JL

CLINICAL

J Ind Orthod Soc 2004; 37:1 32-136

A Simple Therapy for Dual Bite

- A Case Report
Rotraut Rei nhardt, Dr. med.
Po li klini k fOr Ki eferorthop ad ie*
ZMK-Klinik del' jo hannes Gutenberg- Universitat M ain z
Au gustuspl atz 2
55 13 1 M ain z, German y
E-m ail: rreinh ar@mail.uni-m ain z. de
Wilfried Reinhardt, Priv.-Do z. Dr.med. dent.
Po li klini k fur Zahn arztli che Prothetik und W erk stoffkund e
Kl ini kum der Fr iedri c h-S chi ll er-Uni ve rsitat jena
An der all en Post 4
0774 3 j ena, Germany

Abstract

A 15-yea r old girl had orthodontic treatment for B years. The result of the treatment was an
Angle class 11/1, an overjet of Bmm, a deep bite, a scissor bite of both sides and the still
mi ssing toot h 47. The patient was not willing for surgery. A balance-splint was created for
treatment. The normalisatio n of occlusion and function was a result of a three month therapy.

Keywords

Du al bite, balance-splint

Th e dictionary of Denti stry states 2 definitions for dual

bite:

Nevertheless, the patient had rea l problems of occl usion

and function, she was not willing for surgery therapy.

1. Predominantly two hab itu al occl usion s, o n a

skeleta l retruded position and anot her further
forward (ventral) position.
2. An adva nced bite of the mandibl e that, ca n be
created by the patient, but not mani fested in the
TMJ and where the origi nal retru sio n persists.

A new balance-splint was created for treatment:

1. Th e treatment-position was fo und by a wax
co nstru ctio n bite.
2. Th e lower jaw as the seismograph of the body had
to be in a central position.
3. Th e m ater ial was a th erm ofo rm i ng m ate ri al,
physiologically harml ess (spec ifi catio n of th e
ma nufactu ri ng fi rm) .
4. Th e balance-splint was made in the lower jaw
with impress io ns fo r the upper premo lars and
mo lars (figure 12).
5. Th e vertical treatment-position was 10 mm hi gh,
important for a minimal mu sc le activity (figure 13).
6. Th e sagittal treatment-position of the lower jaw
was the nullification of the 8 mm overjet (figu re 14).
7. The dimension of th e lingual front part of the sp lint
was minimal for a good articul atio n of speec h
(figu re 15).

The second definition is often described as o ne created

iat rogeni ca lly. From thi s one may co nclude that every
orthodo nti c bite alterat io n must succeed in correct ing
a distoclusion to neutroc lu sion. Since the patient
compli ance in planned bite alterat io n is not always as
expected, a treatment moda lity mu st be planned such
that it ca n remain effective and successfu l eve n later
on. Thi s type of treatment ca n be used for every ki nd
of dual bite, irrespcet ive of the cause i.e. orthodo ntic
treatment, bruxism, o r any other cause.

Material and methods

A 15 year o ld girl had orthodonti c treatment for 8 years.
The result of the treatment was an Angle class 11/ 1 with
an overj et of 8 mm, a deep bite, a sc isso r bite of both
sides, a dual bite and the still mi ss ing tooth 47 (figure
01 -10).

132

Instruct ions fo r wearing th e splint:

a) The patient had to wear the balance-splint all the
ti me except eati ng.
b) Du ri ng eati ng the pati ent had to try to chew ina
more anterior position.

Reinh ardt et al

Fig. 1: Pre-treatment extrao ral photog raphs

Fig. 2: Pre-treatm ent intrao ral pictures

Fig. 4: Post-t reatment extrao ral photograph s

Fig. 4: Post-treatm ent intrao ral pho tograph s

133

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Reinhardt et al

Fig. 5: Before: Th e case after a 8- year

orthodontic treatment

Fig. 6: Before: Overjet 8mm

Fig. 7: Before: Sc issor bite and deep

bite

Fig. 8: Before: The case after fixed app li ance treatment

Fig. 9: Before: No mol ar 47, sc issor

bite o n ri ght side

Fig. 10: Before: Scissor bite of the

premolars on left side

Fig. 11: Wax co nst ru ct ion bite for the

sp lint

Fig. 12: Th e balance-splint in the

lower jaw

j
Fig. 13: The 10 mm vertical treatmentposition

Fig. 14: Th e 8 mm sagittal treatmentposition

Fig. 15: The lingua l ante ri or part of the

splint

"
Fig. 16: After: The case o ne yea r after
spli nt therapy

Fig. 17: After: Tooth 47 in norm al

pos iti o n

Fig. 18: After: Left side occlusion

135

..

J L~l S

J Ind O rth od Soc 2004; 37: 132 -1 36

Fig.19 : After: Th e upper and lower models

c) Th e pati ent had to cl ose th e lips we ll and to breath

throu gh th e nose .
d) Th e rest -positi on o f th e to ngue had to be in the
ph ys io logica ll y pa latal positi o n.
e) For a good arti cul ati on of th e speec h th e pati ent
had to open th e mouth more th an th e treatm entpositio n.
f) Th e patient had to lea rn a ph ysio log ica lly co rrect
sw all ow ing.
g) Th e patient had to w ea r th e splint w ith a w akeful
and sensitive co nsc iousness.
Results
Th ere wa s no pro bl em fo r th e pati ent to w ea r the
balance-splint all th e time. The no rm ali sation of th e
occ lusion and fun ction w as th e resu It of a three mo nth
th erapy. After the three mo nth th erapy th e pati ent w as
not w i II i ng to have any oth er orthodo ntic treatment.
Durin g th e next reca ll , a harm o ny of th e o ro fac ial
system and th e correct positio n of th e left lower second
mo lar (fi gure 16 -19), w as obse rved.
Discussion
Th ere are so me qu esti o ns co ncernin g th e du al bite
pati ents.
Is there a necessity to treat dual bite patients?
" Du al bite is not assoc iated w ith a hi gh prevalence of
subj ective symptoms of mandibul ar dysfuncti on. Th e
ri sk of develo pin g c lini ca l signs o f dysfun cti o n is
suggested by excessive tooth w ea r. However, treatment
aimed at creatin g stabl e occlu sion in or close to th e
RP is indi cated in du al bite pati ents" 2.
Is there a favoured method to treat dual bite
patients?
A case report demo nstrated a du al bite resulting fro m
bru x ism . " Th e dentiti o n was resto red w ith meta lce rami c crow ns to restore a no rm al occ lu sio n. Th e
kin esiographi c fo ll ow -up studi es revea led th at, initi all y,
it was di fficult fo r th e pati ent to adapt to a new occ lu sa l
design, but 6 yea rs later, the du al bi te had di sappeard"4.

136

M ost of th e du al bite pati ents w ere refe rred by th e

denti st to the o rthodo ntist. The denti st had fo und the
du al bite during a restorative treatm ent and he was not
able to give th e pati ent a hi gh qu ality of resto rati ve
treatment.
Is the task for the orthodontist to eliminate a dual
bite, to create a stable occlusion and a normal
function very difficult?
Th e lea rnin g effect of a system to get a comfo rtabl e
and stabl e positio n of the lower jaw in thi s case w as a
good one.
" It is therefore probabl y fun cti o nall y beneficial to create
a stable occlu sion in the retruded mandibul ar position"J.
But th ere wa s no problem fo r th e system to accept a
mo re anterior positio n after a sho rt training period of
three month.
Transl ated by Dr. Ravi Gupta, MDS
Communications
Rotraut Reinhardt, Dr. med.
Po liklin ik fUr Ki efero rthopadie*
ZMK-Klinik der Johannes Gutenberg- Uni ve rsitat
M ainz
Au gustu splatz 2
55 13 1 M ainz, Germ any
E-mail: rreinhar@mail.uni-mainz.de
References
1.

2.

3.

4.

Hoffm ann-Axth elm: Lex ikon der Zahnmedi zin, 6.

Au flage, Quintessenzverl ags- GmbH 1995
Ege rm ark-Erik sso n, I. , G. E. Ca rl sso n and B.
In ge rva ll: Fun ction and d ys fun c ti o n of t h e
masti catory system in individu als w ith du al bite.
Eu ro p. Ortho. J. 107-11 7, 19 79
Ingerva ll , B., and I. Ege rm ark-Eriksson: Fun cti on
of tempora l and masseter mu sc les in individu als
w ith du al bite. A ngle Orthod. 13 1-140, 1979
Salse nch, J. , M . Peraire and J. Torrent: Du al bite
demon strated by kin esiog raph y : A case report.
Q uintesseence Int. 4 7 1-477, 1995