Bite Records Techniques


Alright and good morning and good morning
to everybody. This morning as we mentioned yesterday we’re going to spend some time
going over the three types of bite records we’re going to do for each other. And I’m
going to officially welcome the people on social media this morning. You might have
the best seat in the house but we’re going to make sure everybody else has a good seat.
So with no further ado what I’m going to do is set our patient, Dawn, back here. And
again this morning our goal is to make sure we all feel comfortable taking three types
of bite records Lucia jig, leaf gauge and bimanual guidance. And they’re also going
to take, by the way, a third record, which is a protrusive record that we’re going
to use to set Condylar Inclination on the articulators tomorrow. So you won’t get
to do that, but everybody in the class will. So we’re going to just basically start like
it might flow in the office. And if, yesterday what we talked about is, if in fact, we used
a leaf gauge to load the joints and find first point of contact, but when we use the leaf
gauge to actually load the joints there is a positive load test. So what we did is we
put some cotton rolls in and squeezed and it didn’t get better. And when it didn’t
get better we made a choice and our choice was to go ahead and put a Lucia jig in. And
so now we’re going to assume just for the sake of flow in the office that we put the
Lucia jig in and things actually got a little bit better. And so now we want to go ahead
and take a bite record with the Lucia jig. But the first things first, I’m going to
go ahead and show and just review with everybody how to do a Lucia jig. So the first thing
is we’ve got a Lucia jig ready to go. And it’s already painted with adhesive. So I’m
going to go real close up here on the monitor as well. So we’ve got the Lucia jig already
painted with adhesive. And as we talked about yesterday we’re going to load up a bunch,
enough to go around the edges, but not too much. And then Jondaee is going to have the
Whale Tail ready to go. So we’re going to put this right on Dawn’s incisors here.
And even if we have a little extra that’s okay because we’re going to put the Whale
Tail in. (Go ahead like you’re biting on the edges of your front teeth, come together.
Beautiful.) And what that does is creates a nice horizontal plane with her lower incisors.
It doesn’t take too awfully long to set up. In fact it’s quite quick. And now our
goal when we take it out is to just make sure that we don’t have lower incisors touching,
as we talked about yesterday. (Go ahead and open for me. Beautiful.) And if we have her
bite on her back teeth and slide forward and back, and forward and back. Even if it’s
a little wobbly everybody can see right there if she slides forward, maybe it moves a little
bit. Does it matter that it moves a little bit? Absolutely not. It’s doing what we
want it to do. And if we want to make sure that she’s not biting on the pink and that
she’s staying on the plastic and we want to make sure we get a good record we can take
our blue articulating tape (so we’ll go ahead and grab our tape and, Dawn, if you
would, come together like you’re trying to bite your back teeth and slide forward
and back and forward and back and forward and back. Go ahead and open for me now.) And
again what we can see, and you can zoom in quite a bit there, Jennifer, is we’ve got
one great mark right there. And you can see as she slides, come together and slides forward
and back and forward and back, what’s the only thing stopping her that we talked about
yesterday? What’s the only thing stopping her right now? Unless she’s got a hot lateral
pterygoid, it’s the balls in the socket. And we want to verify that she’s touching
that point when we take the records so we’re going to switch to a red piece of tape here.
(And, Dawn just like you’re trying to bite on your back teeth I’m going to have you
open for me and just like you’re trying to bite on your back teeth just a couple of
tap, taps. And open for me now.) And again what you can see (come in real close here
now, Jennifer, and tip up just a bit there) you can see that red mark right at the end
of the black stripe. And so in just a second, Dawn, we’re going to load up some goop in
through here. I’m going to ask you just like you just did to bite on your back teeth
and (I’m going to watch like you’re trying to bite on your back teeth go ahead and do
that one more time for me) and you can see she’s going right to that mark. And so now
we’re sure that she is in that fully seated Condylar position. It is just that easy. So
I’ve got Jondaee ready with a 2-by-2 here, we’re going to go ahead and dry. And now,
again, don’t forget we had to look at how much space was back there (in fact before
we do this go ahead and bite together one more time for me) and you’ve got to take
a look at how much space (I’m going to have you tip your head down just a little bit)
how much space is back there. So when we’re putting the material in today, we’ve got
to make sure we fill that much space and we want to make sure we go all the way buckle
and lingual cusp (so then straight back up for me, Dawn, thanks). So I’m going to go
ahead and dry her top teeth. And I always go top teeth that way it keeps the tongue
out of the way and so we don’t have to worry about it getting in the way. We’re going
to be pretty efficient with this so I’m going to start back on second molars. And
I’m going to make sure I have enough thickness in material all the way up to the cuspid.
We’re going to come to the other side, second molars covering buckle and lingual cusps all
the way to the cuspid. (And just like we did before, Dawn, let your jaw drop back into
the chair like you’re trying to bite on your back teeth, bam). Everybody can see that
she is exactly where she was are you absolutely sure that right now you’ve got a bite record
in a fully seated Condylar position? I’m dead sure. It’s just that efficient, it’s
that great. And it doesn’t take too long to set up. A couple of things I’m going
to mention to you right now. I promised you yesterday that when we do bimanual manipulation
today or what I like to call bimanual guidance, not manipulation, that we’re going to speed
up the curve a little bit. One of the ways we’re going to speed up the curve for you
is every time you take a bite record out today, before you take the bite record out of the
mouth. I’m going to demonstrate this with Dawn (I’m going to have you snap open for
me). I’m going to take the Lucia jog out and hand it to Jondaee. Now before you take
anything out today, what I’m going to have you do is sit behind the patient (and Jennifer
if you could pan out for this one a little bit) and what I want you to do is we’re
going to practice bimanual guidance, because right now when Dawn bites together, guess
where she is biting right now. She’s biting in a fully seated Condylar position isn’t
she? And so right now she is hinging. And so what I can do is I can sit right behind
Dawn, by the way I could sit way over to one side and I could have an elbow out here if
I want and have my elbows way out and I could be sitting to the say and I could say, “Dawn
go ahead and open and then come together,” and I could be trying to feel what hinging
feels like. And how’s that going to be with pressure in real life? Not so great. So what
I’m going to do is sit right behind Dawn. And I’m going to make sure literally her
head is in my stomach and I’m going to make sure that my pinky and ring fingers are right
on the corners of her mandible and my thumbs are going to be right here as we talked yesterday
so the pressure is really pinky and ring finger. And now again, you can see I could have my
wings out here and be sitting way away. Or I could come right close I could bring my
wings in and I could be right here with Dawn and I could say, “Go ahead and drop open
and slowly come together.” And what am I feeling right now? I am feeling what it feels
like for a patient to hinge. Because Dawn has no choice but to hinge into these bite
records that we just took. And you can really feel the ball is not moving out of the socket
at all even if you just close your eyes you can feel what hinging feels like. And that’s
what I want you to do today to feel that. The other thing is as a patient, right, the
more you get to feel that as a patient today in the chair the more you’ll appreciate
it as a doctor. And so right now when you bite together, when you bite on your back
teeth and just slam them together… how’s that feel? (Dawn)Good! (Kevin)What other word
would you use? (Dawn)Solid. (Kevin)Solid, and you’re going to see a lot of patients
say that, I didn’t want to coach Dawn but patients are going to go, “OH, that’s
solid!” and you’re going to go, “Yeah. How would that feel for you if all of your
teeth touched? If I was able to take this out and all of your back teeth touched like
that how would that feel to you?” (Dawn)Cool. (Kevin)Pretty cool, so it’s a great way
for your patients to feel a solid bite and it’s a great way for you to feel what hinging
is. So every bite record you take today, before you take it out, I want you to go ahead and
sit right behind your patient, get in proper position and go ahead and feel what hinging
feels like at the same time. So we’ve got a Lucia jig done, now what I want to do before
we move on, I want to show you that what we’ve got here, we can zoom in quite a bit here,
Jennifer, we’ve got second molar to cuspid, just like we said we wanted, we’ve got buckle
cusps and lingual cusps completely covered on one side but then also on the other side.
And we’ve got now a nice bulk to trim which we’re going to trim here in just a bit.
So make sure you’ve got that on both of them. Buckle cusps, lingual cusps, second
molar to cuspid. And today what you’ve got baggies that are filled out. This one says
“Lucia jig” so you’re going to go ahead and take this one that we did the Lucia jig
and you’re going to plop both of these in the baggy that says “Lucia jig.” Now there’s
two of these what we’re going to do today is I would take Dawn’s record and if Jondaee
was going to take her record now, Dawn would stay in the chair, I would trade positions
with Jondaee and then she’s going to come take the Lucia jig record right at the same
time back to back. That way we can compare operator efficiency and operator accuracy.
Does that make sense? So just as soon as I’m done taking it, now Jondaee’s going to take
hers and she would put hers in the other baggy that says “Lucia jig.” Okay so everybody
gets two of each kind of bite record. So that’s the Lucia jig record and it’s really about
that easy. And now we’re going to move on to the leaf gauge and yesterday again, everybody
became pretty comfortable with the leaf gauge and we used it to load the joints and we also
used it to find first point of contact, but today we’re going to use it to take a bite
record. By the way, how much space would you like to have? Enough so you can trim the records
really well, right? That’s what we talked about yesterday. So I’m going to take a
peek in here, remember what her over bite and over jet yesterday, so I’m going to
grab enough leaves to get about a millimeter and a half in the back. What I want to do
is have you come together on the edges of your front teeth, slide forward, back and
like you’re trying to bite on back teeth just squeeze and hold right there. And what
I can do is I can take a peek back here on the screen I’ve got even her first point
of contact yesterday was on the back right, I can take a peek and I can see that I’ve
got about a millimeter and a half almost two millimeters of space back there. So that’s
actually perfect right there. So in a minute what we’re going to do, Dawn, Is I’m going
to put some goop in through here and I’m going to put the leaves in here, we’re going
to practice one more time, we’re going to slide forward, back and squeeze like you’re
trying to bite on back teeth and it’s really important that we have you squeeze in like
you’re trying to bite on your back teeth today, okay, that’s one of the most important
things that‘s your only job with this one. And so what I’m going to do is go ahead
and take this out. And now what I want everybody to see is, what if there’s a big difference
in leaves here? What I want to make sure is that Jondaee hands me back the proper side
because you just set the exact distance that you want. So it’s important that you have
a system with your assistant. I’ve got the leaves that I want down and I hand them to
Jondaee like that on purpose so then she’s totally ready to go with the two by two for
me so that we’re very efficient here, I want you to note that. So I’ve got the two
by two going and as soon as I’m done with the two by two Jondaee is there with the gun
with the handle coming towards me so that we’re very efficient. Just like we did before
I’m going to go second molar all the way to cuspid. Now I know that I need just about
a millimeter and a half so I don’t need to overfill but I want to make sure I have
enough. Second molar all the way to cuspid. Now I hand that back to Jondaee and she has
those leaves exactly as we had them. I’m going to have you come together like you’re
trying to bite on the edge of your front teeth, slide forward and then back like you’re
trying to bite on back teeth. Now hold solid like you’re trying to bite on back teeth
and that will set up pretty quickly there. And it really is that simple. Now one of the
things I’ve pointed out to you is I think it’s really important that we really have
a system with our assistant. Because this system in our office is equally as important
as when we’re filling a posterior composite or packing cord or taking any other impression.
It’s a really important record. So I want to make sure that you think about having a
nice would I would call mini system with your assistant. Be ready to flow, have it worked
out so that it works every single time. And again, today what we’re going to do is before
I take these out, I’ll have Dawn open for me. I’m going to take the leaf gauge out.
But today every time, before you take these bite records out, what I want you to do, let
your lower jaw just drop into the chair, perfect. And again if you can give me your jaw, great.
And if you can’t that’s okay. I’ve got pinky and ring finger on the corner of her
mandible, I’ve got thumbs basically auto rotating. I’m going to just let you have
your jaw drop into the chair and if you can give me your jaw, great, Dawn and if not,
that’s okay. And again, what you can see now is if you’re worried, right now I’m
worried about two things. I can barely feel her touching, she’s not dropping right into
it like she was before. And so I’m wondering, hmm did she actually squeeze forward onto
the leaf gauge like we said yesterday, right? And that’s the beauty of the Lucia jig is
we’re not worried about that. Or, don’t forget, I could have loaded up some extra
material in the back so on the second molars right now she’s arcing closed, she could
just be catching some of that. If I’m not sure, by the way, so this is the bite record.
If I’m not sure, though, today, I could take them out and I could look right now and
see that we’re second molar to cuspid and I’ve got this great bite record and it’s
exactly what we just said and it’s a millimeter and a half apart. But, again, you can see
right here, she’s got this excess over the back. And that’s what she’s catching on.
If I didn’t see that or was worried about it, I would take these two bite records right
now and I would throw them in the garbage as fast as I could and I would just take another
one. How long does it take to take a second bite record? Not that long. So my goal for
you today is if you have any question about it if you don’t like this at all, you take
them, you throw them in the garbage, you put a new tip on and you take another bite record.
Is that fair for everybody today? ‘Cause we want to make sure if you don’t like it
then take it away. Now this one I know she was hinging on that because you could feel
that couldn’t you. You were touching back there. But even so I want everybody to feel
the hinging. So we know we’re going to trim that off. For now I’ve got these two ready
to go. And now I’ve got a baggie, open that up for me since my fingers are all wet, we’ve
got a baggy that now says “Lucia jig” on it. Right? And so we’re going to go ahead
and plop both of these in Lucia jig and then again, right now before we moved on, I would
move and trade places with Jondaee and she would come over and take her Lucia jig record
or her leaf gauge record. So basically we’ve got bite records where they belong. The third
record we were going to do today that everybody has trepidation about is the bimanual guidance.
So remember we’ve already practiced with our patient. I would say to Dawn: If you could
go ahead and just open for me and if you can if you can just let your lower jaw drop into
the chair, and honestly it’s really great because you’re laying down so you can just
let gravity take over. And if you can give me your jaw great and if you can’t that’s
totally okay. The more you let it hang is fine and right now we’re just practicing.
As we come together, you’re feeling that same tooth as yesterday right side touch there?
And so now we’ve practiced and this time what I want to do is really support the joints,
we’re going to do the same thing. So I’m going to place my pinky and ring finger on
the corner of your mandible and I’m going to have you drop open just like you just did
and if you could let your jaw just drop into the chair, just let gravity take over. And
if you could give me your jaw great and if you can’t that’s totally fine too. We’re
going to do the same thing, we’re going to just slowly come together until you feel
that first tooth touch. Are you feeling the same tooth touch? Yeah, so you can see how
you and I are working together, right, to do this? Yeah? Perfect and so in a couple
minutes we’re going to go through some steps and at one point you’re going to have some
nice, soft wax in here and we’re just going to do the same thing and you’re going to
close into the wax, okay. Perfect. So we’ve practiced that. And so now what we have, I’ll
go ahead and move over to the side here, Jennifer. I would not do this over your patient. You
guys are more than welcome to if you want to do this over your patient. I will come
over here. So what I want you to see is what we talked about yesterday is, it’s really
all about tempering the wax. I don’t have the flame right on it, I’ve got it far away
from it. Then I’m actually going to go side to side. Remember we said if you just be patient
and take a good solid minute and a half or two minutes, it really isn’t that long but
I want you to think it is that long. But I want to really not be in a hurry so you can
start to see its getting sort of dark blue on one side, dark blue on the other. And I’m
just moving it side to side going front and back. The first thing we are going to do with
this wax in a minute when it’s tempered properly, is we’re going to put it in and
not take the bite record right away. What’s our goal with the first time we put it in
her mouth? It’s to get a nice indentation of her top teeth that we can trust when we
put it back in. So right now I’ve got the wax staying nice and dark blue, it’s not
fading away. When we put it in, in just a minute, we’re going to put the thick side
forward. And the reason I tell you that is, I may have put it in backwards once or twice
in my career, and you might today too and that’s okay. And so the first thing we’re
going to do now is have the thick side forward and I’m going to go just to the cuspids
maybe just distal to the actual cusp tip on the cuspid. And now what I’m going to do
because I’m wanting her to help me make the indentations I’m going to say: just
like you’re trying to bite on your back teeth, it doesn’t matter where. Now slowly
start to squeeze together. She’s going to help me and hold right there. She’s helping
me make the indentations. I can take a peek right there. And if I don’t like the indentations
I might say: Just a smidge more bite together. Hold right there. Go ahead and open for me.
Now I don’t need to dry this or cool it right now. I just need to, we just need to
check the indentation. And so, I’m going to slide it out and what you can see here.
(Off camera)We have a question online. (Kevin)We have a question? Ooh we have a question online!
This is a new one. (Question off camera)Can we use 2-3 pieces of aluwax? (Kevin)The problem
with using 2-3 pieces of aluwax is you’re not in as much control of it. You can use
any wax you want to guide into it, absolutely any wax that works, as long as it’s soft
enough that you can close into it without the mandible having to fight it. Absolutely
anything that works for you, you can. It’s just a matter of it’s not so much the wax,
it’s the process. And so I’ve got, as you can see here, I’ve got great indentations
of the upper arch. And so now what I’m going to do is, I’ve got some scissors and as
we said yesterday I’m going to look at the top arch and I’m going to come right through,
you’re good, the patient may not be the assistant, I’m going to come right through
the center groove and then, like we said yesterday, I’m going to leave just a little tag on
the cuspids. I’m going to come over to the other side here. I’m going to leave just
a little tag on the cuspids. And now if your wax is super soft, which this stays really
soft, you could put it back in right now, and wrap these guys over the cuspid and have
her bite together. For me, I like to go ahead and just heat it up one more time. And so
you can do this one over the patient if you want. I’m going to see if I can burn some
hair this morning. So now, which side am I warming up right now? I’m only warming up
the bottom side. Right? Because the top side is our beautiful indentations. So I’m just
re-warming up, just to be safe, I’m going to warm up the bottom side, and maybe those
wings just a little bit so I can wrap those over. Now I know we’re super soft on the
bottom, we’ve got indentations on top. I’m going to sneak back in here. It goes right
back into where we were. Now I’m going to fold these little guys over, everybody watch
because this is really important. I’m going to fold these over and adapt them really well
so that now, it’s solid. It really adapts to her upper teeth, the bottom is still nice
and soft. I have plenty of time because we tempered it so well. And now, Dawn, just like
we did a few minutes ago, I’m going to have you drop open for me. I’m going to place
my pinky and ring finger down here and just drop open for me if you can. And if you could
let your lower jaw just drop into the chair that’s great. And if you can give me your
jaw, great, and if you can’t, that’s okay. Now I can feel her touching the wax. I can
actually now take a look and I can say: Just squeeze a little bit and hold right there
for me. Now I see my indentations. We basically have the ball seated in the socket. Now she’s
going to hold like this. This is when your assistant comes in, and by the way, do you
have any sensitive teeth in the back, Dawn? So again, this is a system with your assistant.
I’m actually going to help my assistant out, believe it or not, and I’m going to
create some space and she’s going to come in here and we’re going to cool under compression.
Got one side, now we’re going to come over to this side. Cool under compression. And
now we’re golden. Okay, one question in just a second. So, we’ve got everything
cooled under compression now, if you want, you can test it. You can say, “Dawn, go
ahead and snap open for me.” And like you did before if you could just let your lower
jaw just bite together. And you can really see that and again on this record as well,
I’m going to sit right behind, you’re going to drop open and we’re going to slowly
come together. And you can really feel her hinging. I mean you can look up there and
you can see that she is not, she’s not coming out, she’s definitely within rotation let’s
say. She’s not translating at all right now. And how’s the feel for you when you
bite together? (Dawn)Solid. (Kevin)Solid, that was a little bit. And so now what we
can do with this one is I can slide it out. And we’ve got great indentations all we
need is cusp tips on the bottom. And we’re going to plop that into a cup of water today
because we’re going to keep this chilled so that it doesn’t distort until we use
them to meld the models. And that’s the bimanual guidance record. We have one more
record but before we do, we’ve got a question. (Off camera)Farquad wanted to know what kind
of wax you use. (Kevin)Farquad, it is DeLar wax from Great Lakes. It’s a blue wafer
from Great Lakes, it’s my favorite. These guys are taking up all of our time, aren’t
they? I like it. (Off camera)Can you use a leaf gauge instead? (Kevin)We did use a leaf
gauge already, maybe you chimed in a little bit late. We’ve already demoed a leaf gauge
so when you’re done you can come back and I think you’re going to be able to see it
recorded. We’ve actually done a Lucia jog, a leaf gauge and a bimanual guidance. So there’s
one more record we’re going to take today. We’re all going to take it, just one on
each other. And your visiting faculty are going to help to make sure, you know, who’s
going to take it because you only need one. And it’s a protrusive record. We’re going
to use it tomorrow morning to set Condylar inclination. And what I’m going to do, Dawn,
in just a minute, is just warm up some wax, I’m going to ask you to come forward sort
of like a bulldog. Yup, and then you’re going to end up biting on wax just like that.
Okay, so all we want to do is come forward, we want the ball out of the socket, out of
rotation. She could be just slightly past end to end right now, she could be way, way
out as far as she can. Just be thinking are we out, are we out of rotation, into translation?
That’s why we go into protrusive. So, if you’re anything close to class one and even
if you’ve got a little overage just think, “Let’s move the mandible forward.” So
for you, Dawn, let’s practice that one more time. You’re going to come about that far
forward and you’re going to bite into some wax right there. Okay? Now this wax can actually
be any type of wax. This is actually Master’s Wax. And there’s really no technique to
this. I just want it to be somewhat soft, that’s all. It could be beeswax, ortho wax,
it could be anything. You’re just trying to capture the way her teeth touch with the
ball out of the socket in protrusive. There’s no technique to that, it’s that fast, that
straight forward. Again, you’re going to have the fat part in the back, the skinny
part in front because that’s the way the jaw is. Again, there’s a reason I know that
it works backwards, then you regret it I’ve done that before. And so now what we’re
going to do before we do anything, I’m going to make sure I’ve got it on her lower teeth.
I’m going to place it on her lower incisors and I’m going to have her come forward like
a bulldog. Bite together and squeeze and a pretty good squeeze, we want a good squeeze
here. And hold that like that for me. And you can cool this under compression, it really
doesn’t matter, we just need the indentations. This is not for accuracy, it’s for location
of upper and lower jaw. So can I have you open for me now, snap open? And now what I
want you to see here is that we’ve got, definitely incisors and then lots of back
teeth. So again, that’s why I place the lower incisors because it allows me to capture
as many posterior teeth as possible. Definite indentations. That, also then, will go in
the cup with your bimanual guidance bite record. And again we’re going to use this one tomorrow
morning to set Condylar inclination on our articulators. So those are actually the three
bite records that we’re going to go ahead and do this morning and then a protrusive
one as well. So, what I’m going to do now is I’m going to good-bye to the people on
FaceBook because we’ve got some work to do here. So thanks for signing in, nice wave,
I like that. Thanks for signing in this morning, we’re going to have fun here. I’ll see
you next time.

13 thoughts on “Bite Records Techniques

  1. Excellent demo, excellent pace, great narration. Thanks for not having too many pleasantries that's irritating. Beautiful model.

  2. You never manually manipulate a patient's lower jaw! You let it go where it's comfortable, usually a bit down and forward, not shoved back up into the disk! Idiot

  3. is a big influence of posture in occlusion , second this distalization is not a physiologic position , all your movements are manipulated and artificial , far from physiology of the human motion ,technology today demonstrate that most of those concepts are from cadavers studies with not muscular dynamic movements

  4. synovial compartments are suceptible to squeeze of fluids , not physiologic , the hinge axis Doesn't exist ,, this is not a Knee

  5. Hi, I hope i won't get an automatic answer :))
    I've watched some video of recording CR like yours, especially the bimanual manipulating technique and i realize that no one( even the Dr in this video) use the loading test to confirm that the position you got were the CR before recording it(according to Dawson's concept). so.. how can you know if that position is CR or not?

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