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    Bite

    Discussion in 'Denturist' started by Acrylicwookie, Jul 27, 2017.

    1. Acrylicwookie

      Acrylicwookie New Member Full Member

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      Question/poll for you guys - If you have a patient who has acquired a protrusive bite due to an incorrect centric taken during original dentures, do you adjust and make denture to the new acquired bite or do you force natural centric relation and fabricate to that bite?
       
    2. JMN
      Curious

      JMN Christian Member Donator Full Member

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      I ask the dentist. Headaches, TMJ issues, age of pt, age of the situation, not a leap I'd want to take without someone more trained than me in the musculature and xray reading for the joint issues. Might be dreaming, but I expect that dentists look at these things when approaching such issues.
       
    3. Bumfrey
      Pensive

      Bumfrey Active Member Full Member

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      Pivots.
       
    4. Acrylicwookie

      Acrylicwookie New Member Full Member

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      OK.... what if you don't have the luxury of having a dentist to consult and you are the only provider in the office treating this patient. No headaches or other adverse conditions other than protrusive bite.
       
    5. JMN
      Curious

      JMN Christian Member Donator Full Member

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      How did you learn of the issue? How do you know it's not supposed to be protrusive.

      I can't remember if you're a denturist. Is the pt complaining?
      If yes, then you'd need to have manipulated them into centric for a new record. Guessing could end up worse.

      If it's been that way for a decade, I'd leave it.

      But there may be a reason it was done in the first place.

      As a tech whose not allowed to touch a pt, how would you get the right jaw alignment?
       
    6. TheLabGuy

      TheLabGuy Just a Member Full Member

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      If the patient was a Class II before, YOU CANNOT make him/her a Class I...this is the biggest error I see in Dentures. The patient will absolutely HATE their dentures if a Class 1 is made. If they had a 6mm overbite, you always duplicate that in dentures. Cephalometrics 101. Some may disagree here, but I hammer this to my removable clients, unless the patient is having ognathic surgery, or some type of serious implant support being placed, duplication of the original occlusion is a must!!!
       
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    7. JMN
      Curious

      JMN Christian Member Donator Full Member

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      Exactly. That why I'm wondering if there's nobody to ask how is it known that it was incorrecytly protrusive instead of correct.
       
    8. JMN
      Curious

      JMN Christian Member Donator Full Member

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      Sorry, can you provide more info?
       
    9. TheLabGuy

      TheLabGuy Just a Member Full Member

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      I could go on and on about this....because what we do we techs usually do to get a denture case going?...we make these big @ss chunks of wax, called bite rims, and throw them into the mouth and thats the bite???? I'd bet most of the folks here go with that wax rim bite and start setting up teeth. I have my clients always take a CR bite, especially on immediate denture setups and mount from there, then throw in your wax rims. I find that the Docs out there never get an accurate bite rim, and how can we blame them, you throw this big mound of wax/foreign object into a patients mouth. Sure, they are suppose to remove the wax till the get right curve of spee, curve of wilson, mark midline, thompson sticks, etc... but you're asking a lot of your Docs/assistants to nail this consistently in my opinion. Also, don't even ask me about maxillary anterior alveoloplasty's, or should I say the lack of them. It's crazy to be a trained fixed tech and see what you removable folks are magically suppose to do on a daily basis.
       
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    10. user name
      Question

      user name Well-Known Member Donator Full Member

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      99% agree, but the OP was indicating that the bite was initially not correct.
      @kcdt
      Ken, please chime in.

      IMHO, this is why some States have laws for patient protection.
       
    11. kcdt

      kcdt Well-Known Member Full Member

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      The thing about acquired bites is they are tolerated because they are functionally derived.

      CR is mostly a matter a restorative convenience. It's a repeatable position.
      There's a lot of good reasons to get there; functional in terms of bite force. Acquired bites don't always have complete envelope of function; cosmetics in that you are buttressed in the joint, so if you have the hinge axis( facebow), then dialing in VDO is simpler.
      There are those that mention the whole TMJ rabbit hole, but I've never seen it supported in peer review.
      Can you change it? Yes. But not with the denture. It's too much to ask. I'd go with a branching temp to dial in the bite. Let the muscles reprogram, get a sense of VDO, address aesthetic needs.

      If time or cooperation are at issue, I'd leave the acquired bite alone, unless there's something really egregious
       
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    12. kcdt

      kcdt Well-Known Member Full Member

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      I would chime in that forcing a class II into a classI can violate neutral zone in ways won't be tolerated.
      Don't even get me going on alveoplasty for immediate. I start mumbling to myself. It ain't pretty.
       
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    13. kcdt

      kcdt Well-Known Member Full Member

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      How do you know it was from a bad bite.
      It could be functionally generated by excessive wear.
       
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    14. slotboom.f

      slotboom.f New Member Full Member

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      Do a gothic arch or seagull registration which most definite defines the angle class of the bite.
      If it is class 2, i agree this will be a problem for all. BUT ... the patient should be aware that a denture is NOT a replacement for his or her natural teeth! It is merely a medical device for handicap relief ( just like a glass eye). It may look fine but it will never compensate the natural function.
      This particular patient probably needs to invest in implants and even then the patient may still have problem with proal function.



      Verzonden vanaf mijn iPhone met Tapatalk
       
    15. denturist-student

      denturist-student Active Member Full Member

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      I have corrected up to six millimeters....Any farther than that and I use an intermediate splint. Patients Class II often have two bites one for chewing and the forward for speech....I always pin trace on class II's....because of the two bite phenomenon it is easy to mistake a class II for a class I....
       
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