Reframing Anterior Coupling: Why Mandibular Position Matters in Implant Dentistry

Written by Dr. Agatha Bis

Moving Beyond “Long Centric”

Traditional implant education has long focused on anterior coupling and mechanical loading. The recommended strategy is to use long centric to minimize ceramic fractures. But this approach treats symptoms, not causes. The true etiology lies in undiagnosed mandibular retrusion.

The Role of Mandibular Retrusion

When implants are restored in a retruded mandibular position, neuromuscular systems continue to drive the mandible forward toward its physiologic state. This constant tension results in:

• Fractures of anterior restorations

• TMJ dysfunction

• Chronic muscular strain

• Progressive occlusal instability

Implants exacerbate this because of their lack of proprioceptive feedback. Without periodontal ligaments to guide function, forces are neither absorbed nor modulated, creating destructive stress patterns.

Clinical Presentation

Patients restored in retrusion often present with:

• Frequent anterior ceramic fractures

• Difficulty achieving stable occlusion

• Chronic muscle tension

• TMJ pain and degeneration

These problems are commonly misattributed to anterior coupling mechanics rather than the true root cause of malposition.

The BiteAlign™ Approach

A paradigm shift is required. Mandibular position should be evaluated and optimized prior to implant placement. BiteAlign™ therapy allows the mandible to be repositioned into an optimal physiologic position before surgical or restorative phases. This correction prevents destructive forces and improves long-term outcomes.

Dentists, be part of our Study Club or explore TMJ Essentials Level 1 to learn how to integrate airway and mandibular position into implant planning for more predictable results.