- Pathological wear with missing restorative space
- Complex malocclusion with overall functional planning
- Willingness for diagnostics including functional analysis
109FIFTY · 04
Bite elevation: space, function, expertise of the masticatory system
Finding the bite needs understanding – not a template.
Bite elevation changes or restores the vertical relation when space for tissue-preserving reconstruction is missing. European consensus literature prioritises diagnosis and cause clarification before restoration.
Typically in pathological tooth wear: finding the bite needs expertise of the masticatory system – not a cosmetic standard measure and not a procedure for treating wrinkles.
109FIFTY principle
Include CMD and functional disorders
Craniomandibular dysfunction (CMD) and accompanying functional disorders of the masticatory system must be considered. Common backgrounds include long-standing open-bite situations, previous orthodontic courses, congenital patterns, abrasion-related changes or deep bite.
CMD and facial or jaw pain can have several causes. Tooth contacts can be part of the functional assessment, but must not automatically be presented as the sole cause. No healing promise.
Limits and framing
Create space without unnecessary tissue loss
If restorative space is missing, grinding alone would sacrifice further healthy tissue. A planned vertical change can create interocclusal space for additive or minimally invasive ceramic – always after diagnosis, not by millimetre template (cf. consensus on severe tooth wear and OVD literature).
Source IDs: [loomans2017] · [goldstein2021] · [sterenborg2018] · [chou2014]
Limits and framing
Face and lips – without a facelift promise
When the bite is changed for functional reasons, lower facial height and lip position can change with it in some patients.
That is not a facelift and not wrinkle smoothing. Anti-aging or cosmetic skin effects are not claimed.
Source IDs: [loomans2017] · [goldstein2021] · [sterenborg2018] · [chou2014]
Indication
When it may fit.
And when it may not.
- Purely cosmetic rationale without functional analysis
- Wrinkle or anti-aging promises
- Ignoring CMD / deep-bite / open-bite patterns
Process
Diagnostics before change
- 01
Recognise
Wear pattern, malocclusion history, CMD-relevant and cranio-cervical complaints, parafunction.
- 02
Find the bite
Derive the target relation from function, aesthetics and available space.
- 03
Try-in
Splint, 3D try-in or hybrid simulation as needed – helpful, not universally mandatory.
- 04
Implement
Additive/minimally invasive ceramic and follow-up care.
Materials & technique
Pathways
- Additive ceramic and partial restorations
- Functional splints for trial or unloading as indicated
- Direct prototypes for bite finding when sensible
Limits and framing
What to keep in mind.
- Adaptation reactions of musculature, phonetics or joints are possible.
- No guarantee of freedom from symptoms or profile effect.
Knowledge
Frequently asked questions.
Is bite elevation anti-aging for the face?+
No. Facial height or lip position may change with it – that is not a facelift and not wrinkle smoothing.
Why mention CMD?+
CMD and facial or jaw pain can have several causes. Tooth contacts must not automatically be presented as the sole cause.
- Consensus
[loomans2017]Loomans B et al. Severe tooth wear: European consensus statement on management guidelines. J Adhes Dent. · DOI 10.3290/j.jad.a38102 · PMID 28439579 ↗ - Consensus
[goldstein2021]Goldstein G, Goodacre C, MacGregor K. Occlusal vertical dimension: best evidence consensus statement. J Prosthodont. · DOI 10.1111/jopr.13315 · PMID 33783090 ↗ - Clinical study
[sterenborg2018]Sterenborg BAMM et al. Facial effects of tooth wear rehabilitation measured by 3D stereophotogrammetry. J Dent. · DOI 10.1016/j.jdent.2018.04.014 · PMID 29689294 ↗ - Clinical study
[chou2014]Chou JC et al. Effect of occlusal vertical dimension on lip positions at smile. J Prosthet Dent. · DOI 10.1016/j.prosdent.2014.04.009 · PMID 24836283 ↗
Note
Possible providers — not a recommendation
Whether and how to treat is decided solely by the treating provider after examination — not by 109FIFTY. Naming MEDIKUSS and MEDISMILE is a factual note on possible providers with concept experience, not advertising and not a recommendation.