CASE STUDY
Bite turbos Drs. Nathan Yetter and Donald J. Rinchuse discuss the pros and cons of bite turbos
T
he use of “bite turbos” to help maintain bite opening during aspects of orthodontics has become a relatively routine aspect of treatment. Bite turbos can have some orthodontic biomechanical advantages when using elastic wear during Class II or Class III correction. In addition, there are some claims that by “unlocking” the occlusion, teeth move more freely and this, thereby, shortens treatment time. From a practical viewpoint, they can facilitate bonding both the upper and lower arches, and help prevent the patient from shearing off brackets. Bite turbos can be placed on the lingual surface of the upper incisors, or they can be placed on the posterior teeth. Using the posterior teeth to open the bite can be achieved by using stainless steel crowns or by bonding resin material to the occlusal surface. While posterior “bonded resin” bite turbos have become very common among orthodontists, there are a few side effects and cautions that one needs to be aware of. First, discluding the posterior teeth will make chewing very difficult. In rare instances, this can create a choking hazard for younger patients as well as potential digestive problems. Second, when placed on posterior teeth, bite turbos can cause fremitus and pain due to traumatic occlusion. Third, it may be a contributing factor to exacerbation of TMD in a patient who may be sensitive in the TMJ. Fourth, they can cause unwanted tooth intrusion, and depending on where the bite turbo is placed on the posterior tooth surface, unwanted root movement can occur. The following cases demonstrate that placing bite turbos can cause unwanted tooth movement. In case No. 1, bite turbos were placed on the mesial aspect of the
Nathan Yetter, DDS, is senior orthodontic resident at Seton Hill University, Greensburg, Pennsylvania. Donald J. Rinchuse, DMD, MS, MDS, PhD, is Professor and Graduate Orthodontic Program Director, Seton Hill University, Greensburg, Pennsylvania.
16 Orthodontic practice
Case No. 1 (Figures 1A and 1B)
Figure 1A
Figure 1B
Case No. 2 (Figures 2A-2E)
Figure 2B
Figure 2A
Figure 2D
Figure 2C
Figure 2E
lower first molars and caused unwanted distal root movement into the mesial root of the lower second molar. The taller the bite turbo, the more adverse movement one can expect. Case No. 2 shows an intrusive movement of a posterior single-rooted tooth. Generally, bite turbos should be reserved for posterior molars, but in this case, they were placed on the second
bicuspids due to missing posterior molars on the lower left side. While this movement can be corrected, we question the added stress placed on the root or roots of the affected teeth. Ultimately, bite turbos do have many positive effects and are an important tool for orthodontists, but clinicians must be aware of the adversities that may present when using posterior bite turbos. OP Volume 4 Number 5