What makes dentists "open bites"?


Dentists decide to open a bite for a number of reasons, including a loss of vertical dimension (patient has lost teeth and bite collapsed), prosthodontic convenience (no room to prep teeth for crowns) and to allow for  the creation of longer teeth using crowns (teeth are short but in occlusion).

 If a patient has short worn teeth and dentist wants to restore them to a more normal appearance, they have only a few options. The patient can undergo crown lengthening by removing supporting bone around the teeth that need to be lengthened or the bite can instead be opened. Bite opening can be a good option, especially if a patient may need close to a full arch restoration. Opening the bite usually requires modifying at least one arch in the mouth and sometimes can involve multiple restorations in both arches. Usually a dentist will take study models and have a wax up proposal done on the study models to envision how a patients teeth would look if the bite was opened by one or two mm.

When I choose to open a bite, I make sure to have my patient wear her temporaries for at least a month, before taking final impressions, in order to ensure that my patient will be comfortable at their new opening. When speaking the patients teeth should not contact the opposing arch and their jaw muscles should be comfortable at their new vertical dimension.

Some patients with worn or multiple missing teeth may be "over closed , and  can have their appearance improved by opening the bite a matter of millimeters. Afterwards their naso labial fold lines may be less pronounced and even their chins maybe less pronounced ( over closedbites can make the mandible appear more prognatihic).

Another reason to consider opening a bite is when a patient needs maxillary crowns but has maxillary teeth that are two thin from wear to safely prepare them for full crowns. By opening the bite , enough  room on the lingual surfaces is created to allow more minimal preparation of the worn teeth and allow for a more predictable and successful out come.

Sometimes if orthodontics can be planned as an adjunctive treatment intrusion of teeth can help eliminate the need for bite opening. The intrusion and re-positioning of teeth can often accomplish some of the changes created by bite opening and can allow a dentist not to plan on restoring an entire arch. Unfortunately, many adult patients, especially over fifty shy away from becoming involved in adult orthodontic treatment but are amenable to a full arch restoration with crowns or a combination of  crowns and veneers.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/04/what-makes-dentists-open-bites.html - http://lspindelnycdds.blogspot.com/

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