Thursday, October 13, 2022

 


Factors influencing the interocclusal direct records are:

• Stability of the record base

• Number of reference points used to make the records

• Amount of pressure exerted on the displaceable tissues in the joints

• Amount and equalization of pressure depends on uniform

consistency of the recording material

Indications

• Abnormal skeletal jaw relation

• Large tongue

• Excessively displaceable tissues

• Abnormal mandibular movements

Commonly used materials

• Waxes

• Impression compound

• Dental plaster

• Zinc oxide eugenol paste

Waxes

• These are low-fusing materials.

• These offer little resistance to jaw closure when soft and these stiffen

quickly.

Advantages

• These can be used in a patient with poor muscular control.

• These require less time and equipment.

Disadvantages

• These can easily distort.

• These harden on the surface first then inside.

• These are technique-sensitive and do not provide uniform resistance

to pressure.

Compound, plaster and zinc oxide eugenol

• These should remain in contact until these harden.

• These normally break before distortion.

• Setting and hardening time can be controlled in case of plaster and

to less extent in zinc oxide paste but cannot be controlled in case of

compound.

• These records require longer time to set.

• These can be used when nonanatomic posterior teeth are used.

Tactile or interocclusal record can be made in following two steps:

• Tentative CR is recorded using wax rims attached to stable bases.

• Interocclusal check record is made during try-in stage.

Tentative jaw relation

• Maxillary rim is inserted in patient’s mouth and facebow transfer is

made.

• Maxillary cast is mounted on articulator.

• Vertical dimension at rest is established and the mandibular rims

are reduced to allow excess interocclusal distance.

• Recording material is placed in between and the tentative CR record

is made.

• The mandibular rim is mounted using this record and teeth are

arranged in this relation.

Interocclusal check record during wax try-in:

• Both maxillary and mandibular trial record bases are inserted in the

patient’s mouth.

• Patient is prevented from occluding by using cotton rolls on both

sides.

• Recording material such as Aluwax is placed on the mandibular rim

in the premolar and molar regions and the patient is allowed to

slowly close and stop just short of making tooth contact.

• Once the record is set, the maxillary and mandibular trial dentures

are placed on the articulator and the record is seated on the

maxillary cast.

• If the tentative relation is correct, then the condylar elements will

rest against the centric stops in the same position as the cast were

originally mounted.

• If not, then the record is incorrect and is to be repeated.

• Occlusal indicator wax can also be used instead of the Aluwax as

interocclusal check record, especially when nonanatomic posterior

teeth are used.

Pressureless method

• Nick and notch method.

• V-shaped notch is made on the maxillary occlusal rim.

• Nick is made anterior to the notch on the maxillary rim.

• A trough is created on the mandibular rim from premolar region to

the distal most region.

• Petroleum jelly is applied in the nick and notch areas.

• Aluwax or zinc oxide paste is placed in the trough in the

mandibular rim and the patient is guided into centric position.

• Allow the material to set.

• Occlusal rims along with the recording material are removed.

• Any excess material is trimmed and casts are mounted on

articulator using this record.

Staple pin method

• Occlusal rims are sealed with staple pins in centric position.

• This method should not be used, as the CR record cannot be

verified.

Swallowing method

• T.E.J. Shanahan (1955) used physiologic approach to record CR

position. He advocated cones of soft wax to be placed on the

mandibular occlusal rims and the patient was asked to repeatedly

swallow. According to him, during swallowing, the tongue forced

the mandible to be in CR position (Fig. 6-16).

FIGURE 6-16 Shanahan swallowing method.

Pressure method

• Jacob W. Greene described ‘pressometer’ to check equalization of

pressure in recording CR. It consisted of two celluloid strips which

were placed between the maxillary and the mandibular bite rims

bilaterally. If the pressures were unequal, the rims would hold one

strip while the other could be removed.

Eccentric jaw relations

Eccentric jaw relation is defined as ‘any relationship between the jaws

other than the centric relation’. (GPT 4th Ed)

Eccentric records should include the protrusive and the right and

left lateral records. The purpose of the eccentric relation record is to

adjust the horizontal and lateral condylar inclinations on the

articulator. These adjustments are necessary to achieve balanced

occlusion in the complete dentures. These records can be made by

functional, graphic or tactile methods within the functional range. The

methods of recording eccentric records are similar to the methods

used to record the CR position.

Extraoral tracing with a central bearing device has several

advantages over other techniques, if the recording devices are

attached to stable bases.

Procedure

• Once the mandibular cast is mounted on the articulator in CR, the

recording devices are placed back in the patient’s mouth.

• Distance of 5–6 mm is measured from the apex of the tracing on the

protrusive path and is marked.

• Patient is instructed to protrude the jaw till the stylus rests on the

marked point.

• Quick setting plaster is injected in between the rims and is allowed

to harden.

• Hardened cast is removed from the mouth.

• Horizontal condylar adjustments are freed on the articulator by

releasing the locknuts.

• The incisal guide pin is raised about ½ inch from the incisal guide

table.

• The record bases are seated on the cast, and hardened cast is placed

in between the rims.

• Accurate seating of both the condyles is ensured and locknuts are

tightened.

• The right and left calibrations of the horizontal condylar guidance

are adjusted accordingly.

• For the lateral records, two additional records are made, one on the

right lateral and the other on the left lateral position in similar

manner as described above for protrusive.

• The articulator is adjusted to each of this lateral record.

• Also, the protrusive relation record can be made by using layers of

soft wax.

• During the wax try-in, the patient is instructed to protrude the

lower jaw approximately 5–6 mm.

• Once the patient has learned this position, layers of soft wax are

placed on the posterior and anterior teeth of the lower trial denture.

• Patient is asked to protrude the jaw to a distance of 5–6 mm with the

wax and then close the jaw.

• Wax is allowed to harden and then removed.

• Wax record is inspected for even contact.

• This record is used to adjust the horizontal condylar guidance on

the articulator.

Important consideration during eccentric jaw relations are as follows:

• Condylar path cannot be controlled or altered by the clinician.

• Condyles always follow the contour of the bony fossae and never

travel in straight line path.

• Articulators having straight slot for condylar elements travel are not

suitable for eccentric records.

• Articulators should accept the lateral records which provide other

points of reference.

• Articulators which can record the individual condylar path using

pantographic tracings provide information in three planes.

Key Facts

• Camper’s line is the line joining the inferior border of the ala of the

nose to the superior border of the tragus. Ideally, the Camper’s

plane is considered to be parallel to the occlusal plane.

• Christensen’s phenomenon is the space that occurs between the

occlusal surfaces during mandibular protrusion.

• Central bearing device was first described by Alfred Gysi in 1910.

• Interocclusal distance or freeway space is 2–4 mm which is

observed in the premolar region in class I cases. In class II, it is

greater than 4 mm and in class III, it is less than or equal to 1 mm.

• Gothic arch tracing is a device which produces a tracing resembling

the arrowhead or Gothic arch during the mandibular movements.

• Increased vertical dimension leads to trauma to the tissues, pain in

the TMJ, clicking sound of the dentures, increased facial height,

tense facial muscles and difficulty in speech.

• Reduced vertical dimension results in reduced function of the

muscles with loss of muscle tone, creases at the corner of the mouth,

trauma to the TMJ, decreased facial height, lax facial muscles with

ageing appearance.

• Vertical dimension influences the aesthetics and mechanics of the

denture and if incorrect may produce possible disturbances in the

TMJ.

• M.E. Niswonger (1934) called the rest position as neutral position and

estimated it to be 3 mm.

CHAPTER 7

Selection and arrangement of

teeth

CHAPTER OUTLINE

Introduction, 123

Denture Aesthetics, 123

Definition, 123

Biological, 123

Mechanical, 123

Psychological, 123

Pre-Extraction Records, 124

Pre-Extraction Guides, 124

Evolution of Anterior Teeth Selection, 124

Selection of Anterior Teeth, 125

Size of the Teeth, 125

Size of the Maxillary Arch, 126

Distance between the Canine Eminences, 127

Jaw Relations, 127

Contour of Residual Ridge, 127

Vertical Distance between the Ridges, 127

Lip Support, 127

Form of the Teeth, 128

Composition of Material of Anterior Teeth, 130

Posterior Teeth Selection, 133

Size of the Posterior Teeth, 134

Form of the Posterior Teeth, 135

Colour of the Posterior Teeth, 136

Material of the Posterior Teeth, 136

Arrangement of the Anterior Teeth, 136

Relationship of Anterior Teeth with the Incisive

Papilla, 137

Relationship of Anterior Teeth with the Soft

Tissue Reflection, 137

Horizontal Relation with Residual Ridges, 137

Vertical Positions of the Maxillary Anterior

Teeth, 137

Arrangement of the Posterior Teeth, 138

Horizontal Positioning of the Posterior

Teeth, 139

Vertical Positioning of the Posterior Teeth, 139

Buccolingual Positioning of the Posterior

Teeth, 140

Principles of Arranging Teeth, 140

Maxillary Anterior Teeth, 140

Mandibular Anterior teeth, 141

Maxillary Posterior Teeth, 141

Mandibular Posterior Teeth, 142

Modiolus, 142

Definition, 142

Importance of Modiolus, 143

Phonetics, 143

Components of Speech, 144

Role of Phonetics in Complete Denture

Patient, 144

Prosthetic Considerations, 146

Introduction

Optimum aesthetics in complete denture construction is achieved by

arranging teeth in their natural position and according to the patient’s

aesthetic and functional requirement. Complete dentures are

aesthetically pleasing when teeth and denture bases are in harmony

with the facial musculature, facial profile and colour of eyes, and skin.

Denture aesthetics

Definition

Denture aesthetics is defined as ‘the ef ect produced by a dental prosthesis

that af ects the beauty and attractiveness of the person’. (GPT 8th Ed)

According to S. Winkler, aesthetics in complete denture

prosthodontics is affected by the following three factors:

(i) Biological

(ii) Mechanical

(iii) Psychological

Biological

• The clinician should have proper knowledge of the anatomical

structures, facial musculature and normal facial appearance.

• The clinician should understand the cause and effect relationship.

• If the labial flange is made too bulbous, it will push the lips

outwards giving them an artificial appearance or vice versa.

• Facial wrinkles tend to reduce by increasing the vertical dimension

of occlusion.

• But excessive increase in vertical dimension leads to patient

discomfort, clicking sound during function and compromised

health of residual ridges.

• Also, the placement of maxillary and mandibular teeth affects

speech which is dependent on the interocclusal distance.

Mechanical

• The artificial teeth should be arranged at the position which was

once occupied by the natural teeth.

• The teeth should be placed such that forces from the cheeks and lips

are balanced by the forces from the tongue. This area where forces

are balanced is called the neutral zone.

• Placing the teeth in neutral zone will enhance the stability of the

denture.

Psychological

• A patient’s perception of his/her appearance plays an important role

in dental aesthetics.

• A patient with a positive self-image will have a broad smile,

whereas a patient with a poor self-image will have a tight-lipped

introverted smile.

• Camper’s plane is often considered as the psychological plane of

orientation.

• Higher plane of orientation is seen in patients with positive selfimage, whereas the plane tends to depress downwards in patients

with poor self-image.

• Therefore, plane of orientation established by the clinician

determines the psychological state of the patient to some extent.

Pre-extraction records

Pre-extraction guides

Pre-extraction guides are an important aid in selecting teeth,

especially the anterior teeth. Various pre-extraction guides used are as

follows:

Diagnostic casts

It is defined as ‘life size reproduction of a part or parts of the oral cavity

and/or facial structures for the purpose of study and treatment planning’.

(GPT 8th Ed)

• It is the most reliable aid in selecting and arranging anterior teeth.

• Anterior teeth can be selected by determining the form and size of

the teeth on the cast.

• Usually, the patient accepts the shape and form of the teeth similar

to the natural teeth.

Photographs

• Past photograph which shows the anterior teeth or at least the

incisal edges of the teeth.

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