Anterior Bite Plane Appliance

Part 1 - Anterior bite plane appliance overview

Instructors:

Lee Ann Brady, DMD

Lee Ann Brady, DMD

Dr. Lee Ann Brady is currently the VP of Clinical Education at The Spear Institute and was the former Clinical Director of the Pankey Institute.

Dr. Brady reveiws the indications for an anterior bite plane appliance.

I'm Dr. Lee Ann Brady. Welcome to the video segment on fabricating an anterior bite plane appliance here on HDiQ. So this is a companion video to a piece that I did on HDiQ helping us look at an overview of different appliances. So the different designs and why we would use each style of appliance and what it does from a scientific perspective. And then in this video what I wanted to do is actually show you the clinical technique for fabricating an anterior bite appliance and then for delivering one. We're going to be working today on my dental assistant, Katie, who is my patient in the video on the join diagnosis. So based on the findings in her exam, we're going to use an anterior bite plane appliance to see if we can differentiate the discomfort that she's having on her hand side. Is that coming from something at the condyle disc assembly? Is she pinching inflamed retrodiscal tissue or does she have a lateral pterygoid muscle that spasm or sometimes a combination of both of those things. As we go today and think about making an anterior bite plane, I do want to just back up and talk a little bit about the principles of an anterior bite plane appliance. The design of a bite plane is to get posterior tooth disclusion. So no posterior teeth will be touching bicuspids or molars in either intercuspal position or in any of the excursive movements. So why do we use this appliance design? We use it because what we know is that it's muscles that are activated, that are creating the force, the load that is making the muscles symptomatic. It could be loading the joint as well as damaging the teeth. It's that proprioceptive message that comes from our posterior teeth, our bicuspids and molars that tells our brain that fire those elevator and positional muscles. And so the appliance design is basically to trick our proprioceptive system. Get those teeth out of contact so those muscles are not getting a message and then will therefore release alleviating the signs and symptoms of muscles discomfort and also potentially unloading the joints and protecting the tooth. So this is a great appliance to see condyles if I need to find centric relations so I can get mounted models for diagnostics. It's a great appliance to treat people who have either acute or chronic occlusal muscle discomfort. So they're complaining of muscle pain, tension, tenderness, stiffness, difficulty in whole opening that we know from doing a comprehensive evaluation is coming from the musculature. It can be an appliance that unloads the joints and can help us treat some joint inflammation. We would only want to use this appliance on someone where we are confident that the medial pole of the disc is in place so that the patient can clench their teeth together in intercuspal position without discomfort. And then we also want to know is this a patient who still has their full clenching ability with only anterior tooth contact. As I said in our other video this is a great appliance to use either alternating with a full coverage or alone as a full coverage with a lower Exxis for patients who clench. It can be really difficult to get clencher below their adaptive capacity so that they have no signs or symptoms on a full coverage appliance. So this can be a great appliance for that also. The other thing I love about it it's efficient and it's effective. And so you'll see as I go through this today it can be very cost effective because it does not take a lot of time and materials and it actually works and does what it needs to without a lot of patient appointments. So can be a fabulous appliance from that perspective. So there's lots of reasons to use this. What are the risks of using an anterior bite plane appliance? The risk in some patients if they are off the disc either medially or laterally that loading the joint even that extra little bit even with the muscle shutdown will cause some joint paint or problems. So you know if you are not using a lot of these appliances and you want to sort of be safe in the beginning then only use them for patients with muscle issues and not in your joint patients until you kind of feel a little more about those differentiations. The other probably the biggest risk of an anterior bite plane appliance is that classically none of the lower teeth and none of the posterior teeth are covered in the appliance. So we want to really be careful and watch for super eruption. Now we're not really clear is it the posterior tooth that super erupt or the anterior teeth that intrude. But you can see where patient's occlusion is permanently altered and changed by wearing one of these appliances. So how do we accommodate that? Really for me when I think about that I use this appliance as a transient appliance. So I will have patient sleep in it only not wear it 24 hours a day. The important recommendation with this appliance is its maximum wear is 6 to 8 hours per day. And then I'll use it for several weeks in order to see condyle, treat a muscle situation, be able to get the records that we need. If I think that I'm going to use this style of appliance as an ongoing therapeutic device I'm going to change the design. So you'll see that the foundation of this appliance is made with Biocryl that's been adapted to a model in a Ministar. If I'm going to use the appliance long term I'm going to actually cover all of the maxillary teeth in the appliance with the Biocryl before putting the anterior platform on. And I'm also going to make the patient a lower Essix retainer out of 1-mm Biocryl. So none of their lower teeth can move or super erupt. And then they simply wear the lower Essix against the upper bite plane. And so now they're basically functioning the lower [0:05:55][inaudible] of the Biocryl against the composite platform works great, nice smooth guidance. And now we've eliminated that worry about tooth movement on a long term basis. So you can actually create some alternative designs for this appliance so that people can wear them therapeutically for longer periods of time. The other thing that you can consider and I do this routinely in my practice is if we need a patient in a long term therapeutic appliance I might start them with an anterior bite plane and use that to seat the condyles, to treat their acute symptoms and really sort of jumpstart getting their muscles relax and getting the inflammation down. And then transition them to a full coverage appliance that now becomes their long term therapeutic device. And so one of the things that I make certain that I talk with patients about is that just because we start with an anterior bite plane it doesn't mean it will be their final appliance that we may learn that they need a different style. So I want to be able to set up those conversations so that if that's what we need to do we haven't failed to meet their expectations around the term of the therapy, the fees associated or getting them to their end results. I also make sure my patients are well aware that one of the main reasons we do appliance is its diagnostic. That I have some clinical suspicions and we're going to actually prove those using the appliance. So as a diagnostic device whatever we learn whether we learn that it works perfectly and gets rid of all their signs or symptoms that's important information. If it makes absolutely no changes, that's important information. If it actually makes them worst they get pain somewhere else or the pain seems to be getting worst that's important diagnostic information. So all of those things mean the appliance is working. And that we're learning valuable things we can then use to move them toward the ultimate goal of alleviating their signs and symptoms and feeling comfortable and stable. So with that let's start the process of fabricating an anterior bite plane appliance.