Biting Surface Modification and Rehabilitation

Common Occlusion Dynamics

 Bite and occlusion factors are complex and quite frankly, can be confusing for patients and consumers.
Common examples of occlusal treatment that nearly everyone is familiar with can be the need for orthodontic braces during our younger, formative years or the replacement of a major tooth structure with a dental implant, crown or bridge to preserve basic biting function.
When conditions are obvious, the eventual recommendation and completion of appropriate treatment is eventually obtained.

                                                         THE BIOMETRIC APPROACH

This model encompasses all three aspects of the stomatognathic system including the teeth, muscles, and joints, which interrelate and define a patient’s occlusion. This approach overcomes the difficulty often encountered helping patients to realize their condition and the complex nature of occlusion. When used proactively, clinicians can catch potential problems early, often preventing many overlooked and debilitating conditions. This approach also provides for scalable treatment that is driven by patients and built on objective data and findings, not a subjective belief system, which unfortunately is necessary when diagnosing in the absence of data.

                      
Pre and post biometric bite articulation using the biomimetrics software.

Uncommon Occlusion

There are however, other, not so obvious conditions that can escape our attention yet cause future bite problems that lead to increased trauma to individual tooth structures and overall alignment. Left untreated for an extended period, these seemingly unnoticeable events can cause TMJoint dysfunction that can compound into jaw joint pain and even migraine headaches and neuromuscular dental pain.

Signs of Changing Bite

Our featured patient, a 35 something male had very healthy teeth but was unhappy with the coloration of her teeth and more importantly, felt that her teeth were somewhat uneven... or lacked symmetry in appearance.



Biting surfaces on some of the posterior tooth structures were also beginning to show unusual wear.

                  
Above are the biting surfaces views.

              
Occlusion balanced and corrected with the conventional braces. (Invisalign, clear correct aligners are available for most cases as well.)

                             

Post occlusal treatment and following complete restorative treatment (including veneers).

Orthodontic Alternatives for Early Bite Correction

Many adults who have a need for minor orthodontic adjustment to address tooth straightening or bite adjustment issues seek treatments that eliminate the need for traditional braces.

Invisalign clear braces has become known as a popular alternative.

Our featured patient had an option of conventional braces or Invisalign aligners in addition to using custom feldspathic veneers that would achieve the functional and cosmetic goals she had in mind.

Feldspathic porcelain possesses properties that enable a dentist and an experienced cosmetic dental lab technician to create veneer products that reshape tooth structures, alter biting surfaces (and incisal edges) along with creating coloration qualities that mimick Mother Nature very well.

Southern Dental work closely with technicians at the our California Laboratory to individually create veneer products that provided the coloration, biting surface and size symmetry changes required... on a tooth by tooth basis.  

The final result exceeded the patient’s expectations. By understanding the patient’s individual risk factors, treatment was designed to reduce or minimize any additional risk to the entire dentition. Alternative treatment options to manage the occlusal concerns with orthodontics could have been accomplished by increasing the occlusal vertical dimension. This would have created longer anterior teeth, which would have led to a less favorable esthetic outcome. Without orthodontics, increasing the occlusal vertical dimension would have required full-mouth rehabilitation. This would entail including all the posterior teeth, which would not otherwise be necessary and would have increased the biomechanical risk. Only the anterior teeth that were compromised by attrition and developmentally and esthetically compromised required restoration. All the necessary tooth preparation was kept in enamel, which further minimized additional biomechanical risks. Tooth preparation margin location was also maintained supragingivally, which did not contribute to any periodontal risks. The occlusal management resolved all the TMD symptoms from the constricted chewing pattern and eliminated the concerns of friction contributing to ongoing tooth structure loss. The nightguard, however, is still required to protect the restorations following any episodes of nocturnal bruxism. The patient is also on a 6-month recare interval for maintenance.

Intelligent Orthodontic Alternatives

Traditional orthodontic treatment typically involves the use of metal braces that are continually adjusted over an extended period of time to correct certain functional and cosmetic dental issues.

We provide alternatives to traditional orthodontic treatment for obtaining both cosmetically and functional straight teeth necessary for maintaining proper bite and occlusion. Instant Orthodontics (the use of custom designed porcelain veneers) and the Invisalign® System are popular treatment choices for those who wish to avoid the inconvenience of long term treatment.

Beautifully Straight Teeth - No Metal Braces

With Invisalign®, Southern Dental is able to give you the beautiful straight teeth you've always wanted. It works through a series of invisible, removable, and comfortable aligners that no one can tell you're wearing. So you can smile more during treatment as well as after.

Invisalign® has been proven effective in clinical research and in orthodontic practices nationwide. The technology has become so much of a treatment standard that over 70% of U.S. Board Certified Orthodontists are now providing it as a alternative treatment to traditional metal braces.

How it Works:

• You wear each set of aligners for about 2 weeks, removing them only to eat, drink, brush, and floss.
• As you replace each aligner with the next in the series, your teeth will move - little by little, week by week - until they have straightened to the final position your orthodontist or dentist has prescribed.
• You'll visit your orthodontist or dentist about once every 6 weeks to ensure that your treatment is progressing as planned.
• Total treatment time averages 9-15 months and the average number of aligners worn during treatment is between 18 and 30, but both will vary from case to case.

The Invisalign System uses advanced 3-D computer imaging technology to transform the bite impressions Dr. Bram has made into a custom-made series of clear and removable aligners.

There may be as many as 48 in the series or as few as 12, depending on your individual treatment plan.

You'll wear each set of aligners day and night for about 2 weeks, removing them only to eat, drink, brush, and floss.

Neuromuscular Dentistry

Diagnosis of Neuromuscular Dentistry is to identify problems of the muscles, joints and bite (or occlusion) and to look for problems we can treat to stabilize the bite or occlusion . Many people do not have major symptoms that they can see but their teeth can be worn down which impacts their face. They look older because there is so much wear. Their jaw has to shift to make the teeth contact which makes the muscles work much harder trying to get the bite in a harmonious position. This causes constant muscle tension which leads to muscle fatigue, spasm and pain. Sometimes the muscle tension is so constant that the jaw joint is permanently damaged from bone rubbing against bone.

Your bite is analyzed, usually an orthotic is made to relax the muscles and stabilize the bite.

Temporal Mandibular Dysfunction is problems with muscles and jaw joints that form the mandibular part of the jaw and the temporal bone at the base of the skull. When balance to the teeth, muscles and bones is lost, the result can be:

• Headaches
• Worn Teeth
• Pain Behind the Eyes
• Sensitive Teeth
• Earaches
• Popping or Clicking in the Jaw Joint
• Difficulty Opening and Closing the Mouth
• Jaw Pain
• Stiffness in the neck and shoulders
• Painful muscles in the face, neck and shoulders

Questions?

Contact Southern Dental at (718)439-2988 to arrange a consultation for determining if Invisalign treatment, bite treatment and/or neuromuscular dentistry is right for you.

Extreme Makeovers New York Cosmetic Dentistry
Brooklyn - Queens - Staten Island - Manhattan
Southern Dental
9920 4th Ave, Suite 301
Brooklyn, NY 11209
(718) 439-2988
Ultimate Reconstruction
Aesthetic Dental Makeovers in New York