B I T E M

General info in boldClinical text in regular fontTechnical text in italics

Not often does a new idea spring up and immediately finds its role in almost every facet of the dental field. Such versatility can only be attributed to a material with both controllable and adjustable properties: BITEM.

BITEM is the trade name for a new acrylic and it is the acronym for Biocompatible Intra-oral Thermo Elastic Material.

The initial concept, an invention of Bob Huybrechts, an RDTfrom Newmarket, Ontario, is quite simple and yet yields so many unprecedented applications, they are hard to ignore:Critical parts of dental appliances are created to soften in hot water and can be fashioned to the contours of the oral cavity.

The innovation to this patented technology, lies in controlling the mixture of the two liquid monomers. Their proportion determines an infinite range of BITEM consistencies: from cushiony soft, to as hard as denture base.

1

Beyond that, after polymerization, BITEM always remains “thermo-elastic”, which means it may be heated in water to soften, in order to be adapted to soft tissues and teeth, over and over again. As mentioned, BITEM has dual qualities: its rigidity is controllable during mixing and it remains thermo-adjustable ever after.Each appliance therefore should be tailored exactly to the prerequisites of the case.

Following are some examples of BITEM applications of various rigidities, incorporated into important areas of an acrylic appliance, serving different purposes:

- to adapt to tissues or teeth (postdam / ortho spring retainers)

- to utilize existing undercuts (submandibular fossa / over large maxillary tuberosity)

- to replace clasps or gasket clasps on partials or ortho appliances

- as a heat adjustable reline on partials or difficult lowers - utilized to install pre-manufactured BITEM-LOCK

sublingual stabilizer wings.- multiple applications to simplify orthodontics.- as an absorbent stressbreaker on rigid attachments- “thermo-grip” retention for overdentures.

2

These are just a few examples of the more than 50 (fifty) applications, presently listed for BITEM.Unfortunately, we are so accustomed to “single purpose” products, it takes some exploring to grasp all the potential advantages of BITEM. Its multi-purpose functions, simultaneous with its thermo-flexible properties open up a whole new world for the creative mind.

FULL DENTURES

Postdam

Consider full upper and lower dentures: postdams are always arbitrary; would it have any merit to create an adjustable postdam? Once added to an upper denture, the postdam can be heated in hot water and massaged upwards out of the mouth, then, while still warm, inserted and pressed in place to conform to the palatal bone. There isn’t a better way to establish a perfect palatal seal and if not done right the first time, it can be done over again.

a BITEM postdam

3

This adjustability can be extended to include the Hamular notch regions, where stretched muscles sometimes cause open areas on the finished denture.

Lingual Flanges

Any “undercut” can now be utilized rather than avoided and often become part of the solution instead of the problem.Not least on a full lower denture, where the lingual posterior flange has never properly utilized the submandibular undercut to mechanically stabilize the denture. BITEM gives the patient this option.

Simply immerse the extended flanges in warm water for about 10 seconds, then, freehand, quickly open both flanges towards each other, insert the denture and with both index fingers, press the lingual flanges into the submandibular undercuts, as far as comfortably possible.

a lower denture with BITEM flanges

For the same reason as on the upper, the adjustable portion can include the pterygo mandibular notch region.

4

Other useful undercuts sometimes occur in the alveolar ridge or in the buccal region of the upper tuberosities.

BITEM, on the other hand, can also be used to fit over a taurus or any other anomaly of the soft tissues and it makes fitting immediate dentures, or post-operative appliances so much easier.By warming the adjustable portion, the practitioner can shorten the periphery, where necessary, by cutting with small scissors.

Relines

“Thermo Relines” are a major component of this new idea: can you imagine having the luxury to simply heat the denture and re-adjust the fit in seconds? And if not satisfactory, it can be done again. The proportion of the two liquids controls the rigidity of the reline, from soft to hard and the operator has to determine the appropriate consistency needed for the case at hand.

On upper dentures, only the ridges would be relined, not the palatal area.

5

Thermo-relining the saddle areas on a partial denture, would assist in adjusting the fit of the appliance as it “settles in”.

Sublingual Wings

On lower dentures, where there is lots of bone resorption and insufficient undercut below the mylohyoid eminence, another solution is possible: BITEM-LOCK sublingual stabilizer wings, horizontally attached to the lingual aspects. These wings are pre-manufactured, easy to install and provide unsurpassed comfort, again because of their inherent thermo-adjustable properties.

The BITEM-LOCK wings, are installed in 7mm wide vertical slots, on the lingual flanges of a lower denture, which allows the practitioner to heat the denture and with a dull instrument, move the wings up or down by 2mm either way.The final thermo-adjustments for the patient can now be done at a lower temperature, by closing the mouth and swallowing with the tongue down three or four times. This procedure can be repeated until the desired level of comfort is reached.

6

Polishing BITEM-LOCKS is a lot easier when the wings are heated and flattened completely against the lingual wall, then cooled in cold water. By soaking the denture in hot water afterwards, the wings will return to their original position.

Wings can be easily made smaller, by heating and curving the larger end inward and then cutting off the excess.

Patient management is the primary practitioner’s responsibility: it is up to the practitioner to instruct the patient and to delegate only those functions, deemed necessary for the well-being of the patient.

All BITEM applications can be performed in either heat cure or self cure. To achieve the best results, same as for acrylics in general, heat cure is always recommended over self cure, because it produces a more complete and stable polymerization, giving the appliance a more impervious surface and therefore a longer lifespan.

PARTIAL DENTURES

Partial dentures are all acrylic using the “double packing” method. They require a very different design: we are not looking for the conventional buccal undercuts to accommodate springy metal clasps, instead, BITEM buccal clasps are to be kept short, just to brace the abutments, while a softer mix of BITEM is used to create mesial and distal retention in the interproximal undercuts.

7

This new method of retention uses invisible friction. Internal clasps are incorporated into the major connector and become an integral part of the partial denture. Less breakage, superior esthetics and no metal required are three great advantages.

Since there is usually more interproximal than buccal undercut, the ideal amount of retention can be established. Sometimes lingual retention can be engaged to keep the design as simple and as effective as possibleAs an option, the softer interproximal material could be added after the denture base and the buccal clasps are processed, using the self cure BITEM and a duplicate model to establish the ideal amount of retention.

Buccal clasps are used in the posterior regions, only when necessary, which immediately increases the esthetics of any partial denture.

Lingual aprons can also be thermo-adjustable and this is particularly desirable when lingual retention is gained in the same

8

area with a softer consistency, adding another option to control fit and retention.

A great advantage is that all along, the patient can fine-tune the pressure of the clasp on the tooth, simply by warming and manipulating the clasp. Such control, directly affecting their own level of comfort, has never been extended to patients before..(drawing or photograph of a BITEM clasp)

On the topic of clasps, it is always more esthetical to keep them hidden, but in cases where they are visible, carefully roughen or lightly pencilblast the inside of the BITEM clasps, so the light refraction through the clear acrylic will not result in a “black line effect”, while still picking up the tooth colour.

Free-standing teeth are excellent candidates to receive BITEM gasket clasps. These clasps, surrounding the tooth entirely, are very strength-effective, particularly when the bonding to the denture base is chemically cross-linked.To increase the adjustability it is possible to layer BITEM gasket clasps in more than one rigidity, going from the softest round layer against the tooth, gradually to harder ones, joining the denture base. This can be done in one “double-packing” session.

9

a BITEM gasket clasp

Layering BITEM in different rigidities is advantageous in other applications as well: for example on the lingual flanges of a lower denture, the inside portion could be softer, while the outside shell remains harder and highly polishable.

It is of paramount clinical importance that in the design of all acrylic partial dentures, sufficient relief is given to all the gums adjacent to or surrounding the teeth, to avoid impingement and future periodontal problems.

The all-acrylic partial can be designed to have a continuous peripheral roll, similar to a full denture, consisting of 3mm BITEM straps connecting the pink partial flanges. Such partial denture is very strong and seldom needs clasps or any other retention, as it gains suction and friction by design.(Drawing or photograph of a continuous strap partial denture)

A new and interesting concept lies in the thermo-adjustability of partial denture BITEM rests. Whether they can be integrated in a design, without interfering with the bite, or

10

whether they require clinical preparation, their adjustability remains a unique feature.Prepared occluso-proximal rests to receive BITEM acrylic require a vertical wedge shape of at least 1.5 mm deep and 1 mm width at the occlusal surface.

This more patient-friendly partial is far superior in esthetics, never scratches the tooth enamel and its thermo- adjustable qualities enable the wearer to control the pressure and the tightness at all times.

When an appliance is designed to be retained using genuine undercuts, it is necessary for the patient to warm the denture before each insertion (mostly hot tapwater is sufficient) and each removal, by swishing around warm water in the mouth .

The end-result is a sophisticated partial denture appliance: a challenge for the skillful technician to construct and yet so easy to use by the patient.

If the use of metal is indicated, the framework can often still be designed passively, with BITEM clasps on the abutment teeth. Furthermore, it is technically possible to utilize a good metal-bonding interface and connect BITEM to metal. Imagine all the novel designs made possible with this technique!

To complete the circle of versatility, BITEM can be directly bonded to natural teeth and open up another series of unprecedented applications, useful in orthodontics, for space maintainers, Maryland bridges and possibly other temporary situations.

Great time saving features:

11

- a broken cast clasp is easily replaced by attaching BITEM to the surrounding acrylic and extruding the material over the abutment tooth.

- some portions, like postdams or lingual flanges, can be added chairside, because small discrepancies will be eliminated with the final fit. - often hard splints need grinding to prevent rocking, but a 2mm thermo-adjustable strap in the middle of the arch guarantees a fast and a good fit.

- any appliance that is too loose can be made more retentive by adding a softer BITEM into the interproximal areas.- using heat-adjustable acrylic on the lingual and buccal anterior pads of a full spring retainer, the orthodontist could remedy any situation, chairside, in seconds, rather than returning the appliance for correction.

- imbedding the lower posterior teeth in a layer of BITEM, will create an auto-adjustable bite relationship, whereby porcelain denture teeth, for example, do not need grinding on the enamel.

- to produce a stressbreaker on a rigid dove-tail attachment, cast the male portion with a retentive extention, to fit in a soft box of BITEM, hidden below the teeth of a partial denture.

- the capability to control the rigidity of the material, allows gradual loading of implants.

- once the implants are totally integrated, overdentures are made to release only with warm water, giving the patient security and peace of mind

12

In the interest of space, there are a number of applications that cannot be explained in detail, but will give the reader food for thought:Virginia partials, retention on TMJ appliances, pre-formed bite registrations, pre-formed vacu-forming sheets, thermo-adjustable temporary crowns or bridges, buccal wings and lip pads on Frankel appliance, over unparallel implants or abutments, to imbed female attachment in denture base, etc...

PROPERTIES

BITEM is a cross-linked clear acrylic denture material, guaranteed to create a perfect chemical bond with all other acrylics. It is available in heat cure and in self cure.

The self cure is polymerized in a pressure cooker in lukewarm water at 20 to 25 psi. Heat cure is cured in conjunction with pink denture base and can be done either in water, dry or in the microwave, following the manufacturer’s instructions.

It is noteworthy that no special equipment is required to incorporate the BITEM System into any practise. Moreover, handling the material is all but routine for an experienced operator, but it is recommended to follow the instructions closely until a “feel“ for the material has been developed.

The directions for use are comprehensive and measured in drops, which makes it easy to follow and minimizes waste of material.The suggested schedule for mixing the two monomer liquids contains a blank column, in which the operator can adjust the rigidity of BITEM to their own preference and experience. The more liquid B is added to the mixture, the more rigid the end result will be.

13

Since there is an infinite range of available rigidities, it is the responsibility of the dental team to determine and understand the optimum requirements for each case. Experience and good communication should facilitate the judgment of the operator(s), to obtain the most appropriate result. More than any other system, BITEM appeals to the intelligence and the obligation of the professional to carefully consider all the variables involved : 1. the correct mixture of the liquids 2. the thickness of the extension(s) 3. the leverage which allows movement 4. the temperature necessary to adjust 5. the timing during the adjustments, etc

Polishing BITEM acrylic is not different from regular denture base acrylic, except when venturing into the softer applications, where more caution and cryogenics are recommended. Than, similar to soft reline materials, BITEM can be polished and high-shined after freezing for 15 to 20 minutes. This flattens the surface molecules and produces a much more impervious surface.

CONCLUSION

Any dental professional, by reading this description, can surely think of a few instances, where the BITEM system would have been rather useful and as one develops a further affinity for such applications, new ideas will occur regularly.

14

Multi-purpose BITEM harbours a myriad of creative solutions for all kinds of problems, but like with all new ideas, it will take some time to unlock all its applications and to fully explore its further ramifications.

For now, some 50 applications will readily add a new dimension to the scope of your skills and will increase the level of service to your clients. Anyone who discovers other uses for BITEM is welcome to contact the manufacturer, so that new ideas can be added to the existing list and shared with colleagues all over the world.

Ultimately, BITEM is going to benefit the comfort level and the health of the dental patient, while easing the duty of the professional.This new material will mark a significant contribution to dentistry and to the world of dental technology.

________________________________________

15

BITEM Applications:

1. postdam on upper denture

2. lingual flanges on lower denture

3. adjustable over taurus

4. adjustable pterygo mandibular notch

5. adjustable Hamular notch

6. Virginia partials

7. to adjust a functional pink triangular papilla

8. large periphery on immediate dentures

9. any post-operative section

10. buccal grip on large tuberosities

16

11. any undercut on alveolar ridge

12. full lower reline

13. reline on ridge of a full upper

14. partial denture saddle reline

15.pre-manufactured BITEM-LOCK sublingual wings

16.to attach BITEM-LOCK sublingual wings

17.clasps on partial dentures

18.gasket clasps on single teeth

19. lingual retention on thumb plate

20.strap in middle of palate, fold into undercut

21.retention in interproximal undercuts

22.continuous periphery strap on partial dentures

23.buccal peripheral wing into tissue undercut

24. adjustable lingual apron

25. adjustable (prepared) rest

26. retention flap on TMJ appliances

27. folding straps on obturators

28. gum additions on bridgework

29. sheets for vacu-forming

30. pre-made temporary crowns

31. pre-made forms for wax-up

32. special supplemental devices

33. strap to prevent rocking splints

34. adjustable anterior teeth

35. auto-adjustable posteriors

36. pre-formed bite registrations

37. stressbreaker to rigid attachment

38. to imbed female ball attachment

39. to thermo-release overdentures

40. wings on Frankel appliance

41. anterior pads on spring retainer

42. to add retention to loose partial

43. to layer in different rigidities

17

44. shock absorber for implants

45. bond to metal with medium interface

46. bond to natural teeth

47. replace broken cast clasp

48. repair difficult conventional break

49. a doubtful repair can be adjusted

50. over unparallel abutments/implants

51. as a space maintainer

52. compressed, to replace ortho springs

53. short-term bridgework

54. thin sheets to protect perio-pack

18