HOBO’S TWIN TABLE

CONCEPT
 Introduction

The term occlusal

rehabilitation has been
defined as the restoration
of the functional integrity
of the dental arches by use
of inlays, crowns, bridges
and partial dentures.

Dawson PE. Functional occlusion-e-book: from TMJ to smile design. Elsevier Health Sciences; 2006 Jul 31.
Goals

Irving Goldman . Goals of Full mouth rehabilitation. JPD March 1952; vol 2: no 2
Indications

Restore impaired occlusal function

Preserve longevity of remaining teeth

Maintain healthy periodontium

Improve objectionable esthetics

Eliminate pain and discomfort of teeth and surrounding structures.

Contraindications

Malfunctioning mouths that do not Prescribing a full mouth rehabilitation

need extensive dentistry and have no should not be taken as a preventive
joint symptoms should be best left measure unless there is a definite
alone. evidence of tissue breakdown.
Classification

 Classification by Turner and Missirlain (1984)

The patients were classified into three categories
1. Category 1 - Excessive wear with loss of vertical dimension.
2. Category 2 - Excessive wear without loss of vertical dimension of
occlusion but with space available.
3. Category 3 - Excessive wear without loss of vertical dimension of
occlusion but with limited space available

Turner KA, Missirlian DM. Restoration of the extremely worn dentition. Journal of Prosthetic Dentistry. 1984
Oct 1;52(4):467-74.
According to Breaker

 Group I
1. Class I – Patients with collapse of vertical dimension of occlusion because of
shifting of existing teeth caused by failure to replace missing teeth.
2. Class II – Patients with collapse of vertical dimension of occlusion because of
loss of all posterior teeth in one or both jaws with remaining teeth in
unsatisfactory occlusal relationship.
3. Class III – Patients with collapse of vertical dimension of occlusion because of
excessive attritional wear of occlusal surfaces.
 Group II
Class I – Patients with all or sufficient natural teeth present, with satisfactory occlusal
relationship.
Class II – Patients with limited teeth present but in satisfactory occlusal relationship
requiring aid in the form of occlusal rims.
 Group III – Patients requiring maxillofacial surgery of orthodontic treatment as an
aid in restoring the lost vertical dimension.
 Group IV – Patients in whom sectional treatment is required over extended
periods of time because of status of health of the patient, age or economic factor.
The general rule of the thumb in full
mouth rehabilitation is

 Occlusal plane analysis before the start of the treatment

 Posterior disclusion in all excursive movements
 Peter.E.Dawson states “Without specific treatment goals,
treatment success cannot be measured”.

Dawson PE. Functional occlusion-e-book: from TMJ to smile design. Elsevier Health Sciences; 2006 Jul 31.
 Requirements for occlusal stability

1.Stable holding contacts when the condyles are in centric

relation.
2.Anterior Guidance in harmony with envelope of motion
3.Posterior disclusion during protrusive movements.
4. Immediate disclusion of all posterior teeth on the non
working side
5.Non interference of all posterior on the working side
Sequelae
Diagnostic wax up

Treatment plan

Facebow transfer

Articulation

Sreelakshmy Kammath KS, Babu SC, Nair PV, Bhaskaran S, Sudeep S. An Overview on Full Mouth Rehabilitation. President’s
Message. 2018;8(4):129.
Occlusal plane
BOPA SOPA CAOPA
analysed

VD

Chinpoint Bilateral Unguided

CR
guidance manipulation method

Centric records-
mandibular Anterior jig Leaf gauge Cotton roll
deprogrammer
Various concepts

1991
1987 • Hobos
technique
1977 • Segmented
simultaneo
1974 • Nyman
us
and technique
1971 • Dawson’s
Lyndhe
concept scheme
1960 • Youdelis
• simplificat
scheme
1955 • PMS ion of
concept PMS
• Gnatholog
• Pankey –
ical
Mann –
concept
Schuylur
• McCollum
, Stuart
and
Stallard
Gnathological concept

• McCollum [founder of Gnathological society] promoted the

obtainment of harmony between the teeth and the
temporomandibular joints
Emphasis was
To localize the transverse axis of mandibular rotation.
The concept of BALANCED OCCLUSION.

Jose ‘dos Santos. Occlusion principles and concepts. 2 nd edition Ishitaku EuroAmerica, Inc USA.
Stallard and Stuart presented the concept of organic or organized occlusion.
Postulation
 Teeth might disocclude during functional excursions.
 An organized posterior disocclusion would avoid the enroachment of the
functional freeway space
 preventing disturbances of the muscular rest interval during mastication.
 CANINE PROTECTED OCCLUSION was placed in primary position
by this group.
-Youdelis in 1971- according to this concept centric relation
is coincident with inter cuspal position and the forces
being directed axially

-Nyman and Lindhe- They also advocated a similar concept

with centric coinciding with inter cuspal position.
 Sumiya
Hobo proposed the TWIN TABLE
PROCEDURE The concept of Disocclusion
“ is defined as the separation of opposing teeth during
eccentric movements of the mandible”
- GPT9

 He
advocated that the ANTERIOR GUIDANCE and
CONDYLAR GUIDANCE were dependent factors.
 Hence he used the condylar path to determine the
anterior guidance.

Sumiya Hobo. Oral Rehabilitation. Clinical determination of occlusion. Quintessence Publishing 1997.
Posterior disclusion

 is dependent on; the angle of hinge rotation created by the

angular difference between anterior guidance and condylar
path, and on inclination and shape of posterior cusps which helps
in controlling harmful lateral forces.

 Molar Disclusion was acheived by using two incisal tables;

1. Twin Table without Disclusion

2. Twin Table with Disclusion

Bhavna Tiwari et al, Occlusal cocepts in Full Mouth rehablitation.J Indian Prosthodont Soc. 2014 Dec; 14(4): 344–
351
 The twin table technique Is a practical method for establishing
anterior guidance from the condylar path.
 Anterior guidance and condylar path were previously considered as
independent factors.
 In recent studies it is revealed that anterior guidance influences the
working condylar path.
 In setting anterior guidance it is suggestive to set the condylar path
so that it moves straight outwards along the transverse horizontal
axis.

Sumiya Hobo.Twin table technique for occlusal rehabilitation. Part 1 mechanism of anterior guidance.
JPD Sep 1991
 Table without Disclusion
 Record the condylar path by using a pantograph or interocclusal records.
 Set the working condylar path on the articulator so that the working condyle
moves straight outward along the transverse horizontal axis.
 Make the maxillary study cast with a removable anterior segment.
 Mount the cast to the articulator. Remove the maxillary anterior segment and
move the articulator through eccentric movements to eliminate interferences that
impede an even, gliding motion.
 This procedure results in an cusp -shape factor that harmonizes with the
condylar path..
 Insert a flat incisal table and mold chemical –cure resin by moving the incisal
pin through eccentric movements. Repeat the procedure on a second table to
complete two incisal tables without disclusion
The study casts are initially prepared by making
the anterior portion of the maxillary cast
removable with dowel pins.

The facebow and centric relation records are used

to mount the study casts on the articulator

Sumiya Hobo.Twin table technique for occlusal rehabilitation. Part 1 mechanism of anterior guidance.
JPD Sep 1991
 With the anterior segment of the
maxillary cast removed, the posterior
teeth do not disclude during eccentric
The anterior portion of the maxillary cast
movements, but the molars should glide
is removed to eliminate the effects of
smoothly through maximum
anterior guidance. The articulator is then
intercuspation. If there is an interference
moved in forward, right, and left
that prevents posterior contacts
directions.
throughout eccentric movements, those
contacts are removed and marked with
an indelible pencil.
The mark will be a reference for future intraoral occlusal adjustments. If there is an area
where a tooth does not contact with the opposing occlusal surface, wax is added until it
contacts evenly.

The missing teeth or tooth structure spaces are replaced with wax. If maxillary and
mandibular casts interdigitate evenly during eccentric movement, it means that the cusp
becomes parallel to the condylar path and the cusp shape of the molar has been harmoniously
established. The cusp-shape factor is incorporated during this procedure. Chemical-cure
acrylic resin is placed in a dough stage on the flat incisal table, and the resin is molded by
moving the incisal pin through protrusive and lateral movements.
 These incisal tables are referred to as incisal
tables without disclusion. The molded incisal
table coincides threedimensionally with the
A second incisal table is prepared identically.
condylar path and molar cusp shape. If this table
is used to create anterior guidance, a fully
balanced occlusion will result.
 Twin Table with Disclusion

 Use one of the incisal tables without disclusion on the

articulator. Place two 3 mm spacers behind the condyles to
stimulate a protrusive position.
 Place a 1.1 mm thick spacer on the mesiobuccal cusp tip of
the mandibular first molars, then close the articulator.

 Make a resin cone between the incisal pin and the incisal
table to establish the angle of hinge rotation for an average
disclusion during protrusive movement.
Hobo S. Twin-tables technique for occlusal rehabilitation: Part II—Clinical procedures. The Journal of Prosthetic Dentistry.
1991 Oct 1;66(4):471-7.
 Next place one 3 mm spacer behind one condyle in the articulator.
Place the 1 mm spacer on the non-working side and a 0.5 mm spacer
on the working side at the mesiobuccal cusp tip of the mandibular
first molar to simulate a lateral movement position.

 Make a resin cone between the incisal pin and table . Repeat the
procedure for the other condyle. This creates the angle of hinge
rotation for an average disclusion during lateral movement.

 Connect the three cones with additional resin to form walls. Add
more resin, and direct the articulator through eccentric movements
to complete the three-dimensional incisal table. This completes the
incisal table with disclusion.
The lateral movement can be simulated by placing a 3 mm thick plastic
spacer behind one of the condyles on the articulator.

A 1 mm thick vinyl sheet is positioned on the tip of the mesiobuccal

cusp of the mandibular first molar on the nonworking side and a sheet
0.5 mm thick can be also positioned on the working side.

When the articulator is closed, the incisal pin is directed laterally and
upward. A resin cone is inserted between the incisal pole and incisal
table
Hobo S. Twin-tables technique for occlusal rehabilitation: Part II—Clinical procedures. The Journal of Prosthetic
Dentistry. 1991 Oct 1;66(4):471-7.
This same procedure
The incisal table is
is repeated for the
After the walls are This space is filled easily molded
other condyle, but The three resin
The top of the wall created, a triangular with a chemical-cure because the ' centric
one condyle at a cones are connected
must follow an space remains acrylic resin. The contact and the three
time. This creates with chemical-cure
imaginary line that between centric articulator is moved cone tips mark the
the angle of hinge acrylic resin to make
connects the tips of relation contact of through all border beginning and end
rotation to ensure walls between the
the resin cones. the incisal pin and and eccentric points for eccentric
the average cones.
the top of the wall. movements. articulator
disclusion during
movements.
lateral movement.
Hobo S. Twin-tables technique for occlusal rehabilitation: Part II—Clinical procedures. The Journal of Prosthetic
Dentistry. 1991 Oct 1;66(4):471-7.
 After preparations are completed, the intraoral interferences are removed
by use of the previously marked diagnostic casts. An accurate final
impression is made. The maxillary working cast is again made with a
removable anterior segment using dowel pins. A facebow is used to
transfer the maxillary working cast and a centric relation record is used to
articulate the mandibular working cast

The incisal table without disclusion is initially used in the articulator. The
anterior portion of the maxillary working cast is removed and the
posterior occlusal wax-up is completed.

The anterior segment is repositioned for waxing of the lingual surfaces of

the maxillary anterior teeth. Melted wax is added to the lingual surfaces;
then the articulator is closed and moved through all border movements.
The wax is contoured by the incisal edges of the mandibular anterior teeth
so that they contact evenly
Hobo S. Twin-tables technique for occlusal rehabilitation: Part II—Clinical procedures. The Journal of
Prosthetic Dentistry. 1991 Oct 1;66(4):471-7.
 The articulator should be guided by the incisal table
and the condylar guidance mechanism, and the
eccentric movements of the maxillary and mandibular
posterior teeth should glide evenly. This procedure
develops a cuspal inclination parallel to the condylar
path and creates the cusp-shape factor. The incisal
table is changed on the articulator to the incisal table
with disclusion
Hobo S. Twin-tables technique for occlusal rehabilitation: Part II—Clinical procedures. The Journal of Prosthetic
Dentistry. 1991 Oct 1;66(4):471-7.
This procedure establishes the angle of hinge rotation
and developes anterior guidance in harmony with the
condylar path. Since the anterior guidance programmed
in this manner is steeper than the condylar path and the
molar cuspal inclinations, the posterior restorations
provide a predetermined disclusion during eccentric
movement
Critical analysis

 In Prosthodontics, the condylar path has been considered the main determinant of
occlusion.
 According to the Twin table technique by Hobo, the cusp shape factor and angle
of hinge rotation is derived from the condylar path. These factors contribute to the
determination of an ideal anterior guidance.
 However, in the Twin Stage procedure, the cusp angle was considered as the most
reliable determinant of occlusion.
 This was in accordance with the proven data from studies that cusp angle was 4
times more reliable than condylar and incisal paths.
 Pankey Mann Schyuler’s philosophy advocates that condylar guidance is dictated
anterior guidance.
 Thus it believes in harmonization of the anterior guidance for best possible
esthetics, function and comfort and the determination of an occlusal plane based
on anterior guidance.

Pankey LD. The teaching manual for the Pankey-Mann-Schuyler philosophy of occlusal rehabilitation.
InThe occlusal rehabilitation seminar 1969.
Conclusion
THANK YOU
References

 Dawson PE. Functional occlusion-e-book: from TMJ to smile design. Elsevier Health
Sciences; 2006 Jul 31.
 Irving Goldman . Goals of Full mouth rehabilitation. JPD March 1952; vol 2: no 2
 Turner KA, Missirlian DM. Restoration of the extremely worn dentition. Journal of
Prosthetic Dentistry. 1984 Oct 1;52(4):467-74.
 Sreelakshmy Kammath KS, Babu SC, Nair PV, Bhaskaran S, Sudeep S. An Overview on
Full Mouth Rehabilitation. President’s Message. 2018;8(4):129.
 Jose ‘dos Santos. Occlusion principles and concepts. 2 nd edition Ishitaku EuroAmerica, Inc
USA.
 Sumiya Hobo. Oral Rehabilitation. Clinical determination of occlusion.
Quintessence Publishing 1997.
 Bhavna Tiwari et al, Occlusal cocepts in Full Mouth rehablitation.J Indian
Prosthodont Soc. 2014 Dec; 14(4): 344–351
 Sumiya Hobo.Twin table technique for occlusal rehabilitation. Part 1 mechanism
of anterior guidance.
JPD Sep 1991
 Pankey LD. The teaching manual for the Pankey-Mann-Schuyler philosophy of
occlusal rehabilitation. InThe occlusal rehabilitation seminar 1969.
 Hobo S, Takayama H. Oral rehabilitation: clinical determination of occlusion.
Quintessence Pub Co; 1997.
 Hobo S. Twin-tables technique for occlusal rehabilitation: Part II—Clinical
procedures. The Journal of Prosthetic Dentistry. 1991 Oct 1;66(4):471-7.