Bite registration in functional appliances

BITE REGISTRATION IN
FUNCTIONAL APPLIANCES
www.indiandentalacademy.com

INTRODUCTION.
ORIGINATION OF THE IDEA OF
FUNCTIONAL APPLIANCES.
THEORIES EXPLAINING THE ACTION OF
FUNCTIONAL APPLIANCES.
BITE REGISTRATION IN THREE
PLANES OF SPACE.
VERTICAL
HORIZONTAL
TRANSVERSE
ACCESSORIES USED FOR
BITE REGISTRATION.

METHODS
TECH FOR LOW CONSTRUCTION BITE
FOR HIGH CONSTRUCTION BITE
WITH OUTFORWARDPOSTURING OF THE MANDIBLE
ARCH LENGTH DEFICIENCY
FOR CLIII
CONTROVERSIES OF BITE REGISTRATION
DIFFERENT APPLIANCES TALKING ABOUT
BITE REGISTRATION
ACTIVATOR
BIONATOR
FRANKEL
TWIN BLOCK
DELAIRE FACEMASK
CONCLUSION.www.indiandentalacademy.com

BENNO LISCHER’S THEORY
ABNORMAL PERIORAL MUSCULATURE –
CAUSE OF VARIOUSMALOCCLUSIONS
OVER JET IN CLASS II MALOCCLUSION – EXACER
BATED BY COMPENSATORY , ADAPTIVE LIP AND
TONGUE FUNCTION.
ANTERIOR OPEN BITE AND NARROW MAXILLARY
ARCHES ARE CAUSED BY ABNORMAL SWALLOWING
AND PROLONGED FINGER SUCKING
.

ANDERSEN’S CONCLUSION FROM LISHER’S
THEORY
COULD NOT THE SAME MUSCLES BE USED FOR
THE CORRECTION OF THESE AND OTHER
PROBLEMS?!
HE TESTED THE WORKING HYPOTHESIS ON HIS
DAUGHTER AND FOUND FAVOURABLE RESULTS.HE
TRIED THIS APPLIANCE AND OBSERVED
SIGNIFICANT SAGITTAL BASAL BONE AND
NEUROMUSCULAR IMPROVEMENT THAT HE HAD
NOT BEEN ABLE TO ACHIEVE WITH SUCH DEVICES
AS CONVENTIONAL FIXED APPLIANCES AND
INTERMAXILLARY ELASTICSwww.indiandentalacademy.com

ANDERSEN BELIEVED THAT MANY
MALOCCLUSIONS WERE FUNCTIONAL IN ORIGIN
AND THAT IF FORM FOLLOWED FUNCTION IT
FOLLOWED THAT CORRECT FUNCTION WOULD
EVENTUALLY LEAD TO CORRECT FORM.THIS
OFCOURSE MEANS CORRECT MUSCLE FUNCTION.
THE ACTIVATOR HE CONSTRUCTED DID INFACT
TRANSMIT THE TISSUE FORMING FUNCTIONAL
STIMULI OF THE PERIORAL AND MASTICATORY
MUSCLES,TONGUE AND TEETH TO THE
PERIODONTAL TISSUES,ALVEOLAR BONE AND
TMJBRINGING ABOUT THE EVENTUAL RESOLUTION
OF THE STRUCTURAL CLASSII DEFORMITY.

HE USED THE TERM BIOMECHANICAL
ORTHODONTICS FOR THIS TREATMENT TILL
HE TEAMED UP WITH HAUPL.WHEN
ANDERSEN SHOWED HIM THE RESULTS
OBTAINED WITH ACTIVATOR, HAUPL WAS
EXTREMELY EXCITED ,FOR ANDERSEN’S
FINDINGS COINCIDED EXACTLY WITH
RESULTS HE HAD ALREADY SEEN
INDEPENDENTLY RELATIVE TO TOOTH
MIGRATION AND TISSUE AND BONE
REACTION.
. www.indiandentalacademy.com

TOGETHER THEY FURTHER DEVELOPED
THEMANDIBULAR ADVANCEMENT TECHNIQUE,
REFINED IT AND THEY TOGETHER COINED THE
TERM FUNCTIONAL JAW ORTHOPEDICS WHICH WAS
MORE DESCRIPTIVE.
THE FORWARD POSTURING OF THE MANDIBLE AS
DETERMINED BY THE CAREFULLY MANIPULATED
CB, WAS REASONED TO PRODUCE BENEFICIAL
SAGITTAL SKELETAL CHANGE BY HARNESSING THE
GROWTH POTENTIAL.

THIS WAS A CONTRADICTION OF EARLY BITE
JUMPING PROCEDURES, WHICH WERE
DEEMED STRICTLY POSITIONAL CHANGES OF
THE MAND CONDYLE IN THE FOSSA, HENCE
THE FUNCTIONAL ORTHOPEDIC
CONNOTATION.
TO MUCH OF THE ORTHODONTIC WORLD
THE TREATMENT BECAME KNOWN AS THE
NORWEGIAN SYSTEM EVEN THOUGH
ANDERSEN WAS A DANE AND HAUPL A
GEERMAN AND BOTH TAUGHT AT THE
DENTAL SCHOOL IN OSLO

GRABER’S INTERPRETATION ABOUT THIS IS
ELIMINATION IN THE ABNORMAL PERIORAL
MUSCLE FUNCTION BY MANDIBULAR
PROTRACTION PREVENTED THE DEFORMING
RESTRICTIVE ACTION OF THE TRAPPED LOWER
LIP AND HYPERACTIVITY OF MENTALIS AND
SUBMANDIBULAR MUSCLE GROUPS.
COMPENSATORYMAND OPENING CAUSED BY
CONCOMITTANT MOUTH BREATHING ALSO
COULD BE ELIMINATED.THIS WILL ALSO BRING
ABOUT A CHANGE IN ONY STRUCTURES AS
THEY ADAPTED TO THE NEW FUNCTIONAL
STRESSES. www.indiandentalacademy.com

SERVES AS NIGHT GUARD AND ENHANCES
THE METABOLIC PUMP ACTIVITY OF
RETRODISCAL PAD
THE OBVIOUS BENEFITS OF A PROTRACTED
UNLOADED CONDYLE WERE HYPOTHESIZED
TO BE ENHANCEMENT OF CONDYLAR
GROWTH INCREMENTS AND A MORE
FAVOURABLE UPWARD AND BACKWARD
GROWTH DIRECTION.

•WHY BITE IS REGISTERED?
•THE BITE IS REGISTERED TO CORRECT THE
SPATIAL RELATIONSHIP OF THE OSSEOUS
STRUCTURES TO ELIMINATE THE
NEUROMUSCULAR COMPENSATION WHICH
EXISTED AS A RESPONSE TO THE MALOCCLUSION.
•FORWARD AND DOWNWARD POSITIONING OF THE
MANDIBLE WAS CONSIDERED TO BE THE BEST
POSITION TO CORRECT THE SPATIAL
MALRELATIONSHIP OF THE JAWS IN CLASSII DIV 1
CASES WITH RETROGNATHIC MANDIBLE.

THE SAGITTAL ADVANCEMENT CONCEPT WAS
GENERALLY ACCEPTED BY MOST CLINICIANS IN
EUROPE. IT VARIED FROM 3-6MM DEPENDING ON
THE SEVERITY OF THE ANTEROPOSTERIOR
MALOCCLUSAL RELATIONSHIP AND RESULTANT
ABNORMAL BUCCAL SEGMENT
INTERDIGITATIONS
CONTROVERSY STILL SURROUNDS THIS
WORKING HYPOTHESIS DESPITE DEFINITE
RESEARCH BY PETROVIK ETAL , McNAMARA ETAL
,STUTZMANN ETAL.

THEIR STUDIES INDICATE THAT MANDIBULAR
GROWTH ENHANCEMENT OCCURS AS WELL AS
REDUCTION OF MAXILLARY HORIZONTAL
GROWTH WITH FORWARD POSTURING
APPLIANCES , WORN DURING A GROWING
PERIOD (HEAD GEAR EFFECT).
A NUMBER OF STUDIES ON TREATED PATIENTS
INDICATE THAT WHEN TREATED CLASS II
PATIENTS ARE COMPARED WITH NON-TREATED
CONTROLS ,MANDIBULAR LENGTH IS
ENHANCED BY FUNTIONAL APPLIANCES.

THE RESULTS ARE VARIABLE AS GRABER HAS
SHOWN IN A STUDY OF 58 COMPLETED FRANKEL
APPLIANCE PATIENTS.
BUT THE POTENTIAL FOR CHANGE SEEMS TO BE
THERE.
THE UNLOADING OF THE CONDYLE IS CONSIDERED
A POTENTIALLY SIGNIFICANT FACTOR BY
JHONSTON.
THE WORKING HYPOTHESIS IS THAT ALL GROWTH
RESTRICTIONS ARE REMOVED. THIS IS INSPITE OF
ARTICLES BY CREEKMORE &RADNEY,GIANELLY
ETAL, &RICKETTS THAT DO NOT FIND ENHANCED
MANDIBULAR GROWTH SPECIFICALLY
ATTRIBUTABLE TO FUNCTIONAL APPLIANCES.

THE NET EFFECT IS THAT PATIENTS ATTAIN THE
ACHIEVABLE OPTIMUM WITH THE MOST
FAVOURABLE FUNCTIONAL ENVOIRNMENT
FREED OF ANY RESTRICTIVE NEUROMUSCULAR
ABERRATIONS RESULTING FROM
COMPENSATORY, ADAPTIVE OR HOMEOSTATIC
ACTIVITY. THE CORRECT COMPARISION S/B
WITH SIMILAR MALOCCLUSION NOT SO CALLED
NORMALS. THIS MEANS CONTROLS MATCHED
FOR SEX, AGE, PATTERN OF GROWTH,
DIRECTION, MORPHOLOGY,ETC.

DIAGNOSTIC PREPARATIONS:
PATIENT COMPLIANCE IS ESSENTIAL. VTO&VIDEO IMAGING
AUGUMENTS THE PATIENTS COMPLIANCE.
STUDY MODEL ANALYSIS:
1.FIRST PERMANENT MOLAR RELATIONSHIP IN HABITUAL
OCCLUSION.
2.NATURE OF MIDLINE DISCREPANCY.
3.SYMMETRY OF DENTAL ARCHES.
4.CURVE OF SPEE.
5.CROWDING & ANY DENTAL DISCREPANCIES.
FUNCTIONAL ANALYSIS:
1.PRECISE REGISTRATION OF THE POSTURAL REST POSITION.
2.PATH OF CLOSURE FROM POSTURAL REST TO HABITUAL
OCCLUSION.
3.PREMATURITIES,POINT OF INITIAL CONTACT,OCCLUSAL
INTERFERENCES & RESULTANT MANDIBULAR
DISPLACEMENT.
4.SOUNDS SUCH AS CLICKING & CREPITUS IN THE TMJ.

4.SOUNDS SUCH AS CLICKING & CREPITUS IN THE TMJ.
5.INTEROCCLUSAL CLEARANCE OF FREE WAY SPACE.
6.RESPIRATION.
CEPHALOMETRIC ANALYSIS:
1.DIRECTION OF GROWTH.
2.DIFFERENTIATION BETWEEN POSITION & SIZE OF THE JAW
BASES.
2.MORPHOLOGIC PECULIARITIES,PARTICULARLY OF THE
MANDIBLE.
4.AXIAL INCLINATION &POSITION OF THE MAXILLARY &
MANDIBULAR INCISORS.

THEORIES EXPLAINING THE ACTION
OF FUNCTIONAL APPLIANCES
MYOTATIC REFLEX
•FUNCTIONAL SIGNIFICANCE OF STRETCH REFLEX
VISCOELASTIC THEORY
COMBINATION

IMPORTANCE OF CONSTRUCTION BITE
FABRICATION OF FUNCTIONAL APPLIANCE IN
THREE PLANES OF SPACE
VERTICAL
HORIZONTAL
TRANSVERSE
FACTORS EFFECTING VERTICAL OPENING-
TYPE OF MALOCCLUSION.
DEVELOPMENTAL STATUS.
TYPE OF ACTIVATOR APPLIANCE.
FACTORS TO BE CONSIDERED IN THE HORIZONTAL
POSTURING OF THE MANDIBLE
TRANSVERSE POSTURING OF THE MANDIBLE

COMPLICATIONS OF IMPROPER CB:FABRICATION OF
PROPER CB IS ESSENTIAL FOR THE SUCCESS OF
FUNCTIONAL APPLIANCE.
IF THE CB IS WIDE OPEN IT WILL BE DIFFICULT TO WEAR
THE APPLIANCE & ADAPT TO THE NEW RELATIONSHIP.
MUSCLE SPASM OFTEN OCCUR & THE APPLIANCE TENDS TO
FALL OUT OF MOUTH.
THE HIGH CB ALSO MAKES LIP SEAL DIFFICULT IF NOT
IMPOSSIBLE.FUNCTIONAL CROSS BITEIN THE FUNCTIONAL
ANALYSIS CAN BE CORRECTED BY TAKING THE PROPER
CB .IF MIDLINE ABNORMALITY IS CAUSED BY TOOTH
MIGRATION ,NO ASSYMETRIC RELATIONSHIP EXISTS
BETWEEN THE MAND & MAXILLA, AN ATTEMPT TO
CORRECT THIS TYPE OF DENTAL PROBLEM COULD LEAD TO
IATROGENIC ASSYMETRY.
ALL PRECONDITIONS TOSUCCESSFUL TREATMENTWITH
ACTIVATOR, EVEN SMALL VARIATIONS IN MAND
POSITION ,CAN SIGNIFICANTLY ALTER ACTIVATOR FORCE

IN EXTREME SAGGITAL MAL RELATIONSHIPS THE MAND
SHOULD ALWAYS BE 3MM OR MORE FROM THE MOST
PROTRUSIVE MAND POSITION OTHERWISE IT WILL LEAD TO
PROCUMBANCY OF THE INCISORS.
DURING ACTIVATOR THERAPY THE CONDYLE IS DISPLACED
OR DISLOCATED TO ACHIEVE A REMODELLING OF TMJ
STUCTURES &CHANGE IN MUSCLE FUNCTION. IF THE TMJ
STRUCTURES ARE ABNORMAL AT THE START &
HYPERSENSITIVITY IS A PROBLEM, THE POSSIBILITY OF
EXACERBATING THE SYMPTOMS EXISTS.

PRINCIPLES TO BE FOLLOWED FOR CB:
EVEN WITH GREAT ATTENTION TO THE DIAGNOSTIC
ASSESSMENT, THE FUNCTIONAL PATTERN (NORMAL OR
ABNORMAL PATH OF CLOSURE), DEPTH OF THE OVER
BITE ,THE RELATIVE POSITION OF THE MAXILLA TO
CRANIAL BASE, THE AMOUNT OF SAGGITAL
DISCREPANCY &THE ALL IMPORTANT DIRECTION OF
GROWTH, THERE IS STILL SOME CONTROVERSY OVER
THE EXACT PROCEDURE FOR THIS IMPORTANT
DETERMINATION. HOWEVER THERE ARE SOME
DEFINITIVE PRINCIPLES THAT SHOULD BE CLEARLY
UNDERSTOOD. IF THESE PRINCIPLES ARE FOLLOWED, IT IS
POSSIBLE TO DESCRIBE THE POSITIONING OF THE MAND
IN THE PREPARATION FOR FABRICATION OF THE
FUNCTIONAL APPLIANCE IN 3 PLANES OF SPACE:
-VERTICAL
-HORIZONTAL &
-TRANSVERSE.

VERTICAL OPENING OF THE MANDIBLE:
THE OPENING WILL BE SMALL, MEDIUM OR LARGE.
VERTICAL OPENING OF THE MAND IS DEPENDENT ON 3
MAJOR CONSIDERATIONS :
1.KIND OF DYSGNATHIC OR DISPLASTIC PROBLEM (SAGGITAL
& VERTICAL RELATIONSHIP, MORPHOGENETIC GROWTH
PATTERN).
2. DEVELOPMENTAL STATE, SEX & AGE OF THE PT.
3.TYPE OF THE ACTIVATOR TO BE USED.
TYPE OF MO:
VARIOUS VERTICAL & SAGGITAL DISCREPANCIES REQUIRE
DIFF CB REGISTRATIONS.
IN CLAS II DIV –I &DIV-II, THE CONSTRUCTION BITE IN LOWER
JAW CAN BE BROUGHT FORWARD ONLY AS FAR AS THE
MOST LINGUALLY INCLINED MAX INCISOR,SO THAT
INCISORS ARE IN EDGE-EDGE HORIZONTAL RELATIONSHIP.www.indiandentalacademy.com

IN CLASS-III MO, LOWER JAW IS MANIPULATED AS FAR
POSTERIORLY AS IT WILL GO FOR THE CB.
VERTICAL RELATIONSHIP OR BITE OPENING SB 1.5-3MM
BETWEEN THE INCISAL EDGES DEPENDING ON THE SEVERITY
OF THE CURVE OF SPEE, INFRAOCCLUSION OF POST TEETH &
OVER ERUPTION OF THE L INCISORS.
DEEP BITE CASES-OPENING THE BITE IS 1.5-3MM BETWEEN
THE INCISAL ,MARGINS, TO ALLOW THE CORRECTION OF THE
ANT CROSSBITE.
MIXED DENTITION-BITE OPENED TO 4-7MM IN MOLAR
REGION.
SEVERE CLASS-II DIVII MO IN PERM DENTITION, BITE OPEN
TO 9MM IN MOLAR REGION.
CLASSII DIV I WITH PROTRUTION OF INCISORS & A DEEP
OVER BITE , OPENING OF BITE IS DEPENDENT ON HOW MUCH
ANTERIOR POSITIONING IS NECESSARY TO ESTABLISH A
NORMAL SAGGITAL RELATIONSHIP.www.indiandentalacademy.com

IF SMALL ANT POSITIONING OR NO ANT POSITIONING IS
REQUIRED THE VO S/B RAISED MORE IN ORDER TO ELICITA
MORE POSITIVE FUNCTIONAL & VISCOELASTIC RESPONSE
FROM THE MUSCULATURE.
CLASS-II DIV-I DEMANDING MORE HORIZONTAL POSTURING,
SMALLER VERTICAL OPENING IS NEEDED.
VO OF THE BITE VARIES FROM 1-4MM DEPENDING ON THE
CURVE OF SPEE, AMOUNT OF FORWARD POSITIONING,&
DIRECTION OF GROWTH.
OPEN- BITE PROBLEMS:
INTEROCCLUSAL ACRYLIC TABLE S/N BE GROUND AWAY
BUT SHOULD MAINTAIN CONSTANT INTRUSIVE CONTACT ON
U&L POST TEETH IN BOTH ARCHES.
AUXILLARY USE OF A VERTICAL PULL CHIN CAP CAN BE
QUITE EFFECTIVE IN SUCH CASES.
OBSERVATION OF TONGUE POSTURE & FUNCTION IS
NECESSARY. www.indiandentalacademy.com

DEVELOPMENTAL STATUS :
CLASS-II DIV-I MO WITH A N SAGGITAL MAX POSITION BUT A
RETRUDED MAND .
THE PT MUST BE TREATED DURING THE GROWTH PERIOD TO
ADJUST THE APICAL BASE RELATIONSHIP.
THE MIXED & TRANSITIONAL STAGES OF DENTAL
DEVELOPMENT OFFERS THE BEST TIME FOR HARNESSING
GROWTH & DEV CHANGES.
IN CASES IN WHICH TREATMENT BEGINS EARLY OR IN
CHILDREN WITH RETARDED DEV OR FRAIL STRUCTURES,
LESS VO IS ADVISABLE( 3-4MM).
IN PERM DENTITION CLASS-II DIV-I MO WITH MAND
RETRUSION CAN TOLERATE UPTO 7MM OPENING IN THE
MOLAR REGION WITHOUT DISCOMFORT.

TYPE OF ACTIVATOR APPLIANCE:
ANDERSEN-HAUPL APPLIANCE –WORN ONLY DURING
SLEEP –HIGHER VERTICAL BITE.
DIFF APPERTENANCES MAY BE ADDED TO THE APPLIANCE
SUCH AS A LATERAL TONGUE CRIB.
IT IS ADVISABLE TO CHOOSE A VO NEAR THE PRACTICAL
LIMITS WHEN USING A LINGUAL BOW SPRING TO CORRECT
A CROSS BITE.
THE SAME HOLDS TRUE WHEN USING A DISTALIZING
SCREW TO MOVE MOLARS POSTERIORLY.

HORIZONTAL POSTURING OF THE MAND:
THERE R 4 POSSIBILITIES FOR POSTURING THE MAND IN
SAGITTAL PLANE FOR FUNCTIONAL ORTHOPEDIC
APPLIANCE
THE ORIGINAL SAGITTAL JAW RELATIONSHIP MAY BE
MAINTAINED.
MAND MAY BE POSTURED FORWARD TO CHANGE THE
SAGITTAL RELATIONSHIP EQUALLY ON BOTH SIDES
IN UNILATERAL MO,BITE IS CHANGED ON ONE SIDE BUT
IS MAINTAINED AS MUCH AS POSSIBLE ON THE OTHER
SIDE.
IN CL-III MO, MAND IS POSTURED BACKWARDS AS MUCH
AS POSSIBLE IN THE FOSSA , OPENING THE BITE ENOUGH
TO TRY FOR AN END- END INCISAL RELATIONSHIP, OR
AS CLOSE TO THIS AS POSSIBLE.

WHEN THERE IS TRANSVERSE OR VERTICAL CORRECTION
DESIRED IN CL-I MO , THE CB IS STILL TAKEN WITH A
SLIGHT 1-2MM ADVANCEMENT BECAUSE THE MAND DROPS
BACK AS IT OPENS INTO A CL-II TENDENCY
IT MUST BE COMPENSATED WITH SLIGHT ADVANCEMENT,
SO THAT SAGITTAL CUSPAL RELATIONSHIP IS AGAIN CL-I
OR NORMAL

ACCESSORIES USED FOR BITE REGISTRATION
•Thermostatically controlled water bath capable of warming wax
to 138 to140degrees F.
•Shurwax
•Tongue depressors
•Dowel
•George guage

CONSTUCTION BITE TECHNIQUE
Impressions
Wax rim
Training the pt regarding exact position for bite
Bite registration
chill it
Check it with models
WHY SHOULDN’T WE CONSTRUCT A BITE ON
CASTS ? www.indiandentalacademy.com

POSTURAL REST POSITION:
THE INITIAL TASK OF FUNCTIONAL ANALYSIS IS THE
ASSESSMENT OF MAND POSITION AS DETERMINED BY
MUSCULATURE.
IN ADULTS THIS POSITION IS GENERALLY CENTRIC
RELATION REGISTERED BY GNATHOLOGIC TECH.
HOWEVER, THIS TECH CANNOT BE USED IN DECIDUOS OR
MIXED DENTION AS THE OCCLUSION IS TRANSITIONAL &
CONDYLES ARE NOT FULLY FORMED.
BUT THE POSTURAL REST POSITION IS A RESULT OF A
MYOSTSTIC ANTISTETCH REFLEX THAT RESPONDS ONLY
TO PERMANENT EXOGENOUS FORCES AFFECTING THE
OROFACIAL SYSTEM LIKE GRAVITY.
IN OTHER WORDS ,THE REST POSITION DEPENDS ON &
ALTERS WITH THE POSITION OF THE HEAD.THUS ,NATURAL
HEAD POSITION(NHP)IS A MUST FOR EACH PT
EXAMINATION & CEPHALOMETRIC ANALYSIS.www.indiandentalacademy.com

THE MOVEMENT OF MAND FROM POSTURAL REST TO
HABITUAL OCCLUSION USUALLY CONSISTS OF TWO
COMPONENTS:
1.HINGE (ROTATRY) MOVEMENTS.
2.TRANSLATORY (SLIDING) MOVEMENTS.
FURTHERMORE, DURING CLOSING MANOUVER FROM REST
POSITION ,TWO PHASES ARE OBSERVED:
1.FREE PHASE FROM POSTURAL REST TO POINT OF
PREMATURE OR INITIAL CONTACT.
2.ARTICULAR PHASE FROM INITIAL CONTACT TO CENTRIC OR
HABITUAL OCCLUSAL POSITION.
THE REGIMEN FOR EXAMINATION IS AS FOLLOWS:
DETERMINATION OF POSTURAL REST POSITION
REGISTRATION AND MEASUREMENT OF POSTURAL REST
POSITION.
EVALUATION OF RELATIONSHIP OF REST POSITION TO
OCCLUSAL POSITION IN 1.SAGITTAL 2.VERTICAL
3.TRANSVERSE PLANE.

ASSESSMENT OF POSTURAL REST POSITION:
MUST BE DETERMINED FROM A STANDARD HEAD
POSITION
THE PT IS SEATED UPRIGHT, PREFERABLY WITH BACK
UNSUPPORTED.THE HEAD IS ORIENTED WITH THE PT
LOOKING STRAIGHT AHEAD AT EYE LEVEL ( LIKE
LOOKING DIRECTLY INTO MIRROR)
IF THIS POSITION SEEMS TOOVARIABLE OR THE PT IS NOT
RELAXED , THE HEAD CAN BE POSITIONED WITH EYE-EAR
(FH - PLANE)
METHODS USED TO DETERMINE PRP OF MAND:
BASIS:BASED ON THE FACT THAT AFTER THE PHONETIC
OR FUNCTIONAL MOVEMENTS, THE MANDIBLE USUALLY
RETURNS TO PRP.

METHODS:
PHONETIC EXERCISE
COMMAND METHOD
NON COMMAND METHOD
COMBINED METHOD.
METHODS TO REGISTER PRP OF MANDIBLE :
DIRECT INTRA ORAL METHOD
DIRECT EXTRA ORAL
INDIRECT EXTRA ORAL
EVALUATION OF PATH OF CLOSURE FROM POSTURAL
REST TO OCCLUSION IN
SAGITTAL PLANE
VERTICAL &
TRANSVERSE PLANE.

CONVENTIONAL METHOD

DOWEL UP BITE REGISTRATION

CR and max protrusive
Position noted on mm scale
Heated base plate wax or silicone
putty overbitefork

Pt closes into upper incisor notch while aligning upper
Incisors with midline indicator.

CONTROVERSIES OF BITE REGISTRATION
Andersen and Haupl’s concept.
Opposed by Selmer – oslen.
Grude
Herren
Harvold’s theory
Balters
Witzig

ANDERSEN BELIEVED THAT THE APPLIANCE HE DEVELOPED
WITH HAUPL WORKED ON THE PRINCIPLE OF CHANGING
THE FUNCTIONAL PATTERNS OF THE MUSCLES BY MEANS
OF STIMULATING THE PROTRACTORS AND ELEVATORS AND
STRETCHING THE RETRACTORS BY MEANS OF AN
APPLIANCE THAT IS OVER SIZED BUT STILL PASSIVE IN THE
MOUTH.
HOWEVER IT DID NOT DISPLACE THE MAND BEYOND THE
PHYSIOLOGIC REST POSITION RELATIVE TO THE VERTICAL
AND AND WAS 3MM SHORT OF THE LIMIT OF THE PT’S
TOLERANCE RELATIVE TO THE PROTRUSSIVE ASPECT.HE
BELIEVED THE APPLIANCE DELIVERED INTERMITTENT
FORCES TO THE TEETH AND BONES AS THE MUSCLES
FUNCTIONED AROUND IT AND THAT THE APPLIANCE
NEEDED TO BE WORN ONLY AT NIGHT.

1ST
TO OPPOSE THIS IS SELMER-OLSEN WHO SAID MUSCLES
COULDN’T BE STIMULATED AT NIGHT FOR THIS WAS THE
TIME NATURE USED TO GIVE THEM COMPLETE REST.HE SAY
SWALLOWING OCCURS ONLY 4-8 TIMES /HR AT NIOGHT. HE
INTERPRETED THE ACTIVATOR ACTION AS A STRETCHING OF
THE MUSCLES. THE ACTIVATOR IN TRUTH IS A FOREIGN
BODY AND TOOTH MOVING FORCE IS PRODUCED NOT DUE TO
KE OF MUSCLES OF FUNCTION BUT DUE TO PE OF THE
STRETCHED TISSUES.
SELMER-OSLEN BELIEVED THAT USUAL REST POSITION OF
MANDIBLE DURING SLEEP WAS AT AN INTEROCCLUSAL
DISTANCE OF 2MM BETWEEN THE POSTERIORS ON THE
AVERAGE AND ANY APPLIANCE THAT FORCES MAND
BEYOND THIS REST POSITION VERTICALLY.
THIS WOULD THEREFORE INDUCE STRETCH TO THE MUSCLES
.HE BELIEVED IT WAS THE STRETCH THAT CAUSED THE
EVENTUAL ORTHODONTIC REPOSITIONING.

HERREN’S INTERPRETATION WAS AS FOLLOWS.
MAND IS IN EQUILIBRIUM BECAUSE OF ADJUSTMENTS
BETWEEN VARIOUS FACTORS ACTING ON IT SUCH AS
GRAVITY ,AIRPRESSURE- DOMINANT INDEPENDENT
VARIABLES.
MUSCLE TONUS TENSION- DOMINANT DEPENDANT
VARIABLES
WHEN THERE IS CHANGE IN GRAVITY OR INTRAORAL
AIRPRESSURE MAND IS MOVED TO A NEW POSITION.
WHERE IN INITIAL CHANGES ARE COMPENSATED FOR BY
REACTIVE CHANGES IN MUSCLE TENSION AND TONUS.
CHANGES IN MUSCLE TONUS ARE COMPENSATED FOR BYA
CHANGE IN THE MUSCLE TENSION AS THE MAND TENDS TO
RELOCATE.
MAND POSITION DETERMINED BY THE ACTIVATOR IS THE
DESIRED POSTURAL POSITION RATHER THAN A
MOMENTARY REST POSITION THAT IS FREE OF APPLIANCE
GUIDANCE. www.indiandentalacademy.com

ACTIVATOR LIMITS MAND MOVEMENTS ON ALL PLANES
EXCEPT VERTICAL. MAND HAS A NUMBER OF REST
POSITIONS DURING SLEEP.ACTIVATOR ACTS AS A SPLINT
AND PREVENTS IT FROM MOVING TO THESE POSITIONS.
THE MUSCLE FORCES THA TWOULD NORMALLY BE ACTING
AT NIGHT TO MAINTAIN MAND POSTURAL EQUILIBRIUM
WITH CHANGING BODY POSITIONS ARE TRANSMITTED TO
THE APPLIANCE WHICH IN TURN EXERTS FORCE ON THE
TEETH AND ALVEOLAR BONE CAUSING THE RESULTANT
MOVEMENT.
HEAD POSTURE DURING SLEEP:
HEAD POSITION CHANGES MANY TIMES DURING
SLEEP.DIRECTON OF RESULTANT FORCE ON THE
ACTIVATOR ALSO CHANGES .
AT ANY PARTICULAR MOMENT REST POSITION CHANGES
DEPENDING ON THE HEAD AND BODY POSTURE.

THE RESTRICTION OF MUSCLE MOVEMENT THAT WOULD
CREATE THE DESIRED MAND POSITION CHANGE WITH OUT
THE ACTIVATOR IN PLACE VARIES CONSTANTLY
INVOLVING DIFF MUSCLE GROUPS AND CREATING DIFF
FORCE VECTORS ON THE ACTIVATOR.
PLANE OF SLEEP,INTRAORAL AIR PRESSURE, DREAM CYCLE
AND STATE OF MIND ARE ADITIONAL CONDITIONING
FACTORS , ALL UNCONTROLLED BY THE ORTHODONTIST.
ONLY MAND POSITION HELD BY THE APPLIANCE IS
DETERMINED BY THE CLINICIAN.
THIS SPLINTING EFFECT ON THE MAND IS SUCH THAT IT
CAN HELP PREDETEEMINE THE NET EFFECT OF THE
VARIABLE FORCES.
IF THE ACTIVATOR IS DESIGNED AND WORN AS
PRESCRIBED THE RESULTANT OF ALL THE CONTROLLED
AND UNCONTROLLED FORCES IS USUALLY TO ENHANCE
ADAPTATION TO THE POSITION CREATED BY THE
APPLIANCE.

WT OF THE MAND , TONGUE, AND APPLIANCE ARE
CONST AVERAGING ABOUT 250 GM.
MUSCLE TONUS AND TENSIONS VARY DEPENDING ON
THE DEGREE OF STRETCHING , CONTROLLED FROM CNS,
RELATION WITH BED OR PILLOW, WHETHER THE HEAD
IS PRONE OR SUPINE ETC.
IT IS CLEAR THAT FORCES ACTING ARE ENTIRELY
DIFFERENT IN MULTIPLE PRONE, SUPINE, ROTATED
COMBINATIONS FROM WHAT THEY ARE IN AN ALERT,
AWAKENED AND UPRIGHT HEAD POSTURE.
OVER A PROLONGED PERIOD THE DURATION THAT A
PARTICULAR POSITION IS HELD AND THE RESULTANT
FORCES WOULD BE A FACTOR TO BE CONSIDERED.
FORCES CREATED ARE BASICALLY INTERMITTENT
HOWEVER EVEN THOUGH SOME TEETH OR GROUP OF
TEETH MAY BE SUBJECT TO PRESSURE FOR A
PROTRACTED TIME.

LOOSE APPLIANCE IS RESPONSIBLE FOR SOME OF THE
INTERMITTENT ACTION.
REMOVAL OF THE APPLIANCE DURING THE DAY ALSO
PRODUCES A NET INTERMITTENT ACTION , CALLING UP A
NEW MUSCLE ENGRAM TO ESTABLISH THE
NEUROMUSCULAR ENGRAM CONSISTENT WITH DIURNAL
POSTURAL CHANGES AND ACTIVITIES.
HENCE SAME CONCLUSION WAS REACHED BY HERREN AS
BY SELMER-OSLEN BUT WITH A DIFF BASIS FOR
REASONING.

ROLF GRUDE , A COLLEAGE OF ANDERSEN TRIED TO
SMOOTH THINGS OVER BY SAYING IF AN APPLIANCE
WAS CONSTRUCTED WITH IN PHYSIOLOGIC REST
POSITION IT WORKS ACCORDING TO ANDERSEN’S
THEORIES BUT IT HAPPENS TO BE CONSTRUCTED AT A
VERTICAL BEYOND THE LIMITS OF THE REST POSITION ,
AN ENTIRELY DIFF MECH TOOK OVER AND WORK
ACCORDING TO SELMER-OLSEN’S VIEWS.LITTLE DID HE
OR ORTHODONTIC COMMUNITY KNOW HOW RIGHT HE
WAS.

HARVOLD SAID NEVER MIND SLEEPING ,U HAVE GOT TO GO
ACTIVE ! STRETCH THE MUSCLES THAT’S WHAT DOES THE
JOB . THE MORE STRETCH ,THE BETTER .LIKE ANDERSEN ,HE
TOOK THE CB WITH THE JAW 3 MM SHORT OF THE PT’S LIMIT
OF TOLERANCE RELATIVE TO THE PROTRUSIVE POSITION
BUT WITH A WHOPPING 8-10MM VERTICAL OPENING BEYOND
THE REST POSITION. LATER ON ,WOODSIDE WAS TO GO EVEN
FURTHER TO 12-15MM BEYOND REST.GRABER&NEWMANN
SAID U COULD FIGURE IT OUT MATHEMATICALLY USE A
COMBINATION OF BITE OPENING & PROTRUTION TO EQUAL
10MM ! IN OTHER WORDS IF U OPEN THE BITE 4 MMBETWEEN
THE OCCLUSALS POSTERIORLY,THEN ADVANCE THE MAND
BY 6MM.
FOR MANY YEARS IN US THE BITES WERE TAKEN IN AN
INCISOR END TO END POSITION AS RECOMMENDED BY
BALTERS OF GERMANY, WITH AN INTER INCISAL OPENING OF
2-3MM.IF THE CENTRALS ARE IN ORTHODONTICALLY POOR
POSITION,ALIGNMENT OF LATERALS IS USED.

SCHWARZ IN HIS WIDER OPEN ACTIVATOR STUDIES
NOTED THAT THE FORCES CREATED VARIED WITH THE
CHANGING MAGNITUDE OF THE BP&THE TETANIC
OSCILLATIONS OF THE MUSCLE CONTRACTIONS.
HE DID NOT OBSERVE AN INCREASE IN THE FREQUENCY
OF MAND MOVEMENTS WHEN THE APPLIANCE WAS
WORN.
AGAIN THE VERTICAL OPENING WAS BEYOND POSTURAL
REST POSITION,ELICITING A STRETCH REFLEX
&VISCOELASTIC TISSUE RESPONSE (IN CONTRADICTION
OF SMALL VERTICAL OPENING RECOMMENDED BY
ANDERSEN).

AFTER WORLD WAR II ESCHLERBECAME QUITE PROMINENT
IN THE FUNCTIONAL ORTHOPEDIC FIELD &WIELDED
CONSIDERABLE INFLUENCE WITH HIS RESEARCH &
DEDUCTION.
HE DEVELOPED A WORKING HYPOTHESIS, BASED ON HIS
OWN ELECTROMYOGRAPHIC STUDIES ,THAT VARIED FROM
THOSE PREVIOUSLY CITED.TO HIM THE RESPONSE WAS
PRIMARILY A STRETCH REFLEX.
WHEN APPLIANCE IS IN THE MOUTH IT ELICITS ISOTONIC
CONTRACTIONS IN THE ELEVATOR MUSCLES.
THESE ARE REPLACED BY ISOMETRIC CONTRACTIONS AFTER
THE MAND TEETH ARE FULLY SEATED IN THE APPLIANCE.
BECAUSE THE MAND IS PREVENTED BY THE APPLIANCE
FROM ACHIEVING A NORMAL POSTURAL REST POSITION,THE
MUSCLES REMAIN STRETCHED.
THEY FATIQUE IN DUE COURSE , RLAX & ALLOW THE MAND
TO DROP .THE CYCLE IS REPEATED WHEN THE MUSCLES
RECOVER.

THE THERAPEUTIC EFFECT WAS ATTRIBUTED TO THE
STRETCH REFLEX.
THE EFFECT WAS PROPORTIONATE TO THE OPENING, WITH A
RECOMMENDTION OF 4-6MMFOR OPTIMUM PT TOLERANCE &
COOPERATION.
HIS RESEARCH INDICATED INCREASED FREQUENCYOF MAND
MOVEMENTS WITH ACTIVATOR WEAR,CONFIRMING
ANDERSEN’S OBSERVATION.

THILANDER&FILIPSSON ALSO CONDUCTED EMG STUDIES ON
PTS WEARING ACTIVATOR BUT DURING WAKING HRS.
THEY FUOND ONLY INSIGNIFICANT MUSCLE ACTIVITY WHEN
ACTIVATOR WAS AT REST .
DURING MAND MOVEMENTS HOWEVER,AN INCREASED
ACTIVITY WAS SEEN, ESPECIALLY SWALLOWING ACTIVITY ,
PROBABLY DUE TO INCREASED SALIVARY FLOW.
CLEARLY ALTHOUGH THERE IS ESSENTIAL AGREEMENT
BETWEEN ALGHREN,HARVOLD,HARREN,SELMER-OSLEN &
THAILANDER & FILIPSSON,DIFFERENCES OF OPINION BY
ESCHLER & SCHWARZCOULD BE A MATTER MORE OF
INTERPRETATIONTAN OF ACTUAL FINDINGS.ESCHLER IS
ACTUALLY IN PARTIAL AGREEMENT WITH BOTH BROAD
HYPOTHESES.

WORKING HYPOTHESIS FOR THE CONVENTIONAL NIGHT
TIME WEAR OF THE PASSIVE ANDERSEN ACTIVATOR:
ORIGINAL ANDERSEN-HAUPL THEORY ATTRIBUTED TOOTH
MOVEMENT TO LOOSE FITTING FUNCTIONALLY
GENERATEDMOBILITY PROVIDING INTERMITTENT FORCES
CREATED BY THE ELEVATOR & PROTRACTOR MUSCLES AS
WELL AS BY THE ELEMENTS OF THE BUCCINATOR MECHN.
THAT JOLTED OR SHOOK THE TEETH, PUSHING THE
APPLIANCE BACK INTO POSITION ON THE MAX TEETH WHEN
IT DROOPED AWAY.
A PREREQUISITE WAS THAT THE BITE OPENING COULD NOT
EXCEED THE NORMAL INTEROCCLUSAL CLEARANSE OR FREE
WAY SPACE.
THIS APPROACH UTILIZING NOCTURNAL WEAR OF A LOOSE
FITTING APPLIANCE IS ESPOUSED BY AHLGREN.

SECOND HYPOTHESIS:
DERIVED NOCTURNAL FUNCTION ACTIVITY DURING SLEEP.
IT SUGGESTED THAT THE ACTIVATOR AT REST MOVES THE
TEETH & CREATES THE DESIRED CHANGES.
THE APPLIANCE IS SQUEEZED BETWEENTHE JAWS MOST OF
THE TIME SPLINTING THEM IN THE “OUGHT TO BE” SAGGITAL
RELATIONSHIP &PREVENTING COMPENSATORY POSTURAL
CHANGES THAT WOULD NORMALLY OCCUR WITHOUT THE
ACTIVATOR IN PLACE.
RESULTANT FORCES CREATED VARY FORM TIME TO TIME &
CHANGE IN MAGNITUDE.
THEY ARE INTERMITTENT BUT THE NET RESULT IS THAT
THEY ARE TRANSMITTED TO THE ACTIVATOR, WHICH
DISTRIBUTES THEM TO THE TEETH &ALVEOLAR BONE,
ENHANCING THE ADAPTIVE PROCESS.
THE ACTION IS CONSIDERED TO BE PRIMARILY INTERUPTTED
OR INTERMITTENT IN NATURE.

THE FORCES PRODUCE A STRAIN IN THE TISSUES & ARE A
MECHANICAL PHENOMENON WHETHER THE STRAIN IS DUE
TO MUSCLES DIRECTLY OR WHETHER IT ACTS INDIRECTLY
THROUGH THE APPLIANCE.

ACTIVATOR
BIONATOR
FRANKEL APPLIANCE
TWIN BLOCK
BIMLER APPLIANCE
BASS

ACTIVATOR
tech for low construction bite with a
marked forward positioning of the mandible
Tech for high construction bite with slight anterior
Mand positioning
Tech for a construction bite with out forward
posturing of the mandible.

BIONATOR
Class II cases
Mixed dentition
Permanent dentition

BIONATOR
2-3 mm interincisal clearance at the centrals or
laterals and a mandibular advancement so that
lower centrals are 2-3 mm protruded beyond
upper centrals or laterals
Mixed dentition S:2mm V :2mm for 24hr wear
Permanent dentition S:3mm V: 3mm for 12hr or more

FRANKEL
Balance between protractor and retractor muscles should
not be disturbed
Sagittal: not more than 2.5 – 3mm
Vertical: just to permit cross over of wires(2.5 – 3mm)
Transverse: midlines

TWINBLOCK
Sagittal : edge to edge oclusion of incisors
Vertical : thicker in premolar region
Transverse : midlines should coincide.

BASS APPLIANCE
S: 4mm anterior to
Centric relation
V: 2-3mm posterior to
Bite opening.

MANDIBULAR GROWTH ADVANCER
Upper and lower splints
made separately and are
fixed by cold cure acrylic
in a new construction site
with in the oral cavity.

CONCLUSION

Bite registration in functional appliances

More Related Content

What's hot

Viewers also liked

Similar to Bite registration in functional appliances

More from Indian dental academy

Recently uploaded

Bite registration in functional appliances