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
- Deep bite: Anterior bite block to enable posterior eruption
- AOB: Posterior bite blocks to enable posterior intrusion
- 1mm intrusion posterior 4mm OB increase Hernandez et al 2017
Transverse
- Correction of functional displacement / shift : Posterior bite block in conjunction with expansion appliance – bite blocks preventing inteference
- 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
- 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
- Unlocking the occlusion.
New methods
- D-BIBRE AP correction AlBokle 2020
- 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
