A Little Trick to Solve Anterior Open Bites after Occlusal Appliances – AJ003

I will reveal a little 'trick' that might 'recapture the bite' on a patient who develops an anterior open bite (AOB) after wearing a nightguard/splint/occlusal appliance. There is a degree of risk and uncertainty when we prescribe occusal appliances as it hinges on patient compliance and factors that are out of our control. There are certain risks that come with treatment that we should consent for, and this includes bite changes. Occlusal appliances are not an exact science - the evidence base is not high quality. That does not mean they do not work, it just means that we need more data! We don't even know the mechanism of HOW occlusal splints work as that is yet to be proven. Hello Protruserati! Welcome back to the third episode of #AskJaz where I answered three main questions from our Protrusive Dental Community - 1) developing anterior open bite after an occlusal appliance, 2) how to scan/bite register at a desired OVD, and 3) what should the occlusion look like on composite veneers or edge bonding? https://youtu.be/Li2W-ysYRIE Check out this full episode on YouTube Download Protrusive App on iOS and Android and Claim your Verifiable CPD/CE by answering a few questions + You can get EARLY ACCESS to the episode + EXCLUSIVE content Dr. Mahmoud Ibrahim and I are currently working on a huge project called OBAB, Occlusion Basics, and Beyond – it will be the best occlusion resource in the Milky Way…and that’s our mission! We want to finally demystify Occlusion and make it Tangible AF! Join the waiting list HERE! Highlights of this episode: 1:51 Risk of having AOB after an Occlusal Appliance15:48 Trick to recover an AOB that has developed26:49 Bite Records for Stabilisation Splints30:25 Checking the Occlusion after Composite Veneers37:02 Occlusion Basics and Beyond Do join our Protrusive Dental Community Facebook Group. It has so many great gems and pearls shared in our little community - ONLY FOR LICENSED DENTAL PROFESSIONALS. If you enjoyed this episode, check out this episode with Dr. Barry Glassman - Do AMPSAs cause AOBs? Click below for full episode transcript: Jaz's Introduction: Occlusal appliances can be scary things. When we are given to our patients, we're at the mercy of their compliance. We don't really know if they're going to get along with it or not. [Jaz]We don't really know if it'll help their pain. If pain is the reason that we are prescribing in occlusal appliance, and a lot of times we are taking on a bit of risk because there are certain bite changes that can happen after occlusal appliances. And despite what you think, you know, you might think, oh yes, anterior only appliances, they're the big culprits here. They're the ones, those shifty devices, they're the ones causing all the bite changes. But actually, you can get a bite changer. A patient can get a bite change from any type of occlusal appliance. So, I see this quite frequently on the Facebook groups from dentists and also lots of dentists message me and share some of the cases where they've had some bite change. They're trying to get their head around what exactly happened. So, in this Ask Jaz episode, I'm going to cover three main themes. The main, the big one. The first one is, a patient who develops an anterior open bite after an occlusal appliance, and I'm going to teach you a trick that you can use if this happened to your patient to recover their bite. Okay? So that's number one. Number two and three, a shorter one. The second one is how to scan or record using silicon bite registration paste, the patient's centric relation record at the desired vertical dimension for something like a Michigan splint, for example, and the third one. What should the occlusion look like on composite veneers? These are three questions, or the last two are questions that were sent in by you guys. The first one's something I promised Professor Paul Tipton, that I would do, which is reveal this trick. If you're new to the podcast, welcome. This Ask Jaz series are kind of in their infancy, but I've got hundreds of questions that have been sent in by the Protruserati and just find time sometimes to just go through some of these things. And if you are a regular listener, thanks so much for always coming back. Let's hit the main episode. So my friends theme number one, your patient gets an anterior open bite after a partial coverage appliance. Or actually, you know what, any appliance. You may have had a patient or nova dentist who had a patient who was given a soft bite guard or stabilization spin, or an NTI, SCi or something, and the patient came with some sort of a bite change classically, an anterior open bite, and this can be a little bit scary for dentists. And what happens that the dentist passes on this fear to the patient. And really, you know, I talk about it in other episodes, but this isn't a huge deal, but it's certainly an inconvenience if you didn't warn the patient that this was going to happen. So that kind of makes sense. So, when this dentist colleague on one of the Facebook groups posted about this, about how she gave an SCi appliance and the bite changed and she was really upset, I wanted to help. So what I did was I said, listen, you can PM me. And I'll talk you through a little trick that you can try to recapture the bite, which has worked well for a few colleagues. And so, professor Paul Tipton, THE Paul Tipton messages saying that he would love to know my little trick to solve an anterior open bite that doesn't position the condyles in any other position than centric relations. So Prof, this one's for you. I got you. And some of the other comments from our esteemed colleagues were along the lines of, unfortunately, whilst the incidence remains low, so that's an incidence of a bite change or an AOB. After a splint is very difficult, if not impossible to resolve. So guys, I'm about to share with you the impossible. Allan, this is for you. Akhil, this is for you and for all the others that messaged me. Let's do this. Let me show you the trick. But before I do, let's just talk about what this dentist shared with us. So just want to thank this dentist for raising this to the group. And she said that a patient developed an AOB after a few months of wearing an SCi. So, for those of you who are unfamiliar, SCi stands for Sleep Clench Inhibitor, and it is the same thing as an NTI, which is the American version. So the British version is SCi, American version, NTI, right? So it's those little appliances that cover like lateral incisor. You can get variations. But essentially a small appliance on the front is classically what we think of. When we think of an SCi or an NTI. You see, I was told at the school, never, ever, ever to prescribe a partial coverage appliance due to the over eruption that's inevitably be going to happen, et cetera, et cetera. Fast forward many years and hundred appliances later, guess what? Over eruption hasn't happened. It doesn't happen. It can happen if the patient wears it for a prolonged time and all those things. But the AOB risk, the anterior open bite risk is a real one, but NOT FROM OVER ERUPTION. And that's kind of the theme of the first part of this Ask Jaz. Now, this dentist on the group went on to say something very interesting. She said, 'How unlucky, because the studies show a 1.6% occurrence of an anterior open bite.' So she's referring to the study. By Dr. Blumenfeld, right? So Dr. Blumenfeld's survey, was a 512 dentist, right? And these 512 dentists gave 78,711 NTI splints. So those little ones, and of those 1.6% developed an anterior open bite. Now, what you need to know is that Dr. Blumenfeld isn't a dentist. He's actually a neurologist and he works in a headache center. And so he was fascinated when this appliance was being talked about by dentists as being able to help with headaches. It was natural for a neurologist who's really into headaches to be interested in this field, and I really commend Dr. Blumenfeld for really integrating medicine and dentistry together. Because what they found is that when he incorporated the NTI protocols using a dentist, so James Boyd, they found that 50% of their migraine sufferers were now significantly better so that they didn't need to rely on medication anymore. Let me say that again. Half of the people with migraines responded positively to the extent that they did not need medicines anymore. So I actually read a lot about this and Dr. Blumenfeld said that, now in his protocols in his neurology practice or for his headache center, is that patients will have an NTI and only those that don't respond will then go on to have these heavy duty medicines. I think that's absolutely fascinating. So there's a lot of benefit for headache sufferers with this kind of appliance. But when we give someone an appliance like this, are we really facing this unlucky dip scenario that like spontaneous combustion, any one of these appliance like Russian roulette, you'll get an AOB. Is this really how this works? Well, when I didn't know much and I was like fresh off the course and stuff, and I didn't really know and I hadn't been experienced and I hadn't really put much thought into it. I said this to my patients, I said, look, the studies say that there's about 1.6% chance that you are going to get an AOB. And patients accepted it and I made peace with it. But just like, when we say about wisdom teeth, right? When there's a surgical wisdom tooth and the tooth is impacted, then we say, okay, there's an X percentage chance that you are going to get a numb lip. But for some patients, that's a 0% chance. When their roots are like way away from their inferior alveola nerve canal, you know that this patient is not going to suffer from that fate, therefore they're ultra, ultra low risk or no risk. Whereas other people,