METHOD OF BITE

REGISTRATION
 Contents
• Introduction
• Factors Determining Construction Bite
• Positioning of mandible
Vertical
Horizontal
Transverse
• Analysis of Construction Bite Maneuver
• Construction Bite Technique
Construction Bite Planning
General rules for Construction Bite
Technique for Low Construction Bite
Technique for High Construction Bite
Technique for Construction Bite without Forward Positioning of Mandible
Technique for Arch Deficiency Problems
• Bionator
• Frankel Function Regulator
• Twinblock
• Conclusion
• Reference
 CONSTRUCTION BITE
• The determination of the proper construction bite is critical for a functional
appliance to succeed
• Many failures result from incorrect positioning of the mandible than from any
single clinical manoeuvre.
 Why is Bite Registered?

The bite is registered to correct the spatial relationship of the osseous structures
to eliminate the neuromuscular compensation which existed as a response to
malocclusion.
 Factors determining the construction bite
• Diagnostic assessment
• Functional pattern
• Depth of overbite
• Relative position of maxilla to cranial base
• Amount of sagittal discrepancy
• Direction of growth
Positioning of mandible for fabrication of
the functional appliances

• Vertical

• Horizontal

• Transverse
 Vertical opening of the Mandible

• Dependent on three major considerations:

1. Type of malocclusion
2. Developmental Status
3. Type of Functional appliance
1. Type of malocclusion

i.e., the kind of dysgnathic or dysplastic problem

Different sagittal & vertical dysplasias require different construction bite

registrations
Class II Division 2 Malocclusion

 Thus the original overbite is a determining

factor
• In severe Class II, Div 2 malocclusion, the bite may have to be opened up to 9mm in the
molar region.

• This extensive opening have no unfavourable sequelae.

• Since this is well within normal functional range.

Reason:

Class II Div 2 malocclusion most frequently has

• a palatal plane that is tipped down anteriorly

• a deep bite
• an excessive curve of Spee
Vertical opening  improves growth direction, allows full eruption of posterior teeth (which
are usually in marked infraocclusion)
Class III Malocclusion
Class II Division 1 Malocclusion
RULE OF TEN

The maximum amount of sagittal advancement & vertical opening should be 10mm in
construction bite

Horizontal Bite

Mandible advanced  6-7mm

Vertical opening  3-4mm

Vertical Bite

Mandible advanced  2-3mm

Vertical opening  7-8mm
More vertical growth direction + Deep overbite

 Larger bite opening is desirable

 This allows downward & backward compensation of maxillary growth and palatal plane to

fit the mandibular growth pattern.

Class II Div 1 malocclusion in which,

1. The sagittal malrelationship is width of whole premolar

2. Severe curve of spee
3. Lower incisors are overerupted , impinge on palatal mucosa
4. Significantly retruded irt upper incisors

 The construction bite should not be higher than a vertical end to end incisal relationship

 Because, interocclusal distance in the molar region, with infraocclusion of molars &
supraocclusion of lower incisors might exceed 7mm  possible lateral spread of tongue
2. Develpmental Status

• i.e., the developmental state, sex and age of the patient (potential incremental
change)
• If more dental compensation is wanted,
(closing spaces, distalization of upper teeth, or extraction of premolars, retraction of
incisors)
patient must be treated during the growth period to adjust apical base relationship
• If treatment begins early or in children with retarded development 

Less vertical opening desirable (3mm – 4mm)

• In permanent dentition, Class II Div 1 malocclusion with mandibular retrusion 

tolerate upto 7mm opening

3. Type of Functional Appliance

• If appliance is worn during sleep only, (classic Andresen-Haupl Appliance) 

higher vertical bite registration used to elicit muscle activation & adaptation
because of exaggerated open postural status during sleep.

• If skeletonized activator used, (bionator) 

with constant functional stimuli replacing viscoelastic properties, vertical and sagittal
registration is different
 Horizontal posturing of Mandible
There are four possibilities for posturing the mandible in sagittal or
anteroposterior dimension for the functional orthopaedic appliance.

1. The original sagittal jaw relation may be maintained

2. The mandible may be postured forward to change the sagittal relationship

equally on both sides when the problem is a bilaterally symmetrical class II
condition.
3. The bite is changed on one side but is maintained as much as possible on the
other side, as with a unilateral Class II, Division 1 malocclusion, Class II Division 2
malocclusion, or a Class III malocclusion.

4. The mandible is postured backward as much as possible in the fossa, opening

the bite enough to try for an end to end incisal relationship, or as close to this as
possible, in Class III malocclusions.
 Analysis of the Construction Bite Maneuver

• Forward positioning of mandible  downward & forward condylar translation on the

articular eminence.

• Rotatory action in lower TMJ drops chin down & back, accentuating the facial convexity
& Class II sagittal malrelationship
In case of Functional Retrusion,
with path of closure upward & backward from postural rest to occlusion,

• The translatory component will be larger

• The rotatory component will be smaller

• The sagittal correction compensation will be less

 Relapse Potential

• Relapse after shifting the bite sagittally with an functional appliance is extremely rare

• Danger of relapse exists after transverse widening of dental arches

 Maxillary Protraction Cases
• Class II Div 1 malocclusion due to,
• Mandibular underdevelopment  Mandible is moved forward
• Prognathic maxilla  Maxillary first bicuspids removed,
anterior teeth moved back
• Inbetween cases  First premolars may be removed,
teeth anterior to extraction spaces moved back only half
the distance,
mandible moved forward half the cuspal width
 Transverse Positioning of Mandible
• The upper and lower midlines should line up in the forward posturing in the same
relationship as in habitual occlusion
• Dental midline discrepancies  corrected later with fixed appliances

• If the teeth in each jaw line up with the respective basal midlines but are not
coincident in habitual occlusion with the midline of the other jaw  Use the jaw
midlines to determine the construction bite

i.e., opening the vertical dimension beyond the tooth interference zone
 Construction Bite Technique
Diagnostic Preparation
• Patient compliance is essential
• Clinical assessment
“Instant correction” in Class II malocclusions
Profile analysis
Study model Analysis

1. The first permanent molar relationship in habitual occlusion determined

2. The nature of midline discrepancy determined

3. The symmetry of dental arches determined

4. The curve of spee is checked

5. Crowding and any dental discrepancies are checked

Functional Analysis

1. Precise registration of rest position is made

2. Path of closure from postural rest to habitual occlusion is analyzed

3. Prematurities, point of initial contact, occlusal interferences & resultant mandibular

displacement, if any are checked

4. TMJ is palpated for clicking, crepitus and so forth

5. The interocclusal clearance or freeway space is checked & recorded

6. Respiration checked for any deviation from normal

Cephalometric Analysis

1. The direction of growth

2. The differentiation between the position and size of the jaw bases is determined

3. The morphological characteristics

4. The axial inclination and the position of the maxillary and the mandibular incisors
 Construction Bite Planning
Anterior Positioning of Mandible

• The usual intermaxillary relationship for

average Class II malocclusion is end to end
incisal relationship
• Should not exceed 7mm to 8mm
or three quarters of the mesiodistal
dimension of the first permanent molar
Anterior positioning of this magnitude is contraindicated if:

1. If the overjet is too large

2. If there is severe labial tipping of the maxillary incisors

3. If one of the incisors, usually the lateral incisor has erupted markedly to the lingual
Opening the Bite

1. The mandible must be disclocated from the resting position in at least one direction –
sagitally or vertically
2. If the magnitude of the forward position is great, the vertical opening should be minimal so
as not to overstretch the muscles
3. If the vertical opening must be extensive, mandible must not be anteriorly positioned.
If the bite opening is more than 6mm, mandibular protraction must be very light
 General Rules for the Construction Bite
1. If forward positioning of mandible is 7mm to 8mm, the vertical opening must be slight
to moderate(2mm to 4mm)

2. If the forward positioning is no more than 3mm to 5mm, the vertical opening should be
4mm to 6mm

3. Lower midline deviations can be corrected only if there is actual lateral translation of
the mandible
 Execution of the Construction Bite
Technique
• Before taking the wax bite registration, patient is seated in an upright position
• Posture should be relaxed and not strained
• Operator guides but does not force the jaw into the desired sagittal relationship
• Repeated 3 to 4 times
Fabrication of Construction Bite
 Wax Bite Visualization
• Cutting away extruded lateral wax helps in visualization

• Mixed Dentition : Middle of the upper deciduous canine should fit into
embrasure between lower deciduous canine & first
deciduous molar

• Permanent Dentition : Buccal cusp tip of the upper first premolar should fit
precisely into the embrasure between the lower first and
second premolars
 Technique for Low Construction Bite
With a Marked Forward Positioning of Mandible

 Mandible moves mesially to engage the

appliance, the elevator muscles of
mastication are activated
Technique for High Construction Bite with Slight
Anterior Mandibular Positioning

 Induces activation of myotactic reflex in the

muscles of mastication

 The stretch reflex activation with increased

vertical dimension influence the inclination
of maxillary base
 Technique for Construction Bite Without Forward
Positioning of Mandible
Deep overbite
• Forward inclination of maxillary base desired by loading the incisors
• Opening is beyond 5mm to 6mm freeway space

Openbite
• Bite is opened 4mm to 5mm
• Develops sufficient depressing force to load the molars
Arch Length Deficiency Problems

 Malocclusions with crowding can sometimes be

treated
 In these cases low construction bite is used since
jaw positioning & growth guidance by selective
eruption of teeth is not desired
Bionator

• Edge to edge relationship of all or atleast the lateral incisors

• This provides maximum functional space for the tongue and is also convenient for
patient
Frankel Functional Regulator

• Frankel advocates advancing mandible 2 to 3mm every 4 to 5 months

• Incremental advancement will decrease the risk of muscle fatigue

• Sagittal : not more than 2.5 to 3mm

• Vertical : Just to permit cross over of wires through the interocclusal space
(2.5 to 3mm)
Twin Block

Sagittal : Edge to edge incisor relationship with 2mm interincisal clearance for an
overjet upto 10mm

If overjet more than 10mm – initial advancement of 7 to 8mm followed by

reactivation of the appliance

Vertical : Not less than 5mm in premolar region

• The ideal wax bite should be at least 7–8 mm thick in the premolar region.

• This thickness encourages the patient to bite in the desired ‘postured forward’ position.
Conversely adequate height discourages the patient biting on the blocks in the ‘retruded
contact’ position.

• The 7–8 mm rule is ideal for average or low angled cases

Shah AA, Sandler J. How to ... take a wax bite for a Twin Block appliance. J Orthod. 2009;36(1):10-2.
 Conclusion
Bite registration is a crucial factor in design & construction of a functional appliance.
The construction bite determines the degree of activation built into the appliance
aiming to reposition the mandible to improve the jaw relationship.

The degree of activation should stretch the muscles of mastication sufficiently to

provide a positive proprioceptive response. At the same time the activation must be
within the physiological range of activity of the muscles of mastication & the
ligamentous attachment to TMJ
 Reference
• Graber T.M., Neumann B., Removable Orthodontic Appliances, 2nd edition

• Graber Petrovic Rakosi, Removable Orthodontic Appliances, 3rd edition

• Clark William J., Twin block Functional Therapy, Applications in dentofacial orthopedics, 3 rd
edition

• Thomas Rakosi, Thomas M Graber, I Jonas, Thomas Graber textbook of orthodontic diagnosis,
1st Edition
• Carels C, van der Linden FP. Concepts on functional appliances' mode of action. Am J
Orthod Dentofac Orthop. 1987;92(2):162-8.

• Shah AA, Sandler J. How to ... take a wax bite for a Twin Block appliance. J Orthod.
2009;36(1):10-2.

• Bishara SE, Ziaja RR. Functional appliances: a review, Am J Orthod Dentofac

Orthop:1989;95(3):250-8.