Esthetic Stick Bite

I learned again today why I make an esthetic stick bite as one of my records for diagnostic wax-ups and fabrication of restorations. I sat down today to complete a diagnostic workup for a patient I had seen a few weeks ago for records. I had personally mounted the models using the facebow and centric relation records. As I placed them on the articulator, I was struck immediately by the cant to the upper occlusal plane. Not remembering the patient having a cant in person, I reached into the lab pan and retrieved the stick bite. Sliding it over the anterior teeth, it was clear by the cant of the stick bite, the patient did not have a cant in real life, but the facebow mounting had created one on the articulator. With the stick bite as a reference, I was able to level the articulator and complete the diagnostic work-up creating an incisal plane that will work in the patient’s face.

This exact same mounting, sitting on a lab bench in front of a technician, what would have happened? The technician has no way to know if the cant they see is actual or not. If they assume it is a good mounting, they will proceed with the wax-up, leveling the incsial plane, and then the inaccuracy will ruin my day  when I make provisionals that run uphill in the patient’s face. If the technician questions the mounting, I might get a call and have to bring the patient back in to redo the facebow record. With a stick bite in hand, it is easy to verify the mounting, make adjustments if necessary and keep going with no inconvenience to anyone.

Taking a stick bite is quick and easy. Have the patient stand in front of a level reference. I use my vertical blinds, assuming they were hung with a level. You can use painter’s tape and a level to create a place to do this on the back of a door. Inject silicone bite registration paste over the lower incisors. Have the patient close into it, adding more silicone to stabilize it over the maxillary teeth. Place a long cotton tip applicator or bend a brush into the silicone and level it with the reference. Once set, I make sure the stick is covered in silicone so it can not break loose. I also take a full face photo of the patient with the stick bite in place to send with the case to the lab.

I was glad today, to see that stick bite sitting in the lab pan with the other records. Two minutes to gather the record, saved me quite a bit of aggravation and time, and I was able to go confidently into my treatment consult. I did check when the patient was in to verify the facebow mouting. Turns out, we encountered a common scenario, unlevel ears!