Once the anterior bite plane appliance is fabricated we need to deliver it to the patient. The first step is to check and adjust the fit of the appliance in the patient’s mouth. The appliance should seat with finger pressure only. During the fabrication process we left the labial edge of the biocryl trimmed to about 1/3 of the distance from the gingival margin. If the appliance is too snug to seat with finger pressure, begin shortening the labial flange .5mm at a time. Once the appliance seats, if it feels snug to the patient you can place it in water that was nearly boiled for ten seconds ( more and it will distort), then seat in the mouth and let cool.
With the appliance seated and adjusted for proper fit the next step is to adjust the occlusion. Our aim is to create even intensity stops in equal number on the left and right of the midline. I use green articulating paper and simply have the patient tap against the composite. My initial adjustments are done with an e-cutter carbide bur in a straight handpiece. Finer adjustments are then done with polishing points. All of the burs I need for fabrication and adjustment are part of the Spear Education Appliance block from Brasseler.
With the intercuspal contacts adjusted I use red articulating film and begin to work out the excursions. The goal is smooth even excursive guidance with a transition to crossover. You can have the canines and centrals working together or create a hand off. The last piece is to check the return stroke from all excursive movements. Typically you will need to place a bevel on the labial of the composite to allow the patient to cone back without catching the edge.
With all of the occlusion adjusted in the last step is the final polish. When the platform is made from composite I take it to a lathe wheel. The first step is flour of pumice and then I finish with a polishing paste. If you use Triad or another lab composite you may want to finish by coating the platform with Palaseal by Heraeus. The Palaseal is cured in a light oven, and then polished the same way.
Patient instructions are to brush and floss and then put their appliance in and sleep with it. Make sure your patient understands the appliance is designed to be worn 6-8 hours out of twenty-four and not more. I see the patient back in two weeks and repeat the sections of the exam with positive findings.
Jim Boyd, DDS says
In addition, ensure that there is no canine contact on the pipeline in excursive movements. The clinching intensity that can be created in that position can be very detrimental to the joint(s).
Also ensure that in extreme protrusion that the incisors remain in contact with the plate. Otherwise, posterior contacts in extreme protrusion can create symptoms that had otherwise not existed prior .
Lee Ann Brady says
Jim, Thanks so much for adding these additions, they are great things to think about with this design.