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

It is common for these patients to complain of sore muscles and occasionally have front teeth that are slightly loose, which is 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 over-eruption of the lower anteriors, orthodontic treatment that impinges on the pathway and is sometimes caused by restorative dentistry that isn't compatible with the patient's pathways of movement.

In order 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.


Commenter's Profile Image Julie Kwon
September 10th, 2013
I understand this principle: WHen I see pathway wear I need to either increase the OJ or the vertical/ decrease the OB. WHat I struggle with is knowing HOW MUCH OJ increase or Vertical increase I will need. When I refer to an orthodontist, what would my specific instructions or treatment goals be especially since many orthodontist simply level/ align and couple the anteriors. Finally, when I am correcting this restoratively -- I would use a custom anterior guide table, If you are doing this orthodontically does an anterior guide table assist you in any way?