K.I.S.S. Keep it simple, sister!
Scanning the upper and lower arch. Taking digital impressions. Call it what you want. I call it not taking an alginate or PVS impression (Figure 1).
Cheating? Slacking? Taking short-cuts? I guess, if that’s the way you feel. I don’t. If it’s at least as accurate, faster, and easier for the patient, I call it brilliant. And so it is. Evaluate it, critique it, research it, try it. No need to overthink it, right?
Dentistry is hard enough. Let’s not complicate the simple. More importantly, as dentistry evolves, let’s not keep the complicated around if we don’t have to.
So, if we agree that scanning is easier and as accurate as taking a traditional impression, why do we continue to complicate the bite record? Yes, I know. I like silicone too. It has been so good to me over the years. It is still good to me when necessary, and I am grateful.
For instance, when taking a bite record to mount models in a fully-seated condylar position, a leaf gauge is one of the most predictable methods to help obtain the physiological position. And one way to hold that position while scanning the bite is to use silicone and trim off the material in the premolar area before scanning the bite, thus preventing the patient from moving while moving the camera from one side to the other (Figure 2).
Again, makes sense, right? But would you be open to the possibility that we can just quickly and accurately scan the bite while the patient is maintaining adequate pressure, helping seat the condyles? (Figure 3)
Yes, I have mentioned this in past articles, but it warrants review here. Why?
I was recently at the American Academy of Dental Sleep Medicine annual meeting, chatting with one of my mentors/colleagues/good friends. He was asking me how I take the record for a mandibular advancement device (MAD). Here is what I told him:
- Place the George Gauge and help the patient find a position that feels tolerable for six to eight hours. Tighten the nob to hold the position (Figure 4).
- Take out the George Gauge and chat with the patient for a few minutes, facilitating natural mandibular movement and forgetting what our goal is for those two minutes.
- Put the George Gauge with the nob tightened at the previously decided “comfortable” position back in the patient's mouth. Ask the patient to imagine staying in this position for six to eight hours. Ask if he would like me to loosen the nob and allow him to find a new starting position.
- Repeat until the patient is comfortable with that starting position (Figure 5).
- Scan the bite!
- There is no step 6! That's it. The position is captured and the file is ready to send to the lab (OK, that can officially be step 6 if you still need to complicate the simple). (Figure 6)
Certainly, if for some reason you are worried about the patient shifting as you are moving the camera from one side to the other, you are more than welcome to place some of our good friend, silicone, onto the George Gauge, as much as you want! (Figures 7, 8)
But you have to clean up the premolar area before scanning the bite, an added and usually unnecessary step.
If you are planning on using a software like SicatAir to compare airway volume at that position compared to maximum intercuspation, then it might be a good idea to leave the silicone and you could even take out the lower part of the bite fork, allowing the patient to bite solidly into the material (Figures 9 to 12).
That entire digital file can then be uploaded and sent to fabricate an appliance, capturing the position of the mandible, while confirming the anticipated volume (yes, I know the patient is awake and sitting up. If you find a way to take a scan with the patient supine and asleep, it would be even better, right?) (Figure 13)
Anyway, I digress. I wanted to share with you how simple it can be to take records for a MAD in the digital world. Keep it simple, s----- (my friend).
Kevin Kwiecien, D.M.D., M.S., Spear Faculty and Contributing Author
(Click this link to read more dentistry articles by Kevin Kwiecien.)
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July 23rd, 2017