Managing a bite relationship is oneof the most critical aspects of anyrestorative dental procedure. The

bite registration is a key component inrecording intraoral relationships for effec-tive reconstruction of a single preparedtooth, a quadrant of prepared teeth, or a fullarch of teeth prepared for restorative aes-thetic reconstruction. Bite registrations areused to help orient the maxillary andmandibular relationship during the mount-ing of study models, provisional restora-tions, removable appliance construction,and restorative dentistry.

The bite registration or interocclusalrecord can be used for diagnostic mountingsin a habitual accommodated centric positionor in a physiologic maxillo-mandibular rela-tionship to assess jaw relationships. Thebite registration can assist the clinician andlaboratory technician to better understandpathologic and physiologic relationshipsthat exist when diagnostically analyzingthe mounted study cast. The bite registra-tion or interocclusal bite record is also usedfor treatment purposes. A bite registrationshould be easily and precisely transferred tostone models without rocking or flexing inorder to reproduce an accurate, yet stableupper and lower jaw relationship.

THREE TYPES OF BITE REGISTRATIONS

Interocclusal registrations or bite recordscan be divided into 3 categories: 1. bite reg-istrations for one to 2 teeth (limited treat-ment segments), 2. bite registrations for agroup of teeth such as a quadrant of teeth,and 3. bite registrations for a single arch orboth dental arches together for treatmentand transferring of intraoral information tothe laboratory mounting.

When treating a limited segment ofteeth or a quadrant of teeth the intercuspalposition can be recorded to the habitual cen-tric occlusion accurately and precisely as longas there is sufficient occlusal support from theadjacent teeth in that quadrant or dental arch(no mandibular torque) (Figs. 1 and 2).

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Bite-Management Considerations for the Restorative Dentist

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DENTISTRY TODAY • JANUARY 2008

Clayton A. Chan,DDS

Figure 1. LuxaBite (Zenith Dental/DMG) allows forprecise model mounting and orientation to accuratelyfabricate the occlusal contacts of the upper right firstand second bicuspid all-ceramic crowns (Empress,Ivoclar Vivadent).

Figure 2. The occlusal contacting marks immediatelyafter bonding the upper right first and second bicus-pids before any occlusal adjustments. Further refine-ment was made to balance the bite with theMyomonitor TENS.

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Figure 3. Note the detail in the thin areas (right quad-rant vs. left quadrant) of the LuxaBite bite registra-tion, indicating imbalances in the terminal contact ofthis case. This rigid (nonflexing) intraoral bite recordallows for precise transfer to the models for accuratemounting.

Figure 4. Using a rigid bite registration (LuxaBite)avoids vertical compression transfer error during themounting of the master die models for precise crownfabrication and occlusal management.

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RESTORATIVE110

Registering the existinghabitual bite relationship viaany bite registration materialrelies on the ability of thepatient to close reproduciblyinto a centric position.Whether the bite is balancedprecisely or not, a bite regis-tration can be made as long asthe patient is able to proprio-ceptively close to a terminalcontact position. Any prema-ture contacting incline thatgoes unnoticed during habitu-al closure can induce an in-accurate bite recording duringthe bite registration (Figure3). If the patient closes slight-ly into another position otherthan the position intended for

treatment, an inaccuratemounting of the opposingcasts will reproduce unwant-ed prematurities on the newrestorations at the time ofcrown delivery, resulting inundesired occlusal adjust-ments. Most experiencedlaboratory technicians havean ability to identify thesebite registration inaccura-cies during the mountingand articulating stages ofthe dental casts, and willimmediately correct for theerror and problem by alter-ing the mount of the caststhemselves without anybite record.

BACKGROUND Dental practitioners aroundthe world spend a consider-able amount of time adjust-ing the occlusion, especiallywhen delivering posteriorcrowns.1 Why? Some mayblame the laboratory techni-cian for not mounting themodels accurately. Othersmay say that the shrinkageor expansion ratios of stone,mounting plaster, and theprocessing of the crown fab-rication lends itself to minorocclusal changes. Othersblame the patient’s poorbite. Some may blame theimpressions for their inaccu-racies. Inadvertent grindingof the occlusion due to slight-ly high premature contactson the new crown(s) orbridge(s) can be less thandesirable and frustrating tothe dentist. Excessive ad-justing of the occlusion, evenat successive office visits,can be an indicator thatother underlying problemsmay exist, compromising thefunctional integrity, mor-phology, stability, and aes-thetics of the restorations.

A full upper and lowerset of dental casts can behand mounted to the exist-ing habitual bite with rela-tive accuracy when one or 2 crown preparations aredone, as long as there existgood interdigitation of theteeth and supportive oppos-ing abutments. If free endededentulous ridges exist inposterior regions of themouth (eg, missing first andsecond molars), or molarsthat are severely worn downwith no supportive occlu-sion, it is imperative thatjudicious care be taken todetermine a physiologic bite

relationship and re-establisha proper posterior verticalrelationship of the jaw (Fig-ures 4 to 6).2

Sequencing which toothto prepare first while main-taining a vertical stop with afirm bite registration is crit-ical when treating multipleunits of teeth for crownpreparations.

BITE-MANAGEMENTCONSIDERATION OF THE

OCCLUSALLYCOMPROMISED

Bite recording errors andmismanagement of the bitecan affect the central nerv-ous system’s feedback loop,resulting in debilitatingpathologic reactions (myo-pathy and TMD) at all lev-els of the craniomandibu-lar/neuromuscular/cervicalpostural complex.

The adaptive and accom-modating capacity of mostpeople’s bites certainly canbe attributed to high levelsof tolerance of the musclesand temporomandibularjoints during restorative pro-cedures. Fortunately, not allpatients present with masti-catory dysfunction, pain, and/or joint derangement.

Dentists treating thecomplex arch type casesinvolving severely worndentition with accompany-ing musculoskeletal occlu-sal problems may need torehabilitate a complete den-tal arch to a more physiolog-ic vertical dimension. Estab-lishing a new bite positionfor these myogenic or arthro-genic compromised cases isoften required. The Councilon Dental Care of AmericanDental Association (ADA)Guidelines for initial TMJtreatment recommends aphase I (reversible) treatmentapproach for those casesthat are not stable; provingthe jaw relationship withtime and implementing areversible appliance is highlyrecommended to prevent fur-ther harm. A phase II level ofnecessary therapy may berequired after the patient ispain free (3 to 6 months).3Many within our professionrecognize that a majority ofindividuals with internalderangement and associatedmyofacial pain will respondfavorably to orthotic andfunctional jaw orthopedicappliance therapy.4,5

Managing a proven biterelationship after pain sym-ptoms have been alleviatedshould not be a casual orroutine procedure. It re-quires an ability to managethe interocclusal space accu-rately in multi-dimensions,which includes the vertical,antero-posterior, frontal/lat-eral, pitch, yaw, and roll as-pects of the mandible. Themaxillo-mandibular verticalrelationship should corre-spond to the physiologic rest-ing tonus of the masticatorymuscles to ensure adequateinterocclusal freeway space.The physiologic relationshipshould be recorded and accu-rately maintained with thecondyles and disc in a physi-ologic position.

RELAX THE MUSCLESBEFORE TAKING A BITE

Pathologic muscle en-grammed movement pro-gramming and musculardysfunctions often preventan unstrained bite registra-tion and optimal condylarposition. A useful tip forthese types of cases is torelax and deprogram themusculature prior to takinga bite by placing 2 moist cot-ton rolls over the premolarregion bilaterally and askthe patient to close their jawwith minimal pressure for afew minutes before actualregistration.

Relaxing the musclesvia low frequency Myo-monitor TENS (Myotron-ics) for 60 minutes hasbeen preferred by many cli-nicians to assist in estab-lishing an optimal jaw re-lationship 6-dimensionally.Low frequency TENS hasbeen an effective means toassist in removing patho-logic engrams, allowing thecomplete craniomandibu-lar complex to better alignitself in a physiologic re-lationship prior to bite registration.2,6

MANAGING THE BITE INTHE LABORATORY

Techniques used to index theintercuspal/accommodatedbite position for restorativeand prosthetic dentistryhave historically used soft-ened pink base plate waxfolded and positioned be-tween the bite to capture theinterarch relationship fordental cast mounting and

evaluation.7 It is no longerrecommended to use the tra-ditional wax bite methodwhen full arch models can be directly hand articulatedwith maximum intercuspa-tion. Even if the wax bite is carefully handled in themouth, distortions of thewax cannot be avoided whenrepositioning it back to thestone model. The same ap-plies to wafer bites, whichare often recommended andcause definite changes whentrying to establish a morephysiologic relationship.

Other materials such asacrylic resin-base, compositeresins, polyether, polyvinylsiloxane, and irreversiblehydrocolloids have beenused.8 Polyvinyl siloxanes

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DENTISTRY TODAY • JANUARY 2008

Figure 5. (A) The first molar wasprepared first and a bite registra-tion was immediately recorded tohold the bite relationship (stage1). (B) The second molar was thenprepared and LuxaBite was inject-ed over the second molar prep(stage 2) while the first molar biteregistration was held in position tohold the vertical dimension (pre-venting joint collapse). (C)Empress (Ivoclar) crowns were fab-ricated to the recorded bite relationship.

Figure 6. Articulating paper mark-ings (40 µm, Bausch Thin) immedi-ately after cementation of the firstand second molar before anyocclusal adjustments.

Figure 8. A preliminary fabricatedacrylic matrix (Sapphire) is madeprior to tooth preparation to holdthe upper and lower bite relation-ship. LuxaBite is injected over theacrylic matrix to reline the pre-pared teeth to capture the detailsof the bite and hold the bite posi-tion accurately. Note the visualease and control the hard bite reg-istration offers during treatment.

Figure 7. Diagnostic wax-up of theupper and lower posterior quad-rants at the physiologic positionafter 23 months of stabilization.

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(although seemingly conven-ient to use) have been usedwith limited success in accu-rately maintaining therecorded maxillo-mandibu-lar relations.9 Most experi-enced dentists and laborato-ry technicians value a goodsolid bite registration, whichminimizes compression andflexural characteristics.10-13

Extensive effort by experi-enced laboratory technicianshas been given to ensuresuccessful seating of the newrestorations, not always tothe credit of a good bite reg-istration by the doctor. Somebite registrations are ren-dered useless and not usedwhen the laboratory techni-cian recognizes distortionsand lack of accuracy in regis-tering a correct bite relation-ship. The ability to compressor flex the recorded bite reg-istration with the softer biteregistration materials hasbeen found to increase chair-side occlusal adjustments ofthe new restorations at theseating appointment. Remov-ing unwanted bubbles andflash from various bite regis-trations is often required tomount the dental casts cor-rectly. Any small discrepancyin the mounting or distortionin the impression can lead toloss of time and inaccuraciesduring occlusal waxing andcrown fabrication.

IMPORTANCE OFMAINTAINING THE BITE

IN THE POSTERIORQUADRANT

Temporary crowns are im-portant not only to protectthe prepared tooth, but alsoto hold the bite and stabilizethe condyles and disc withinthe glenoid fossa. Few clini-cians recognize the impor-tance of maintaining an ac-curate bite relationship be-

tween the maxilla and man-dible during the temporiza-tion phase. Many dentistsbelieve that the provisionalcrowns are “just tempo-raries” and the final restora-tions will be seated in a cou-

ple of weeks with littleregard to the musculatureand jaw joint maintenance.

Temporary crowns areroutinely adjusted with lightto no occlusal marks to avoidinterfering contacts (eg, first

and second molar regions).Teeth that are prepared inthe posterior molar regionsmay be purposefully leftwith slight contacting occlu-sion during the provisional-ization stage, resulting in an

unrealized loss of verticaldimension in that quadrant.With the slight loss of verti-cal change there will alsobe a compensating verticalchange in the condyle/disc

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FREEinfo, circle 77 on card

Extensive effort byexperienced laborato-ry technicians hasbeen given to ensuresuccessful seating ofthe new restorations,not always to thecredit of a good biteregistration by thedoctor.

RESTORATIVE112

relationship within the gle-noid fossa.

Accommodation will oc-cur in the bite, joints, andmusculature during the tem-porization period if properattention is not given to theocclusal issues. Whateverocclusal relationship exists,immediately after restora-tive treatment the patient’sbite is forced to rely on theexisting occlusion to supportthe jaw position. Although abite registration was takenand recorded at a particularrelationship for the laborato-ry to mount, the patient’stemporized bite relationship

may have been unknowinglyaltered and will adapt to aslightly lower vertical posi-tion than what the laborato-ry actually mounted usingthe bite registration givenfor crown fabrication. As aresult of the “human artic-ulator” changing verticalposition over time, the newrestorations that were fab-ricated in the laboratorywill appear high at thetime of crown try-in andcementation. Crowns arerarely high in occlusion dueto super-eruption of thetooth. Eruption in the molarregions rarely occurs in 7 to10 days.4,14 Most dentists donot realize they have con-tributed to a subtle verticalloss in occlusal dimension oftheir patient’s bite.

SIGNS AND SYMPTOMS OF BITE PROBLEMS

Diagnosis of the condition ofthe jaw joints is often over-looked in our general dentalprofession. It has been re-ported that 82% to 90% ofTMJ disorders comes frommuscles.15,16 Although a fullseries of periapical films andpanoramic is a standard ofcare to most clinicians, wemust not overlook the factthat not all temporoman-dibular joints are healthy,just as not all masticatorymuscles (tender muscles) arehealthy when evaluated. Jawjoints that present with con-dylar degenerative changes(eg, flattening, beaking, scle-rosing, bend in the neck ofthe condyle, hyperplastic)and present with displaceddiscs should be identified ascontributing to occlusal man-agement bite challenges.Clicking and popping joints,restricted mandibular open-ing, joint pain, muscularpain, and tooth sensitivitiesand aches in other regions ofthe mouth could be clinicalindicators that something iswrong with the jaw jointsand muscles. Complaints bythe patient that their bitedoesn’t feel right or that cer-tain contacts hitting prema-turely in the anterior regioncause irritation should notbe taken lightly. Numerousrepeat followup adjustmentvisits and patient com-plaints about their bite notfeeling right would be one ofthose indicators. To helpassist the recognized oc-

clusal, joint, and muscleproblem type cases, strict oc-clusal management protocolsshould be undertaken to firststabilize the jaw joints andsupporting musculature.

INTEROCCLUSAL RECORDSSHOULD BE UTILIZED

A comprehensive evaluationof not only the teeth andexisting condition of therestorations should be made,but also the health of thejaw joints and surroundingmusculature. The quality ofthe functional movements ofthe head, neck, and man-dible should be consideredas to how they will impactthe dentistry performed andvice versa.

A record as to the pre-existing bite should be docu-mented, especially whenmultiple teeth are involvedin restorative dental proce-dures. Undiagnosed jaw jointproblems, unrecognized hy-pertonic musculature, andpoor interdigitation of occlu-sion will undoubtedly resultin occlusal challenges andpatient management issues.Diagnostic findings shouldbe discussed and treatmentoptions presented to the pa-ient. Interocclusal bite re-cord protocols should be uti-lized to confirm and docu-ment an existing bite rela-tionship prior to any in-volved occlusal treatment.

PROPRIOCEPTIVE DETAILS AND THE BITE

MANAGEMENT Not only is a precise impres-sion material necessary forexact bite recordings, buteven at an elementary basisa high quality hard bite reg-istration material is neces-sary to relate the upper andlower casts accurately to-gether. “Elastomeric impres-sion materials are popularfor making interocclusal re-cords to mount casts on den-tal articulators. The resist-ance of these materials tocompressive forces is criti-cal, because any deformationduring the recording ormounting process could re-sult in inaccurate articula-tion of casts and faulty fabri-cation of restorations.”12

When bite registrationmaterials do not accuratelyindex the bite relationship ofboth the opposing archesand tooth preparation along

with supporting abutmentteeth, it opens the door toguesswork on the part of thelaboratory technician. It isfar too common for the labo-ratory technician to estab-lish the bite of the case,rather than the treatingdentist, due to faulty biteregistrations. The laboratorytechnician appreciates anaccurate, definite hard biteregistration from the treat-ing dentist, making their joband responsibilities easier.

Removing all torque,flexure and unwanted com-pression in a bite registra-tion material must be con-sidered if treatment castsare to be mounted accurate-ly and precisely.

Precision and accuracyin any bite/occlusion re-quires an awareness andattention to details. Mostdentists demand precision inthe fit of the crown. Theyalso expect the restorationsto not only accurately fit theprepared tooth, but also fitthe bite accurately.

WHY NOT GIVE THE LABO-RATORY AN ACCURATEBITE REGISTRATION?

The human incisors can dis-criminate 14 µm thicknessbetween the teeth.17 Someinvestigators suggest dis-crimination below 10 µm.8Patients who present with ahigh level of discriminationmay require a high level ofprecision and treatmentfrom their dentist. If thedentist uses 60 to 80 µmthick articulating paper tocheck the bite and thepatient unknowingly de-mands a 10 µm level of de-tailed treatment, there maybe a mismatch in meetingthe patient’s expectations. Ifthe dentist is not aware ofthese very real issues, espe-cially of the high propriocep-tive detailed patient, frus-tration will ensue.

MATERIALS

This Is What I Use—Tipsand Techniques toManaging the Bite

I personally like to use ahard bite registration ma-terial—LuxaBite (Zenith/DMG)—for which my labo-ratory technician does notneed to guess how to relatethe upper and lower caststogether. It is the doctor’s

responsibility to determineand establish the bite rela-tionship accurately so thatthe laboratory techniciancan mount the case to thesame precision as what thedentist observed and estab-lished in the patient’s mouthat chairside.

The laboratory techni-cian’s responsibility is tomaintain the bite relation-ship that was determined bythe doctor and to accuratelyfabricate the restoration(s)to match the patient’s bite.

LuxaBite is the mostrigid of all bite registrationmaterials that I have usedthanks to its innovativebisacryl chemistry.18 Its hard-ness (Shore D-69 or Barcol25) eliminates compression or flexing when mounting themodels. LuxaBite ensures an exact and reliable bite re-cording. During implantprocedures many clinicianshave found it effective toassist in fixating multipleimpression posts in order toobtain torsion-free implantimpressions.

LuxaBite is a bite regis-tration material that is easyto dispense from an automixcartridge using a standarddispensing gun and fine sy-ringe tips for accuracy andplacement. Working time is45 seconds for easy, quick de-livery and placement. Set-ting time is 2.0 to 2.5 min-utes. LuxaBite has a thixo-tropic characteristic, whichprevents it from penetratinginto proximal areas. Its blueopaque color makes it easyto see in contrast to the sur-rounding tooth structure. Ithas been shown to be verystable, firm, and easy toadjust with any dental bur

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Bite-Management...

DENTISTRY TODAY • JANUARY 2008

Figure 9. The relined LuxaBite/Sapphire acrylic arch matrix istrimmed and transferred to themaster cast models for precisemounting. Upper posteriorEmpress crowns are fabricated toa hard and rigid bite relationship,increasing occlusal accuracy.

Figure 10. Before restorative treat-ment of posterior teeth and afterrestorative treatment. Occlusalcontact marks immediately aftercementation before adjustmentswere made, as a result of using ahard rigid bite registration material(LuxaBite/Sapphire matrix) and aquality lab (Mike Milne, CDT,Sunrise Dental Laboratory, LasVegas, Nev, [800] 933-6838).

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It is the doctor’sresponsibility to deter-mine and establish thebite relationship accu-rately so that the lab-oratory techniciancan mount the case tothe same precision aswhat the dentistobserved and estab-lished in the patient’smouth at chairside.

RESTORATIVE113

or diamond.The benefits of LuxaBite

are:• Shortens occlusal ad-

justment time.• Reduces the need to

break the porcelain glaze(avoiding re-glazing and pol-ishing steps).

• Reduces surface failurefatigue points from over-ad-justing porcelain restorations.

• Ease of crown seatingleads to happier patients anddentists.

• Increased confidencelevel of the dentist.

• Increased recognitionfrom the patients and peers of the precise and accuratetreatment.

Why a Rigid BiteRegistration Is Important

A rigid full arch bite regis-tration is a critical compo-nent of accurately managingthe bite in both the posteriorvertical, anterior vertical,and antero-posterior do-main, especially for thosecases which require atten-tion to detail in managingthe maxillo-mandibular oc-clusal relationships. Losingvertical or antero-posterior(AP) dimensions duringtooth preparation can lead toa relapse of neuromuscularocclusal symptoms if carefuland methodical steps are notimplemented.

In cases that requirenumerous teeth to be pre-pared in an arch, I prefer tofabricate a foundationalacrylic matrix, which acts asa reinforcing stable bitematrix to hold the jaw rela-tionship. LuxaBite is inject-ed over the Sapphire matrixto reline the bite registrationfor further detail and accu-racy over the prepared teeth.I make the foundationalacrylic matrix using Sap-phire (Bosworth Company),an ethyl methacrylate acryl-ic, by mixing it into a doughyrope consistency which isformed (hands lubricatedwith Vaseline) and placedover the lower teeth duringthe uncured stage to form arigid interocclusal arch ma-trix. The patient is asked toclose the bite together andwait until the Sapphire ropefirms up. Just before the ma-trix hardens in the mouth itis loosened with a hand in-strument to make sure thematerial does not lock inter-proximally. The patient willcontinue to bite the teethtogether firmly until the Sap-phire bite matrix hardens.

The Sapphire is mixed toa powder-liquid ratio of 2.5vials of powder to 1 vial ofliquid. This combined re-lined rigid registration be-comes a critical transfer ma-trix that allows the master

die model to be accuratelymounted for final waxingand crown fabrication. Alight-cured resin adhesive(Optibond Solo Plus, Kerr)is painted over the hardenedSapphire matrix to bond the LuxaBite to the Sap-phire matrix.

CASE HISTORY A 36-year-old female patientpresented with chronic head-aches (migraine type), previ-ous orthodontic treatment,awakening with sore jaws,ringing in the left ear, tender-ness in the left joint, restrict-ed head movements (flexionand extension), restrictedhead rotation, and sore andtender occipital region.

Following a comprehen-sive evaluation and a seriesof thorough diagnostic re-cords, a physiologic bite rela-tionship was determined af-ter using low frequencyTENS (J5 Myomonitor) andthe K7 Kineseograph (Myo-tronics-Noramed) to trackthe jaw position.6 After con-sultation and discussion re-garding the patient’s TMJpain and aesthetic needs,a treatment plan was de-signed to stabilize her man-dible and later restore theupper and lower posteriorquadrants once the bite wasproven and the jaw stabi-lized. A lower orthosis wasfabricated and worn 24/7.Five weeks after initialplacement of the orthosisthe patient reported nolonger having symptomsand pain. Three follow upadjustment visits were re-quired over a one-year peri-od to fine tune the bite. Theorthosis was worn for a to-tal of 23 months prior torestorative treatment.

Once stabilization of themusculature and precisionof the bite were established,new upper and lower im-pressions were taken andmodels were mounted to thenew determined centric oc-clusion. The upper posteriorteeth were cleaned and exca-vated of all decay. The failingamalgam fillings were re-moved and replaced with all-ceramic restorations whileat the same time maintain-ing the new stabilized bitewithout a relapse of painsymptoms. A diagnostic wax-up (Figure 7) was completedat the new physiologic posi-

tion and a provisionalizationmatrix was prepared andused to temporize the pre-pared upper posterior teeth.The Sapphire/LuxaBite bitematrix was used to registerthe physiologic bite rela-tionship intraorally andtransferred to the upperand lower models to holdthe physiologic bite position(Figure 8).

The master casts anddies were prepared for mount-ing using the LuxaBite/Sapphire bite registrationarch matrix (Figure 9). Thefinal all-ceramic restora-tions (Empress, Ivoclar Viva-dent) were fabricated andbonded with a light-curedresin-base luting material(Variolink Veneer, IvoclarVivadent [Low value minusone]). Minimal bite adjust-ments were required, pre-serving the beautiful ceram-ic work done by the dedicat-ed laboratory technicians(Figures 10 and 11). The bitewas carefully monitored forstability before proceedingto the lower posteriors.

CONCLUSION A firm and rigid bite regis-tration is a valuable meansto capture the details nec-essary to accurately man-age simple to complex jawrelationships. Reducing thechances of distortion, flex-ure, and compression fromthe intraoral bite registra-tion to the bite registrationtransfer onto the stone mod-els for laboratory mountingis critical if precision res-torative crowns are to beachieved. LuxaBite has beenshown to be a key bite regis-tration material that is easyto work with when accuracyand precision are required inquality restorative proce-dures. Implementing goodbite taking skills and oc-clusal management aware-ness, combined with anunderstanding of the tem-poromandibular joint andmuscle health, will reducethe needless occlusal adjust-ments at the crown deliveryappointment especially withcomplex cases. F

References1. Christensen GJ. Making fixed pros-

theses that are not too high. J AmDent Assoc. 2006;137:96-98.

2. Chan CA, Thomas NT. Clinical andscientific validation for optimizing theneuromuscular trajectory using theChan protocol. International College

of Cranio-Mandibular OrthopedicsAnthology. Volume VII. 2005:2-16.

3. The Council on Dental Care ofAmerican Dental Association (ADA).Guidelines for TMJ Treatment (2004).http://www.cda.org/library/cda_mem-ber/pol icy/qual i ty/ tmj_mpd.pdf.Accessed: December 3, 2007.

4. Broadbent JM. TMJ in your practice.Funct Orthod. 2006;23:38-45.

5. Simmons HC 3rd. Guidelines foranterior repositioning appliance ther-apy for the management of craniofa-cial pain and TMD. Funct Orthod.2006;23:22-31 [republished fromCranio. 2005;23:300-305].

6. Cooper BC. The role of bioelectronicinstrumentation in the documentationand management of temporo-mandibular disorders. Oral Surg OralMed Oral Pathol Oral Radiol Endod.1997;83:91-100.

7. Shillingburg HT Jr, Hobo S, WhitsettLD. Fundamentals of Fixed Prostho-dontics. 2nd ed. Chicago, IL: Quin-tessence; 1981:259-267.

8. Breeding LC, Dixon DL, Kinder-knecht KE. Accuracy of three interoc-clusal recording materials used tomount a working cast. J ProsthetDent. 1994;71:265-270.

9. Campos AA, Nathanson D. Com-pressibility of two polyvinyl siloxaneinterocclusal record materials and itseffect on mounted cast relationships.J Prosthet Dent. 1999;82:456-461.

10. Keyf F, Altunsoy S. Compressivestrength of interocclusal recording ma-terials. Braz Dent J. 2001;12:43-46.

11. Michalakis KX, Pissiotis A, Anastasi-adou V, et al. An experimental studyon particular physical properties ofseveral interocclusal recording me-dia. Part III: resistance to compres-sion after setting. J Prosthodont.2004;13:233-237.

12. Breeding LC, Dixon DL. Com-pres-sion resistance of four interocclusalrecording materials. J Prosthet Dent.1992;68:876-878.

13. Small BW. Centric relation bite regis-tration. Gen Dent. 2006;54:10-11.

14. Chan CA. Multi-dimensional diagno-sis and treatment to avoid orthodon-tic and surgical pitfalls. J Am Ortho-dontic Soc. 2006;6:18-28.

15. Baker L. Tension headache, or not?Study shows pain may be due toTMJD. [Study by Ohrbach R., et al].Buffalo Physician. Autumn, 2006;41:32.

16. Garry JF. Telephone communication.September 29, 2002.

17. Riis D, Giddon DB. Interdental discrim-ination of small thickness differences.J Prosthet Dent. 1970;24:324-334.

18. Miller MB. LuxaBite: bite registrationmaterial. In: Reality. Volume 20,Houston, TX: Reality Pub Co;2006:31-39.

Dr. Chan is a dentist dedicated tosharing his passion, and teaches theneuromuscular principles that haveworked for him. He is an educator tothousands of dentists around theworld as well as mentor, teacher, andcounselor to study clubs and organi-zations. He is considered by many anauthority on neuromuscular dentistryand occlusion. Dr. Chan focuses hisprivate practice on aesthetic cran-iomandibular orthopedics, orthodon-tics, TMJ, and full mouth rehabilita-tion, implementing both the gnatho-logic and neuromuscular principles.He can be reached at clayton@drclaytonchan.com or clayton-chandds.com.

Disclosure: The author does not haveany financial interest in products orcompanies mentioned in the article.This includes a salaried position inthe company (including a consultantposition) or funding from the manu-facturer for research studies.

JANUARY 2008 • DENTISTRY TODAY

Figure 11. Final upper posterior restorations bonded to maintain a physi-ologic relationship with minimal occlusal adjustments.

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