Pathway Wear

The wear this patient has on her lower anteriors is something I know you’ve all seen before. I bet if you look at the palatal surface of the upper front teeth, you’ll find wear patterns as well.

It’s common for these patients to complain of sore muscles, and they occasionally have front teeth that are slightly loose (also known as fremitus). These signs are indications of a restricted pathway to movement of the mandible; there simply isn’t enough room for the lower jaw to move freely within the confines of the upper arch.

There are many things that can result in a lack of excess overjet. It can be caused by overeruption of the lower anteriors, orthodontic treatment that impinges on the pathway, or sometimes restorative dentistry that isn’t compatible with the patient’s pathways of movement.

To restore harmony to the system, overjet must be increased. That may mean orthodontic treatment, new restorative dentistry, opening the vertical dimension of occlusion, or reshaping teeth to solve the lack of overjet. To diminish overjet, the upper anteriors must be proclined, the lower anteriors retroclined, or the anterior guidance needs to be shallowed by opening the bite.