Going Digital With the Anterior Bite Plane

An anterior bite plane can be used for many purposes: diagnosing muscle and/or joint tenderness, at-home anterior deprogrammer, reduction of clenching habits, and immediate protection of newly bonded restorations, to name a few.

The general concept and mechanism of action is to keep back teeth apart. By default, elevator muscle activity will decrease, the lateral ptergygoid will release, and the condyle will be allowed to seat in the fossa – basically a larger version of a lucia jig. (Figure 1) Therefore, it would be contraindicated with patients experiencing pain when the joint is loaded when symptoms increase with a lucia jig. 

As we continue to evolve into and embrace the digital side of dentistry, I try to incorporate digital dentistry when it makes sense. The questions that always need to be addressed, in my opinion, are:

1. Does it save time?
2. Is it as accurate, if not more?
3. Does it improve predictability?

These questions are asked with respect to:

1. Design
2. Strength
3. Fit
4. Adjustments

I want to share with you a story about my evolution and a process I am really excited about.

Recently, during an exam, it was becoming evident that an anterior bite plane was indicated to quiet muscles, hopefully decreasing pain from muscular origin, and predictably seating the condyle for an accurate bite record to mount models; however, decreasing the extreme muscle tenderness was my first priority and time was an issue that day (I’m sure you’ve never had time issues in your practice). I happened to run into my co-worker and brilliant colleague Dr. Samir Puri (cerecdoctors.com) who said, “Hey, Kev, why don’t we just scan the upper arch and mill one?” And so the digital evolution continued.

We scanned the upper and lower arch using the current version of the CEREC ortho software. (Figure 2) Compared to taking an alginate impression and pouring it up in stone, did it save time? Was it at least, if not more, accurate? Yes. And yes.

We created finish lines about half way up the facial and lingual surfaces from cuspid to cuspid (Figures 3 and 4) to create enough retention to hold it in, but not so much that it would be hard to take in and out. Did it save time? Was it very accurate? Was it very predictable? Easy to design? So far, yes to all.

Now the easy part: Design the ugliest bridge you have ever designed. That’s my wheelhouse! Sam is good at that, too. And between the two of us, we excelled. Top of the class for sure. At this point we also realized that there had been no reason to even scan the lower arch or take a buccal bite. I had just done it because that’s what CEREC told me to do (I’m a little slow sometimes). We could have saved even more time.

Regardless, at this point the goal was to use the designing tools to pull the lingual wall out to at least the level of the cuspids (depending on the amount of overjet) and make it at least level to the incisal edge (depending on the amount of posterior clearance in an edge-to-edge position). (Figures 5 and 6) And while we were at it, we felt we might as well add a little bulk to the facial and lingual for strength. For the occlusal plane, you are more than welcome to spend 10 minutes playing with the smooth tool to get the incisal table silky smooth. Feel free. I am much quicker with a flat acrylic bur or lathe after it is milled. With my “technique,” you can make it flat and smooth in less time than it took you to read this sentence. So … easy to design? Takes very little time? Seem predictable?

Now the easier part? Plop in a block of really dense acrylic and mill it. In this case, we used a 40 mm Telio CAD block and pushed the start button. (Figure 7) I know, it sounds complicated, right? It only took about 20 minutes to mill. If, by the way, the span from cuspid to cuspid is greater than 40 mm, does that mean you can only go from lateral to lateral? No way. Half or 3/4 or 2/3, or 7/8 of the cuspid is better than none. You can always use all of the possible 40 mm, which actually covers the entire length most of the time. The anterior bite plane will always be about 40 mm, always be made out of a solid, non-porous bock of acrylic, and always look exactly as you want it to look. (Figure 8)  Hmmm … Less time? Accurate? Predictable? Easy to design? Check. Check. Check. And check!

After removing the appliance from the sprue and flattening the occlusal table, it was time to finish testing the digital world. The appliance dropped in without any internal adjustment and the occlusal adjustments were no different from the traditional method. (Figures 9 and 10)

Let’s go over the questions again:

1. Does it save time?
2. Is it as accurate, if not more?
3. Does it improve predictability?

Asked with respect to:

1. Design
2. Strength
3. Fit
4. Adjustments

For me, the answers – as well as the experience – were positive. Utilizing the digital world to the extent at which I was comfortable certainly saved time with respect to imaging, designing, fabricating and adjusting. Even as a novice, it was very predictable and resulted in an appliance with great material, great fit and simple adjustments that the patient could take home that day.

I continue to look forward to incorporating digital technology into the comprehensive model of dentistry.

(Click this link for more dentistry articles by Dr. Kevin Kwiecien.)

Kevin Kwiecien, D.M.D., M.S., Spear Faculty and Contributing Author