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5 Jaw Relation, Artificial Teeth, Articulators
5 Jaw Relation, Artificial Teeth, Articulators
MAXILLOMANDIBULAR RELATIONSHIP
Jaw Relation
refers
According to the Glossary of Prosthodontic terms, the term JAW RELATION is objectionable, MAXILLOMANDIBULAR RELATIONSHIP is recommended
Orientation
Centric Relation
Protrusion
1. Orientation Relation
establish references in the cranium relationship of the jaw to the TMJ or opening axis of the jaw opening axis can be located by using a FACE BOW
FACE BOW
a
balanced occlusion is desired When cusp form teeth are used When interocclusal check records are used When occlusal vertical dimension is to be changed during teeth setting For diagnostic mounting and treatment planning For making occlusal corrections after denture processing
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
Types of Vertical Relation / Dimension 1. Vertical Dimension at Rest (VDR) 2. Vertical Dimension at Occlusion (VDO) 3. Vertical Dimension at other position
position of the mandible when all muscles that closes and opens the jaws are in a state of minimal tonic contraction sufficient only to maintain posture
or gap between the upper and lower teeth when the mandible is in physiologic rest position usually 2-4mm when observed at the position of the first premolars essential because it maintains health of periodontal tissue when teeth are present
no significance in CD construction vertical dimension when mouth is half open or wide open
teeth possibility of pain in the TMJ more awkward to manipulate due to longer leverage clicking of dentures more easily displaced face appears long patient could hardly closes his mouth rapid destruction of residual ridges facial muscles appears strained
reduces function of the muscles with resultant loss of muscle tone cause creases at the corners of the mouth cause loss of space in the oral cavity with an adverse effect on the eustachian tube may affect hearing may produce trauma in the TMJ chin appears to far forward shrunk appearance of the face vermillion borders of the lips reduced approximately to a line lips lose their fullness face is flabby instead of being firm corners of the mouth turn down or droop
PHYSIOLOGIC METHODS
Niswongers method
Two marking are made, one on the upper lip below the nasal septum, the other on the chin. Patient is told to swallow and relax. The distance between the two marks are measured a difference of 2-4mm when VDO is subtracted from VDR if less than 2mm, VD is probably too great
if greater than 4mm, VD is considered too small
2. Phonetics
consist of listening to speech sounds Using m sound, presence of 2-4mm space observing the relationships of teeth during the production of ch, s, and j sounds ( bring anterior teeth close together but no contact)
Using thirty-three, enough space for tip of the tongue to protrude between the anteriors Using f or v sounds, maxillary incisal edge, lightly contact the lower lip Silvermans closest speaking space (1mm), presence of space during the function of speech
if speaking space is too large VD is considered too small if speaking space is too small VD is probably too great
3. Esthetics
Facial Esthetics
tone of skin throughout the face should be the same
Willis Method
Distance between the outer canthus of the eye and corner of the mouth should be equal to the distance between the lower border of the septum of the nose and lower border of the chin
4. Swallowing
presence of a very light contact at the beginning of the swallowing cycle if denture occlusion is missing VD maybe too small if there is difficulty VD is probably too great
5. Tactile Sense
Boos Bimeter
Patient is asked if the rims appear to touch too soon, or if the jaw closes too much or if it feels just right
A device the measures the biting force Maximum biting force ocurs at VDO Using a central bearing plate and pin
Lytles method
Electromyography
Mechanical Methods
Mechanical Methods
been used but cannot be considered adequate an indication of the amount of space required between the ridges for the teeth of this size of Willis gauge
Facial measurement
use
refers to the front to back, side to side relation of the mandible to the maxilla Classifications of Horizontal Jaw Relation 1.Centric relation the basic horizontal jaw relation 2. Eccentric relation A. protrusion B. right and left lateral excursion C. all intermediate position
Centric relation
A maxillo-mandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective disks with the complex in the anteriorsuperior position against the slopes of the articular eminence the most retruded position of the mandible against the maxilla at the established vertical dimension
Relation
Occlusion
The occlusion of opposing teeth when the mandible is in centric relation. In natural dentition this may or may not coincide with maximum inter-cuspal position In complete denture CR=CO=MIP
centric relation and centric occlusion do not coincide, it will result to denture instability and pain or discomfort
Passive Method
Active Method
guidance central bearing point stretch-relax exercises tongue curling backward swallowing reclining the patient palpation of temporal muscle
1. Static Method
placing
the mandible in centric relation, then making a record of the 2 rims to each other. advantage
minimal displacement of recording bases in relation to the supporting bone
2. Functional Method
involve
functional activity or movement of the mandible at the time the record is made includes: A. chew-in technique by Needles, House, Essig, Paterson B. swallowing disadvantage causes lateral and anteroposterior displacement of the record base
3. Graphic Method
involve the used of intraoral or extraoral tracing devices, with a central bearing point secured to the record base
wax
ZOE
Complications in Recording CR
Biologic
- Realeff - Neuromuscular problems - TMJ abnormalities
Mechanical
- Ill fitting bases - Excessive pressure
Psychological
- Patient factors
- Operators abilities
Mandibular Movements
Mandibular Movements
Mandibular
Movements occur during mastication speech swallowing respiration facial expression parafunctional habits like clenching and bruxism
TMJ
2. Articular disc 3. Articular capsule 4. Ligaments A. temporomandibular ligaments B. sphenomandibular ligaments C. stylomandibular ligaments
Mandibular Movements
1.Hinge movement 2. Translatory movement - forward or protrusive - direct lateral side shift (Bennett movement) - translatory movement that occurs when the mouth is opened wide
Envelope of Motion
Border
movements of the mandible Types 1. Envelope of motion in sagittal plane 2. Envelope of motion in the frontal plane 3. Envelope of motion in the horizontal plane
ARTICULATORS
ARTICULATORS
a
mechanical device that represents the TMJ and jaw members to which maxillary and mandibular casts can be attached
Parts of an Articulator
Represents the maxilla & mandible where casts are atached Connects the casts to the articular arm Represents the condyle Represents the slope of the articular eminence which guides the movement of the condyle Can be fixed or adjustable or customized
Classification of Articulators
1. Simple Hinge
accept only centric relation record can be opened and closed only also called onedimensional instrument because only one interocclusal record is necessary for its adjustment and use
2. Mean value
allows
lateral and protrusive movements based on average determinations condylar guidance angle and incisive guidance are fixed, 30 and 10 degrees respectively
3. Semi- adjustable
with
individually adjustable condylar guidances in both the vertical and horizontal planes accepts face-bow transfer interocclusal records can be used to record the condylar guidance
4. Fully Adjustable
a 3-dimensional articulator that requires a CR record, at least 2 lateral records, and some means for controlling the height and inclination of the cusps capable of reproducing jaw movements with great accuracy Pantograph (consist of six styli and tracing tables) use to produce tracings called pantogram
ARCON Articulator
a
contraction of the words articulator and condyle means that the condylar guidance is located in the upper member on the articulator and the ball (condylar analogue) is located in the lower member Better visualization and understanding of mandibular movements
Lateral guidance
Occlusion
Definition of Terms
Occlusion
a static state used when opposing teeth are in contact without movement
Articulation
is a dynamic state used when opposing teeth are in contact during movements of the mandible
Centric Occlusion
Eccentric Occlusion
Occlusion of opposing teeth when mandible is in centric relation Occlusion other than centric occlusion that includes lateral and protrusive occlusion
Artificial Occlusion
1. Supported by denture base placed on slippery mucosa 2. Move as unit on their base 3. Malocclusion evokes immediate instability and pain 4. Forces acting on a complete denture affect the whole base 5. Nonvertical forces are usually not well tolerated 6. The second premolar area is preferred for mastication; mastication in the second molar region can cause shifting of the base 7. Bilateral balance is usually considred necessary for denture stability 8. Poor feed back mechanism, so neuromuscular control is compromised
BALANCED OCCLUSION
The bilateral simultaneous, anterior & posterior occlusal contact of teeth in centric & eccentric Advantages
Denture stability Enhanced retention Enhanced patient comfort Maintenance of the integrity of supporting tissue
Occlusion
2. Incisal Guidance
- the influence of the contacting max & mand anteriors on the mandibular movement
Christensens Phenomenon
is
the development of spaces between the upper and lower occlusal surfaces at the distal of the occlusal rims or dentures with the downward and forward movement of the mandible
Bennett Movement
Mandibular
lateral translation Also known as Bennetts shift, direct lateral side shift, side shift, laterotrusion Cause separation during lateral movement Determines cusp height and morphology
Condylar Guidance
Incisal Guidance
Occlusal Plane
Compensating Curve
Nonbalanced
occlusion
Nonanatomic teeth are used Plane of occlusion parallel to residual ridge No compensating curve
Lingualized
occlusion
Upper lingual cusps are set into the lower central fossa; buccal cusps out of contact
Functionally
generated occlusion
Maxillary teeth carve out a path in the wax placed on the lower occlusal table, then wax is replaced with cast gold or metal alloys
1. Color or Shade
Qualities of Shade Hue specific color eg. Blue, green, grey, brown, reddish yellow Saturation or chroma amount of color per unit area Brilliance or value the lightness or darkness of a tooth Translucency permits light to pass through but cast no image Aids in Determining the Shade shade is correlated with the color of skin, hair, eyes should not contrast with the surrounding structures should be examined both under artificial and natural light possible to make minor variations to create a more natural appearance
Shade Selection
should be examined in 3 positions outside of mouth, side of nose gives hue, chroma, value under the lip, incisal edge exposed give effect of color when mouth is relaxed under the lip, covers only the cervical simulate smiling do the squint test
of the face Square Tapering Ovoid Square tapering Facial profile - convex - straight - concave
Sex of the Patient Female - More pronounced curvatures - rounded point angles - more delicate appearance - Lateral incisors are smaller
length of max central incisors is 1/16 of the length of the face from patients hairline to the chin or is equal to the distance from high lip line to incisal plane
width of max central incisors is usually 1/16 of the bizygomatic distance width of six anterior teeth is equal to the bizygomatic distance divided by 3.3 or distance between the 2 cuspid lines
4. Materials Used
A. Plastic or Acrylic Advantages: - Economical - easily adjusted - bond to denture base - can be stained to esthetic mprovement - dont abrade gold or teeth Disadvantage: - poor abrasion resistance
B. Porcelain
Advantages: - Hard and wear resistant - mastication is more efficient Disadvantages: - mechanical bonding by holes or pins - much lower thermal expansion thus can produce stress in denture base - very hard to adjust, glaze lost with grinding - may cause clicking noise on eating or in patient with hearing aids - teeth may chip in used
D. Hard Acrylic - more wear resistant than acrylic but dont have staining problem of composite
form buccolingual width mesiodistal width length cuspal inclines materials ( porcelain, resin, metal insert, teeth with metal occlusals) shade
Non-anatomic
A. use in Class II and Class III jaw relationship B. closure of the jaws over a broad contact area C. creation of minimal horizontal pressures
be greatly reduced - to enhance the development of the correct form of the polished surface - to reduce the amount of stress to the supporting tissues
be measured from the distal of canine to the beginning of the retromolar pad
5. Cuspal Inclinations
angle form by the MB cusp of the lower first molar with the horizontal plane Types: A. 33 degrees - maximum opportunity for a fully balanced occlusion B. 20 degrees - develop balancing contacts in eccentric jaw position C. 0 degree - no cross-arch balanced occlusion - effective only when it is difficult to record centric jaw relation precisely - there are abnormal jaw relation
Materials Used
Acrylic
Porcelain
Inexpensive, easily available, easy to grind, absorbs stresses, does not wear opposing natural teeth and gold crowns Use in sufficient interridge space, well formed ridges, superior esthetics, can cause wear of natural teeth and gold crowns and bridges To reduce the wear of resin when oppose by porcelain teeth
or Plastic
Acrylic
Acrylic