Horizontal jaw relation in complete denture

9,979 views

Published on

jaw relation, horizontal jaw relation, gothic tracing, programming of semi adjustable articulators (hanau)

Published in: Health & Medicine, Technology
0 Comments
107 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
9,979
On SlideShare
0
From Embeds
0
Number of Embeds
26
Actions
Shares
0
Downloads
1,219
Comments
0
Likes
107
Embeds 0
No embeds

No notes for slide

Horizontal jaw relation in complete denture

  1. 1. Horizontal jaw relations Vinay PavanKumar . K 1st year MDS student Department of Prosthodontics AECS Maaruti Dental College
  2. 2. Jaw Relation • It is described as any spatial relationship of the mandible to the maxilla
  3. 3. Horizontal jaw relation • Horizontal Jaw relation is the relationship of the mandible to the maxilla in a horizontal plane or it is the relationship of the mandible to the maxilla in an antero-posterior direction.
  4. 4. •Centric relation •Eccentric relation •Protrusive relation •Lateral relation •Left lateral •Right lateral It can be of two types
  5. 5. Centric relation The most retruded relation of the mandible to the maxilla when the condyles are in the most posterior unrestrained position in the glenoid fossa from which lateral movements can be made, at any given degree of jaw separation.
  6. 6. GPT-8 • A maxillomandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective disks with the complex in the anteriorsuperior position against the slopes of the articular eminences. This position is independent of tooth contact. This position is clinically discernible when the mandible is directed superiorly and anteriorly and restricted to a purely rotary movement about a transverse horizontal axis.
  7. 7. Purpose of recording centric relation • It is a bone to bone relation and it is constant • It is repeatable and recordable and thus serves as a reliable guide for developing centric occlusion in complete dentures • It is related to the terminal hinge axis ,in CR condyles exhibit pure rotation without any translation
  8. 8. • Functional movements like chewing and swallowing can be carried out since it is the most unstrained position. Final act of masticatory stroke ends in centric relation • Reference relation • It is more definite than vertical relation since it is independent of tooth contact
  9. 9. Criterias for mandible to be in centric • Disk properly aligned on both condyles • Condyle-disk assembly at the highest point against the posterior slopes of eminentia • Medial pole of condyle-disk assembly braced by bone
  10. 10. Theories of centric relation • The Muscle theory • The Ligament theory • The Osteofiber theory • The Meniscus theory Saizer P. Centric relation and condylar movement: anatomic mechanism. J Prosthet Dent 1971;26(6):581-91.
  11. 11. The Muscle theory Defense reflex External pterygoid muscles contracts Halts the jaw
  12. 12. The Ligament theory • Bind the elements of the articulation • Lateral radiographic views • ‘Suspended’ or ‘Floating’ condyle • Anatomic arrangement- not well suited to halt retrusive movement
  13. 13. The Osteofiber theory • Meyer • Fibrous stop - buffer • Retroarticular cushion • retrusive terminal stop
  14. 14. The Meniscus theory • The posterosuperior surface unfolds along the roof of the glenoid fossa • Discs with their retromeniscal fibrous tissues--stop the retrusive condylar movements
  15. 15. Factors influencing centric relation records • The resiliency of the supporting tissues • Fit of the denture bases • Residual alveolar arch • Saliva • Tongue Yurkstas AA, Kapur KK. Factors influencing centric relation records in edentulous mouths. J Prosthet Dent 2005;93:305-10.
  16. 16. • The health and cooperation of the patient • The posture of the patient • The temporomandibular joint and its associated neuromuscular mechanisms • The skill of the dentist • Pressure applied in making the recording • The technique used and the recording devices used
  17. 17. Difficulties in obtaining mandibular retrusion • Biologic difficulties • Mechanical difficulties • Psychological difficulties
  18. 18. Methods of assisting the patient to retrude the mandible • Let the jaw relax, pull it back and close slowly on the posterior teeth • Push the upper jaw out and close on the back teeth • Protrude and retrude the mandible repeatedly
  19. 19.  Roll the tongue backwards towards the posterior border of upper denture and close the rims until they meet Bissasu M. Use of the tongue for recording centric relation for edentulous patients. J Prosthet Dent 1999;82:369-70.
  20. 20. • Boos stretch-relax exercises • Tilting the head backwards • Swallow and close
  21. 21. Recording the Centric relation • Primary requirements - • accuracy • equalized vertical pressure • recording medium - uniform consistency • retain the record in an undistorted condition
  22. 22. Pressure used while recording the centric relation • Minimum closing pressure Opposing teeth to touch uniformly and simultaneously at their first contact • Heavy closing pressure To produce same displacement of the soft tissues as on the dentures during function
  23. 23. Methods used for recording centric relation • Tactile or interocclusal check record method • Functional (chew-in) methods • Meyer’s method • Patterson’s method • Needles-House method • Excursive (graphic) methods • Intraoral tracing • Extraoral tracing
  24. 24. • Terminal hinge axis method • Other methods • Deglutition • Pantography
  25. 25. Tactile or interocclusal check record method • Philip Pfaff – “biscuit bite” • Patient’s proprioception and tactile sense • Indications: • abnormally related jaws • excessively displaceable supporting tissues • large tongue • abnormal mandibular movements • verify occlusion in existing dentures
  26. 26. Interocclusal check record can be made- • Between upper and lower rims • Between upper and lower artificial or natural teeth • Between a central bearing plate and pin
  27. 27. Bite registration/recording materials • Waxes • Quick setting plaster • Impression compound • Bite registration paste (ZnO-E) • Bite registration silicone
  28. 28. Technique • Two steps- • Tentative records using occlusion rims • Interocclusal check records with the teeth arranged for try-in • Anterior try-in • Posterior try-in
  29. 29. Seat the patient with head upright
  30. 30. Nick and Notch method Too shallow 2 mm
  31. 31. Bite registration material
  32. 32. Recording centric relation
  33. 33. Mounting of the casts
  34. 34. Stapler pin method
  35. 35. Functional (chew-in) methods • Meyer’s method • Patterson’s method • Needles-House method • Meyer’s method • Soft wax - generated path • Plaster index - set the teeth
  36. 36. Patterson’s method • Wax occlusal rims • Mixture of half plaster and • half carborundum in the trench • Compensatory curve
  37. 37. Needles-House method • Compound occlusion rims • Four metal styli • Diamond-shaped tracings
  38. 38. Excursive (graphic) methods • Gothic arch tracing • Arrow point tracing • Tracing in one plane • Apex - the most retruded position
  39. 39. • Uses- • Verify centric relation • Obtain protrusive and lateral records • Types- • Intraoral tracer • Extraoral tracer
  40. 40. Intraoral tracing assembly
  41. 41. Intraoral tracing
  42. 42. Extraoral tracing (Hight tracing device)
  43. 43. Extraoral tracing
  44. 44. Types of arrow point tracings • Typical • Flat • Asymmetric
  45. 45. • Absent apex • Miniature tracing • Double arrow point
  46. 46. • Dorsally extended arrow point • Interrupted form • Atypical form
  47. 47. Terminal hinge axis method • An imaginary line around which the mandible may rotate without translatory movement.
  48. 48. Other methods- • Deglutition • Pantography • Deglutition • Physiologic method • ‘swallow and hold’
  49. 49. Physiologic Centric Relation (Shanahan) • Swallow and hold Shanahan TEJ. Physiologic jaw relations and occlusion of complete dentures. J Prosthet Dent 2004;91(3):203-05.
  50. 50. • Verification after denture fabrication • 30-gauge wax Shanahan TEJ. Physiologic jaw relations and occlusion of complete dentures. J Prosthet Dent 2004;91(3):203-05.
  51. 51. Centric-relation recording techniques • Swallowing or free closure (Shanahan) • Chin point guidance • Chin-point guidance with anterior jig • Bilateral manipulation Kantor ME, Silverman SI and Garfinkel L. Centric-relation recording techniques-a comparative investigation. J Prosthet Dent 1972;28(6):593- 600.
  52. 52.  Chin point guidance • Chin-point guidance with anterior jig • Bilateral manipulation
  53. 53. Median variability • Swallowing or free-closure records - 0.40 mm • Chin-point guidance - 0.14 mm • Chin-point guidance with an anterior jig - 0.07 mm • Bilateral manipulation - 0.05 mm
  54. 54. Pantography • Used clinically to measure mandibular movement • Graphic record in three planes • Types- • Mechanical (by McCollum and Staurt) • Electronic
  55. 55. Pantographic tracings
  56. 56. Eccentric relation records • Protrusive relation • Lateral relation • Left lateral • Right lateral
  57. 57. Protrusive jaw relation • Register the influence of the condylar paths over the movements of the mandible • Christensen’s phenomenon
  58. 58. Protrusive interocclusal record (Whip mix)
  59. 59. Protrusive interocclusal record (Hanau)
  60. 60. Lateral jaw relations • Influence the intercuspation of teeth in working mastication • Used to program the articulator
  61. 61. Lateral interocclusal records (Whip mix) • Set side shift guide at 45o • Mark 6mm from centric relation along Left Lateral tracing and centre the hole of plastic piece over it • Right condylar ball is in protrusion • Side shift guide brought in contact with the ball
  62. 62. Lateral interocclusal records (Hanau) L = H/8 + 12 ( H – Horizontal condylar inclination L – Lateral condylar inclination)
  63. 63. Clinical protocol Nair CK. Programming the semiadjustable articulator. Trends in Prosthodontics 2011;2(1):12-14.
  64. 64.  Protrusive records made of plaster at 2mm, 4mm, 6mm, 8mm and 10mm Nair CK et al. Relationship between protrusive record and horizontal condylar guidance angle. Trends in Prosthodontics 2011;2(1):15-16.
  65. 65. Programming the articulator using interocclusal records to note variation in the condylar guidance angle Nair CK et al. Relationship between protrusive record and horizontal condylar guidance angle. Trends in Prosthodontics 2011;2(1):15-16.
  66. 66. Nair CK et al. Relationship between protrusive record and horizontal condylar guidance angle. Trends in Prosthodontics 2011;2(1):15-16. Right condyle ( Mean ±SD) Left condyle ( Mean ±SD) 2mm 7.083o±5.42o 10.42o ± 7.22o 4mm 14.17o ± 6.56o 17.08o ± 10.97o 6mm 18.75o ± 5.28o 22.5o ± 8.66o 8mm 18.33o ± 3.89o 18.75o ± 5.69o 10mm 11.25o ± 4.33o 14.58o ± 5.42o
  67. 67. References:  Nair KC, A primer on complete denture fabrication, 1st edition, 2013, Ahuja publication, India Pp 67-77  Winkler S, Essentials of Complete Denture Prosthodontics, 2nd edition, India, A.I.B.T.S Publishers and distributors, 2009, pp 192-201.  Sharry JJ, Complete Denture Prosthodontics, 3rd edition, USA, Mcgraw-Hill Book Company, 1974, pp 215-222.
  68. 68.  Manappallil JJ, Complete Denture Prosthodontics, 1st edition, India, Arya (Medi) Publishing House, 2006, pp 145-67, 181-83, 194-98.  Saizer P. Centric relation and condylar movement: anatomic mechanism. J Prosthet Dent 1971;26(6):581-91.  Avant WE. Using the term centric. J Prosthet Dent 1971;25(1):12-15.
  69. 69.  Yurkstas AA, Kapur KK. Factors influencing centric relation records in edentulous mouths. J Prosthet Dent 2005;93:305-10.  Shanahan TEJ. Physiologic jaw relations and occlusion of complete dentures. J Prosthet Dent 2004;91(3):203-5.  Kantor ME, Silverman SI and Garfinkel L. Centric- relation recording techniques-a comparative investigation. J Prosthet Dent 1972;28(6):593-600
  70. 70.  Kingery RH. A review of sone of the problems associated with centric relation. J Prosthet Dent 1952;2(3):307-19.  Bissasu M. Use of the tongue for recording centric relation for edentulous patients. J Prosthet Dent 1999;82:369-70.  Gothic arch tracing ppt.
  71. 71.  Nair CK. Programming the semiadjustable articulator. Trends in Prosthodontics 2011;2(1):12- 14.  Nair CK et al. Relationship between protrusive record and horizontal condylar guidance angle. Trends in Prosthodontics 2011;2(1):15-16.

×