If you are a dentist that is new to the Luco Hybrid appliance, it can be daunting to start using. Rest assured, it is easier to adjust than most conventional bruxism appliances and actually treats the condition.
We have answered a number of questions from dentists like yourself and will list some here:
Why is there no coverage over the incisors? Won’t the incisors super-erupt?
All mandibular advancement appliances act to stimulate pharyngeal reflexes that act to protrude the tongue forward. If there is no space for the tongue to go, it presses on the lingual of the incisors, potentially resulting in flaring. With the Luco Hybrid, the open anterior allows the tongue to rest between the incisors preventing super-eruption. There is also a significant reduction of flaring of the incisors as there is no anterior pressure on them. with all other mandibular advancement appliances, the risk is real and occurs regularly.
I make standard bruxism appliances and they seem to work. Why should I switch?
You may think that convention bruxism appliances are working but have you ever recorded the patient sleeping with one? We and others have found that bruxism actually increases during wear. The evidence can be seen as wear on the appliance or breakage during use. Studies have shown that upper bruxism appliances can actually induce apnea events in some! We have seen this in sleep studies with an increase in the AHI with wear. Lower bruxism appliances do not have this effect but still do not treat the bruxism.
Standard bruxism appliances are taught in most dental schools and very few, if any, teach dual arch appliances. Unfortunately, this is not based on sound science and most dentists graduate with little or no training on treating a dental condition that is a risk factor for heart disease.
The Luco Hybrid treats the underlying cause and there is a reduction or elimination of the bruxism events. This is in stark contrast to single arch appliances. So how does the Luco Hybrid do this? Click Here
I have never used a dual arch appliance. What special training or equipment do I need?
Any dentist has the skill set to use the Luco Hybrid. The only new technique required for dual arch appliances is the bite registration.
When treating sleep-related bruxism, the positioning of the lower jaw is critical. It must be maintained at a 75% advancement for the condition to be effectively treated.
To achieve this, a special bite registration apparatus is needed: the George Gauge.
This is available through Great Lakes Orthodontics or Henry Schein Dental as a kit. It consists of disposable bite forks (in different thicknesses) and the body. There are bite grooves that the incisors line up with and the bite forks can move inward and outward, along the horizontal plane. There is a scale built into the body of the George Gauge that can be used to calculate the amount of advancement.
As discussed, for sleep-related bruxism, a 75% advancement is the goal. To achieve this is relatively easy.
- Assemble the bite fork into the George Gauge. For sleep-related bruxism, a white 5mm is a good start
- Do not tighten the thumb screw yet, leave the bite fork to move freely
- Place into the patient’s mouth aligning the incisors into the grooves.
- Instruct the patient to slide their jaw forward and back while keeping their incisors in the grooves.
- Record the most retrusive positioning by asking them to move their jaw as far back as possible (towards their ears). Record the number in their chart as RP of retusive positioning.
- Ask them to protrude as far as possible and record this number in their chart as PP or protrusive positioning,
- Add the two together and calculate 75%. for example: if RP was -3 and PP was + 8, then you would have 11, which is the protrusive range or PR
- To calculate 75%, multiply the PR by .75. In the example given, this would be 8.25
- For the treatment position, you would set the George Gauge to 8.25 and lock the thumb screw.
- Place it into the patient’s mouth and ask how it feels. Most patients will report it feels good
- Make sure that the George Gauge is level. Instruct the patient to gently bite into the bite grooves and inject fast-setting vinyl polysiloxane bite registration material between the molars and up to the cuspids. Once set remove.
- This is the bite registration for the Luco Hybrid.
- Remove the bite fork and label it with the patient’s name, your name, and the date it was taken.
- Send with upper and lower full digital scans or high-quality dental casts to a licensed dental lab with a prescription and that is all that is needed.
PP The most retrusive position
RP The most retrusive position
75% advancement for the Luco Hybrid
With VPS bite registration in place
The bite registration just after removal
This technique is highly reproducible and, once returned from the lab with the Luco Hybrid, stored as part of the patient record.
We hope this step-by-step guide on how to take a bite registration for sleep-related bruxism with the Luco Hybrid has been helpful. With a little practise, this type of bite is simple to do.