Dental Specialist Brisbane TMJ Disorders

Oral Rehabilitation – Occlusal Bite Reconstruction

Full mouth ‘Oral Rehabilitation’ should be performed with an emphasis of an ‘Occlusal Bite Reconstruction’ not just aesthetics. Bite reconstruction can be either Partial Bite Reconstruction or Full Bite Reconstruction.

A. Partial bite reconstruction – left right and forward bites

After bite adjustment and hinge bite you will have a protective hinge bite, that is balanced left to right side on the back teeth. However, your prosthodontist will inform you that maybe one, two or three of your other bites are unprotected.

For example, your left bite may be unprotected because you have worn your lower left canine tooth away from grinding at night.

This tooth may need a composite resin overlay, porcelain veneer or ideally a crown to create a left protective bite.

Read More with Photographs on Partial Bite Reconstruction

B. Full mouth bite reconstruction

Full mouth bite reconstruction usually involves building up all the teeth at once because most of the teeth have worn down too much with age. When the worn out teeth are built up a variety of restorative materials can be used. This includes:

  • Composite resin overlays
  • Porcelain veneers
  • Crowns and bridges
  • Implant crowns and implant dentures

This building up process will increase the facial height (nose to chin distance) of the patient back to the age of 25 years old and is called increased vertical dimension.


Showcase of Full Mouth Bite Reconstruction (Rehabilitation) of recent Patient Cases

Worn teeth
Before – Patient had worn out teeth

Missing back teeth with removable partial denture
Before – Missing back teeth with removable partial denture.


Finished crowns & fixed bridges for full mouth occlusal reconstruction.
After – Finished crowns & fixed bridges for full mouth occlusal (bite) reconstruction (rehabilitation).

Something to smile about
After – Something to smile about.


 

 Minimal front teeth showing
Before – Minimal front teeth showing.

Teeth worn flat and sensitive
Before – Teeth worn flat and sensitive.


Final occlusal bite reconstruction
After – Final occlusal bite reconstruction (rehabilitation) using some resin overlays lower incisors, remainder crowns

Final smile with teeth showing
After – Final smile with teeth showing


 

Extreme overbite and tooth wear
Before – Extreme overbite and tooth wear.

Finished crowns following full mouth occlusal reconstruction
After – Finished crowns following full mouth occlusal (bite) reconstruction (rehabilitation).


Final Smile
After– Final Smile.


 

Short worn damaged angled teeth
Before – Short worn damaged angled teeth.

Finished 'straight' crowns following full mouth occlusal reconstruction
After – Finished ‘straight’ crowns following full mouth occlusal (bite) reconstruction (rehabilitation).


 

Heavily treated teeth with uneven bite and missing teeth
Before – Heavily treated teeth with uneven bite and missing teeth.

Finished crowns and bridge for full mouth occlusal reconstruction
After – Finished crowns and bridge for full mouth occlusal (bite) reconstruction (rehabilitation) but treatment ongoing on patients left side.


Occasionally Orthodontic Braces with Prosthodontic Treatment for TMJ Disorder is required. This is a detailed form of dental treatment that involves both the orthodontist and prosthodontist. Very rarely, it may involve an oral surgeon who will perform jaw surgery or osteotomy.


Repositioning teeth involves Orthodontist treatment

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 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 are often necessary before both the orthodontist and I are happy to remove the braces.

Occlusal Prosthodontic treatment

During these consultations, the likely need for occlusal prosthodontic treatment will become evident to all of us. The various treatments that may need to be performed on the day or several days after 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.

NOTE: It is very important that you are aware that the role of an orthodontist is a supportive one and that there are many limitations to orthodontic treatment because of mismatching of jaw bone size and tooth size. These limitations can usually be addressed by your prosthodontist after orthodontics.