Avoiding Resets / Dr. Bite Regs

[evanosu]

Our lab seems to experience a too many resets that are normally due to either a poor bite registration taken by the dentist or an inaccurate mount done by one of my technicians. We mount to both regular silver hinged articulators as well as pinned semi-adjustable articulators.

I realize if the doctor takes a bad bite not much you can do about it but does anyone have a good technique to ensure that a doctor takes a good bite, they often are using blue bite reg material or our bite blocks. Also any suggestions/tips on how to better mount cases to the bites that are provided.

 

[Doris A]

Tell the Dr to have the patient swallow as they're taking the bite. When you swallow, you automatically go into centric....every time! Sometimes they're going to mess up the bite no matter what you tell them, because it's usually not the Dr taking the bite. As far as mounting, we use a hot glue gun and popsicle sticks to hold the models together. You just have to make sure your models are dry.

 

[evanosu]

Tell the Dr to have the patient swallow as they're taking the bite. When you swallow, you automatically go into centric....every time! Sometimes they're going to mess up the bite no matter what you tell them, because it's usually not the Dr taking the bite. As far as mounting, we use a hot glue gun and popsicle sticks to hold the models together. You just have to make sure your models are dry.

Hmm good suggestion, I had not heard about the swallowing before. Next time you get a case that is mounted, do you mind sending a photo with the mounting and the popsicle sticks? We do use a hot glue gun too but have not tried the sticks. Thanks!!

 

[Car 54]

Some cut up the metal coat hangers into about 2-3" lengths, and sticky wax to the bases works nice, too (Dawson Technique). You can even bend a couple to bypass any anterior overjet. The swallowing pulls the elevator muscles up into occlusion, nice tip, Doris It's also nice if the Dr can have the patient sitting upright, instead of laying back in the chair, to make sure the patient bites without sliding into occlusion (i.e. a more accurate bite). The below was previously hot glue gunned on the teeth for a scan, but I just used it for reference sake to show you the coat hanger (Popsicle sticks) idea Doris mentioned. Put a dab of glue on the upper and lower casts about where the coat hanger ends will be, and seat it in the glue, then after it sets for 5-10 seconds, glue on top of it to strengthen that bond. Once the surface is wet, the glue comes off easily (it's just a hobby type of glue gun and and sticks you can pretty much get anywhere).

Also, if I can, I just use the part of the bite on the preps, and cut it there. Trim it down to its occlusal table, you want to see the bite is closed, so trim off the excess (Blue Mousse is Bard Parker carvable). If the bite doesn't show "burn through" consistently on the non prep side, and you're having a hard time establishing a bite, if you can (a local account),send it back to the Dr. to have him wax (glue gun) it together.

 

[Marcusthegladiator CDT]

Tell the Dr to have the patient swallow as they're taking the bite. When you swallow, you automatically go into centric....every time! Sometimes they're going to mess up the bite no matter what you tell them, because it's usually not the Dr taking the bite. As far as mounting, we use a hot glue gun and popsicle sticks to hold the models together. You just have to make sure your models are dry.

I use pop sticks too. I had one doc try and convince me the pop sticks were why his mounts were off. The doc also tried to get me to switch to paper clips instead of pop sticks. Meanwhile I suggested a L/R bite reg wasn't enough. Since he started using Left, Right, AND center, there hasn't been a problem.
And am I seeing something wrong with Car54s bite reg pic? A little tight on 7-10?

 

[evanosu]

Some cut up the metal coat hangers into about 2-3" lengths, and sticky wax to the bases works nice, too (Dawson Technique). You can even bend a couple to bypass any anterior overjet. The swallowing pulls the elevator muscles up into occlusion, nice tip, Doris It's also nice if the Dr can have the patient sitting upright, instead of laying back in the chair, to make sure the patient bites without sliding into occlusion (i.e. a more accurate bite). The below was previously hot glue gunned on the teeth for a scan, but I just used it for reference sake to show you the coat hanger (Popsicle sticks) idea Doris mentioned. Put a dab of glue on the upper and lower casts about where the coat hanger ends will be, and seat it in the glue, then after it sets for 5-10 seconds, glue on top of it to strengthen that bond. Once the surface is wet, the glue comes off easily (it's just a hobby type of glue gun and and sticks you can pretty much get anywhere).

Also, if I can, I just use the part of the bite on the preps, and cut it there. Trim it down to its occlusal table, you want to see the bite is closed, so trim off the excess (Blue Mousse is Bard Parker carvable). If the bite doesn't show "burn through" consistently, and your having a hard time establishing a bite, if you can (a local account),send it back to the Dr. to have him wax (glue gun) it together.

Awesome really appreciate it, will show it to my tech who does most of the mounts, your tips on the trimming etc is key!

 

[Car 54]

Thanks, glad it was helpful..after all, it was Doris who got us going on this, kudos, Doris

Be sure to re-read my post, evanosu, as I did do a bit of editing for about 2 minutes. Yet, your tech will see the revised version when he comes back

 

[Car 54]

I use pop sticks too. I had one doc try and convince me the pop sticks were why his mounts were off. The doc also tried to get me to switch to paper clips instead of pop sticks. Meanwhile I suggested a L/R bite reg wasn't enough. Since he started using Left, Right, AND center, there hasn't been a problem.
And am I seeing something wrong with Car54s bite reg pic? A little tight on 7-10?

lol, good catch Marcus...yes, I went a little bit through On a posterior prep bite, we'd really be in trouble if I cut into the prep occlusal table of the bite.

 

[Doris A]

Thanks, glad it was helpful..after all, it was Doris who got us going on this, kudos, Doris

Be sure to re-read my post, evanosu, as I did do a bit of editing for about 2 minutes. Yet, your tech will see the revised version when he comes back

That's what we're here for...to help each other out!

 

[kcdt]

Some cut up the metal coat hangers into about 2-3" lengths, and sticky wax to the bases works nice, too (Dawson Technique). You can even bend a couple to bypass any anterior overjet. The swallowing pulls the elevator muscles up into occlusion, nice tip, Doris It's also nice if the Dr can have the patient sitting upright, instead of laying back in the chair, to make sure the patient bites without sliding into occlusion (i.e. a more accurate bite). The below was previously hot glue gunned on the teeth for a scan, but I just used it for reference sake to show you the coat hanger (Popsicle sticks) idea Doris mentioned. Put a dab of glue on the upper and lower casts about where the coat hanger ends will be, and seat it in the glue, then after it sets for 5-10 seconds, glue on top of it to strengthen that bond. Once the surface is wet, the glue comes off easily (it's just a hobby type of glue gun and and sticks you can pretty much get anywhere).

Also, if I can, I just use the part of the bite on the preps, and cut it there. Trim it down to its occlusal table, you want to see the bite is closed, so trim off the excess (Blue Mousse is Bard Parker carvable). If the bite doesn't show "burn through" consistently on the non prep side, and you're having a hard time establishing a bite, if you can (a local account),send it back to the Dr. to have him wax (glue gun) it together.

This is my preferred method. Keep in mind that Popsicle sticks are wood and wet wood can swell. Plus you can reuse coat hanger wire.

 

[2thm8kr]

This is my preferred method. Keep in mind that Popsicle sticks are wood and wet wood can swell. Plus you can reuse coat hanger wire.

If you let the sticks dry out after eating the popsickle you should be good to go.

 

[Car 54]

This is my preferred method. Keep in mind that Popsicle sticks are wood and wet wood can swell. Plus you can reuse coat hanger wire.

Hadn't thought about the wood swelling, and maybe the lack of integrity, good point

If you let the sticks dry out after eating the popsickle you should be good to go.

lol, was that my problem...you're supposed to glue them after you eat them...I was getting the strawberry red and lime green dripping all over me, and staining the models

 

[cdtwade]

Swallowing pulls the elevator muscles into occlusion? I'd like to read that book.

 

[Car 54]

Good question, Wade

Considering from a "rest position" and as was stated here, that swallowing brings you into centric (I can swallow without going into centric) causes this dynamic, "As the mandible starts is closure, the middle and posterior fibers of the temporal muscle contract to pull the mandible back while the lateral pterygoid releases it's protrusive action. The depressor muscles also release as the elevator muscles start their contraction. The combined contraction of the elevator muscle pulls the condyle up the lubricated incline....." taken from; Evaluation, Diagnosis and Treatment of Occlusal Problems, Dr. Peter E. Dawson, 2nd edition, page 24. On the previous page, 23, starts this topic of what happens from the rest position to closure, and in this case, when swallowing brings you into centric, clousure, is part of what the muscles are doing. Hope this helped

Maybe I over simplified it in my previous post? Or am not understanding that correctly, please let me know, as I'm always willing to learn. I will be seeing Dr. Dewitt Wilkerson (Dawson Institute) this Friday, so if you have any follow up thoughts or questions (within reason ),let me know, and I'll see if he has the time after his lecture to answer them.

 

[cdtwade]

In the edentulous? Thx.

 

[Car 54]

Now that is a good question, Wade...as I have to admit, I got myself into a bit of trouble posting in this thread in this regards...I "read" the initial post yesterday by evenosu, and with Doris post thought, "I have an idea for that" and posted without really regarding the denture nature of the original post (I'm totally crown and bridge) until this morning and your above question, #15. So I'm hoping what I did post helped (as it seemed to). So in that regards, Wade..I have no idea as far as your good questions asked, in regards to dentures/edentulous.

 

[cdtwade]

Edentulous cases are a whole different animal. The majority of them are actually a NM position. Here comes the firestorm !!!!

 

[kcdt]

Food for thought:


Report on the determination of occlusal vertical dimension and centric relation using swallowing in edentulous patients.
Millet C, et al. J Oral Rehabil. 2003.
Show full citation
Abstract
When constructing a complete denture, the correct vertical dimension of occlusion (VDO) and centric relation (CR) can be difficult to determine. The aim of this study was to compare the swallowing technique used to determine the maxillomandibular relationship with a conventional technique. Fifteen edentulous patients were selected, each having a complete denture. The VDO and CR were assessed using acrylic base plates and a Boley gauge. First, the VDO was established by means of the vertical dimension of rest (VDR) and interocclusal rest space, and the CR was obtained by mandibular manipulation. Secondly, the VDO and the antero-posterior mandibular position were determined using swallowing. All measurements were repeated three times and the average was calculated. The results showed that (i). the VDO determined by means of the swallowing method was reproducible and significantly higher than the one established from the VDR (P < 0.01),and (ii). the swallowing position was located 2 mm anterior to CR (P < 0.01) and was moderately reproducible. This study suggests that swallowing can be used to determine the vertical position but no as a reference position in the sagittal plane.

PMID
14641678 [PubMed - indexed for MEDLINE]
Full text
Full text from provider (Blackwell Publishing)

 

[cdtwade]

Thanks Ken. This topic is loosely akin to the chicken or the egg debate. As I'm sure you know, even the very best clinicians will occasionally have a patient that is difficult to obtain accurate, repeatable CR.

 

[Denturepropgh]

Something that I like to do for partially edentulous cases is to examine casts for wear facets and hand hold the casts together to estimate what height the bite blocks should really be, and adjust them accordingly prior to sending out for jaw records. The closer you can get it, the better chance you have of getting a more accurate bite. Plus, it may save some chair time which will make your account happier. This may be a no-brainer, but make sure that there are no saliva blibs on the occlusal surfaces so you can better achieve maximum intercuspation. And be certain to trim excess stone by the hamular notches, and retro molar pad areas. I've caught a few articulations that were hung up on the stone in these areas. Pay extra careful attention to the details because one extra minute of scrutiny can save you an hour of reset.