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3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
3.jaw relation and occ in rpd
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3.jaw relation and occ in rpd

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  • It is considered as the 4th phase of treatmentIt is a procedure that is generally overlookedAlthough recording jaw relation is not difficult as compared to CD but it should be performed with at most care and perfection
  • The vertical dimension at rest is determined when the patient is in a upright positionThe ditancebetweent the rest poistion and the occlusion is caled the interocclusal rest space or freeway space
  • For most patients whorecieverpd occlusal vertical dimension measurement is generally not required if the teeth appear normal in size, shape and position and they display acceptable contact during closure
  • If the free way space is greater then 4mm then the vdo has to be increased
  • The appliance has to be worn contionious for 24hrs expects for cleaning and mainatiningpurposes. If the patient can tolerate the the newly establised vertical dimension
  • Centri relation:- is a bone to bone relation of the mandible to maxillaCusp of teeth are not considered This position can be repaeated again and again Thus it is considered as a reference point in devloping occlusion
  • Iin 90% of the cases the cr and co does not coinicide.... It has been sated that the co is 0.1-2mm ahead of the CRIt can ange from tenth of a mm to 5mm
  • Interocclusal materials used are impression plaster, compound. Polyther and polyvinyl siloxane are the best interocclusal record that ca be used
  • After the framework has been adjusted to fit the mouth, the technique for registration is as followsthwe denture base has to be stable, and it should be fabricated in such a way that it depicts the final restorationUSUALLYHARD INLAY WAX HAS BEEN FOUND SUTIABLE FOR THIS PROCUDUREThe occlusal rim only has to be removed during eatingBoth voluantry and involuntary movement have to be recorded
  • Care must be taken to see if alll the cusp are carved or noIf no the deficient arear must be added and another 24hrs has to be spent
  • Transcript

    • 1. GOOD MORNING
    • 2. JAW RELATION RECORDING AND OCCLUSION IN REMOVABLE PARTIAL DENTURES By Dr Zarir Ruttonji
    • 3. CONTENTS 1. Introduction 2. Objectives 3. Vertical jaw relation 4. Horizontal jaw relation 5. Establishing occlusal relationship 6. Selection of an articulator 7. Mounting of cast 8. Selection and Arrangement of prosthetic teeth 9. Preliminary objectives for establishing an occlusal scheme 10. Conclusion 11. References
    • 4. INTRODUCTION
    • 5. OBJECTIVES 1.To create an arrangement of the opposing teeth which is in harmony with the mandibular movements. 2. To provide the patient with a masticating mechanism that is at the same time efficient, comfortable and aesthetically pleasing. 3.Need to distribute the functional forces between the remaining natural teeth and the residual ridge to withstand stress Miller and Grasso, Removable Partial Prosthodontics; 2nd edition, pg215
    • 6.  It may provide information which is difficult to obtain by intraoral examination Problems such as….. 1. Interarch distance - enlarged maxillary tuberosity….. -moderate to severe undercuts…. EVALUATION OF DIAGNOSTIC CAST Stewarts- Clinical Removable Partial Prosthodontics.
    • 7. 2. Occlusal plane: - Irregular due to extrusion…. - Several treatment options…. Stewarts- Clinical Removable Partial Prosthodontics.
    • 8. 3. Tipped or malposed teeth: - Minor orthodontic corrections…. - Sometimes removal….. Stewarts- Clinical Removable Partial Prosthodontics.
    • 9. 4. Occlusion: - lingual surfaces can be assessed -Selective grinding and coronal reshaping - Interferences….. Stewarts- Clinical Removable Partial Prosthodontics.
    • 10.  Vertical Jaw Relations: Vertical Dimension at rest Occlusion Vertical Dimension  Horizontal Jaw Relations: Centric Relation Centric Occlusion Eccentric Relations Protrusive relation Lt & Rt Lateral relations JAW RELATION RECORDS
    • 11. VERTICAL DIMENSION OF OCCLUSION Stewarts- Clinical Removable Partial Prosthodontics. It is measured between two arbitrary point marked on the face one above the mouth one below the mouth Two vertical dimension are commonly recognised 1.Vertical dimension at rest 2. Vertical dimension at occlusion
    • 12. ALTERING THE EXISTING OVD Normally the OVD of a partially edentulous patient is provided by the opposing natural teeth contact and it should not be changed Stewarts- Clinical Removable Partial Prosthodontics.
    • 13. ALTERING THE EXISTING OVD cont.. 1.Symptoms of diminished OVD exist such as. tired aching muscles, unexplained pain in the head and neck region, shortened nose-chin distance (appearance of premature aging). 2. Excessive Free way Space or ‘over-closure’ of the jaws. Stewarts- Clinical Removable Partial Prosthodontics.
    • 14. HOW TO ALTER THE EXISTING OVD 1. Confirm the loss of Vertical dimension by taking history, and the presence of excessive free-way space. 2. Increase the existing OVD temporarily by fabricating an acrylic resin occlusal overlay appliance in maximum intercuspation, ensuring that 4mm of freeway space must exist. Stewarts- Clinical Removable Partial Prosthodontics.
    • 15. HORIZONTAL JAW RELATION Stewarts- Clinical Removable Partial Prosthodontics.
    • 16. It is determined after a correct vertical dimension of occlusion is established There are two horizontal relationships that are of importance in developing occlusion 1. Centric relation 2. Centric occlusion
    • 17. HORIZONTAL JAW RELATION What to Record – C.R or C.O . Centric Occlusion should be recorded whenever a patient requiring a partial denture has cusps on remaining natural teeth that can guide the mandible back to this position,
    • 18. HORIZONTAL JAW RELATION C.R should be recorded, e.g., for distal extension RPD, or when the opposing arch is edentulous.
    • 19. ESTABLISHING OCCLUSAL RELATIONSHIP 5 methods can be used for establishing occlusal relationship in removable partial denture fabrication 1.Direct apposition of cast 2. Interocclusal records with posterior teeth remaining 3.Occlusal relation using occlusion rims on record bases 4.Jaw relation made entirely on occlusion rims 5.Functionally generated path McCracken’s- Removable Partial Prosthodo
    • 20. DIRECT APPOSITION OF CAST Used when there are sufficient opposing teeth that remain in contact. This method at the best can perpetuate the existing vertical dimension. McCracken’s- Removable Partial Prosthodo Any existing occlusal discrepancy present between the natural dentition
    • 21. INTEROCCLUSAL RECORDS WITH POSTERIOR TEETH REMAINING Used when sufficient natural teeth are remaining but the cast cannot be occluded by hand articulation McCracken’s- Removable Partial Prosthodo Interocclusal records have to be used to records the jaw relation Usually softened, metal- reinforced wafer of baseplate or set up wax in used
    • 22. OCCLUSAL RELATION USING OCCLUSION RIMS ON RECORD BASES Used when on or more distal extension areas are present Tooth supported edentulous space is large or when opposing teeth do not meet In this method the missing teeth are replaced by occlusal rims McCracken’s- Removable Partial Prosthodo
    • 23. FUNCTIONALLY GENERATED PATH Is based on the theory that the patient is the best articulator for developing the occlusion. Miller and Grasso, Removable Partial Prosthodontics; 2nd edition, pg215 Using the removable partial denture framework as a base, a dynamic recording of the occlusal patterns is generated in the patient’s mouth under normal functional conditions.
    • 24. STEPWISE PROCEDURE Denture base has to be fabricated which is stable and which will support the wax occlusal rim A film of hard stick wax is placed on the base before the occlusal rims are adjusted The wax rim then has to be worn by the patient for the next 24hrs including in the night The occlusal rim has to be in positive contact with the dentition in all excursion so that the functional path of all the cusp are carved in wax McCracken’s- Removable Partial Prosthodo
    • 25. After 24hrs the occlusal rim is examined, it has to have a continuous gloss, which indicates functional contact of all the cusp. The completed occlusal registration is now ready for conversion to a occlusal template The occlusal registration is the boxed with modelling clay after it has been secured on the master cast Only the wax registration and the vertical stops are left exposed, rest all in poured with dental stone, which forms the template McCracken’s- Removable Partial Prosthodo
    • 26. SELECTION OF AN ARTICULATOR Based on adjustability, articulators are classified as: Nonadjustable articulators 1. Kennedy class III 2. Functionally generated path Semi adjustable articulators 1. Kennedy class I II IV Highly adjustable articulators 1. Used when extensive occlusal rehabilitation is done Stewarts- Clinical Removable Partial Prosthodontics
    • 27. Miller and Grasso, Removable Partial Prosthodontics; 2nd edition, pg215 MOUNTING THE CAST ON ARTICULATOR The cast have to be transferred to the articulators ARBITARY MOUNTING MOUNTING USING FACE BOW
    • 28. ARBITARY MOUNTING OF CAST The cast are properly related to each other in horizontal and vertical planes They are secured using stick wax Then they are mounted in the centre of the articulator, midline of the cast aligns with the incisal pin and occlusal plane parallel to the bench topMiller and Grasso, Removable Partial Prosthodontics; 2nd edition, pg215
    • 29. FACE BOW TRANSFER It relates the maxillary cast to the opening and closing axis of the articulator It also places the maxillary cast in the correct horizontal plane. Facebow should be compatible with the chosen articulator. Stewarts- Clinical Removable Partial Prosthodontics
    • 30. SELECTION OF DENTURE TEETH Choice of materials 1. Acrylic resin denture teeth 2. Porcelain denture teeth, .In more recent years 1. Glass ceramics and 2. Composite materials. John R. Ivanhoe , Kevin D. Plummer; Removable partial denture occlusion; Dent Clin N Am 48 (2004) 667–683
    • 31. ACRYLIC RESIN DENTURE TEETH 1. Resilient, 2. Wear-resistant, 3. Natural-sounding in function, and 4. Aesthetic 5. They are easy to adjust, can be recontoured when necessary, 6. Polished with little effort 1. low abrasion resistance 2. Proper function of the occlusal relationships must be checked more frequently when acrylic resin teeth are used ADVANTAGES DISADVANTAGES John R. Ivanhoe , Kevin D. Plummer; Removable partial denture occlusion; Dent Clin N Am 48 (2004) 667–683
    • 32. PORCELAIN DENTURE TEETH 1. High abrasion resistance 2. Exhibit minimal wear 3. Highly Aesthetic 4. match the porcelains used for fixed restorations 1. Sound unnatural to the patient 2. Brittle 3. Chip or crack, 4. Difficult to adjust, recontour, and polish ADVANTAGES DISADVANTAGES John R. Ivanhoe , Kevin D. Plummer; Removable partial denture occlusion; Dent Clin N Am 48 (2004) 667–683
    • 33. ARRANGMENT OF PROSTHETIC TEETH ANTERIOR TEETH 1. Should be selected using the manufactures shade guide 2. Should be done as quick as possible 3. Natural light should be used Shade:- Stewarts- Clinical Removable Partial Prosthodontics
    • 34. ARRANGMENT OF PROSTHETIC TEETH cont... MOLD Each mold exhibits a different shape and size and also different surface characteristics Stewarts- Clinical Removable Partial Prosthodontics
    • 35. Mold selection is based on two important factors: 1) The space that has been created by tooth loss. - If single tooth is replaced…. - If multiple anterior teeth are replaced….. HOUSE technique Stewarts- Clinical Removable Partial Prosthodontics
    • 36. 2) Overall form or shape of the teeth. Stewarts- Clinical Removable Partial Prosthodontics
    • 37. ARRANGMENT OF PROSTHETIC TEETH POSTERIOR TEETH 1. They should fit into the edentulous spaces 2. But be in harmony with the natural existing occlusion also Stewarts- Clinical Removable Partial Prosthodontics
    • 38. POSITION OF NATURAL TEETH It is desirable to place artificial denture teeth in close proximity to the original position of the natural teeth.. Landmarks for the anterior teeth 1.Incisive papilla 2.Labial vestibule Arthur R. Roraff, Arranging artificial teeth according to anatomic Landmarks J. Prosthet. Dent. 1977;38,2:120-131
    • 39. Landmarks for the occlusal plane 3. Commissures of the lips 2. Retromolar pad 1. Parotid papilla Landmarks for the posterior teeth 1.Maxillary tuberosity 2.Retromolar pads Arthur R. Roraff, Arranging artificial teeth according to anatomic Landmarks J. Prosthet. Dent. 1977;38,2:120-131
    • 40. 1.If a physiologic state exists, maintain the patient’s maximum intercuspal position. 2.Bilateral simultaneous contacts of the opposing anterior and posterior teeth should be established in restored occlusion 3. Do not alter a patient’s existing occlusal scheme in lateral movement unless such alterations are needed to correct a nonphysiologic condition. John R. Ivanhoe , Kevin D. Plummer; Removable partial denture occlusion; Dent Clin N Am 48 (2004) 667–683 PRELIMINARY OBJECTIVES FOR ESTABLISHING AN OCCLUSAL SCHEME
    • 41. 4. If the restoration must re-establish lateral guidance, canine- protected articulation is preferable when the remaining natural canines are present and not periodontally compromised. 5.Establish group function or a unilateral balanced articulation for patients with missing canines being replaced by a removable prosthesis or periodontally compromised canines that will be maintained John R. Ivanhoe , Kevin D. Plummer; Removable partial denture occlusion; Dent Clin N Am 48 (2004) 667–683
    • 42. 6.Do not establish nonworking contacts on remaining natural teeth unless these teeth are opposed by a complete denture for which bilateral balanced articulation is desirable 7.When there are healthy remaining natural anterior teeth, posterior tooth contact during the protrusive movement is not desirable John R. Ivanhoe , Kevin D. Plummer; Removable partial denture occlusion; Dent Clin N Am 48 (2004) 667–683
    • 43. DETERMINING THE OCCLUSAL SCHEME The number and positions of the remaining natural teeth in both the arch in which a removable partial denture is being fabricated and the opposing arch determine the necessary occlusal scheme. John R. Ivanhoe , Kevin D. Plummer; Removable partial denture occlusion; Dent Clin N Am 48 (2004) 667–683
    • 44. Class III removable partial denture If the existing occlusion is physiologically healthy, the patient is restored to the existing occlusal scheme A group function articulation is recommended if the patient’s natural canine is missing or periodontally compromised A balanced articulation is recommended if the restoration is to oppose a complete denture John R. Ivanhoe , Kevin D. Plummer; Removable partial denture occlusion; Dent Clin N Am 48 (2004) 667–683
    • 45. Class II removable partial denture Group function articulation should be avoided when there are no remaining premolars. Except when opposing a complete denture, a balanced articulation should be avoided to prevent nonworking contacts on natural teeth. John R. Ivanhoe , Kevin D. Plummer; Removable partial denture occlusion; Dent
    • 46. Balanced articulation is recommended for patients for whom canine-protected articulation is not possible to provide bilateral occlusal contacts for increased denture stability. Class I removable partial denture John R. Ivanhoe , Kevin D. Plummer; Removable partial denture occlusion; Dent Clin N Am 48 (2004) 667–683
    • 47. Class IV removable partial denture During excursive movements the anterior artificial teeth should either disocclude or have passive occlusal contact. John R. Ivanhoe , Kevin D. Plummer; Removable partial denture occlusion; Dent Clin N Am 48 (2004) 667–683 A balanced articulation is recommended if the restoration is to oppose a complete denture
    • 48. CONCLUSION
    • 49. References 1. Stewarts- Clinical Removable Partial Posthodontics. 2. McCrackens- Removable Partial Posthodontics 3. Miller and Grasso, Removable Partial Prosthodontics; 2nd edition, 4. Louis S. Block. Preparing and conditioning the patient for intermaxillary relations, JPD 1952: 2 ;599-603 5. Davis Henderson. Occlusion in removable partial prosthodontics , JPD 1972: 27; 151-159 6. John R. Ivanhoe , Kevin D. Plummer; Removable partial denture occlusion; Dent Clin N Am 48 (2004) 667–683
    • 50. 7. Arthur R. Roraff, Arranging artificial teeth according to anatomic Landmarks J. Prosthet. Dent. 1977;38,2:120-131

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