What is the role of bite analysis in treatment planning in dentistry?

Bite Analysis in Dental Treatment Planning

Bite analysis plays a limited but specific role in orthodontic treatment planning, primarily for evaluating caries risk and posterior occlusion, while computerized occlusal force measurement can guide prosthetic and implant treatment decisions but lacks strong evidence for routine orthodontic use.

Role in Orthodontic Treatment Planning

Bitewing Radiographs

• Bitewing radiographs serve a dental diagnostic purpose rather than an orthodontic treatment planning function, as no studies demonstrate their contribution to orthodontic diagnosis or treatment planning 1.
• The indication for bitewings is primarily caries detection and periodontal assessment, not orthodontic evaluation 1.
• When orthodontic records are being obtained, bitewings should only be prescribed based on caries risk assessment, not as routine orthodontic documentation 1.

Clinical Occlusal Assessment

• Clinical examination of occlusion, combined with extra-oral and intra-oral photographs and dental casts, forms the foundation of orthodontic diagnosis before any radiographic analysis 1.
• For specific malocclusions like open bite, clinical diagnosis should be viewed in the context of skeletal and dental structure, with cephalometric analysis providing supplementary information 2.
• Accurate classification of vertical malocclusions (including open bite extending into premolar/molar regions) requires assessment of multiple etiologic factors including habits, airway obstruction, and skeletal growth patterns 2.

Role in Prosthetic and Implant Treatment Planning

Bite Force Measurement

• Bite force measurement can assist in treatment planning for tooth- and implant-supported restorations, as restoration damage may depend on resistance to loading conditions 3.
• Maximum bite forces reach up to 2,000 N, with higher forces in posterior versus anterior regions and sexual dimorphism present 3.
• For patients with elevated bite force magnitude, increase the number and diameter of implants, reduce occlusal tables buccolingually, and plan for lighter occlusal contacts 3.

Computerized Occlusal Analysis

• Computerized occlusal analysis systems (T-Scan) provide quantifiable force and time variance data from initial tooth contact to maximum intercuspation, offering advantages over conventional articulating paper 4.
• The Dental Prescale II and T-Scan measurements show significant positive correlation and are convertible using linear equations, allowing clinicians to compare results between systems 5.
• These digital methods evaluate treatment outcomes more objectively than traditional indicators, though their routine use remains limited in clinical practice 4, 5.

Evidence Quality and Limitations

Strength of Available Evidence

• The evidence for radiographic contributions to orthodontic treatment planning is graded as very low to low quality using GRADE methodology 1.
• A systematic review of 484 studies yielded only 17 studies meeting inclusion criteria, with considerable lack of high-quality scientific evidence 1.
• No randomized controlled trials exist examining the role of bite analysis specifically in orthodontic treatment planning 1.

Clinical Implications

• Radiation exposure carries health risks with no dose being completely risk-free, particularly in children, requiring justification for every radiographic examination 1.
• The diagnostic value of orthodontic radiographs remains debatable, with the minimum set of records for orthodontic diagnosis never solidly established in literature 1.
• Treatment decisions should follow the ALARA principle (as low as reasonably achievable) for radiation exposure 1.

Practical Clinical Algorithm

For Orthodontic Cases

1. Begin with clinical examination, photographs, and dental casts for initial diagnosis 1
2. Order orthopantomogram for evaluating root resorption, tooth anomalies, and treatment progress 1
3. Add lateral cephalogram only when skeletal analysis will influence extraction decisions or growth modification planning 1
4. Reserve bitewings exclusively for caries risk assessment, not orthodontic planning 1

For Prosthetic/Implant Cases

1. Measure bite force in patients requiring extensive restorations or implants, particularly in posterior regions 3
2. Use computerized occlusal analysis to quantify force distribution and timing when planning complex restorations 4
3. Adjust implant number, diameter, and occlusal design based on measured bite force magnitude 3
4. Consider endodontic status, as endodontically treated teeth show significantly increased bite force due to reduced proprioception 3

Common Pitfalls to Avoid

• Do not order bitewing radiographs as routine orthodontic records—they provide no orthodontic diagnostic value and expose patients to unnecessary radiation 1.
• Avoid relying solely on radiographic analysis without comprehensive clinical examination, as radiographs primarily confirm rather than establish orthodontic diagnoses 1.
• Do not assume bite force is uniform across the arch—posterior forces significantly exceed anterior forces, requiring different treatment planning approaches 3.
• Recognize that vertical growth completes last, so open bite treatment may appear successful initially but fail later, requiring long-term follow-up 2.