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The Art of Disarticulation in Orthodontic Therapy Dalia El-Bokle. Episode 143. January 26th 2022

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Farooq Ahmed

The Art of Disarticulation in Orthodontic Therapy Dalia El-Bokle

Join me for a summary of Dalia El-Bokle’s lecture looking at disarticulation, and how they can be utilised to correct malocclusions in 3 planes of space. In this summary a novel use of disarticulation is described for class 2 and class 3 correction. This lecture follows Dalia’s publication in the AJODO 2020.

 

 

Definition:

disocclusion by using bite turbos or so the teeth has freedom to move in the three planes of space

 

Indications:

 

Vertical

  1. Deep bite: Anterior bite block to enable posterior eruption
  2. AOB: Posterior bite blocks to enable posterior intrusion
    1. 1mm intrusion posterior 4mm OB increase Hernandez et al 2017

Transverse

  1. Correction of functional displacement / shift : Posterior bite block in conjunction with expansion appliance – bite blocks preventing inteference
  2. Pseudo class III: With a Catlan’s appliance or resin blocks Kravitz 2019, mindful when using on lower arch to include multiple teeth as it may result in mobility of the lower incisors f placed an 2 only.

Using an anterior bite block will help in the clockwise rotation of the mandible that will help in Class III correction Liou et al 2018 APOS

 

Other

  1. Anchorage reinforcement, large amounts of bite block create deep intercuspation between upper and lower teeth, preventing mesial movement of the posterior segment Georgio Fiorelli et al 2013
  2. Unlocking the occlusion.

 

New methods

  1. D-BIBRE AP correction AlBokle 2020
  2. Transverse correction Georgio Fiorelli 2013

Bonded inclined bite raisers elastics D- BIBRE  .

Use of disarticulation as a functional appliance for class 2 correction

 

What is it?

Flowable composite Triad Gel placed on the upper and lower 1st premolar

 

How does it work?

  • 45 degree Inclined planes are formed from the RMGIC which disarticulate the patient in a forward direction.
  • Activation 2mm
  • Indirectly made on models, transferred by transfer tray
  • Reactivate chairside with Triad gel
  • Removed after 7 months
  • Night time class 2 elastics guide the patient into a forwards position

 

Occlusal cant and Asymmetries

Mild mod cases, Georgio Fiorelli 2013

  • Mandibular repositioning with triad gel, full coverage bonded in the lower arch buccal cusps group guidance
  • Results 22/32 stable TMJ 2 years after treatment follow up.

Recommend CBCT for condyle assessment

 

Bite turbos:

 

 

Anterior bite turbos:

  • Bonded Resin or Metal turbos (High incidence of Debonding)
  • Acrylic plane with modified Nance
  • Digitally designed – even occlusion

Increased overjet

  • Bite turbo extended = increase fracture and trauma
  • Apply turbo to caninex

Placement tip

  • Use Articulating paper to mark contact (so minimize the area covered by turbo)
  • Don’t etch the fossa so easily removed
  • Bite turbos need to be planned based on the estimated CR and the movement required,

 

Complications

  • Discomfort (eat speech)
  • Traumatic occlusion and PDL,
  • Wear and breakage
  • Loss of vitality
  • Undesired intrusion –
  • Bruxism or functional shift
  • Space opening
  • Occlusal cant

 

  • Can correct malocclusion in 3 planes
  • Need to consider side effects in 3 planes to limit tooth movement complications

 

Link to full lecture

The Art of Disarticulation in Orthodontic Therapy – YouTube

 

Content by AbdAllah Sharafeldin

Edited and produced by Farooq Ahmed

 

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