The dowel-up bite registration for
functional appliances requiring a
protrusive and open jaw position: A
clinical report
John J. Sheridan, D.D.S., M.S.D.*
New Orleans, La.
The dowel-up technique is an alternative
open position of the mandible required
This requires protrusive jaw movement.
mandible.
Key words: Dowel-up, protrusion, opening, impression. mandible
A critical point in the sequence of func-
tional appliance fabrication is registration of the bite.
The accuracy of this bite registration will be directly
related to the efficiency of the appliance. In the func-
tional appliances that require a protrusive jaw position
and some amount of bite opening (activator, Frinkel II,
Bimmler, Bionator, etc .), the bite registration is an
exacting technique because the mandible must be in
the desired position, both anteroposteriorly and ver-
tically. l, *
This procedure can be difficult because of the
young patient’s difficulty in perceiving the instructions
related to the spatial position of the mandible and the
orthodontist’s ability to guide the jaw in a forward and
open position into the bite-registration wax. These
variables can compromise the accuracy of the con-
ventional bite registration and, therefore, the fit and
treatment potential of the appliance.
The “dowel-up” technique is an alternative to con-
ventional jaw-manipulating methods of bite registration
for functional appliances. This procedure is applicable
to children who have trouble with the concept of mov-
ing the mandible to a fixed position in space. The only
directions given to the child are to raise or lower the tip
of a dowel. Jaw movement does not have to be men-
tioned; nor does the mandible have to be manipulated
by the orthodontist.
*Associate Professor, Department of Orthodontics, Louisiana State University
School of Dentistry.
--
Dr. Sheridan
-
to conventional jaw manipulation in obtaining the desired protrusive and
for functional appliances. The patient raises or lowers the tip of a dowel.
The thickness of the dowel will determine the vertical position of the
TECHNIQUE
The point of a dowel is placed between the patient’s
anterior teeth at the midline. The stick may be
sharpened in an ordinary pencil sharpener. The dowel
is held firmly between the teeth in the patient’s habitual
bite (Fig. 1). In Class II patients, the dowel tip will be
tilted below the horizontal. The patient is requested to
raise the tip of the dowel (Fig. 2). The only way the
patient can accomplish this is to protrude the mandible.
The more the mandible is protruded, the more the
dowel is raised (Fig. 2); when the mandible is retruded
the dowel is depressed (Fig. 1). When the desired jaw
position is achieved, the patient is told to hold the
dowel still (Fig. 3). There is no need for the operator to
guide the mandible. The patient will achieve the de-
sired mandibular position by following the simple di-
rections to either raise or lower the dowel tip.
The amount of vertical opening to be incorporated
in the bite registration will depend on the type of func-
tional appliance and the preferences of the clinician.
With the dowel-up technique, the vertical opening with
the jaw protruded can be controlled by adjusting where
the patient bites on the conical end of the dowel (that is,
minimal bite opening toward the point and maximum
opening toward the shaft of the dowel). By varying
where the patient bites on the conical end of the dowel,
the bite opening can vary from 2 to 8 mm. If bite
opening in excess of a pencil width is desired, a
wooden dowel of appropriate diameter can be used.
The procedural steps for the dowel-up technique are
as follows:
427
428 Sheridun

Fig. 2. Protrusive jaw position with the dowel tilted above the
Fig. 1. Retrusive jaw position with dowel tilted below the hori- horizontal.
zontal.

1. Rehearse the procedure by having the patient

bite lightly on the end of a wooden dowel (Fig.
1). Place the opposite spines on the dowel shaft
on the upper and lower midlines. (a) Insert or
withdraw the conical end of the sharpened
dowel until the patient’s jaw is at the desired
vertical position. (b) Request the patient to raise
the tip of the dowel until the required amount of
jaw protrusion is obtained (Fig. 2).
2. Remove the dowel and place a roll of heavy-
bodied impression material on the occlusal and
incisal surfaces of the lower teeth (Fig. 4).
Again have the patient bite on the sharpened end
of the dowel and repeat step 1 (b). While the
impression material is setting, the patient can
support the dowel with their hand (Fig. 3).
3. Mold the impression material to the buccal sec-
tions and around the dowel (Fig. 5).
4. Remove dowel with the bite registration when
the impression material has set.
5. Place casts in the impression for laboratory pro-
cedures .
The dowel-up technique is a simple and efficient
method of obtaining a desired vertical and anteropos- Fig. 3. Required protrusive jaw position for this case with pa-
terior jaw position. Quite often patients can protrude tient stabilizing the dowel.
Volume 84 Dowel-up bite registrution for finctionul uppliances 429
Number 5

Fig. 4. Heavy-duty impression material on lower occlusal Fig. 5. Impression material adapted to buccal sections for bite
surfaces. registration.

the mandible farther than with conventional jaw- 2. Adams CP: The design and construction of removable appliances.
positioning methods if they practice raising the dowel Bristol, 1976, John Wright & Sons, Ltd.
tip for a few minutes prior to bite registration. I have Reprint requests to:
found that requesting children to raise or lower the tip Dr. John J. Sheridan
of a dowel is less complex than traditional jaw-position- Department of Orthodontics
Louisiana State University School of Dentistry
ing techniques.
1100 Florida Ave.
New Orleans, La. 70119-2799
REFERENCES
1. Graber TM. Neumann B: Removable orthodontic appliances.
Philadelphia, 1977. W.B. Saunders Company.