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Dr. Sanjay AroraDr. Sanjay Arora A regular feature is being brought to the readers of Famdent, where you can ask questions to Dr. Sanjay Arora, an eminent Implantologist, Endodontist, Occlusion specialist (eminent Neuro Muscular Dentist and a Cosmetologist. His clinic Alchemist Dental and Cosmetic Research Institute redefines “The state of the art” in India.

A trainer, thinker and an ace clinician acclaimed by international researchers, Dr. Sanjay Arora will try solving questions in these areas at a very basic level of understanding for Famdent readers. Send your queries to or facebook page “Alchemist Academy for Dental Education”, a site for postgraduate level participation into dental discussions and publications. The focus of this article would be NEW TECHNOLOGY IN DENTISTRY.

Dr. Rashida AliDr. Rashida Ali is a renowned Cosmetic Dentist, heading a leading chain of dental centres, DENTZZ. Apart from Cosmetics, Botox and implants, her most important area of focus remains- Dental Occlusion, Neuro Muscular Dentistry and Cranio Sacral Dentistry. She has fast emerged as a sought after keynote speaker on the subject. TMD, today being recognised as the most important disorder, in causation of several body disorders, is mastered by her. This places her formidably amongst the best “Full Mouth Rehabilitation Dentist” in the country.


Bruxism refers to grinding of teeth. In bruxism there is spontaneous excessive contraction of the masticatory muscles in a way that ultimately results in grinding of the teeth.

Some people may refer bruxism as clenching of teeth but according to me clenching should not be confused with bruxism as it is a separate disease.

Most of the bruxism patients experience grinding of teeth at night time(night grinders) but few patients may also experience day time teeth grinding.

Most tenderness and tiredness in the jaw muscles is felt after waking up from sleep in the morning.

Sometimes itmay go unnoticed. It may turn out to be a terrifying condition for some people. Sometimes it can be so debilitating that it can make the person go crazy and the sufferer may even fall into depression.To make the condition worse for the patient, most doctors and dentist are not able to exactly diagnose the exact cause of the disease and they just end up relating the disease to stress. At times this condition can put the patient into so much stress and depression that the patient may even develop suicidal tendency.


  • Tooth sensitivity
  • Food impaction
  • Neck and upper shoulder pains
  • TMJD
  • Sleep Apnea (some believe sleep apnea is the etiology behind bruxism and vice versa).


  • Exercises (hardly found beneficial in bruxism patients)
  • Cold and hot fomentations
  • Relaxing baths
  • Splints (innumerable types)
  • Psychological therapies
  • Long acting lateral Pterygoid blocks
  • There are many other treatment options also proposed but our aim is not to dig out the facts that are already known.


Few facts that may change your perception related to bruxism-

  • No other body muscle generally bruxes, except when exposed to extraordinary circumstances, like a person at gun point pressure, made to hold a very heavy item with his/her hand stretched for a lengthy period of time. It is observed that the arm muscles continue to contract even after the person is no longer holding the weight.
  • Have you ever given a thought that how come these bruxism patients remained perfectly normal up to certain age and then gradually developed this disease? Why was this condition not noticed earlier since childhood? Though some argue that even children tend to grind usually while sleeping.
  • I remember a seminar held at Mumbai,which I happened to attend almost 13 years ago, in which a leading Implantologist, spoke about hisworries related to his daughter suffering from habit of bruxism. I told him, probably she must be under 13 and he looked at me visibly surprised. The reason why children below 13 years of age bruxes is that
  • Bruxism is believed to be an involuntary contraction of muscle that occurs mostly at night (though in some it may occur even during daytime) due to relaxation of muscles after overwork. It is observed that people having bruxism, an action that is believed to be involuntary and experienced mostly at night time due to relaxation of muscles and also involves production of loud crackling sound that can be heard from even a few feet distance, can be produced voluntarily by a bruxer during the daytime easily but a non-bruxer fails to do the same voluntarily during daytime .F or example, if anyone can shake his hand unconsciously, so will be able to do the same even voluntarily. Then don’t you agree that it can be done in case of bruxism as well?

If you have really understood this logic, then you would have found the answer by now.

(Author once attempted to put it on Wikipedia, the moderator rejected it saying, it’s not published in peer reviewed journal but a non-peer reviewed. Read the note above.)

Consider situation 1: Doctor, my child goes clickety clacking her teeth in the night. What do I do? A common complaint of a concerned mother. Answer by the doctor- all of the above. Some books even say “Please take her to a physician or a gastroenterologist.”

Doctor, my child goes clickety clacking her teeth in the night. What do I do?

Now You Can’t

If you have this relation both anteriorly and laterally during lateral excursion, with zero overjet throughout the 3mm overbite and 17 mm of Shimbashi number- You can’t brux.

Now You Can

If you have Canines with lost tips, or misplaced Canines that don’t tip against each other during lateral excursion, due to wear of tip or palatal surface, along with other factors listed on left- You brux.

The complete cure to bruxism is hidden in the above shown pictures and explanations-

  • Patients with misplaced canine- bring back canines to correct position either orthodontically or tip them with a crown (in case of slight misplacement).
  • Most cases requirecapping or crowning on all theanteriorteeth or sometimesonly the canine teeth in order to achieve the right pressures in the glide which is not so easily achievable with Orthodontics.
  • Anterior teeth are angulated teeth anatomically which basically functions to take the angular loads. Bruxing loads are angular in direction and must be handled by anterior teeth, mostly the Canines. Crown lengthening of only the canines by restoring the tips of the canines is mostly not recommended as it leads to unaesthetic facial smile along with concomitant supraeruption of other remaining anterior teeth.
  • Ideally, upper and lower Canine complex must be shifted orthodontically towards the midline just a little, before capping them. The purpose of doing this is to allow for an early disclusion of canine. The reason for allowing early canine disclusion is that, normally upper palatal canine surface of canine abrades along the buccal surface of lower canine during disclusion. Gradually lower canines into this gap created by abrasion thereby leaving no trace of space that must be recaptured. This is further facilitated by the tongue pressure. The same can be achieved marginally for anteriors as well.
  • If patient had an overjet or an inadequate overbite or an openbite or misplaced canines, patient must be warned of experiencing teeth entangling for few months, as neural reconnections take some time to get adjusted to the new biting pattern. Most patients usually get accustomed to new bite in less than 6 months. Patient must be advised to have conscious eating for few months until neural reconnection takes place to avoid breakage of ceramic material of the crowns.
  • In majority of the patients bruxing stops almost immediately after doing these adjustments. Though some patients do require an extreme guidance control, through the use of T-Scan, BioJVA and BioEMG.
  • According to the author, patients having greater posterior attrition, with Arora’s number* lesser by 2 mm of the normal, FMR or preferably Cranio-Sacral rehabilitation bite is strongly indicated. This takes care of Yaw, Pitch and roll. This must accompany loss of the vertical dimension. Vertical dimension must be guided by Arora’s Shimbashi number or preferably Arora’s modified Shimbashi number*

Misplaced Canine in excursion: the tangential loads are being taken by the tipped 14, leading to abfraction lesion, misconstrued as abrasion and gum and bone recession and eventual fate of becoming mobile.

Extreme excursion shows how 14 is doomed because it’s playing for long the role of canine, which was supposed to do this dirty work. That’s why canine was designed the longest; most curved and placed at the most curved part of the arch. This arrangement continues to push or place 44 lingually.

Anterior and lateral grinding both possible, as there is no stop for grinding. Hence Dr. Sanjay Arora recommends Zero Overjet of the type of “Zero” called “Arora’s Zero Overjet”- where entire 3mm of proposed “Arora’s Overbite” is having Zero gap between the Upper and Lower Anteriors, with Pressures as recommended by “Arora’s Anterior Guidance” Principles, which requires a T-scan, BioEMG and BioJVA

Canine Guidance under correction. The lower canine distal slope meets the upper canine mesial slope during excursion. Inspite of adjustment not enough guidance.

Esthetics was compromised to slightly build the slopes mentioned above to provide required guidance in this Bruxer.



  • “Arora’s Dental overjet” refers to the “minimum horizontal distance between buccal of lower and palatal of upper incisors or their projections as in openbite cases”.
  • This dictates the extent to which mandibular teeth need to move forward and laterally before Disclusion starts. This is contrary to authors like Dawson, who state Overjet as the horizontal distance between upper incisor edge and lower buccal surface and other state it between lower incisal edge and upper palatal surface, as this fall flats if lower incisors are tilted lingually. Author therefore recommends “Zero Overjet” as ideal to facilitate immediate disclusion. He further goes on to describe “What kind of Zero”. He states it to be “Zero” throughout the 3mm overbite that he recommends, at an “Arora’s modified Shimbashi” of 17 mm, more aptly described below as 20-3(Read 20 minus 3mm), as the anterior Vertical Dimension” and with pressure recommendations as described below in “Arora’s Anterior Guidance”.


  • This is recommended to be 2.5-3mm, by Dr. Sanjay Arora. The rationale being, that the way to check anterior guidance by asking one to protrude and check Disclusion is absolutely wrong as this motion is never done in nature. It’s the incursion where anterior guidance plays a role (parameters described in “Arora’s Anterior Guidance”)and not excursion which anyways becomes zero because of zero overjet recommended by Arora. So this is in conjunction and not independent of Overjet, to be more specific zero (unlike literature which agrees to 2mm overjet, with a wrong definition of overjet) throughout the overbite. Most people will argue that 1.5 mm to 2 mm is enough to cause posterior disentanglement, but this is not enough to provide anterior incursive guidance.
  • Hence its strongly recommended, that the entire thing be described as “Arora’s Anterior Relation”, where Arora’s -Overjet, Type of Overjet, Overbite, Anterior guidance parameters described at the Arora’s modified Anterior Shimbashi number and “Arora’s posterior Vertical Dimension” number, with 10-20 degree proclination to the vertical passing roughly through the center of upper & lower anteriors, are all interconnected and not independent of each other.


  • Under the above mentioned “Arora’s Anterior Relation”, the broad parameters set by Dr. Robert Kerstein, described by me further as of 100% load on anteriors on biting, reducing to less than 2%, in less than 0.2 seconds, with anteriors contacting first, as witnessed on T-scan, may be accepted as the new Definition of Anterior Guidance. It takes into account incursion only. Excursion is automatically taken care of.
  • In the light of above, “Arora’s modified Shimbashi”,can be defined as vertical distance between CE junction of Incisors measured on CBCT in occlusion, or visibly if its exposed, which should be 17, plus or minus 0.5mm, with 3 mm overbite (Arora’s Overbite in context to Arora’s Anterior relation). They cannot be described individually. Hence 20-3 at (AAR), Arora’s Anterior Relation. 20 is the average length of incisors edge to edge, 3mm is the overlap, bring it to 17/3 where 17mm denotes the vertical length of Incisor complex in occlusion and 3mm the overlap. Both are critical.


  • It is another adjunct, needs a CBCT-in Occlusion, to measure.
  • Author suggests to go for FBCT, with a small FOV, which is the least exposure one can do to a patient. Posterior VD is calculated by taking into account a fairly stable landmark – that is floor of the pulp chamber, which hardly changes less than 0.1 mm during life time.
  • I propose floor of the pulp chamber of posterior upper to lower, which is a reasonably stable land mark in 1:1 ratio OPG in absolutely interdigitated position to be taken, and at molar cusp tip to pulpal floor a very stable landmark is 8.8-9.2mm. Multiplied by 2 is 18mm. -2 mm overlap is 16 mm. So posterior VD in first molar(16-17),2nd molar (14.5-16) (will call it Arora's posterior VD number as I believe it’s given for the first time)(patent filed).
  • These are stable landmarks for posterior VD and one need not arbitrarily raise the bite.

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