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TECHNIQUE CLINIC
Bite Opening with the Gray Bite Raiser
Orthodontists often need toopen the bite in the beginning stages
of treatment to avoidtraumatic occlusion caused bybracket
interferences, crossbites,or other impediments to tooth
movement. Many devices havebeen utilized for this purpose,
including anterior or posterior bitesplints, bonded lingual
biteplanes or Bite Turbos,* andbonded occlusal composite
resinbuild-ups.1,2
All of these devices havesome limitations. The bite
splintsrequire impressions, laboratoryprocedures, and additional
appointments for insertion and
monitoring. Bonded lingualbiteplanes are not adjustable andcan
be difficult to remove. Composite resin build-ups require
additional chairtime and may causeundesired occlusal enamel wearif
filled resins are used. In addition, the composite may becomeworn
down and ineffective dueto bruxism, requiring additionalchairtime
to restore it to the appropriate height.
In 1999, Gray introduceda new type of bite-opening appliance,
the temporary bite raiser.3
This was made of .040" stainlesssteel wire that was adapted to
the
*Registered trademark of Ormco/ACompany, 1717 W. Collins Ave.,
Orange,CA 92867.
**Registered trademark of GAC International, Inc., 185 Oval
Drive, Islandia, NY11749.
occlusal surface of the maxillaryfirst molar. At the time of its
introduction, the principal drawback of the appliance was thetime
necessary to fabricate it atchairside. Recently, however, a
prefabricated version of Graysdevice has been introduced. Ihave
found it effective undermost conditions when molarbands with
headgear tubes areused.
The Gray Bite Raiser** isdesigned to be inserted into
theheadgear tube and then hingedinto place over the occlusal
surface of the maxillary first molar.It is tied with a stainless
steel lig
ature wire to a lingual attachment on the molar band (Fig.
1).The Bite Raisers are manufactured in two sizes, .8mm and1mm,
which can accommodatemost bite-opening requirements(Fig. 2).
Although Gray initially recommended placing the device
unilaterally, I have foundthat bilateral placement balancesthe
posterior occlusion more effectively and comfortably for
thepatient.
The Bite Raiser has severaladvantages over existing techniques:
It can be placed or removedeasily and quickly without patient
discomfort or the need forspecial instruments. The patients bite
relationshipcan be assessed as often as necessary by removing the
ligature
Fig. 1 Gray Bite Raisers at-tached to maxillary first
molars.
Fig. 2 Change in occlusal con-tact after placement of
BiteRaisers.
and hinging the device out of occlusion. No laboratory
procedures arerequired. Patient acceptance has beencomparable to
that of other biteopening appliances. The stainless steel appliance
isadjustable and designed for usewith either occlusally or
gingi-
VOLUME XXXVI NUMBER 11 2002 JCO, Inc. 639
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Bite Opening with the Gray Bite Raiser
vally placed headgear tubes. Inaddition, I have found that it
canbe equally effective if insertedinto a lingual molar sheath
andhinged over the occlusal surface(Fig. 3).
The major disadvantage ofthe Bite Raiser is that it may notallow
headgear or auxiliarywires to be placed simultaneously. It also
should not be used incases where anterior biteplanes
are required.
REFERENCES
1.V anarsdall, R.L. and Musich, D.R.: Adultorthodontics:
Diagnosis and treatment, inOrthodontics: Current Principles and
Techniques, ed. T.M. Graber and R.L.Vanarsdall Jr., C.V. Mosby
Co., St. Louis,2000, p. 870.
2. Brobakken, B.O. and Zachrisson, B.U.:Abrasive wear of bonding
adhesives:Studies during treatment and after bracket removal, Am.
J. Orthod. 79:134, 1981.
3.Gray , E.: Temporary bite raiser, J. Clin.Orthod. 33: 206-208,
1999.
RICHARD F. CEEN, DDSProfessor
Department of OrthodonticsBaylor College of Dentistry
3302 Gaston Ave.Dallas, TX 75246
e-mail: [email protected]
Fig. 3 Attachment of Bite Raiserinto lingual sheath instead
ofheadgear tube (holding auxiliarysegmental wire).
640 JCO/NOVEMBER 2002
