Happy New Year! I have been really busy the last few months because I accepted a part time teaching position at the University of Toronto. So between preparing course materials, managing my practice and with two active boys at home, I haven’t had a lot of time to keep up with my blog entries. It is my hope to get back on my blog this year. Today I want to talk about cheek biting after posterior teeth replacement with implants
Whenever I find myself replacing posterior teeth using dental implants, I have had the odd occasion of dealing with cheek biting issue soon following insertion. Often times, if it’s a minor issue and I tell the patient that it takes time for the cheek muscles and the tongue to get used to the teeth as the space was previously not restored for a long time. The cheek muscles and the tongue somewhat invaded that space, and most of the time, the patient will soon adapt to the new teeth.
And this problem would have been minimized if it were a situation with a fixed partial denture replacement because the teeth would have been provisionalized and tested and it would have allowed me to test the horizontal overjet and alter the design prior to definitive fabrication of the final prosthesis.
In reality, for a single or two implants in the posterior area, we don’t often provisionalize the implants unless it is part of a comprehensive rehabilitation case. Recently, I had to deal with a very bad cheek biting case following insertion. It was so bad that I don’t think telling him to wait would be a sensible solution. I had to think on my feet and see what I can do to help this patient. This is a case involving replacing of single implant at site 47 (Tooth 31)
Borrowing from the denture concepts, we know that cheek biting is often due to insufficient overjet in the posterior region. Here, since it’s not part of a comprehensive rehabilitation case, I would have very little control of the opposing tooth and the location of the occlusal plane. They have already been predetermined. If I reduce the buccal contour of 47 in this case, I risk losing the entire occlusal contact that I had planned to create for the patient.
In this particular case, the patient is wearing a cast RPD replacing posterior missing 16 17 (#2,3) in the maxilla. What I ended up doing is to thicken up the buccal flange using flowable resin*. The hope is to push the buccal cheek out of the way to prevent it from getting caught between the teeth. Instantly, the patient thought he felt better. I saw him one month later and the problem had been resolved.
Now that I know it worked, if the case had not been a cast RPD but a natural tooth, I may consider bulking up the buccal surface of the natural teeth to increase the horizontal overjet. It really depends on how bad the cheek biting is. But I thought I want to share this case so if you run into a similar situation you can try what worked in my hands.
*In modifying the buccal flange, I could have used cold cured denture acrylic but I just wanted to add something to that area quickly so I used flowable resin. Below are the steps:
- Clean the surface well and roughen the area with acrylic bur
- Etch the surface with phosphoric acid
- Apply bonding resin to surface
- Apply flowable resin to the surface and light cure
- Smooth out any rough areas and polish as required.
Thank you for reading. I hope you find this post useful. Have a great day!
Please check out my other posts too.