Construction bite /certified fixed orthodontic courses by Indian dental academy

CONSTRUCTION BITE

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

CONSTRUCTION BITE
The determination of the proper construction bite is critical for a
functional appliance to succeed. More failures result from incorrect
posturing of the mandible
The Vertical Opening of the Mandible:
The amount of vertical opening of the construction bite is still
a subject of some considerable controversy despite long clinical
experience.
The vertical opening of the mandible is dependent on three
major considerations. (1) the kind of dysgnathic or dysplastic problem
(sagittal and vertical relationships, morphogenetic growth pattern);
(2) the developmental state, sex, and age of the patient (potential
incremental changes); and (the type of functional appliance).

Types of Malocclusion:


The Horizontal Posturing of the Mandible:
There are four possibilities for posturing the mandible in
the sagittal or anterioposterior dimension for the functional
orthopedic appliance.
1. The original sagittal jaw relationship may be maintained, as in a
neutroclusion.
2. The mandible may be postured forward to change the sagittal
relationship equally on both sides when the problem is a bilaterally
symmetrical Class II condition.
3. The bite is changed on one side but is maintained as much as
possible on the other side, as with a unilateral class II, Division I
malocclusion, Class II, Division 2 malocclusion, or a Class III
malocclusion.

Analysis of the Construction Bite Maneuver:


•

Functional retrusion, with the path of closure upward and
backward from postural rest to occlusion, sagittal correction
compensation will be less.

•

It is good treatment planning to allow the mandible to come
forward a bit, even in a Class I deep bite malocclusion.

•

Class II malocclusion may be a mesial position of the maxilla.

•

Class I case with an inverted bite (cross bite) of individual or
all incisors.


The Magnitude of Horizontal Correction for Class II,
Division 1 malocclusions is another controversial question.
The construction bite is shifted as far as the occlusion
allows without the creation of a cross bite condition anteriorly
or posteriorly for single teeth or groups of teeth. If large width
differences exist between the maxillary and the mandibular
arches, the shifting, especially in the permanent dentition, is
possible only so far that the canines are opposing each other
cusp tip to cusp tip. Further mandibular posturing is not to be
until the maxillary arch is expanded to prevent cross bite.


Relapse Potential:
Relapse after shifting the bite sagitally with an functional
appliance is extremely rare.
Danger of relapse – after transverse widening of dental
arches.

Maxillary Protraction Cases:
• Class I, Division I malocclusions that are the result of mandibular
underdevelopment.
• Prognathic maxilla
• Cases that are in between the cepahlometric and the cast analysis.
• Excessive labial position of the incisors
• The forward position of the maxilla is being treated in mixed
dentition.

Fabrication of Construction Bite:


Wax Bite Visualization:
• Mixed dentition – the middle of the upper deciduous
canine should fit into the embrasure between lower
deciduous canine and the first deciduous molar.
• Permanent dentition – the tip of the buccal cusp of the
upper first premolar serves well as a guide point. It should
fit precisely into the embrasure between the lower first and
second premolars.


The Transverse Posturing of the Mandible:
• The upper and lower midlines are coincident in habitual
occlusion and the sagittal relationship is bilaterally
symmetrical, there is no need to make any transverse
compensations.
• The midlines should line up in the forward posturing in the
same relationship as in habitual occlusion.
Midline Considerations:
•The upper and lower midlines do not coincide, a
determination must be made as to the fault-maxillary or
mandibular.
• The patient is observed in the postural rest to full habitual
occlusion. If there is any shift from one side to another, the
occlusal interference should be checked.

• Dental midline discrepancies – corrected later with fixed
appliances.
• If the teeth in each jaw line up with the respective basal
midlines but are not coincident in habitual occlusion with the
midline of the other jaw. The clinician must use the jaw
midlines to determine the construction bite relationship.
• Cross bite
• Tooth size discrepancy


The Construction Bite Technique:
• Patient compliance is essential
• Patient motivation compliance
• Instant correction
• Clinical maneuver
Study Model Analysis:
•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.

Functional Analysis:
The functional analysis is performed before taking the
construction bite to obtain the following information:
1. The precise registration of the rest position is made. The
vertical opening of the construction bite depends on this.
2. The path of closure from postural rest to habitual
occlusion is analyzed. Any sagittal or transverse
deviations are recorded.

3. 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.
4. The TMJ is carefully palpated for clicking, crepitus, and so
forth, which might be characteristic of a functional
abnormality or indicative of the need for some modification of
the design of the appliance.
5. The interocclusal clearance or freeway space is checked
severaltimes, and the mean amount is recorded.
6. Respiration

Cephalometric Analysis:
The most important information required for planning for
the construction bite includes the following:1. The direction of growth
2. The differentiation between the position and the size of the
jaw bases.
3. The morphological characteristics
4. The axial inclination and the position of maxillary and
mandibular incisors.

Anterior Positioning of the Mandible:
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.

Opening of the Bite:
There are some guiding principles in maintaining the
proper horizontal 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.

General Rules for Construction Bite:
1. If the forward positioning of the mandible is 7mm to 8mm,
the vertical opening must be slight to moderate (2mm4mm).
2. If the forward positioning is no more than 3mm to 5mm, the
vertical opening should be 4mm to 6mm.
3. Lower midline shifts


The construction bite prepared on casts has the following
disadvantages:
1. The appliance does not fit.
2. There is asymmetrical biting on the appliance.
3. The patient is not really comfortable and there are more
frequent disturbances during sleep.
4. The likelihood of unwanted lower incisor procumbency
is greater because the appliance exerts undue stress on
these teeth.


Technique for the Low Construction with a Marked
Forward Positioning of the Mandible:
• Class II functional retrusion cases.
• The mandible moves mesially to engage the appliance, the
elevator muscles of mastication are activated.
• The horizontal “H” activator.
• The indication for anterior posturing of the mandible is
not only an original posterior position but also the
likelihood of a favorable growth pattern.


Technique for a High Construction Bite with Slight
Anterior Mandibular Positioning:
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. The appliance induces activation of
myotactic reflex in the muscles of mastication. The stretch
reflex activation with increased vertical dimension may well
influence the inclination of maxillary base. This appliance is
indicated in vertical growth patterns.
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 bite.

The Technique for Construction Bite without Forward
Positioning of the Mandible:
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
• The skeletal deep overbite
• Open bite
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 desired.

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.
• Tooth guidance or functional protrusion Class III malocclusion
• Pseudo Class III malocclusion
• Skeletal Class III malocclusion


Myodynamic Appliances:
The development of the myodynamic appliances is due
to ingenuity of H.P. Bimler.
I. Petrovic, McNamara substantiate the Andressen-Haupl
concept:
• Myotactic reflex activity and isometric contraction induce
musculoskeletal adaptation by introducing a new
mandibular closing pattern.
• Muscle function with kinetic energy and intermittent
forces.
• Stimuli from the activator and muscle receptors and
periodontal mechanoreceptors promote displacement of
mandible.
• LPM play the most important role in adaptations.

Myotonic appliances
II. Selmer-Olsen, Herren, Harvold and Woodside:
• Viscoelastic properties of the muscles and stretching of soft
tissues are decisive for activator action I.e. skeletal adaptation.
• During each application of the force, secondary forces arise in
the tissues, introducing a bioelastic process.
• Depending on the magnitude and duration of the applied force,
the viscoelastic reaction can be divided into the following stages:
- Emptying of vessels
- Pressing out of interstitial fluid
- Stretching of fibers
- Elastic deformation of bone
- Bioplastic adaptation
•Skeletal adaptation in the vertical plane alone according to
Woodside.

The vertical displacement of the mandible was increased first in
order to prevent the loss of appliance during the sleep. The
gradual increase in the interocclusal distance during the years
apparently was due to clinical experience. Thus, the
myodynamic activator of Andresen become the myotonic
appliance of Andersen-Haupl-Petrik.
• The effect of muscular pressure is increased by immobilizing
the activator.
• The construction bite dislocates the mandible in a vertical
and sagittal direction. Additional pressure is obtained by
increase of dislocation in either direction.


Functional Regulator of Frankel:
• The Frankle’s approach differ from other methods because he
makes the oral vestibule the “operational basis” for his
treatment.
• According to Kraus, the physiological development of the
motor stereotype in muscular action in the orofacial system is
interrupted by the results of a substitute, thumb, or tongue
sucking, leading to a functional disturbance in the formation of
the skeletal components.
• Frankel is in agreement with Kraus that malocclusion,
especially that caused by crowding of the teeth, may result
from a disturbance of the tonus as well as of the function of the
perioral muscles, and this is the keyproblem for successful
treatment.

• Widening of dental arches achieved by Frankle
• The stability of results achieved by FR, therefore, interpreted
as connected with a change in the original muscular balance
and the establishment of a new balance.

The Functioning Space:
•S.F. Fish – denture study
• Surgical repositioning of mandible


Head Posture and Craniofacial Morphology:
The comprehensive system of associations between
the varieties expressing the size, shape and position of the
craniofacial components and those expressing the postural
relationships of the head and cervical column, clearly
indicates a relationship between craniofacial morphology and
head posture.
Moss and Young have emphasized that morphology
of craniofacial skeletal is determined by surrounding
functional matrix.
The treatment with functional appliances was based
on a simple concept of influencing muscle activity in this
region, learning a lesson from morphological adaptability
seen with aberrant muscle patterns and changing head
posture.

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Construction bite /certified fixed orthodontic courses by Indian dental academy

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