Bite registration is a technique carried out in dental procedures, by taking an impression of the teeth, to capture the way the teeth meet together. This is then used to accurately make restorations which will not change the position the teeth meet in. [1]
The jaws of the face need to meet in a way that allows effective function but is not damaging to the temporomandibular joint (TMJ). [2] This is equally important for those who are edentulous (have no teeth), those with few teeth or those with a full, healthy dentition.
Recording bite registration (also referred to as occlusal registration) allows 3-dimensional recognition of how the opposing jaws normally contact - dynamically and at-rest - in relation to one another. This is controlled by the TMJ, muscles aiding chewing and teeth (if applicable). The information gained can be transferred to a diagnostic study model (a stone cast of teeth), imperative when planning direct (fillings); indirect (crowns, dentures, bridges, mouthguards and orthodontics) and provisional restorations; implants; craniomaxillofacial surgeries; orthognathic surgeries or when a dentist plans to change the way in which a patient's teeth meet. [1]
Centric relation (CR) is a phenomenon integral to bite registration success. Although its definition is variable, it refers to a replicable clinical relationship between the upper and lower jaws that is unrelated to intercuspation, the way the teeth meet together when biting. [3] This is a useful reference point when considering jaw movements (vertical/lateral/protrusive), mounting casts in dental laboratories and overseeing oral rehabilitation. If centric relation is not considered, prostheses made could interfere with normal masticatory (chewing) function, causing instability, discomfort and sequelae like temporomandibular disease (TMD).
If a patient is edentulous, the centric relation should conform with the most superior, anterior temporomandibular condyle position, where the joint disc and adjacent bone contact without distortion.
A wax bite-block/occlusal rim will be used in those with inadequate tooth contact, allowing the jaws to meet when registering the bite.
Recording of a patient's bite registration has been common practice for over 400 years. [4] Generally, this is completed using a variety of impression materials and related tools, but with technological advancements, use of innovative intraoral scanners is on the rise. Although the outcome should be the same whatever the technique, it is important that errors are minimised to ensure an accurate reproduction of occlusal relationships. [5]
Dental technicians working in the laboratory require the information obtained from registering a patient's bite to fabricate indirect restorations. Using this, they can set-up an articulator - a "stand" capable of imitating jaw movements on which a model of the patient's jaws sits - and arrange teeth (if applicable) in the correct positions [6] .
Bite registration aims for an accurately fitting final prosthesis where:
The purpose of bite registration is to convey how the upper and lower jaw are vertically and horizontally positioned against each other when the patient bites together. [7] This information is important for any restorative work that may change or interfere with how the patient normally bites, such as dentures, crowns, and bridges. [8] An unchanged bite is usually preferred, and where change is preferred, it is necessary to control how the bite changes and by how much. [8] Once a patient's bite has been registered, this information can then be used to mount dental models onto an articulator in a manner that resembles how the patient normally bites, a process known as 'articulation'. [8]
The most accurate method of articulating tooth models is via "hand articulation". [7] With this method, pairs of teeth (1 upper tooth and 1 lower tooth), from at least 3 different locations on the jaws, that contact each other when the patient bites together are identified and recorded, these teeth (known as index teeth) are then positioned together on the models to reproduce the bite. [8] [7] This method is indicated where it is feasible. [7]
Where insufficient index teeth are present in a dentition for a stable hand articulation, a material (see 'Materials' section) is bit on by the patient, on which tooth imprints can then be used to articulate the models appropriately. This method may be more commonly required for (but not limited to). [7]
1. Multiple adjacent teeth requiring restoration, especially for fixed restorations;
2. Last standing molar in either side of an arch, as it may be the first tooth to make contact with the opposite jaw when the patient bites;
3. Restorative work involving the last tooth on an arch, as it would be the first tooth to make contact with the opposite jaw when the patient bites;
4. Tooth completely missing in the opposite jaw, such as in denture cases;
5. Multiple teeth located next to each other that do not contact the opposite jaw due to tooth wear;
6. Individual crowns
Recent advancements in CAD/CAM technology has also allowed teeth to be scanned and recreated as digital models, which may then be used to identify index teeth or even algorithmically recreate the patient's bite to a similar accuracy as hand articulation, which may be useful for crown and bridgework. [9] [10] [11]
Bite registration can be achieved using a variety of materials including, zinc oxide-eugenol paste, thermoplastic wax, elastomers, impression plaster, acrylic resin, T-scan, pressure-sensitive films, transparent acetate sheet and occlusion sonography. [12]
The material used should not change the position of the teeth but should accurately record the occlusal and incisal surfaces of the teeth. The ideal material has a low viscosity, low resistance to closure, easy manipulation, adequate working time, precision in detail, rapid hardening, and is dimensionally stable. [13]
High viscosity materials pose the risk of displacing teeth affected by periodontal issues, resulting in jaw misalignment and inaccurate jaw registration. The material chosen should allow for both passive and precise placement of dental casts. [13] Materials that are rigid or possess high surface reproducibility may hinder the easy seating of casts, often necessitating forceful articulation of the models. [13]
Thermoplastic waxes are commonly utilised for bite registration, serving either as records themselves or as carriers for registration. These waxes are versatile and widely embraced material largely due to its affordability and ease of handling. [14] Thermoplastic waxes have the advantage of being versatile, affordable and have ease of handling. However, they have a poor dimensional stability.
Zinc oxide-eugenol paste serves as a reliable and efficient material for bite registration. Therefore, it is recommended to use minimal amounts of zinc oxide-eugenol to prevent excessive flash, which can impede the precise seating of casts. [7] Zinc oxide-eugenol pastes have the advantage of being rigid, having good flow, dimensionally stable and having an ease of application. However, they have a long setting time, are brittle and adhere to the teeth which leads to a loss of detail in the impression. They are also only usable in custom tray and have been known to cause a burning sensation of the mucosa. [7] [15]
Impression plaster is a historic material which can be used for bite registration. Its primary component is calcined calcium sulfate hemihydrate, which, upon mixing with water, reacts to form a rigid mass of calcium sulfate dihydrate. [15] Plaster of Paris is a plaster material used for casting impressions, impression plaster for bite registration consists of plaster of Paris with additives, more water can be added to the powder than with the casting material to provide more flow for taking the impression. These additives hasten the setting time and reduce setting expansion. [15] Impression plaster advantages include having a good flow, and dimensional stability while also being accurate. However, they are brittle and prone to fracture especially where undercuts are present. They are also an untidy material with difficult handling properties. [15]
Alginate is an elastic irreversible hydrocolloid and one of the most common impression materials. It has a mixing time of 45–60 seconds and is fast setting. [16] Advantages of alginate are it has good surface detail, it is elastic so it works well with undercuts, it has a low wetting angle and it is cheap with a fast setting time. However, alginate has a poor tear strength and it cannot be used for bite registration against a Polyvinyl siloxane (PVS) impression as poor articulation will result from the lack of surface detail. For a PVS impression, bite registration should be taken with a PVS material or an alginate substitute. [16]
Elastomers were introduced to overcome the disadvantages of acrylic resins. There are two varieties of silicone elastomers used for bite registration: condensation silicone and addition silicone. Polyester Elastomeric compounds, condensation elastomers, are made from polyether terminated with amino groups cross linked with strong acids. [13] The advantages of elastomers as an impression material include its high dimensional stability, ease of manipulation, low resistance to closure, ease of trimming with no distortion and its good elastic recovery after deformation. [13] [14] However, elastomers have a low to moderate tear strength and have a short working time. they are also very stiff materials and cannot be immersed in disinfecting solutions for longer than 10 minutes due to hydrophilic nature. [14]
Acrylic resins were introduced as a bite registration material in 1961 to overcome the disadvantages of other bite registration materials. [13] Acrylic resin is an accurate and rigid material post setting, however the material contracts on setting, therefore is not dimensionally stable. [13] Once cured, the material can also damage the stone model due to its rigidity, therefore are not in current use. [13]
Silicones are synthetic compounds composed of silicone and oxygen linked together to form a 16 siloxane chain. [17] Elastomeric materials are beneficial when recording the intermaxillary relationship for an unstable occlusion, however are not the first materials of choice for bite registration. [12] Polyvinyl siloxane is an addition silicone which is chemically similar to impression silicones with modifications to the flexibility. [17] The advantages of Polyvinyl siloxane include its accuracy, ease of handling and dimensional stability. However, the material shrinks on curing and has a short working time. [18]
This technique is used when the edentulous area is large or when opposing teeth do not meet. Occlusal rims can be mounted on record bases, made from various materials like Shellac or resin. [8]
Wax occlusal rims should be reduced in height until the opposing teeth are not touching the rims. [8] Jaw relation record is made in a uniformly soft material which sets to a hard state such as quick-setting impression plaster, bite registration paste silicone. In this instance record blocks act as carriers for a more accurate registration medium (e.g. silicone).
Another method involves the use of wax rims as a recording medium, as opposed to a carrier. In this instance, the indent of opposing teeth is recorded directly in the wax without using any other registration medium. [8]
When no occlusal contact exists between the remaining natural teeth, jaw relation records are made entirely on occlusion rims. The same method is used for complete dentures and the use of a face bow is implemented. [8]
A range of intraoral scanners are available to allow data acquisition of the dental arches or tooth preparation(s), which is coupled to software for designing the virtual restoration(s) and a computerised milling device to construct the definitive restoration. Following scanning of the dental arch or area of specific interest to obtain an optical impression, an instant interocclusal record can be obtained by taking a buccal scan of the teeth in the intercuspal position, as in the case with the iTero and Lava Chairside Oral Scanner systems. Another system involves placing registration material over the prepared tooth only, and a scan is taken to determine the occlusal relationship. [19] [20]
Bite registration is used in several dental treatments, including a wide range of prosthetic restorations such as inlays/ onlays, single crowns, bridges, frameworks and partial and full dentures. It is also an essential technique for implants, orthodontic diagnosis and treatment planning, and temporomandibular joint disorder treatment such as splints. [21] [22]
Bruxism is excessive teeth grinding or jaw clenching. It is an oral parafunctional activity; i.e., it is unrelated to normal function such as eating or talking. Bruxism is a common behavior; reports of prevalence range from 8% to 31% in the general population. Several symptoms are commonly associated with bruxism, including aching jaw muscles, headaches, hypersensitive teeth, tooth wear, and damage to dental restorations. Symptoms may be minimal, without patient awareness of the condition. If nothing is done, after a while many teeth start wearing down until the whole tooth is gone.
Orthodontics is a dentistry specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, as well as misaligned bite patterns. It may also address the modification of facial growth, known as dentofacial orthopedics.
A bridge is a fixed dental restoration used to replace one or more missing teeth by joining an artificial tooth definitively to adjacent teeth or dental implants.
A mouthguard is a protective device for the mouth that covers the teeth and gums to prevent and reduce injury to the teeth, arches, lips and gums. An effective mouthguard is like a crash helmet for teeth and jaws. It also prevents the jaws coming together fully, thereby reducing the risk of jaw joint injuries and concussion. A mouthguard is most often used to prevent injury in contact sports, as a treatment for bruxism or TMD, or as part of certain dental procedures, such as tooth bleaching or sleep apnea treatment. Depending on the application, it may also be called a mouth protector, mouth piece, gumshield, gumguard, nightguard, occlusal splint, bite splint, or bite plane. The dentists who specialise in sports dentistry fabricate mouthguards.
In dentistry, a crown or a dental cap is a type of dental restoration that completely caps or encircles a tooth or dental implant. A crown may be needed when a large dental cavity threatens the health of a tooth. Some dentists will also finish root canal treatment by covering the exposed tooth with a crown. A crown is typically bonded to the tooth by dental cement. They can be made from various materials, which are usually fabricated using indirect methods. Crowns are used to improve the strength or appearance of teeth and to halt deterioration. While beneficial to dental health, the procedure and materials can be costly.
In dentistry, inlays and onlays are used to fill cavities, and then cemented in place in the tooth. This is an alternative to a direct restoration, made out of composite, amalgam or glass ionomer, that is built up within the mouth.
In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855–1930), the "father of modern orthodontics", popularised it. The word "malocclusion" derives from occlusion, and refers to the manner in which opposing teeth meet.
A dental impression is a negative imprint of hard and soft tissues in the mouth from which a positive reproduction, such as a cast or model, can be formed. It is made by placing an appropriate material in a dental impression tray which is designed to roughly fit over the dental arches. The impression material is liquid or semi-solid when first mixed and placed in the mouth. It then sets to become an elastic solid, which usually takes a few minutes depending upon the material. This leaves an imprint of a person's dentition and surrounding structures of the oral cavity.
Macrodontia is a type of localized gigantism in which teeth are larger than normal. Macrodontia seen in permanent teeth is thought to affect around 0.03 to 1.9 percent of the worldwide population. Generally, patients with macrodontia have one or two teeth in their mouth that is abnormally large; however, single tooth growth is seen in a number of cases as well.
CAD/CAM dentistry is a field of dentistry and prosthodontics using CAD/CAM to improve the design and creation of dental restorations, especially dental prostheses, including crowns, crown lays, veneers, inlays and onlays, fixed dental prostheses (bridges), dental implant supported restorations, dentures, and orthodontic appliances. CAD/CAM technology allows the delivery of a well-fitting, aesthetic, and a durable prostheses for the patient. CAD/CAM complements earlier technologies used for these purposes by any combination of increasing the speed of design and creation; increasing the convenience or simplicity of the design, creation, and insertion processes; and making possible restorations and appliances that otherwise would have been infeasible. Other goals include reducing unit cost and making affordable restorations and appliances that otherwise would have been prohibitively expensive. However, to date, chairside CAD/CAM often involves extra time on the part of the dentist, and the fee is often at least two times higher than for conventional restorative treatments using lab services.
Dental attrition is a type of tooth wear caused by tooth-to-tooth contact, resulting in loss of tooth tissue, usually starting at the incisal or occlusal surfaces. Tooth wear is a physiological process and is commonly seen as a normal part of aging. Advanced and excessive wear and tooth surface loss can be defined as pathological in nature, requiring intervention by a dental practitioner. The pathological wear of the tooth surface can be caused by bruxism, which is clenching and grinding of the teeth. If the attrition is severe, the enamel can be completely worn away leaving underlying dentin exposed, resulting in an increased risk of dental caries and dentin hypersensitivity. It is best to identify pathological attrition at an early stage to prevent unnecessary loss of tooth structure as enamel does not regenerate.
Dental radiographs, commonly known as X-rays, are radiographs used to diagnose hidden dental structures, malignant or benign masses, bone loss, and cavities.
A post and core crown is a type of dental restoration required where there is an inadequate amount of sound tooth tissue remaining to retain a conventional crown. A post is cemented into a prepared root canal, which retains a core restoration, which retains the final crown.
Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.
The Dahl effect or Dahl concept is used in dentistry where a localized appliance or localized restoration is used to increase the available interocclusal space for restorations.
Tooth mobility is the horizontal or vertical displacement of a tooth beyond its normal physiological boundaries around the gingival area, i.e. the medical term for a loose tooth.
Digital dentistry refers to the use of dental technologies or devices that incorporates digital or computer-controlled components to carry out dental procedures rather than using mechanical or electrical tools. The use of digital dentistry can make carrying out dental procedures more efficient than using mechanical tools, both for restorative as diagnostic purposes. Used as a way to facilitate dental treatments and propose new ways to meet rising patient demands.
A complete denture is a removable appliance used when all teeth within a jaw have been lost and need to be prosthetically replaced. In contrast to a partial denture, a complete denture is constructed when there are no more teeth left in an arch, hence it is an exclusively tissue-supported prosthesis. A complete denture can be opposed by natural dentition, a partial or complete denture, fixed appliances or, sometimes, soft tissues.
Overdenture is any removable dental prosthesis that covers and rests on one or more remaining natural teeth, the roots of natural teeth, and/or dental implants. It is one of the most practical measures used in preventive dentistry. Overdentures can be either tooth supported or implant supported. It is found to help in the preservation of alveolar bone and delay the process of complete edentulism.
Occlusion according to The Glossary of Prosthodontic Terms Ninth Edition is defined as "the static relationship between the incising or masticating surfaces of the maxillary or mandibular teeth or tooth analogues".
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