What is bite raising?
Decay, periodontitis, dental accidents or wear lead to a loss of tooth substance and bite height. When the front and back teeth in both jaws are equally worn, this is called an abraded dentition: the front teeth in particular become shorter, and the teeth lose their shape, length and function. In a deep bite, the upper incisors overlap the lower ones heavily; in extreme cases the lower teeth press into the palate.
Therapeutic bite raising is done orthodontically, for example with splints. Prosthetic bite raising uses occlusal splints or suitably designed restorations when the bite has dropped through wear or tooth loss – by building up the back teeth, shortening the front teeth, or both. It is important to treat the causes of the faulty load too, so they do not return.
Natural bite raising in children
Children go through three natural bite raises: when the first milk molars erupt at 14–18 months, when the first permanent molars come through at about 6 years, and when the premolars change and the second molars settle at about 10–12 years. Orthodontic check-ups during growth allow misalignments to be corrected before they become established.
Causes and effects
The main cause is increased wear of the teeth – from stress-related grinding and clenching, congenital misalignment or gaps, poorly fitting restorations, inadequate oral hygiene, decay and periodontitis, and stomach acid in bulimia, reflux or chronic alcohol abuse. An untreated deep bite should be treated promptly, as it can lead to:
- a sunken lower third of the face and unbalanced facial features
- faulty loading when chewing, jaw joint and chewing muscle problems
- pressure, tension and pain in the head, neck, shoulders, back, hips and knees, tension headaches
- earache, tinnitus, visual disturbances with dizziness, difficulty swallowing in the morning and a tilted pelvis
Planning and procedure
We start with a clinical function analysis and impressions; analysing the study models shows which measures are needed. If the teeth are only slightly worn, a Michigan splint to relieve the teeth and jaw joint is the treatment of choice. With more substantial loss, ceramic crowns or tabletops are required. Digital simulation, three-dimensional planning, digital impressions and CAD/CAM production make the process efficient and safe; we work closely with the dental technician throughout.
In the laboratory, a wax-up of the target situation is made first. It is transferred into a mock-up of tooth-coloured resin that is bonded onto your teeth – so you can see how your teeth and facial profile could look after treatment.
We test the new bite height with temporary restorations, or alternatively with a splint. This trial phase lasts 3–12 months – the time the masticatory system needs to stabilise. You get used to the new bite while we fine-tune it. The temporaries replace missing substance, protect teeth and gums from irritation and stabilise the position of the teeth.
Over several appointments in our laboratory we determine and refine colour and shape until you are satisfied. The final ceramic crowns, partial crowns or bridges are fitted no earlier than 3 and usually no later than 12 months after the temporaries.
Duration and aftercare
The damage of an abraded dentition can generally be fully repaired. For slightly worn teeth, treatment with the Michigan splint takes a few weeks with up to five appointments. With advanced loss of substance, possibly with implants and bone augmentation, it can take about a year – during this time you wear aesthetic, fixed long-term temporaries. Bite raising should never be rushed.
Once the final restoration is in place, you receive a Michigan splint for the night. It protects the restoration from wear, relaxes the chewing muscles, relieves the jaw joints and counteracts grinding at night. It can also help restore balance in postural problems such as hip or spine misalignment or differences in leg length.
Costs
Costs are as individual as your situation. Lost tooth substance can be rebuilt with composite or ceramic (lithium disilicate, zirconia), or a combination of both. We are happy to explain the pros and cons of each material. Extensive bite raising can be paid for in interest-free instalments.