Construction of bite for various functional orthodontic appliances

Construction BiteConstruction Bite
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing DentalLeader in continuing Dental
EducationEducation
www.indiandentalacademy.comwww.indiandentalacademy.com

CONTENTSCONTENTS
Introduction .Introduction .
Theories.Theories.
Genetic Control Theory.Genetic Control Theory.
Functional Matrix Hypothesis.Functional Matrix Hypothesis.
Lateral Pterygoid Hyperactivity Hypothesis.Lateral Pterygoid Hyperactivity Hypothesis.
Growth Relativity Hypothesis.Growth Relativity Hypothesis.
Construction biteConstruction bite
In various malocclusions.In various malocclusions.
In various appliances.In various appliances.
Fabrication of Construction Bite:Fabrication of Construction Bite:
Construction bite technique.Construction bite technique.
Study Model AnalysisStudy Model Analysis
Functional AnalysisFunctional Analysis
Cephalometric analysis.Cephalometric analysis.
General Rules for Construction Bite.General Rules for Construction Bite.
Bibliography .Bibliography .

IntroductionIntroduction
OrthodonticsOrthodontics has been expanded tohas been expanded to
includeinclude dentofacial orthopedicsdentofacial orthopedics, which, which
deals with the correction of skeletaldeals with the correction of skeletal
relations, that of the jaws to be precise.relations, that of the jaws to be precise.
The correction of mandibularThe correction of mandibular
retrognathism is mainly achieved by theretrognathism is mainly achieved by the
acceleration of mandibular sagittal growthacceleration of mandibular sagittal growth
by use of myofunctional appliances.by use of myofunctional appliances.

Functional appliances act by changingFunctional appliances act by changing
the spatial relationship of the mandible inthe spatial relationship of the mandible in
relation to maxilla. This is accomplishedrelation to maxilla. This is accomplished
by the means of forward repositioning ofby the means of forward repositioning of
the mandible by making athe mandible by making a CONSTRUCTIONCONSTRUCTION
BITE.BITE.
The method of construction biteThe method of construction bite
depends on the principles and theorydepends on the principles and theory
behind the appliance.behind the appliance.

Genetic Control TheoryGenetic Control Theory
Van Limborgh in 1970 reaffirmed by Sicher onVan Limborgh in 1970 reaffirmed by Sicher on
1952.1952.
It stipulates that the genotype supplies allIt stipulates that the genotype supplies all
information required for phenotypic expression.information required for phenotypic expression.
This theory suggest that condyle is under strong
genetic control like an epiphysis that causes the
entire mandible to grow downward and forward.
According to study of Brodei (1995) GenomicAccording to study of Brodei (1995) Genomic
control is not as important as epigenetic factor.control is not as important as epigenetic factor.

Functional Matrix HypothesisFunctional Matrix Hypothesis
- The most popular current working hypothesis of Moss in- The most popular current working hypothesis of Moss in
1962. It is based on functional cranial component theory1962. It is based on functional cranial component theory
of Vander Klauw.of Vander Klauw.
- The growth of cartilage and bone seems to be a- The growth of cartilage and bone seems to be a
compensatory response to functional matrix growth.compensatory response to functional matrix growth.
- Two types of functional matrix are recognized:- Two types of functional matrix are recognized:
i) Periosteali) Periosteal
ii) Capsular.ii) Capsular.
- The growth of the functional matrix is primary , whereas- The growth of the functional matrix is primary , whereas
that of a skeletal unit is secondary.that of a skeletal unit is secondary.

Effect of retrodiscal padEffect of retrodiscal pad
The retrodiscal pad controls mandibularThe retrodiscal pad controls mandibular
growth in two ways:growth in two ways:
1) Its vascular component control the1) Its vascular component control the
condylar cartilage growth rate andcondylar cartilage growth rate and
endochondral ossification rate ; anendochondral ossification rate ; an
increase activity of the retrodiscal padincrease activity of the retrodiscal pad
produces an increase in condylar cartilageproduces an increase in condylar cartilage
growth and endochondral ossification.growth and endochondral ossification.

2) Its biomechanic component governs2) Its biomechanic component governs
bone apposition and condylar growthbone apposition and condylar growth
direction at the posterior border of thedirection at the posterior border of the
ramus.ramus.
An increase in activity of theAn increase in activity of the
retrodiscal pad produces an accentuationretrodiscal pad produces an accentuation
of the ramus posterior concavity and aof the ramus posterior concavity and a
local increase in bone apposition and thelocal increase in bone apposition and the
number of negative charges at the ramusnumber of negative charges at the ramus
posterior concave surface.posterior concave surface.

LATERAL PTERYGOID
HYPERACTIVITY HYPOTHESIS
Based on the earliest available acute and blind
EMG monitoring technique. (McNamara in 1973)
It suggests that hyperactivity of the lateral
pterygoid muscles (LPM) promotes condylar
growth.
Rees in 1954 reported that other muscles and
tendons, including those of the deep masseter
and temporalis, also attach to the condylar head
or articular disk which may be the expected
cause of condylar growth.

But anatomic research has not found
evidence that significant attachments
actually exist. The LPM tendon is
observed attaching, however, to the
anterior border of the fibrous capsule that
in turn attaches to the fibrocartilage of the
condylar head and neck anteriorly.
Whetten and Johnston in 1985,found little
evidence that LPM traction had any
pronounced effect on condylar growth.

More recently, permanently implanted
longitudinal muscle monitoring techniques,
have found that the condylar growth is
actually related to decreased postural and
functional LPM activity.
Petrovic in 1997, studied the removal of
the lateral pterygoid muscles and
retrodiscal tissues “condylar frenum” for
the effect on condylar growth.

GROWTH RELATIVITY HYPOTHESIS
Given by : Endow and Hans in 1996.Given by : Endow and Hans in 1996.
According to them mandibular growth isAccording to them mandibular growth is
the composite of regional forces andthe composite of regional forces and
functional agents of growth control thatfunctional agents of growth control that
interact in response to specific extrainteract in response to specific extra
condylar activating signals.condylar activating signals.

Growth here is related to the:-Growth here is related to the:-
- Displaced condyles from actively- Displaced condyles from actively
relocating fossae.relocating fossae.
- Long term results.- Long term results.
- Viscoelasticity- Viscoelasticity
- Synovial fluid , fibrous capsule, body fluid.- Synovial fluid , fibrous capsule, body fluid.

Theory is based on the triad:Theory is based on the triad:

Graber and Joho in 1968, stated thatGraber and Joho in 1968, stated that
compression of condyles decreasescompression of condyles decreases
activity of lateral pterygoid muscle.activity of lateral pterygoid muscle.
Storey and Smith in 1962, stated thatStorey and Smith in 1962, stated that
increases in the vertical dimension have
accompanied decreased postural EMG
masticatory muscle activity.

Popovich and Thompson in 1977, have found
that the glenoid fossa grows in a posterior and
inferior direction. So acc. to them the effect of
func. App. is by restricting the backward growth
of GF.
The law of Growth Relativity states that bone
architecture is influenced by the
neuromusculature and the contiguous,
nonmuscular, viscoelastic tissues anchored to
the glenoid fossa and the altered dynamics of
the fluids enveloping bone.

THREE GROWTH STIMULI
Displacement + Viscoelasticity +
Referred Force
To offer an analogy following the literature
review, the condyle appears to act like a
light bulb on a dimmer switch. It lights up
during advancement, dimming back down
to near normal levels in retention. Its
growth potential diminishes with age,
whereas the glenoid fossa remodeling
“lighting” potential lasts long into
adulthood.

Why Bite is Registered?Why Bite is Registered?
The bite is registered to correct the spatialThe bite is registered to correct the spatial
relationship of the osseous structures torelationship of the osseous structures to
eliminate the neuromusculareliminate the neuromuscular
compensation which existed as acompensation which existed as a
response to the malocclusion.response to the malocclusion.

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 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).
(3) The type of functional appliance.www.indiandentalacademy.comwww.indiandentalacademy.com

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 cephalometric and the cast analysis.
• Excessive labial position of the incisors
• The forward position of the maxilla is being treated in mixed
dentition.

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.www.indiandentalacademy.comwww.indiandentalacademy.com

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.

Harvold Woodside in 1975, tested theHarvold Woodside in 1975, tested the
effect of activators with wide verticaleffect of activators with wide vertical
openings in the construction bite (8mmopenings in the construction bite (8mm
beyond the rest) by comparing them withbeyond the rest) by comparing them with
small vertical opening (3 to 4 mm) andsmall vertical opening (3 to 4 mm) and
concluded that large vertical opening biteconcluded that large vertical opening bite
registrations were used only until normalregistrations were used only until normal
lip strength was achieved.lip strength was achieved.

Harvold believed that a small increase inHarvold believed that a small increase in
construction bite is ineffective, becauseconstruction bite is ineffective, because
the vertical dimension normally increasedthe vertical dimension normally increased
during sleeping, which permitted theduring sleeping, which permitted the
mandible to slip out of the appliance.mandible to slip out of the appliance.
So, Harvold used a construction bite thatSo, Harvold used a construction bite that
increased the vertical dimension aincreased the vertical dimension a
minimum 5 to 6 mm beyond the average 4minimum 5 to 6 mm beyond the average 4
to 5 mm rest position.to 5 mm rest position.

Herren,Herren, modified the activator in bymodified the activator in by
overcompensating the vertical position ofovercompensating the vertical position of
the mandible in the construction wax bite.the mandible in the construction wax bite.
He followed following rules while takingHe followed following rules while taking
the construction bite:the construction bite:
1) Positioning the mandible in an1) Positioning the mandible in an
anteroposterior direction dominates overanteroposterior direction dominates over
the vertical direction.the vertical direction.

2) Anterior positioning : from the2) Anterior positioning : from the
postnormal distoclusion , the mandible ispostnormal distoclusion , the mandible is
carried forward – not only to a neutralcarried forward – not only to a neutral
molar relationship but also an additional 3molar relationship but also an additional 3
mm to 4mm beyond neutroclusion.mm to 4mm beyond neutroclusion.
3) Vertical positioning: in a deep vertical3) Vertical positioning: in a deep vertical
overbite, the incisal edges are kept tooverbite, the incisal edges are kept to
4mm apart, this amount of opening allows4mm apart, this amount of opening allows
sufficient thickness of acrylic to cover thesufficient thickness of acrylic to cover the
incisal edges of the mandibular incisors.incisal edges of the mandibular incisors.

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.

Balters in 1950, said that tongue is theBalters in 1950, said that tongue is the
essential factor in the development ofessential factor in the development of
dentition.dentition.
He prefered, an edge to edge relationshipHe prefered, an edge to edge relationship
of all or atleast the lateral incisors.of all or atleast the lateral incisors.
He said this will provide theHe said this will provide the
maximum functional space for the tonguemaximum functional space for the tongue
and is also convenient for the patient.and is also convenient for the patient.

Balter followed step by step protractionBalter followed step by step protraction
procedure in case where overjet is toprocedure in case where overjet is to
large, to allow an edge to edge incisal bite.large, to allow an edge to edge incisal bite.
He covered the mandibular incisors by aHe covered the mandibular incisors by a
grooved rim similar to that of the activator.grooved rim similar to that of the activator.
He also added acrylic to the lower incisorHe also added acrylic to the lower incisor
bite rim , and allowed the upper incisors tobite rim , and allowed the upper incisors to
bite into it when it is still soft.bite into it when it is still soft.

Bite registration in twin block.Bite registration in twin block.
The Exactobite or Projet bite Gauge isThe Exactobite or Projet bite Gauge is
used to record bite in wax for constructionused to record bite in wax for construction
of twin block.of twin block.
Bite registration for twin blocks orginallyBite registration for twin blocks orginally
aimed for a single activation to an edge toaimed for a single activation to an edge to
edge incisor relationship with 2mmedge incisor relationship with 2mm
intercisal clearance for an overjet of uptointercisal clearance for an overjet of upto
10mm.10mm.

The total protrusive movement isThe total protrusive movement is
calculated by first measuring the overjet incalculated by first measuring the overjet in
centric occlusion and in the position ofcentric occlusion and in the position of
maximum protrusion. The protrusive pathmaximum protrusion. The protrusive path
of the mandible is the difference betweenof the mandible is the difference between
the two measurements.the two measurements.
George bite is used to measure theGeorge bite is used to measure the
distance.distance.

In class II div 1 malocclusion-In class II div 1 malocclusion-
A protrusive bite is registered to reduceA protrusive bite is registered to reduce
the overjet and the distal occlusion onthe overjet and the distal occlusion on
average by 5 to 10mm.average by 5 to 10mm.
2mm vertical clearance between the2mm vertical clearance between the
incisal edges of the upper and lowerincisal edges of the upper and lower
incisors are registered.incisors are registered.

In class II div 2 malocclusionIn class II div 2 malocclusion::
Incisors in edge to edge occlusion.Incisors in edge to edge occlusion.
As these patients require more verticalAs these patients require more vertical
development, the occlusal bite blocksdevelopment, the occlusal bite blocks
should be thicker in the premolar region toshould be thicker in the premolar region to
allow clearance of the upper and lowerallow clearance of the upper and lower
incisors.incisors.
The amount of mandibular advancementThe amount of mandibular advancement
is limited here.is limited here.

In class III patient :In class III patient :
The blue exactobite is used to register biteThe blue exactobite is used to register bite
with the teeth closed to the position ofwith the teeth closed to the position of
maximum retrusion, leaving sufficientmaximum retrusion, leaving sufficient
clearance between the posterior teeth forclearance between the posterior teeth for
the occlusal bite blocks.the occlusal bite blocks.
This is achieved by recording aThis is achieved by recording a
construction bite with 2mm interincisalconstruction bite with 2mm interincisal
clearance in the fully retruded position.clearance in the fully retruded position.

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 key problem for successful
treatment.

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.

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.www.indiandentalacademy.comwww.indiandentalacademy.com

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.

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 (2mm-
4mm).
2. If the forward positioning is no more than 3mm to 5mm, the
vertical opening should be 4mm to 6mm.
3. Lower midline 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.www.indiandentalacademy.comwww.indiandentalacademy.com

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
• Skeletal Class III malocclusion

ReferencesReferences
1) Clark William J1) Clark William J., Twin block Functional., Twin block Functional
Therapy, Applications in dentofacial orthopedics,Therapy, Applications in dentofacial orthopedics,
2nd Ed., Mosby; Pgs.12,25,26,161,193,218,90.2nd Ed., Mosby; Pgs.12,25,26,161,193,218,90.
2) Graber T.M., Neumann B.2) Graber T.M., Neumann B. , Removable, Removable
orthodontic appliances, Ed.2,1984, W.B.orthodontic appliances, Ed.2,1984, W.B.
Saunders, Pgs.310-314,364,365,411, 521.Saunders, Pgs.310-314,364,365,411, 521.
3) Graber Petrovic Rakosi3) Graber Petrovic Rakosi, Removable, Removable
orthodontic appliances, Ed.3 Pgs. 41, 42, 81,orthodontic appliances, Ed.3 Pgs. 41, 42, 81,
82, 87.82, 87.
4) Carels and van der Linden : Functional4) Carels and van der Linden : Functional
appliances' mode of action; Am J Orthodappliances' mode of action; Am J Orthod
Dentofac Orthop :1987: 10:162 - 168.Dentofac Orthop :1987: 10:162 - 168.

5)5) John C. Voudouris,John C. Voudouris, Improved clinicalImproved clinical
use of Twin-block and Herbst as a resultuse of Twin-block and Herbst as a result
of radiating viscoelastic tissue forces onof radiating viscoelastic tissue forces on
the condyle and fossa in treatment andthe condyle and fossa in treatment and
long-term retention: Growth relativity; Amlong-term retention: Growth relativity; Am
J Orthod Dentofac Orthop: 2000:3:157-J Orthod Dentofac Orthop: 2000:3:157-
168.168.
6) Bishara and Ziaja: Review article;6) Bishara and Ziaja: Review article; Am JAm J
Orthod Dentofac Orthop:Orthod Dentofac Orthop: 1989: 3: 250 –1989: 3: 250 –
258.258.

Construction of bite for various functional orthodontic appliances

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