether they can beintegrated in a design, without interfering with the bite, or 10
  11. 11. whether they require clinical preparation, their adjustabilityremains a unique feature.Prepared occluso-proximal rests to receive BITEM acrylic requirea vertical wedge shape of at least 1.5 mm deep and 1 mm width atthe occlusal surface.This more patient-friendly partial is far superior in esthetics,never scratches the tooth enamel and its thermo- adjustablequalities enable the wearer to control the pressure and thetightness at all times.When an appliance is designed to be retained using genuineundercuts, it is necessary for the patient to warm the denture beforeeach insertion (mostly hot tapwater is sufficient) and each removal,by swishing around warm water in the mouth .The end-result is a sophisticated partial denture appliance:a challenge for the skillful technician to construct and yet soeasy to use by the patient.If the use of metal is indicated, the framework can often still bedesigned passively, with BITEM clasps on the abutment teeth.Furthermore, it is technically possible to utilize a good metal-bonding interface and connect BITEM to metal. Imagine allthe novel designs made possible with this technique!To complete the circle of versatility, BITEM can be directlybonded to natural teeth and open up another series ofunprecedented applications, useful in orthodontics, for spacemaintainers, Maryland bridges and possibly other temporarysituations.Great time saving features: 11
  12. 12. - a broken cast clasp is easily replaced by attaching BITEM tothe surrounding acrylic and extruding the material over theabutment tooth.- some portions, like postdams or lingual flanges, can be addedchairside, because small discrepancies will be eliminated withthe final fit.- often hard splints need grinding to prevent rocking, but a2mm thermo-adjustable strap in the middle of the archguarantees a fast and a good fit.- any appliance that is too loose can be made more retentive byadding a softer BITEM into the interproximal areas.- using heat-adjustable acrylic on the lingual and buccalanterior pads of a full spring retainer, the orthodontist couldremedy any situation, chairside, in seconds, rather thanreturning the appliance for correction.- imbedding the lower posterior teeth in a layer of BITEM, willcreate an auto-adjustable bite relationship, whereby porcelaindenture teeth, for example, do not need grinding on theenamel.- to produce a stressbreaker on a rigid dove-tail attachment,cast the male portion with a retentive extention, to fit in a softbox of BITEM, hidden below the teeth of a partial denture.- the capability to control the rigidity of the material, allowsgradual loading of implants.- once the implants are totally integrated, overdentures aremade to release only with warm water, giving the patientsecurity and peace of mind 12
  13. 13. In the interest of space, there are a number of applications thatcannot be explained in detail, but will give the reader food forthought:Virginia partials, retention on TMJ appliances, pre-formedbite registrations, pre-formed vacu-forming sheets, thermo-adjustable temporary crowns or bridges, buccal wings and lippads on Frankel appliance, over unparallel implants orabutments, to imbed female attachment in denture base, etc... PROPERTIESBITEM is a cross-linked clear acrylic denture material,guaranteed to create a perfect chemical bond with all otheracrylics. It is available in heat cure and in self cure.The self cure is polymerized in a pressure cooker in lukewarmwater at 20 to 25 psi. Heat cure is cured in conjunction with pinkdenture base and can be done either in water, dry or in themicrowave, following the manufacturer’s instructions.It is noteworthy that no special equipment is required toincorporate the BITEM System into any practise. Moreover,handling the material is all but routine for an experiencedoperator, but it is recommended to follow the instructionsclosely until a “feel“ for the material has been developed.The directions for use are comprehensive and measured in drops,which makes it easy to follow and minimizes waste of material.The suggested schedule for mixing the two monomer liquidscontains a blank column, in which the operator can adjust therigidity of BITEM to their own preference and experience. Themore liquid B is added to the mixture, the more rigid the end resultwill be. 13
  14. 14. Since there is an infinite range of available rigidities, it is theresponsibility of the dental team to determine and understandthe optimum requirements for each case. Experience and goodcommunication should facilitate the judgment of theoperator(s), to obtain the most appropriate result.More than any other system, BITEM appeals to theintelligence and the obligation of the professional to carefullyconsider all the variables involved :1. the correct mixture of the liquids2. the thickness of the extension(s)3. the leverage which allows movement4. the temperature necessary to adjust5. the timing during the adjustments, etcPolishing BITEM acrylic is not different from regular denturebase acrylic, except when venturing into the softer applications,where more caution and cryogenics are recommended. Than,similar to soft reline materials, BITEM can be polished and high-shined after freezing for 15 to 20 minutes. This flattens the surfacemolecules and produces a much more impervious surface. CONCLUSIONAny dental professional, by reading this description, can surelythink of a few instances, where the BITEM system would havebeen rather useful and as one develops a further affinity forsuch applications, new ideas will occur regularly. 14
  15. 15. Multi-purpose BITEM harbours a myriad of creative solutionsfor all kinds of problems, but like with all new ideas, it willtake some time to unlock all its applications and to fullyexplore its further ramifications.For now, some 50 applications will readily add a newdimension to the scope of your skills and will increase the levelof service to your clients.Anyone who discovers other uses for BITEM is welcome tocontact the manufacturer, so that new ideas can be added tothe existing list and shared with colleagues all over the world.Ultimately, BITEM is going to benefit the comfort level and thehealth of the dental patient, while easing the duty of theprofessional.This new material will mark a significant contribution todentistry and to the world of dental technology. ________________________________________ 15
  16. 16. BITEM Applications:1. postdam on upper denture2. lingual flanges on lower denture3. adjustable over taurus4. adjustable pterygo mandibular notch5. adjustable Hamular notch6. Virginia partials7. to adjust a functional pink triangular papilla8. large periphery on immediate dentures9. any post-operative section10. buccal grip on large tuberosities 16
  17. 17. 11. any undercut on alveolar ridge12. full lower reline13. reline on ridge of a full upper14. partial denture saddle reline15. pre-manufactured BITEM-LOCK sublingual wings16. to attach BITEM-LOCK sublingual wings17. clasps on partial dentures18. gasket clasps on single teeth19. lingual retention on thumb plate20. strap in middle of palate, fold into undercut21. retention in interproximal undercuts22. continuous periphery strap on partial dentures23. buccal peripheral wing into tissue undercut24. adjustable lingual apron25. adjustable (prepared) rest26. retention flap on TMJ appliances27. folding straps on obturators28. gum additions on bridgework29. sheets for vacu-forming30. pre-made temporary crowns31. pre-made forms for wax-up32. special supplemental devices33. strap to prevent rocking splints34. adjustable anterior teeth35. auto-adjustable posteriors36. pre-formed bite registrations37. stressbreaker to rigid attachment38. to imbed female ball attachment39. to thermo-release overdentures40. wings on Frankel appliance41. anterior pads on spring retainer42. to add retention to loose partial43. to layer in different rigidities 17
  18. 18. 44. shock absorber for implants45. bond to metal with medium interface46. bond to natural teeth47. replace broken cast clasp48. repair difficult conventional break49. a doubtful repair can be adjusted50. over unparallel abutments/implants51. as a space maintainer52. compressed, to replace ortho springs53. short-term bridgework54. thin sheets to protect perio-pack 18

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