CLINICAL PROCEDURES CRUCIAL TO COMPLETE DENTURE FABRICATION (FINALS)

Jaw relation

any relation or position

of the mandible to the maxilla.

maxillomandibular relationship

According to the Glossary of

Prosthodontic Terms, the term jaw relation is objectionable;

______ is recommended.

ORIENTATION RELATION

VERTICAL JAW RELATION

HORIZONTAL JAW RELATION

3 types of jaw relation:

Orientation relation

established as

references in the cranium.

Orientation relation

It is the relationship of the jaw to the TMJ or opening axis of the jaw.

face bow.

The opening axis can be located by using a_____

FACE BOW

A U-shaped frame, caliper-like device

1. Record the relationship of the jaws to

the opening axis of the TMJ.

2. Orient the casts in this same

relationship to the opening axis of

the articulator.

FACE BOW is used to: (2)

1. When balanced occlusion is desired.

2. When cusps form teeth are used.

3. When interocclusal check records are used.

4. When the occlusal vertical dimension is to be changed during teeth setting.

5. For diagnostic mounting and treatment

planning.

6. For making occlusal corrections after denture

processing.

6 INDICATIONS FOR FACE BOW USE:

1. ARBITRARY

2. KINEMATIC

2 CLASSIFICATION OF FACE BOW:

ARBITRARY

● Gives approximate values.

● Condylar rods placed

approximately over the

condyle.

● Fork attached to maxillary

occlusal rim.

● Approximately determines

the terminal hinge axis.

● Used for CD procedures.

KINEMATIC

● Fixed values.

● Condylar rods placed

accurately over the

condyles.

● Fork attached to

mandibular rim.

● Accurately determines the

terminal hinge axis.

● Used commonly for FPD or

RPD.

VERTICAL JAW RELATION

The distance between two selected anatomic or marked points, one on a fixed and one on a movable member.

VERTICAL JAW RELATION

It is the vertical measurement of the face between any two arbitrarily selected points conveniently located, one above and one below the mouth, usually in the midline.

A. Vertical Dimension at Rest (VDR)

B. Vertical Dimension at Occlusion (VDO)

C. Vertical Dimension at Other Position

3 TYPES OF VERTICAL RELATION/DIMENSION:

VERTICAL DIMENSION AT REST (VDR)

● when the mandible is in the physiologic rest position.

● Established by muscle and gravity.

● Used as a guide to the lost vertical dimension

at occlusion (VDO).

● Measured when the head is upright in position and not supported by the headrest.

PHYSIOLOGIC REST POSITION

Position of the mandible when all muscles that close and open the jaws are in a state of minimal tonic contraction, sufficient only to maintain posture.

VERTICAL DIMENSION AT OCCLUSION

(VDO)

● Established by the natural teeth when present and in occlusion.

● Established by the vertical height of two dentures/OCR in contact.

● Computed by the formula: VDO = VDR - FWS

(2–4 mm).

VDO = VDR - FWS

(2-4 mm).

VERTICAL DIMENSION AT OCCLUSION

(VDO)

Computed by the formula

INTEROCCLUSAL DISTANCE/FREEWAY SPACE (FWS)

● Space or gap between the upper and lower teeth when the mandible is in physiologic rest position.

● Usually 2–4 mm when observed at the position of the first premolars.

● is essential because it maintains the health of

periodontal tissue when teeth are present.

VERTICAL DIMENSION AT OTHER

POSITION

● No significance in CD construction.

● Vertical dimension when the mouth is half open or wide open.

● Increased trauma to the denture-bearing

areas.

● Increased lower facial height - face appears

long.

● Cheek biting.

● Difficulty in swallowing and speech.

● Pain and clicking in the TMJ.

● Stretching of the facial muscles.

● Loss of lip fullness.

● Obstruction in the opening of the Eustachian

tube due to the elevation of the soft palate,

tongue, and mandible - may affect hearing.

● Loss of muscle tone - reduces function of

muscles.

● Corners of the mouth turn down or droop.

10 CONSEQUENCES OF INCREASED VERTICAL DIMENSION:

1. Physiologic methods.

2. Mechanical methods.

2 METHODS OF DETERMINING

VERTICAL DIMENSION:

1. Physiologic Rest Position

2. Phonetics

3. Esthetics

4. Swallowing

5. Tactile Sense

6Patient Perceived Comfort

6 PHYSIOLOGIC METHODS:

Physiologic Rest Position

PHYSIOLOGIC METHOD

1. Swallow and relax

2. Niswonger's Method

great; small

PHYSIOLOGIC METHOD

Niswonger's Method

The distance between the

two marks is measured. A

difference of 2-4 mm when

VDO is subtracted from VDR.

⇢ If less than 2 mm, VD is probably too ____.

⇢ If greater than 4 mm, VD is

considered too ____.

m; ch, s, and j; thirty-three; f or v

PHYSIOLOGIC METHODS

Phonetics

○ Using "___" sound, presence of 2-4 mm space.

○ Observing the relationships of teeth during the production of ___,___,___ sounds (bring anterior teeth close together but no contact).

■ Presence of speaking space

of not more than 1 mm at the

anteriors.

○ Using "_____": enough space for the tip of the tongue to protrude between the anteriors.

○ Using "___ or v" sounds: maxillary incisal edge lightly contacts the lower lip.

small; great

PHYSIOLOGIC METHODS

Phonetics

Silverman's closest speaking space (1mm): the presence of space during the function of speech.

■ If speaking space is too large

- VD is considered too ____.

■ If speaking space is too small

- VD is probably too ____.

small; great

PHYSIOLOGIC METHODS

Swallowing

Presence of a very light contact at the beginning of the swallowing cycle.

■ If denture occlusion is

missing - VD may be too

____.

■ If there is difficulty - VD is

probably too ___.

Boos Bimeter.

PHYSIOLOGIC METHODS

Tactile Sense

A device that measures the

biting force. Maximum biting

force occurs at VDO.

Lytle's Method.

PHYSIOLOGIC METHODS

Tactile Sense

Using a central bearing plate

and pin.

Electromyography

PHYSIOLOGIC METHODS

Tactile Sense

Rest position determined by

recording minimal activity of

muscles of mastication.

1. Ridge Relation

2. Measurement of Former Denture

3. Pre-extraction Record

3 MECHANICAL METHODS

Ridge Relation

MECHANICAL METHOD:

- Incisive papilla to mandibular incisors: approximately 4 mm in natural dentition.

- Parallelism of ridges

4 mm ; Parallelism

MECHANICAL METHOD:

Ridge Relation

- Incisive papilla to mandibular incisors: approximately ______ mm in natural dentition.

- ____ of ridges

1. Profile Radiographs

2. Cast of Teeth in occlusion

3. Facial measurement

MECHANICAL METHODS:

3 Pre-extraction Record

Profile radiographs

MECHANICAL METHODS:

Pre-extraction Record

- have been used but cannot be considered adequate.

Cast of teeth in occlusion

MECHANICAL METHODS:

Pre-extraction Record

- give an indication of the amount of space required between the ridges for the size of artifcial teeth.

Facial measurement

MECHANICAL METHODS:

Pre-extraction Record

- use of Willis gauge.

HORIZONTAL JAW RELATION

- is the maxillomandibular relation in a horizontal plane

- Described as the relationship of mandible to maxilla in the anteroposterior direction

- Refers to the front-to-back, side-to-side relation of the mandible to the maxilla

maxillomandibular; horizontal

HORIZONTAL JAW RELATION

is the ________ relation in a _____plane

front-to-back, side-to-side

HORIZONTAL JAW RELATION

- Refers to the ______, ______ relation of the mandible to the maxilla

1. Centric Relation

2. Eccentric Relation

2 TYPES/CLASSIFICATION OF HORIZONTAL JAW RELATION

Centric Relation

TYPES/CLASSIFICATION OF HORIZONTAL JAW RELATION

the basic horizontal jaw relation.

Eccentric Relation

TYPES/CLASSIFICATION OF HORIZONTAL JAW RELATION

- deviation occurring from centric relation:

- Protrusive

- Lateral

- Protrusive

- Lateral

TYPES/CLASSIFICATION OF HORIZONTAL JAW RELATION

Eccentric Relation

- deviation occurring from centric relation: (2)

Centric Relation

CENTRIC RELATION & ECCENTRIC RELATION

The most retruded position of the mandible against the maxilla at the established vertical dimension

Eccentric Relation

CENTRIC RELATION & ECCENTRIC RELATION

Any relationship of the mandible to the maxilla other than centric relation.

eccentric relations

CENTRIC RELATION & ECCENTRIC RELATION

are recorded and used in complete dentures are protrusive right lateral and left lateral

Centric Relation

CENTRIC RELATION & CENTRIC OCCLUSION

It is usually defined by the position of the condyles, rather than the teeth

Centric Relation

CENTRIC RELATION & CENTRIC OCCLUSION

Bone to bone.

Centric Occlusion

CENTRIC RELATION & CENTRIC OCCLUSION

"The occlusion of opposing teeth when the mandible is in centric relation; this may or may not coincide with the maximal intercuspal position (MIP)." ■

- In complete denture: CR = CO = MIP.

CR = CO = MIP

CENTRIC RELATION & CENTRIC OCCLUSION

Centric Occlusion

- In complete denture: __ = __= ___.

maximum occlusal contact

CENTRIC RELATION & CENTRIC OCCLUSION

Centric Occlusion

The intercuspal position is the vertical and horizontal position of the mandible in which _____ ____ _____ occurs

coincide

CENTRIC RELATION & CENTRIC OCCLUSION

Centric Occlusion

In the denture wearer, the intercuspal and centric relation positions should ____

CR

SIGNIFICANCE OF CENTRIC RELATION

Artifcial teeth are best to occlude evenly at ____.

not pathogenic.

SIGNIFICANCE OF CENTRIC RELATION

Conducive to health - ______

denture instability; pain or discomfort

SIGNIFICANCE OF CENTRIC RELATION

If centric relation and centric occlusion do not coincide, it will result in ____ and ___ or ____

1. Passive Method

2. Active Method

METHODS OF RETRUDING THE MANDIBLE (2)

Passive Method

METHODS OF RETRUDING THE MANDIBLE

Dentist guides the mandible in terminal hinge axis movement.

Active Method

METHODS OF RETRUDING THE MANDIBLE

Patient responds to instruction by actively retruding the mandible

- Finger guidance

- Central bearing point.

- Stretch-relax exercises

- Tongue curling backward

- Swallowing

- Reclining the patient

- Palpation of temporal muscle

TECHNIQUES TO RETRUDE THE MANDIBLE (7)

- The Dawson Method (bimanual manipulation) produces reasonably good results (the method of choice).

- Giving instructions such as "Close together slowly on your back teeth."

- Ask the patient to curl the tongue to the back of the mouth and to touch the posterior border of the upper record base while closing.

- Protrude and retrude the mandible repeatedly while the patient holds a fnger lightly against the chin.

- Swallow and close - Disadvantage: patient can swallow to slight eccentric positions also.

METHODS OF REGISTRATION OF CENTRIC JAW RELATION

Dawson Method

METHODS OF REGISTRATION OF CENTRIC JAW RELATION

The _____ ____ (bimanual manipulation) produces reasonably good results (the method of choice)

"Close together slowly on your back teeth"

METHODS OF REGISTRATION OF CENTRIC JAW RELATION

Giving instructions such as "________."

curl ; back; posterior border; closing

METHODS OF REGISTRATION OF CENTRIC JAW RELATION

Ask the patient to ____ the tongue to the ____ of the mouth and to touch the _____ of the upper record base while _____.

Protrude and retrude; repeatedly

METHODS OF REGISTRATION OF CENTRIC JAW RELATION

____ and ____ the mandible ____ while the patient holds a finger lightly against the chin.

slight eccentric

METHODS OF REGISTRATION OF CENTRIC JAW RELATION

Swallow and close

Disadvantage: patient can swallow to _______ ____ positions also.

1. Recline the patient all the way back.

2. Stabilize the head.

3. Lift the patient's chin to slightly stretch the neck.

4. Gently position the four fngers of each hand on the lower border of the mandible.

5. Bring the thumbs together to form a C with each hand.

6. With a gentle touch, manipulate the jaw so it slowly hinges open and closed.

7. After the mandible feels like it is hinging freely and the condyles seem to be fully seated up in their fossae, it will be assumed that the mandible is in centric relation.

DAWSON METHOD (BIMANUAL MANIPULATION)

1. Static Method

2. Functional Method

3. Graphic Method

METHODS OF RECORDING CENTRIC RELATION (3)

Static Method

METHODS OF RECORDING CENTRIC RELATION

Placing the mandible in centric relation, then making a record of the two rims to each other

Minimal; recording bases; bone

METHODS OF RECORDING CENTRIC RELATION

Static Method

Advantage: _____ displacement of ____ in relation to the supporting ____

Functional Method

METHODS OF RECORDING CENTRIC RELATION

Involves functional activity or movement of the mandible at the time the record is made. ○ Includes:

- Chew-in technique by Needles, House, Essig, Paterson

- Swallowing

1. Chew-in tehnique

2. Swallowing

METHODS OF RECORDING CENTRIC RELATION

Functional Method

Includes: (2)

- _______ by Needles, House, Essig, Paterson

- _____

displacement; record base

METHODS OF RECORDING CENTRIC RELATION

Functional Method

Disadvantages:

Causes lateral and anteroposterior ______ of the ______

Graphic Method

METHODS OF RECORDING CENTRIC RELATION

Involves the use of intraoral or extraoral tracing devices, with a central bearing point secured to the record base

● Plaster (quick setting)

● Bite registration wax

● ZOE registration paste

● Elastomeric bite registration materials

● Warm staple wires

● Pins

6 RECORDING MEDIUM (MATERIALS USED IN RECORDING CR)