17 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001
Prost het i c Dent i st ry
The Biofunctional Prosthetic System (BPS) A new approach in removable denture prosthetics Dr. O. He 1 - Dr. P. Mariani 2 1- Olivier He. Vice-Dean and Lecturer, Dental Clinic Htel-Dieu, University Paris VII Denis Diderot, rue Lincoln, F-75008 Paris 2- Paul Mariani. University Professor, Dental Faculty Marseilles, Department for Dental Research and Education, Centre Gaston Berger, 19, boule- vard Mireille-Lauze, F-13010 Marseilles I N T R O D U C T I O N The treatment of edentulous patients fre- quently goes hand in hand with a number of clinical and technical problems. According to the authors Olivier He and Paul Mariani, the BPS system, developed by Ivoclar under the supervision of Professor U. Stttgen (University Dssel- dorf), represents an efficient approach to the prosthetic treatment of edentulous and partially edentulous patients. As this publication will show, the Stratos 200 articulator is a decisive component of the BPS system. Given the fact that the design of the articulator is based on anatomic and geometric concepts, which will be described in detail by our authors, the Stratos 200 permits the fabrication of dentures by means of the template tech- nique. After the comprehensive descrip- tion of the mode of function of the articu- lator, the working steps involved in setting up denture teeth will be explained in detail. INDICES: removable denture prosthetics, BPS complete denture prosthetics external auditory meatus Campers plane occlusal plane Fig. 1: Orientation of the occlusal plane in relation to the different Camper's planes (depending on the selection of the posterior reference point) 1: upper position; 2: central position; 3: lower position). 18 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001 Prost het i c Dent i st ry The Stratos 200 articulator T h e g e o me t r i c c o n c e p t The Biofunctional Prosthetic System (BPS) is based on a logical concept for the treatment of edentulous and partial- ly edentulous patients. The correspond- ing therapy concept combines impor- tant treatment steps and provides both clinicians and dental technicians with an exact and logical method. Today, the use of clinical protocols and simple, reliable treatment methods that can be easily adjusted to the needs of the majority of the patients is gaining in importance. The golden standard developed overseas complies with the above finding. In the field of complete denture pros- thetics, the BPS System and the Stratos 200 articulator, combined with a specif- ic technique to setup denture teeth, strive to meet these requirements as well. This Arcon type articulator has been developed by Ivoclar in cooperation of Professor Stttgen (University Dsseldorf). It is a multifuctional articu- lator, which means that it is suitable for the two main concepts of analysis and reproduction of the jaw movements, i.e. the geometric concept and the anatom- ic concept. The Stratos 200 is based on four main geometric conditions, which will be described below in the sequence of their appearance. 1. Camper's plane Camper defined this reference plane during excavations conducted in the southwest of Spain in 1780. When the skulls found in the course of the exca- vation were placed in a straight line on a table, all of them resting on the occlusal surfaces of the maxillary teeth, Camper identified a plane with the external audi- tory meatus and the sides of the nose as reference points, which ran parallel to the table surface and thus parallel to the occlusal plane. In the clinical practice, this plane, which runs through the ante- rior nasal concha and the tragus, was and still is used as a reference plane in prosthetics. The determination of the anterior refer- ence point is relatively easy and reliable. However, this is not valid for the tragus. There are three possibilities: should the upper edge, the centre, or the lower part of the tragus be used as the refer- ence point? The selection of this angle is important as far as the final alignment of the occlusal plane is concerned (Fig. 1, Table 1). According to the investigations of Karkaris et al., it seems to be preferable to take the lower part of the tragus as the reference point. Occlusal Average Standard Range plane value deviation Camper 1 5.25 3.35 -2.0 to 11.50 Camper 2 2.75 3.64 -5.0 to 9.0 Camper 3 0.50 3.55 -8.0 to 6.5 Table 1: Average angles between the different Camper's planes and the occlusal plane [2]. Fig. 2: The Balkwill angle is formed by the occlusal plane and the straight line that connects the incisal point with the articular processes. Fig. 3: The posterior vertical dimension of occlusion equals L sin (L = dis- tance between the hinge axis and the incisal point; = Balkwill angle accord- ing to Orthlieb). hinge axis occlusal plane reference plane Balkwill angle Fig. 4: Bonwill triangle. An equilateral triangle between the incisal point (A) and the upper edges of the articular processes (B-C). The angle LAD corre- sponds with the Balkwill angle. reference plane Fig. 5 Geometric relationship between the Bonwill triangle and the Christensen angle. 2. Balkwill angle The Balkwill angle was first described on the occasion of a congress in London in 1866. It corresponds with the angle pro- duced by the mandibular occlusal plane of dentulous patients and a second plane, which runs through the incisal point and the two upper edges of the articular processes (Fig. 2). According to the author, the corresponding value ranges from 22 to 30. This angle corresponds with the values suggested by Khler (21 to 22), Hart (20) and Bergstrm (18) as the aver- age, with the extreme values ranging from 12 to 24. For the Stratos 200 articulator, the Balkwill angle was defined at 15, which is rather low com- pared with the above values. In this context, it has to be pointed out that the Balkwill angle is directly related to the distance between the occlusal plane and the condylar axis of rotation. The importance of this distance has 19 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001 Prost het i c Dent i st ry T h e a n a t o mi c c o n c e p t been proven by Orthlieb [7] (Fig. 3). According to this author, the bending radius of the compensation curve would depend on the Balkwill angle. 3. Bonwill triangle After approximately 6000 measure- ments of mandibles and 4000 measure- ments conducted on living individuals, Bonwill found out that the triangle formed between the incisal point and the upper edges of the two articular processes [8] is an equilateral triangle with a side length of 104 mm (Fig. 4). Other authors, however, have chal- lenged these results, particularly the measurements of skulls showing devia- tions of up to 10 mm. Bonwill's measure (104 mm), however, is still a universally accepted value. In the articulator in question, this value was defined at 108 mm. 4. Monson template [9] The template theory attributed to Monson is based on the theory of the Bonwill triangle. According to this theo- ry, the mandibular cusps are arranged on a part of a circle that measures 10.4 cm. Its centre is located on the crista gali apophysis. However, the above circle must not be confused with the curve of Spee [10]. s 110 mm 100 mm 90 mm () = 110 x sin 60 = 100 x sin 60 = 90 x sin 60 15 0.79 3.64 0.79 30 2.26 2.50 2.78 45 2.26 2.50 2.78 50 3.20 3.53 3.94 / 30 26 22 18 14 10 5 0.32 0.30 0.30 0.29 0.29 0.28 10 0.61 0.60 0.59 0.58 0.57 0.57 15 0.88 0.87 0.86 0.86 0.86 0.86 20 1.15 1.14 1.13 1.13 1.14 1.15 25 1.40 1.40 1.40 1.41 1.43 1.45 30 1.65 1.66 1.68 1.70 1.73 1.76 Table 2a: Incidence of the measures of the Bonwill triangle (s) and the condylar path () on the Christensen angle [13]. Table 2b: Christensen angle in dependence of the changes of the Balkwill angle () and the condylar path () [14]. Critical analysis The Balkwill angle, the measures of the Bonwill triangle, and the condylar path are directly related to the phenomenon described by C. Christensen [11], as was confirmed by the examinations of F.T. Christensen [12, 13, 14]. The individual factors can be expressed with the fol- lowing formula (Fig. 5): sin {(/)/} = sin (/) + p/ sin = Condylar path = Christensen angle = Balkwill angle = Measures of the Bonwill triangle p = Protrusion length The combined deviations of the condy- lar path and the measures of the Bonwill triangle result in a change of 3.15 in the angles of Christensen's phenomenon (Tables 2a and 2b). Likewise, the devia- tions of the Balkwill angle combined with the deviations of the condylar path result in a change of 1.44 of the Christensen angle. In view of these results, it has to be pointed out that the inclination of the condylar path, the Balkwill angle, and the measures of the Bonwill triangle demonstrate only limit- ed incidence as far as the Christensen angle (i.e. the cusp height) is concerned, which is necessary to achieve a bilater- ally balanced occlusion. Consequently, the average values that were selected for the Stratos 200 articulator are excel- lently suitable for the fabrication of com- plete dentures. The Stratos 200 is a semi-adjustable articulator that follows the concept of simulating the displacement of the mandible. The maxillary model is aligned with the joint axis by means of the facebow. The axial infra-orbital plane, which is very close to the Frankfort horizontal, is used as the reference plane for the facebow. It is important to note that the present articulator demonstrates an angle differ- ence of 15 between Camper's plane and the axial infra-orbital plane. This fact is important for the subsequent selec- tion of the correct joint inserts. These inserts are different from conven- tional ones. The concept behind these inserts rather tends to correspond with the Condylator articulator according to Gerber. The upper part of the joint insert holder does not really simulate the canine fossa. Rather, the inserts are guid- ing joint inserts, which slide over a hori- zontal, metallic protuberance and actual- ly represent the condyles. The exchange- able joint inserts are available with vari- ous angles, ranging from 15 to 60. If the articulator is used with Camper's plane as the reference plane, the 30 inserts are required. If the Frankfort hori- zontal is used as the reference plane, the 45 inserts are needed. Furthermore, it is also possible to use joint inserts that are specifically fabricat- ed according to the recordings of the optical pantograph system according to Klett. However, this technique is not usually applied in clinical practice and is restricted to certain complex cases (Figs. 6a and 6b). The horizontal displacement of the bal- ancing condyle is achieved by means of exchangeable Bennet inserts (Figs. 7a and 7b), while that of the vertical 20 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001 Prost het i c Dent i st ry displacement is adjusted by the inner eminence of the TMJ protuberance. In this way, the working condyle is lowered (Fig. 8). Critical analysis The analysis of this articulator refers to its multifunctionality and the selection of the reference plane. How is this multifunctionality achieved? It is the result of two objectives, which strongly contrast in the analysis and reproduction of the mandibular move- ments. This contrast was already proven by Monson, who noted that the princi- ples of mandibular movements are dominated by two important concepts. Fig. 6a: The joint insert holder with the securing mechanism for the jaw rela- tion. Fig. 6b: Exchangeable joint inserts ranging from 15 to 60. The first one assumes that the occlusion of the teeth is determined by the shape and the movements of the condyles. The second one suggests that the occlusion of the teeth is the determining factor, which controls the shape of the condyles as well as their movements in the canine fossa. [15] The first assumption is advocated by all the supporters of gnathology. The sec- ond concept is backed by the works of Monson, which have since been redis- covered by Pankey, Mann and Schuyler. The BPS concept is based on the sec- ond assumption and uses canines that have been designed according to the occlusal morphology defined by Strack. Fig. 7a: Bennet insert attached to the joint mechanism of the articulator. Fig. 7b: Exchangeable Bennett inserts: red = 15; black = 30 Selecting the reference plane In complete denture prosthetics, there is no generally applicable scientific method for the definition of the occlusal plane. Rather, the various methods may be divided into two groups: Occlusal plane and maxillary arch: Although, from a historical point of view, Camper's plane proved to be the refer- ence plane most frequently used, a vast number of studies have shown that this Downward movement of the working condyle Fig. 8: The 'condyle' of the articulator. In a lateral movement, the inner ridge results in a downward movement of the working condyle. The guiding joint insert of the upper holder (a) slides along the 'condyle' of the lower artic- ulator frame (b). plane does not seem to run parallel to the occlusal plane [16, 17, 18, 19]. This objection caused a number of authors to prefer the Frankfort horizon- tal as the reference plane. The use of anatomically-correct articulators further backs their decision [20]. In this context, however, it is important to point out that this approach is based on a major mis- conception. The Frankfort horizontal must never be confused with the axial infra-orbital plane, since the angle differ- ence between these two planes is 6.5. This fact also explains why the differ- ence between the axial infra-orbital plane and the Camper's plane of the Stratos articulator is 15 and not 10 as it is the case in other articulators, which are erroneously based on an angle of 9.8 as suggested by Downs [21]. Occlusal plane and mandibular arch: In contrast to the above controversy, the mandibular reference points seem to be preferred by the majority of the authors. They are most often intra-oral reference points, such as the tongue equator plane, maximum buccinator curvature, or the retromolar triangles [22]. All of these references are subsequently passed on to the dental laboratory with the mandibular occlusion pattern. The Stratos articulator offers the indisputable advantage that it has been designed for model transfer and orientation accord- continued on page 25 25 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001 Prost het i c Dent i st ry C l i n i c a l a p p l i c a t i o n s ing to the various reference planes selected by the individual practitioners. In clinical practice, there are two meth- ods to mount the models for complete dentures in the articulator, depending on whether the practitioner has selected a maxillary reference point or a mandibular reference point. Fig. 9: The maxillary model is mounted by means of the bite fork attached to the lower articulator frame. Fig. 10: The principle of determining the occlusal plane. It runs in the cen- tre of the distance between the low- est points of the folds towards the upper thirds of the retromolar trian- gle. Method No. 1: First, the maxillary model is positioned in the articulator by means of a facebow or a setting-up tem- plate. The facebow allows the spatial position of the maxilla to be transferred by selecting Camper's plane or the axial infra-orbital plane as the reference plane (Fig. 9). Subsequently, the maxil- lary model is mounted in the articulator using conventional, clinical techniques. In a second step, the mandibular model is aligned in the correct relation to the maxillary model by means of the bite registrations. In this case, the measures of the Bonwill triangle are taken into account, with the exception of the intercondylar distance, which remains unchanged. The (anteri- or/posterior) position of the incisal point and the Balkwill angles, however, are more individualized. In the dental office, the practitioner adjusts the ridge of the maxillary model according to the usual criteria: paral- lelism with the pupil line and Camper's plane, lip support, identification of the median plane. In the laboratory, the model is posi- tioned on the setting-up template by means of the base record and subse- quently secured to the upper frame of the articulator. In this case, the Bonwill triangle of the articulator is exactly main- tained. However, the Balkwill angle is not individualized. Method No. 2: If this method is applied, the mandibular model is positioned first. For this step, either the usual anatomic reference points or the base record are used. In the dental office, the vertical dimen- sion of occlusion is determined and the jaw relations recorded. All these data are passed on to the laboratory by means of the base record. Basically, the occlusal plane meets the following criteria: In the anterior region, the occlusal plane runs at an equal dis- tance between the bottom of the mandibular and the maxillary folds, while it runs through the upper third of the retromolar triangle in the posterior region (Fig. 10). These reference points seem to match exactly the ideal course of the occlusal plane, which has also been confirmed by the works of Cbelic [22]. In the laboratory, the models are mount- ed according to the following method: What is known as the horizontal guide (Fig. 11) is used to position the mandibu- lar model in the articulator. This compo- nent is attached to the upper frame of the articulator and is equipped with a small ruler that can be vertically adjust- ed. Furthermore, it features a horizontal insert that can be adjusted towards the front and the rear. In a first step, the reference point of the maxillary centre (between the central incisors) is transferred to the mandibular model. After that, the distance between the lowest points of the mandibular and maxillary folds is measured (Fig. 12). In the second step, the small ruler is adjusted to a value that corresponds to half the distance between the two folds with the two ends of the ruler resting at the bottom of the folds. In the posterior region, the wings of the horizontal guide touch the upper third of the retromolar triangles (Fig. 13). The mandibular model is mounted on the horizontal guide with sticky wax or silicone. Subsequently, the entire unit is attached to the upper frame of the articulator (Fig. 14). In this way, the mandibular model is exactly oriented according to the Bonwill trian- gle. However, the Balkwill angle is not individualized. Finally, the maxillary model is positioned in the articulator with the help of the base record. If the occlusal plane of the wall of the mandibular base record is aligned with the mandibular reference points, the horizontal guide is attached to the ridge. In this process, the median plane and the centre line between the central incisors have to be taken into consider- ation. Subsequently, the mandibular model is positioned in the articulator. If the models are positioned by means of the base plate or the horizontal guide, Fig. 11: Horizontal guide. 26 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001 Prost het i c Dent i st ry the 2D setting-up template may be used to set up the posterior teeth. If a facebow is used, however, the mod- els are not oriented according to the geometric reference points. In these Fig. 12: Measuring the distance between the lowest point of the mandibular fold and the maxillary fold. Fig. 13: In the distal area, the horizon- tal guide rests in the upper third of the retromolar triangles. In the front, the end of the small ruler rests in the median plane. Fig. 14: The mandibular model attached to the horizontal guide is positioned in the articulator and secured by means of a fast-setting plaster. cases, a setting-up template is required that permits three-dimensional orienta- tion of the teeth (Figs. 15a and 15b). These two setting-up templates demon- strate a curve radius of 125 mm, which is 20 mm more than the value suggest- ed by Monson. However, the incidence of occlusion between these two radii does not exceed 0.1 mm. Setting up the denture teeth The setup is carried out according to the template technique, in other words, an occlusal pattern, in which all occlusal forces are directed according to the Robin support cone. This method pro- motes the stability of the dentures (of the mandibular dentures in particular). The suggested setup technique offers the following two sets of features: In the laboratory, this method is both easy to carry out, as well as exact and codified. The suggested working steps enable technicians to set up the teeth in opti- mum symmetry. At the same time, the correct relationships between the two dental arches can be checked at all times. Moreover, the sagittal and frontal compensation curves may be estab- lished in harmony with the morphologi- cal properties of the occlusal surfaces. In the dental office, the use of a setting- up template permits quick and reliable checking of the position and the corre- sponding orientation of each group or unit of teeth. However, the following seven working steps must be meticulously observed in order to benefit from the above advan- tages: 1 st working step: Recording the vari- ous reference points Analysis of the models: In addition to the classical reference points, such as the median plane or the perpendicular canine plane in the anterior region (which runs through the central palatal fold), the axes of the posterior sectors are defined for the maxillary model. In this process, it has to be made sure that these axes run through the outer quar- ter of the tubera (Fig. 16). Fig. 15a: Underside of the 2D setting- up template. Fig. 15b: The 3D setting-up template permits three-dimensional orientation of the template. As far as the mandibular model is con- cerned, the reference points recorded are comparable, i.e. axis of symmetry or median plane, anterior ridge axis in the frontal plane, axis of the posterior sec- tors, which points towards the position of the canine in the inner quarter of the pear-shaped elevation or retromolar tri- angle (Fig. 17). Analysis of the interocclusal relation of the dental arches: The general axes are extended in the distal parts of the model. This enables the practitioner to assess the transverse relations and to determine the bucco-lingual position of the intercuspal fissure (Figs. 18a and 18b). In this context, the fact that the frontal inclination of the occlusal plane in the Stratos 200 articulator depends on the transverse size of the arch and not on the inclination of the axis between the two ridges must be taken into account. This approach is different 27 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001 Prost het i c Dent i st ry from Gysi's, who assumed that the incli- nation between the ridges influences the frontal inclination of the occlusal plane (Fig. 19) [23]. 2 nd working step: Setting up the maxillary anterior teeth Once the size and the shade of the teeth have been selected, the maxillary ante- riors are set up according to one of the following two methods: Observing the ridge determined by the practitioner: The teeth are set up according to the usual criteria, such as central lip support, symmetry, etc. Observing the anatomic criteria: With the BPS System, anatomic reference Fig. 16: Reference lines of the maxil- lary arch: (a) median plane, (b) the axis of the posterior sectors runs through the outer quarter of the tubera, (c) canine plane, (d) tubera. Fig. 17: Reference lines of the mandibular arch: (a) median plane, (b) the axis of the posterior sectors runs through the inner quarter of the retro- molar triangle, (c) canine plane that runs through the vertex of the frontal ridge, (d) retromolar triangle. points, i.e. the palatal folds, are taken into consideration when positioning the anterior teeth. The bucco-lingual dimensions of the central incisors are always identical in the cervical area (7 mm), which indirect- ly facilitates their setup. The central incisors are set up on either side of the central palatal fold (seen from the medi- an plane) (Fig. 20). The incisal edges are located two millimetres in front of the halfway point between the two ridges. In this way, a slight anterior overbite is ensured. The actual degree of the over- bite is adjusted to the corresponding setup method used for the posterior teeth (0.5-1 mm with a lateral overbite; 2-3.5 mm with a pronounced lateral overbite). Positioning the setting-up template on the lower part of the articulator allows these parameters and the correspon- ding symmetry to be checked. After that, the maxillary canines are set up, for which the palatal folds are used as the reference points. There is a cor- relation between the position of the canines and the first two palatal folds [24]. The tips of the canines are located on an imaginary straight line that runs through the large axis of the palatal folds. The cervical areas of the canines are positioned two millimetres away from the end of the folds. In this way, the vestibular side of the teeth are nine mil- limetres away from these ends (Figs. 21 and 22). Finally, the lateral incisors are set up, taking the morpho-physiological characteristics of the patient into account. Fig. 18a: In the Stratos system, the frontal orientation of the occlusal plane is independent of the inclination of the axis between the ridges. curvature of the setting-up template 3 rd working step: Setting up the mandibular canines During the setup of the mandibular canines, it has to be made sure that the distal sides are located perpendicular to the tips of the maxillary canines. This setup prevents the mandibular canines from producing a pronounced over- turning moment during excursive move- ments (Figs. 23a and 23b). At the same time, an overbite of approximately one millimetre is achieved. 4 th working step: Setting up the mandibular posterior teeth The morphology and the mould of the posterior teeth are selected according to the jaw relation type (angle class) (Table 3). When positioning the setting-up tem- plate, the front part has to be positioned at the height of the distal angle of the mandibular canines. The canine tips must protrude over the front edge of the setting-up template by 1 mm. The posterior teeth are set up according to the defined axis that runs from the anterior region to the posterior region. All the vestibular cusps of the mandibu- lar teeth come in contact with the set- ting-up template (Fig. 24). However, only the lingual cusps of the second premo- lars and the mesial cusps of the second molars touch the template. The graduat- ed reference points allow continuous checks of the symmetry and the lineari- ty of the setup. Fig. 18b: According to Gysi, the frontal orientation of the occlusal plane depends on the inclination of the axis between the ridges. 28 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001 Prost het i c Dent i st ry 5 th working step: Setting up the maxil- lary posterior teeth The maxillary posterior teeth are set up in such a way that optimum occlusion with the mandibular teeth is achieved. For that reason, the contact cusps must touch the corresponding contact sur- faces in the antagonist dental arch (cusp/interdental area in the premolar region and cusp/fossa in the molar region (Fig. 25)). 6 th working step: Setting up the mandibular incisors The mandibular incisors are the last ones to be set up. In this process, the sagittal overbite proportional to the angle class and the height of the occlusal plane must be observed. With this method, the ideal occlusal relations between the incisors, the premolars, and the molars, which have been estab- lished with the previous working steps, can be maintained. 7 th working step: Checking the occlu- sion At this point, the harmony of the setup during lateral movements is checked: In protrusion, the mesial inclines of the premolars, the mandibular molars, as Fig. 19: Reference lines of the axes between the ridges. The axes of the maxillary sectors (a) and the mandibu- lar sectors (b) are extended in the posterior part of the model. The gen- eral setup axis (c) is located in the centre of the distance between the maxillary reference points (a') and the reference points of the mandibular axes (b). well as the free edges of the mandibu- lar anteriors touch the inclines of the antagonist maxillary teeth. During lateral movements, the incisors and the mandibular premolars on the working side touch the inner inclines of the maxillary premolars. In contrast, the lingual cusps of the premolars and all the molar cusps are not in occlusion (Fig. 26). width of tooth neck Fig. 20: Position of the incisors in rela- tion to the central palatal fold. Fig. 21: The cervical ridge of the canines is located at a 2-mm distance from the ends of the main palatal fold. Therefore, the design of the working side corresponds with the principle of group guidance. This concept, however, is entirely contrary to the principle of the dynamic rest cone according to Robin Fisher [18]. This approach might result in an overturning moment, partic-ularly if severe atrophy is present in the area of the maxillary cusps. Together with the balancing side, the two rearmost molars are in contact. Subsequently, the dentures are complet- ed, polymerized, polished and incorpo- rated into the oral cavity of the patient. With the BPS System, selective grinding is not required. The concept of occlu- sion should permit optimum balance during the various lateral movements of the mandible. Fig. 22: The reference points on the setting-up template attached to the lower frame of the articulator permit the checking of the symmetry. Fig. 23a: Position of the canine in occlusion. Fig. 23b: In lateral movement, the dis- tal incline of the mandibular canine slides along the mesial incline of the maxillary canine. Jaw relations Type of tooth Class I N Class II T Class III K Table 3 Properties and indications of the posterior teeth according to the angle class. 29 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001 Prost het i c Dent i st ry Fig. 24: Setup in the mandible in con- tact with the setting-up template. C o n c l u s i o n s A c k n o wl e d g e me n t A streamlined setup procedure as a part of a comprehensive denture fab- rication system undoubtedly repre- sents an advantage for patients, prac- titioners, and dental technicians alike. In this respect, the BPS System meets these requirements. However, the fol- lowing three points must be taken into consideration: 1. Golden standards: Although the concept has been developed in the United States, the trend is such that the system is particularly popular in Germany and the Scandinavian coun- tries. Moreover, certain selection cri- teria and technical possibilities of the concept can be explained if one knows the country of origin. 2. Selection of Camper's plane: The entire German teachings according to Gysi and Gerber are based on Camper's plane. Do we have to renounce this approach in favour of the Frankfort horizontal or the axial infra-orbital plane? Undoubtedly, it is more a habit than a real therapeutic 'plus', even if certain investigations [Literature available from the authors] We would like to thank Ivoclar for the technical support. Ivoclar Aktiengesellschaft Bendererstrasse 2 FL-9494 Schaan / Liechtenstein Fax ++423 / 235 33 60 Fig. 25: Intercuspation. Fig. 26: Setup during lateral movement. have attempted to demonstrate the therapeutic superiority of orienting the occlusal plane according to the Frankfort horizontal instead of the Camper's plane. 3. Selection of the articulator and the setup method: The BPS System cer- tainly offers a number of decisive advantages when it comes to setting up denture teeth. Even if the template principle of starting the setup with the posterior sectors in the mandible has been known for quite a while, the revival of this method satisfies a gen- uine technical necessity. It permits optimum control of the lingual space and improved distribution of the occlusal stress on the underlying rest areas. Le professeur Pierre RISCALLAH me fait un grand honneur en me demandant dcrire une prface ce nouveau livre. Je nai pas prsenter le professeur RISCALLAH au public professionnel libanais, spcialis ou non. Tous connaissent cet mi- nent Matre Cet ouvrage reprsente lnorme travail dun auteur qui sait prendre ses respons- abilits. Il pense offrir au spcialiste dOrthopdie Dento-Faciale une possibilit effective de mieux cerner les problmes thoriques et pratiques qui sont la base de la Spcialit et restent non rsolus. Il espre ainsi ramener LO.D.F., qui vient de traverser, selon lui, une priode de dsorientation, sur une voie quil juge la fois nouvelle et exacte. Le professeur RISCALLAH sait combien jap- prcie son attachement ses ides. Loriginalit de ses conceptions mrite une approbation sans rserve, du moins un sen- timent admiratif pour la qualit et la nature de son savoir. Il tente dans cet ouvrage de nous faire partager sa philosophie fruit de quarante ans dexprience. Je souhaite quil y parvienne Zouhair SKAFF Directeur, Socit Libanaise dOrthodontie PRECIS DORTHODONTIE PRECIS DORTHODONTIE