Oral Rehabilitation – Braces – Crowns – Bridges – Implants
Once your TMJ discs and jaw is back in its home position or true hinge bite, the poor position and arrangement of your teeth will be obvious to us both. You will then appreciate why this unprotected bite of your teeth has created all your symptoms. The splint is just one part of the process and sometimes people may need braces, crowns, bridges or implants to maintain the healthy disc hinging bite and also occlusal or bite adjustment. This is the spot grinding mini flat areas (helicopter landing pads) to eliminate problems in the future.
Occlusal or bite adjustment (or occlusal equilibration) initially involves spot grinding mini flat areas (helicopter landing pads for points or cusps) on the back teeth to correspond to the cusp tip or points on the opposite teeth. Spot grinding at the back of the top front teeth is also performed, but in general, most is performed on back teeth.
This is nearly always performed after 4 splint adjustments during occlusal splint therapy when the hinge motion of the jaw joints is relatively stable, healthy and reproducible. The aim is to have the teeth mesh at exactly the same time as the lower jaw hinges. When this occurs, it is called the hinge bite.
The diagram below illustrates (NAT INSERT from ADJ) flat landing pads that have been adjusted to accommodate the points of the opposite teeth. This then allows the teeth to bite vertically in the long axis of the teeth. This prevents sideways forces being generated inside the teeth and therefore preventing premature wear and/or fracture of the tooth, filling or crown. It also prevents the lower jaw from being pushed unnaturally onto the discs of the jaw joints and causing a displaced clicking disc.
Your referral to an orthodontist is for repositioning your very poorly arranged teeth so that prosthodontic occlusal (bite) therapy will be more successful. Also, if an orthodontist can reposition your teeth optimally, your teeth may not need crowns or other restorative procedures. However, this ideal situation only occurs when there is no mismatching of the tooth size and jaw size. We only precisely know this towards the end of Orthodontic Therapy.
As mentioned, there are 4 bites, namely, hinge, right, left and forward bites. Each of these bites must be made protective to prevent premature cracking or wear of teeth or painful facial muscles or jaw joints. Also, protective bites are largely responsible for keeping teeth from drifting after orthodontics.
In some cases, an orthodontist can re-arrange all your teeth but not achieve even one fully protective bite. However, what the orthodontist does do is place the teeth in a position that makes it possible and easier for a prosthodontist to bio-design protective bites.
During your orthodontic treatment, your orthodontist will refer you back to Your Dental Specialist, Dr. Michael Darveniza, for an occlusal bite evaluation and for further recommendations in the management of your treatment. Two or three consultations with Your Dental Specialist during orthodontics is often necessary before both the orthodontist and myself are happy to remove the braces.
During these consultations, the likely need for occlusal prosthodontic treatment will become evident to all of us. The various treatments that may need to performed on the day the braces are removed include:
- Occlusal bite adjustment or spot grinding of back teeth to create mini flat helicopter landing pads for the points or cusps to create a protective hinge bite on the back teeth – left to right sides.
- Bonding or splinting of the lower incisor teeth (in a hygienic manner) with composite resin to prevent drifting when an orthodontic splinting wire is not indicated.
- Placing crowns or resin overlays or porcelain veneers on the lower canine teeth to create left and right protective bites.
- Building-up upper incisor or canine teeth with the bonded composite resin overlays to help create forward or left and right protective bites.