JOURNAL CLUB PRESENTATION
Occlusal device for diagnostic evaluation of
maxillomandibular relationships in edentulous
patie...
INTRODUCTION
 complete denture wearers experience gradual

and continuous reduction of occlusal vertical
dimension (OVD) ...
 Potential problems associated with increasing the

OVD during fabrication of new complete dentures are
controversial. Se...
 For patients wearing complete dentures that

demonstrate insufficient OVD, it is necessary to identify
an appropriate OV...
 Diagnostic modification of OVD prior to complete

denture therapy is often indicated for patients who have
worn existing...
www.indiandentalacademy.com
 This article describes a procedure for fabricating

a diagnostic occlusal device for edentulous patients. The
procedure ...
TECHNIQUE

Wax sprues attached to
distal extension of denture
bases

www.indiandentalacademy.com

Polished denture surface...
Reverse side of second impression
tray and impression material is
adapted to tissue denture surface
and first layer of mat...
TECHNIQUE

www.indiandentalacademy.com
www.indiandentalacademy.com
 After conditioning the denture-bearing tissues,

subject the prostheses to definitive laboratory reline
or rebase proced...
 Clinically evaluate the patient to estimate appropriate

vertical and horizontal maxillomandibular relationships.
Use an...
 This mandibular posture will approximate the rest

vertical dimension (RVD). Practice this sequence of
maneuvers several...
www.indiandentalacademy.com
 With the mandible in the CR position and the

central bearing pin contacting the bearing plate, evaluate
the space betwe...
 If adequate interocclusal distance is not available,

reduce the occlusal surfaces of the mandibular posterior
denture t...
www.indiandentalacademy.com
 Instruct the patient to close to the predetermined OVD,

bringing the central bearing point into contact with
the bearin...
 Remove the prostheses from the patient’s

mouth. Place the mandibular occlusal device in
a polymerization vessel for 30 ...
 Following complete polymerization, trim excess acrylic

resin using standard laboratory rotary instrumentation to
establ...
At the placement appointment, adjust the maxillary
complete denture and mandibular occlusal device
for optimal fit, form, ...
 Instruct the patient to wear the occlusal device throughout

the diagnostic phase of therapy and report complications.
I...
SUMMARY
 Critical examination of appropriate maxillomandibular

relationships is indicated prior to fabricating new
compl...
 In these situations, the use of an occlusal device will serve

to: (1)aid in neuromuscular deprogramming of habitual
man...
REFERENCES
 Occlusal device for diagnostic evaluation of maxillomandibular

relationships in edentulous patients: A clini...
THANK YOU

www.indiandentalacademy.com
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Journal club presentation /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Journal club presentation /certified fixed orthodontic courses by Indian dental academy

  1. 1. JOURNAL CLUB PRESENTATION Occlusal device for diagnostic evaluation of maxillomandibular relationships in edentulous patients: A clinical technique INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. INTRODUCTION  complete denture wearers experience gradual and continuous reduction of occlusal vertical dimension (OVD) over time. This is primarily owing to deterioration of the denture-supporting tissues and denture tooth wear.  Accompanying the loss of OVD is reduction of lower face height and compromised facial esthetics. www.indiandentalacademy.com
  3. 3.  Potential problems associated with increasing the OVD during fabrication of new complete dentures are controversial. Sequelae may include altered phonetic and masticatory function, unacceptable facial appearance, muscular discomfort, accelerated alveolar bone loss, sore residual ridges, premature and excessively audible denture tooth contact, and exaggerated gagging. www.indiandentalacademy.com
  4. 4.  For patients wearing complete dentures that demonstrate insufficient OVD, it is necessary to identify an appropriate OVD prior to fabricating new prostheses. Diagnostic evaluation of a new OVD may be accomplished with the aid of a stable, durable, and predictable intraoral device www.indiandentalacademy.com
  5. 5.  Diagnostic modification of OVD prior to complete denture therapy is often indicated for patients who have worn existing prostheses for many years. For these patients, clinical examination may reveal the following conditions: severe decrease in lower face height yielding poor facial esthetics, inadequate fit of complete dentures, worn denture teeth, clinically discernible deficiency in OVD, acquired protrusive maxillomandibular relationship and angularcheilitis. www.indiandentalacademy.com
  6. 6. www.indiandentalacademy.com
  7. 7.  This article describes a procedure for fabricating a diagnostic occlusal device for edentulous patients. The procedure involves modification of existing or duplicate complete dentures to evaluate proposed alterations of the existing OVD. www.indiandentalacademy.com
  8. 8. TECHNIQUE Wax sprues attached to distal extension of denture bases www.indiandentalacademy.com Polished denture surface placed in impression material to level of denture borders
  9. 9. Reverse side of second impression tray and impression material is adapted to tissue denture surface and first layer of material www.indiandentalacademy.com Separated trays show negative impression of denture
  10. 10. TECHNIQUE www.indiandentalacademy.com
  11. 11. www.indiandentalacademy.com
  12. 12.  After conditioning the denture-bearing tissues, subject the prostheses to definitive laboratory reline or rebase procedures using a functional impression technique. Prior to making occlusal modifications, ensure that the diagnostic prostheses accurately contact the denture-bearing tissues with acceptable border extensions to assure optimal support, stability, retention, and comfort. www.indiandentalacademy.com
  13. 13.  Clinically evaluate the patient to estimate appropriate vertical and horizontal maxillomandibular relationships. Use an ink marker to place a small dot on the tip of the patient’s nose and on the anterior prominence of the chin. With diagnostic prostheses in place and the patient sitting upright, instruct the patient to breathe in and out several times, open the mouth wide, and then slowly close the mouth until lip contact is first perceived. www.indiandentalacademy.com
  14. 14.  This mandibular posture will approximate the rest vertical dimension (RVD). Practice this sequence of maneuvers several times. Use a Boley gauge (William Dixon Co, Carlstadt, NJ) to record the distance between the marks on the nose and chin. When a repeatable distance is established, subtract approximately 4 mm, accounting for the necessary interocclusal distance, to arrive at the diagnostic OVD. www.indiandentalacademy.com
  15. 15. www.indiandentalacademy.com
  16. 16.  With the mandible in the CR position and the central bearing pin contacting the bearing plate, evaluate the space between opposing posterior occlusal surfaces to assure that at least 2-3 mm is available to mold new functional surfaces. www.indiandentalacademy.com
  17. 17.  If adequate interocclusal distance is not available, reduce the occlusal surfaces of the mandibular posterior denture teeth using conventional laboratory rotary instrumentation. Also, reduce the vertical length of the facial cusps on the maxillary posterior denture teeth to dimensionally accentuate the palatal cusps as the dominant functional cusps. www.indiandentalacademy.com
  18. 18. www.indiandentalacademy.com
  19. 19.  Instruct the patient to close to the predetermined OVD, bringing the central bearing point into contact with the bearing plate. Direct the patient to perform mandibular movements through all eccentric jaw positions while maintaining contact between the central bearing point and the bearing plate. Prompt the patient to continue mandibular movements until polymerization results in a perceivable exothermal reaction. www.indiandentalacademy.com
  20. 20.  Remove the prostheses from the patient’s mouth. Place the mandibular occlusal device in a polymerization vessel for 30 minutes. Assure that the vessel contains warm water and is pressurized to 20 pounds per square inch. www.indiandentalacademy.com
  21. 21.  Following complete polymerization, trim excess acrylic resin using standard laboratory rotary instrumentation to establish acceptable facial and lingual denture contours. Finish and polish the dentures in preparation for placement. www.indiandentalacademy.com
  22. 22. At the placement appointment, adjust the maxillary complete denture and mandibular occlusal device for optimal fit, form, and function.  Assure that the functional occlusal objectives of this diagnostic therapy are met, including: (1) multiple, even occlusal, contacts coincident with CR at the established OVD, (2) bilaterally balanced occlusion, if desired.  www.indiandentalacademy.com
  23. 23.  Instruct the patient to wear the occlusal device throughout the diagnostic phase of therapy and report complications. Inform the patient that use of the occlusal device will be continued until stable and comfortable maxillomandibular relationships are achieved. Monitor patient progress at biweekly examinations and accomplish adjustments when indicated. www.indiandentalacademy.com
  24. 24. SUMMARY  Critical examination of appropriate maxillomandibular relationships is indicated prior to fabricating new complete dentures. This is particularly true for long term edentulous patients wearing ill-fitting dentures that demonstrate severe occlusal disharmony www.indiandentalacademy.com
  25. 25.  In these situations, the use of an occlusal device will serve to: (1)aid in neuromuscular deprogramming of habitual mandibular posturing influenced by the malocclusion of existing ill-fitting complete dentures, and (2) facilitate diagnostic evaluation of the patient’s esthetic, phonetic, and functional tolerance of maxillomandibular relationships proposed for complete denture therapy.  Achieving these diagnostic objectives may take weeks or months. www.indiandentalacademy.com
  26. 26. REFERENCES  Occlusal device for diagnostic evaluation of maxillomandibular relationships in edentulous patients: A clinical technique J Prosthet Dent 2004;91:586-90.  Denture duplication technique with alternative materials J Prosthet Dent 1997;77:-8.  A review of traditional therapies in complete dentures J Prosthet Dent 1994;72:538-42.  The continuing reduction of the residual alveolar ridges in complete denture wearers: A mixed-longitudinal study covering 25 years J Prosthet Dent 2003;89:427-35 www.indiandentalacademy.com
  27. 27. THANK YOU www.indiandentalacademy.com

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