PROS 5 - Jaw Relation
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Transcript of PROS 5 - Jaw Relation
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Occlusal Rims and JawRelation
Dr Adam Husein
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Outline
Introduction
Objectives
Terminologies
Materials Procedures
Recording jaw relation
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Introduction
Laboratory stage following secondary
impression is the construction of basesand rims
Secondary impressions master/working
casts bases occlusal rims Bases and rims are then used for
recording jaw relation (JR) or biteregistration or maxillo-mandibularrecording (MMR)
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Introduction
Construction of occlusal rims or bite block
is a laboratory stage Jaw relation record (JR) is the clinical
stage
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Base
Same or different materials
Rim
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Different materials
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Materials for Bases
Acrylic resin
Cold cure Light cure
Thermoplastic material Wax
Do not use not stable
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Bases
Well adapted and conform closely to the
master cast Stable on the cast in situ
Free of voids and surface projections onthe impression surface
No more than 1 mm thick over the residual
ridge to prevent the base interfering withthe placement of the denture teeth
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Bases
2 mm thick in the post dam area of the
maxillary denture (and 2 mm thick in thelingual flange of the mandibular denture)
to impart rigidity
Easily removed from the cast
Smooth and rounded so as to reproduce
the contours of the master cast
Constructed in materials that are stable
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Common materials used as bases
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Summary of stages
Stages
Clinical Laboratory
History and exam
Primary
Secondary
JR
Try in
Issue
review
Study model or primary model
Master cast
Working cast
Bite blocks
Teeth arrangement
Processing
Wax up
Flasking
Trimming and polishing
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Objectives
Creating and outlining the form of the
upper denture Recording of intermaxillary relations
Selection of teeth
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Occlusal registration stage
Three components
Creating and outlining the form of the upperdenture
Recording of inter-maxillary relations
Selection of teeth
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Clinical Procedures
Correct patient
Inspect the prosthesis properly done ornot polishing and finishing
Following prescription Ensure that the rim is well adapted to the
master cast
Disinfection appropriately
Try in patients mouth
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Summary of steps in JR
1. Lip support
2. Incisal plane3. Occlusal plane
4. VDR, VDO and freeway space5. Lower rim
6. Recording JR
7. Midline, smile line and canine line
8. Shade and mould
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1.Lip Support
Restoration of the vermilion border
Restoration of the philtrum
90 vertical naso-labial angle
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Naso-labial Angle
The angle between the columella of the
nose and anterior surface of upper lip inthe sagittal plane (Patnaik et al, 2003)
A preliminary study of determining naso-labial angle for Malay subjects
(Ramasamy and Husein, 2005)
12 males and 12 females
Mean angle for male 73 degrees
Mean angle for female 72 degrees
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Vermilion borderPhiltrum
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2. Incisal Plane
Determine the upper anterior plane
Upper anterior six is usually parallel to the inter-pupillary line
Foxs occlusal plane guide or any device e.g. awooden spatula
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Incisal Show
Determine the position of the incisal point
relative to the resting lip Usually 2 mm below, but should suit individual
case
Younger patients 4-5 mm
Elderly level with the resting lip or 1 mm above
In general, incisal point should correspond tothe vermilion border of the lower lip
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Summary of steps in JR
1. Lip support
2. Incisal plane3. Occlusal plane
4. VDR, VDO and freeway space5. Lower rim
6. Recording JR
7. Midline, smile line and canine line
8. Shade and mould
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3. Occlusal Plane
Using the canine points on the upper rim asreference points, the right and left posterior
planes are formed Accepted guideline this plane is parallel to the line
drawn from the inferior border of the alar cartilage to aposition two-thirds of the way up the tragus
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Summary of steps in JR
1. Lip support
2. Incisal plane3. Occlusal plane
4. VDR, VDO and freeway space5. Lower rim
6. Recording JR
7. Midline, smile line and canine line
8. Shade and mould
4 VDR VDO and Freeway
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4. VDR, VDO and Freeway
Space VDR/RVD vertical dimension at rest/rest
vertical dimension VDO/OVD vertical dimension of
occlusion/occlusal vertical dimension
Freeway space (FWS) or inter-occlusal
distance (IOD)
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FWS or IOD
Determined by a balance between the
elevator and depressor muscles attachedto the mandible, and the elastic nature of
the surrounding soft tissue in a natural
dentition
Resting vertical dimension vertical
dimension of occlusion (OVD) = FWS
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How to measure RVD
Facial measurements
Swallowing methods Biting force measurements
Phonetic methods Tactile methods
Electromyographic measurements Combinations are recommended
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Excessive OVD
Increased risk of trauma to the underlying
tissuesLack of FWS continuous clenching
Painful mucosa
Muscle soreness (especially masseter)
Clicking
Phonetic problems
TMD may develop
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Reduced OVD
Lack of support of the angles of the mouth
DribblingAngular cheilitis
Reduced masticatory efficiency Poor esthetics
Chin protrusion on closure
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5. Lower Rim
Trim to fit upper rim
Even contact with upper rim Contact at established OVD
Tongue position can be used as a guide
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Summary of steps in JR
1. Lip support
2. Incisal plane3. Occlusal plane
4. VDR, VDO and freeway space
5. Lower rim
6. Recording JR
7. Midline, smile line and canine line
8. Shade and mould
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6. Recording MMR/JR
Retruded contact position (RCP) or centricrelation
Reproducible Present with or without the presence of natural teeth
Curl the tongue back to touch the back of the palate
Methods Wax
Bite registration paste
Tracing
Staples
Methods chosen must be repeatable
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M t i l
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Materials
ZnOE or bite registration paste
S f t i JR
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Summary of steps in JR
1. Lip support
2. Incisal plane3. Occlusal plane
4. VDR, VDO and freeway space
5. Lower rim
6. Recording JR
7. Midline, smile line and canine line
8. Shade and mould
7. Midline, Smile and Canine
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7. Midline, Smile and Canine
lines Determine the positions of the mid points of the
upper canine Extend dental floss from the inner canthus of the eye,
via the lateral border of the alar cartilage (with thepatient smiling) onto the incisal edge of the upper rim
For completion, the following should be clearlymarked on the upper rim Centre line
High smile line
Canine points
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8 T th S l ti
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8. Teeth Selection
Dentists responsibility should not assign thetask to the technician
Categories Shape or mould
Shade
Guide Pre-extraction record
Photographs
Natural teeth or dentures admired by them
Casts
Patients wishes (spacing or crowding)
Teeth selection
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Teeth selection
Guide
Measurement from canine to canineInverted shape of the face
Shape of the edentulous maxillary arch
Both have no scientific credence
Posterior teeth
Teeth with cusps
Teeth without cusps
Hybrid teeth
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Color and Shade
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Color and Shade
Careful and deliberate consultation withpatients
Considerations
Age (teeth tend to become darker with age
although this is not always absolute)Patient preference
Skin color (usually darker skin whiter teeth)
Canine teeth slightly darker than incisors
Summary of Teeth Selection
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Summary of Teeth Selection
Dentists responsibility
Photographs or favored dentures ifpossible
Select lower to complement the upper Fulfill esthetic and functional requirements
Good practice to produce study models
prior to extracting all teeth for FF
Infection Control
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Infection Control
Disinfect properly before sending the work
to the lab
Conclusion
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Conclusion
JR is probably the most critical stage in
denture construction Carefully follow all the steps
Ensure to recheck the recording prior todischarging the patient
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hank Youhank You