Ab jr ts cosmetic /certified fixed orthodontic courses by Indian dental academy

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Ab jr ts cosmetic /certified fixed orthodontic courses by Indian dental academy

  1. 1. ARRANGEMENT OF ARTIFICIAL TEETH IN ABNORMAL JAW RELATIONS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. TEETH SETTING IN ABNORMAL JAW RELATIONS ♦ TEETH SETTING IS A COMBINATION OF ART AND SCIENCE AND IS ONE OF THE MOST ABUSED SECTIONS OF PROSTHETIC DENTISTRY. ♦ USUALLY IT DOES NOT TAKE MUCH EFFORT TO DO A REASONABLY ACCEPTABLE SETUP FOR A NORMAL JAW RELATION-BUT WHEN ABNORMAL JAW RELATIONS OCCURTHEY POSE A PROBLEM IN MODIFYING NORMAL GUIDELINES TO FULFILL ALL DEMANDS www.indiandentalacademy.com
  3. 3. RIDGE RELATIONSHIPS NORMAL RIDGE RELATIONSHIP  Upper Ridge in the anterior region is slightly labial to the lower ridge www.indiandentalacademy.com
  4. 4. NORMAL RIDGE RELATIONSHIP CONTD….  The interalveolar crest line between the two ridges in the posterior region forms an 80 degree angle to a horizontal plane(i.e crest of lower ridge slightly buccal to that of upper www.indiandentalacademy.com
  5. 5. ABNORMAL RIDGE RELATIONSHIP ♦ Any deviation in the anterior or posterior region from the normal ridge relationship is considered abnormal www.indiandentalacademy.com
  6. 6. Abnormal relation if : Upper ridge is located much further anteriorly than the lower ridge, i.e., ( Maxillary Prognathism)  Upper ridge is located in the same line as (or) lingual to the lower ridge,i.e., ( Mandibular Prognathism)  www.indiandentalacademy.com
  7. 7. ♦ In the Posterior region; abnormal relation if:  Crest of lower ridge is placed lingual to that of upper ridge ,i.e., (wider upper arch)  when crest of lower ridge is placed further bucally to that of the upper arch,i.e., (wider lower arch) www.indiandentalacademy.com
  8. 8. TEETH SETTING IN NORMAL RIDGE RELATION-SYNOPSIS OF STEPS INVOLVED ♦ 1)MOUNTING CASTS AFTER JAW RELATION RECORD ONTO ARTICULATOR ♦ 2)ESTABLISHING GUIDE LINES ♦ 3)ARRANGING MAXILLARY ANTERIOR TEETH ♦ 4)ARRANGING MANDIBULAR ANTERIOR TEETH ♦ 5)ARRANGING MANDIBULAR POSTERIOR TEETH ♦ 6)ARRANGING MAXILLARY POSTERIOR TEETH ♦ 7)BALANCING THE OCCLUSION www.indiandentalacademy.com
  9. 9. ARRANGEMENT OF TEETH PRINCIPAL FACTORS TO BE CONSIDERED ♦ 1.POSITION OF THE ARCH ♦ 2.CONTOUR OF THE ARCH ♦ 3.ORIENTATION OF THE PLANE ♦ 4.INCLINATION FOR ARTICULATION ♦ 5.POSITIONING FOR ESTHETICS www.indiandentalacademy.com
  10. 10. POSITION OF THE ARCH ♦ a) Former anteroposterior position of the natural teeth ♦ b) Esthetics(lip fullness and relation of orbicularis oris to its attaching muscles) ♦ c) Relation and form of the ridges ♦ d) Phonetics ♦ e) Fullness of the ridge ♦ f ) Height of the ridge ♦ g ) Surgical preparation of the mouth www.indiandentalacademy.com
  11. 11. ARCH FORM ♦ A ) Anterior arch form 1)Contour of the face 2)Relation of the opposing arch 3)Contour of the edentulous arch a)Square b)Tapering c)Ovoid www.indiandentalacademy.com
  12. 12. ARCH FORM - Contd… ♦ Posterior Arch Width 1) Bucco lingual position in relation to the opposing ridge ( to be in harmony between lines of force of two ridges) a)Prognathous ridge relation b)Cross-bite A ridge relation c)Cross-bite B ridge relation 2) Orthognathous ridge relation 3) Buccolingual contour of the ridge 4) Tongue shape and size www.indiandentalacademy.com
  13. 13. ORIENTATION OF THE PLANE ♦ A)Inclination of the posterior teeth to harmonize with the condylar and incisal inclination to form compensating curves ♦ B)Anterior vertical position for esthetics ♦ C)Favorable division of the intermaxillary space ♦ D)Relative size of bearing area of the mandible and maxilla ♦ E)Inclination of the plane to prevent shunting of the denture ♦ F)Height of the ridges www.indiandentalacademy.com
  14. 14. INDIVIDUAL TOOTH POSITIONS FOR ARTICULATION ♦ A)Condylar Inclination ♦ B)Incisal guide inclination(overbite and overjet) ♦ C)Compensating curve ♦ D)Inclination of the cusps ♦ E)Orientation of the plane www.indiandentalacademy.com
  15. 15. POSITIONING FOR ESTHETICS ♦ A)Normal positions ♦ B)Variations for harmony 1)Balanced opposing lines 2)Harmony with types of profiles 3)Harmony with lateral lines of the face a)Square b)Tapering c)Ovoid d)Combination of square,tapering and ovoid www.indiandentalacademy.com
  16. 16. ANTEROPOSTERIOR POSITION OF THE ARCH ♦ Factors governing: ♦ 1.Consideration of the orbicularis oris and its attaching muscles(means positioning and expression of lips)-teeth should be positioned in a way that this muscle is not thrown backwards which will render them ineffective whiling contracting ♦ 2.Ridge resorption and its influence in www.indiandentalacademy.com
  17. 17. 2. Ridge resorption and its influence in anteroposterior position of arch ♦ Ridge resorption process in the maxillary arch occurs in a upward and backward direction-therefore crest of ridge is more posterior in a resorbed ridge than in a fresh ridge www.indiandentalacademy.com
  18. 18. RIDGE RESORPTION-CONTD….. ♦ Teeth are therefore placed too far lingual for the correct facial expression and the function of the facial muscles around the mouth ♦ If teeth are set over the ridge(as per rules of teeth setting)-artificial senile appearance results ♦ Moreover positioning of teeth in their former position does not create an unfavorable leverage-’coz,a reduction in incisal angle is permissible and advisable-which aids in functional occlusion ♦ (hence both function and esthetics are obtained) www.indiandentalacademy.com
  19. 19. RIDGE RESORPTION-CONTD….. ♦ Ridge resorption in the lower arch is more straight and downwards and hence in this case,teeth are usually placed over the ridge www.indiandentalacademy.com
  20. 20. POSTERIOR ARCH WIDTH – INFLUENCE ON ARRANGEMENT OF TEETH ♦ Posterior arch width is governed by a line drawn between the crests of the two ridges in any abnormal jaw relation ♦ Difference in the method of ridge resorption in both arches leads to many ridge relations which are abnormal and require a setting of teeth in cross-bite relations in order to obtain maximum efficiency of dentures www.indiandentalacademy.com
  21. 21. POSTERIOR ARCH WIDTH CONTD….. 1 2 ♦ PROGNATHIC RELATIONSHIP ♦ 1.Anterior and posterior teeth of the maxilla are set to the lingual instead to the buccal of the mandibular teeth throughout www.indiandentalacademy.com
  22. 22. CROSS-BITE “A” RELATION ♦ Relation normal in the anterior region and prognathic in the posterior region www.indiandentalacademy.com
  23. 23. CROSS-BITE “B” RELATION ♦ Relation- Normal in the posterior areas. Prognathic in the anterior anterior part www.indiandentalacademy.com
  24. 24. ORTHOGNATHIC RIDGE RELATION ♦ Relation-Retrusion of the lower anterior teeth with the posterior teeth in normal relation to each other www.indiandentalacademy.com
  25. 25. ORIENTATION OF THE PLANE ♦ Height of the occlusal plane is influenced by various factors in the anterior and posterior region of arch (for ex,anteriorly-lip length,ridge fullness influence etc influence the anterior plane) (for ex,posteriorly-intermaxillary space ,ridge height and fullness influence the posterior plane) www.indiandentalacademy.com
  26. 26. ORIENTATION OF PLANE-CONTD ♦ In any case balance must be obtained in various levels of plane orelse a unfavorable leverage may result b’coz of poorly divided intermaxillary space ♦ Favorable positioning of plane should be established and then harmony in balance attempted at that position www.indiandentalacademy.com
  27. 27. ORIENTATION OF PLANE-CONTD ♦ Inclination of plane – important factor in denture stability ♦ 1)Plane too low in anterior region,too high in posterior region-maxillary denture shunting forward may occur ♦ 2)Plane too high in anterior region,too lowin posterior regionmandibular denture shunting forward may occur www.indiandentalacademy.com
  28. 28. ESTABLISHING GUIDE LINES MAXILLARY CAST ♦ 1)Line 1 (A): designates anterior margin of the incisal papilla – valuable aid for positioning the maxillary central incisors. www.indiandentalacademy.com
  29. 29. CONTD…….. ♦2)Line 2:designates midline and indicates division between the right and the left quadrants. ♦3)Line 3:designates the posterior margin of the eminences when the canine eminences are visible on cast and coincides with the posterior surface of canines www.indiandentalacademy.com
  30. 30. ESTABLISHING GUIDE LINES Contd……. ♦ MANDIBULAR CAST ♦ Line 1:Bisecting the curve of the arch aids in positioning the mandibular central incisors.the curve of arch is used for positioning the central incisors and the canines. www.indiandentalacademy.com
  31. 31. MANDIBULAR GUIDE LINES CONTD…… ♦ Line 2:Canine points are the approx.. points that designate the distal surface of the mandibular canine ♦ Line 3:The line following the crest of the residual ridge from the canine point to the retromolar pad aids in positioning the posterior teeth ♦ Line 4:bisects the vertical height of the retromolar pad and aids in establishing the vertical position of the occlusal surfaces of posterior teeth www.indiandentalacademy.com
  32. 32. ANTERIOR TEETH SETTING CONSIDERATIONS ♦ 1)Anteroposterior positioning ♦ 2)Anterior slope ♦ 3)Mesiodistal inclination ♦ 4)Inferosuperior positioning in relation to a horizontal plane ♦ 5)Rotation on long axis www.indiandentalacademy.com
  33. 33. ARRANGEMENT OF UPPER ANTERIOR TEETH LABIO-LINGUAL INCLINATIONS ♦ Central incisors♦ Set to harmonize with patients profile according to labial surface of the wax occlusion rim established during jaw relation registration www.indiandentalacademy.com
  34. 34. LABIOLINGUAL INCLINATION CONTD……. ♦ Lateral incisors- Inclination more than that of the central incisor. ♦ Placed slightly lingual to and above level of incisal plane. www.indiandentalacademy.com
  35. 35. LABIOLINGUAL INCLINATION CONTD……. ♦ Canines ♦ Inclination is almost perpendicular to and the incisal edge contacts the lower wax rim www.indiandentalacademy.com
  36. 36. MESIO-DISTAL INCLINATION OF UPPER ANTERIOR TEETH ♦ 1)SQUARE FORM ♦ 1)Central incisor is nearly perpendicular ♦ 2)Lateral incisor inclined more distally ♦ at the cervical end than the central ♦ 3)Canine is inclined more distally than ♦ any other anterior teeth(provides more ♦ vigorousness of personality) www.indiandentalacademy.com
  37. 37. CONTD……. ♦ OVOID FORM TEETH: ♦ 1)Central incisor inclined approximately 2 degrees distally at the cervical end ♦ 2)Lateral incisor is inclined ,more than the central ♦ 3)Canine is inclined more than the lateral incisor approx… 6 degrees at cervical end to www.indiandentalacademy.com provide softness of appearance
  38. 38. CONTD……. ♦ TAPERING FORM TEETH: ♦ 1)Central incisor is inclined approximately 3 degrees at the cervical end ♦ 2)Lateral incisor is inclined more than the central incisor ♦ 3)Canine is more inclined than the lateral incisor approximately 6 degrees at cervical end to provide delicacy to the personality www.indiandentalacademy.com
  39. 39. FORM OF RESIDUAL RIDGE AND ANTERIOR TEETH SETTING SQUARE ARCH FORM: Distance between canines are wider Posterior ridge are more parallel than others Curvature of anterior ridge are mild www.indiandentalacademy.com
  40. 40. CONTD… TEETH SETTING IN SQUARE ARCH …. Sense of individuality given by changing the alignment of teeth ♦ 1)Distal end of the central incisors rotate toward the edge ♦ 2)Edge of lateral incisors are perpendicular to the midline. ♦ 3)Distal end of canines rotate toward the line of posterior arch form ♦ ARRANGEMENT PROVIDES-PERSPECTIVE AND VIGOR TO ANTERIOR SETUP www.indiandentalacademy.com
  41. 41. CONTD……. ♦ OVOID ARCH FORM ♦ ♦ Distance between canines are narrower and the curvature of anterior ridge is more severe than the upper arch. www.indiandentalacademy.com
  42. 42. CONTD.. - TEETH SETTING IN OVOID ARCH FORM 1)Edges of central incisor are perpendicular to midline 2)Lateral incisor follows to the arch line 3)Distal end of canine follows towards the line of posterior ridge ARRANGEMENT PROVIDES SOFTNESS IN APPEARANCE www.indiandentalacademy.com
  43. 43. CONTD……. ♦ TAPERING ARCH FORM ♦ 1)Distance of canines is narrower ♦ 2)Curvature of anterior arch is more severe than others www.indiandentalacademy.com
  44. 44. CONTD…… ♦ TEETH SETTING ♦ 1)Distal ends of central incisors should be rotated lingually. ♦ 2)Lateral incisors follow to arch line ♦ 3)Distal end of canine is set up to posterior ridge ♦ ARRANGEMENT EXPRESSES DELICACY www.indiandentalacademy.com
  45. 45. ARRANGEMENT OF MANDIBULAR ANTERIOR TEETH LABIOLINGUAL INCLINATION ♦ Central Incisors - properly inclined labially ♦ Lateral Incisors - Perpendicularly ♦ Canines - Properly inclined lingually www.indiandentalacademy.com
  46. 46. CONTD…… (MESIODISTAL INCLINATIONS) 1)Central incisors - Perpendicularly ♦ 2)Lateral Incisors - Perpendicularly or ♦ slightly inclined mesially ♦ 3)Canines - Properly inclined mesially www.indiandentalacademy.com
  47. 47. POSTERIOR TEETH ARRANGEMENT ♦ The arrangement - should position them in relation to their 3 possible dimensions( as close as practical to their original or natural,position) this placement makes it ♦ 1) for patient easy to adapt to dentures ♦ 2)permits the tongue and cheeks to function ♦ effectively during speech, mastication ♦ and deglutition and ♦ 3)esthetically more acceptable www.indiandentalacademy.com
  48. 48. REASONS FOR SETTING LOWER TEETH FIRST       Setting of upper posterior teeth first - makes it necessary to make many adjustments Lower ridge offers more reliable landmarks Lower denture more difficult denture to stabilize Lower denture offers less support than the upper More critical limitations to the positioning of the lower teeth If the lowers are set first ,they seldom need to be altered www.indiandentalacademy.com
  49. 49. MANDIBULAR TEETH SETTING Contd……… ♦ Mandibular 1st molar setting ♦ 1)Compensating curve – start with the first molar. ♦ 2)Mesial cusps are on the plane established by the anterior teeth and the bicuspids. ♦ 3)Distal cusps of the 1st molar are raised about 0.5mm above this plane. ♦ 4)Buccal and Lingual cusps are set at the same height to make the transverse plane horizontal. ♦ 5)Central Fossa is aligned with the canine -retromolar padwww.indiandentalacademy.com reference line
  50. 50. MANDIBULAR MOLAR SETTING Contd……… ♦ Mandibular Second Molar setting ♦ 1)Second molar continues the cuspal elevation of the compensating curve. ♦ 2)Buccal and Lingual cusps are horizontal ♦ 3)Central fossa is aligned with the canine – retromolar pad reference points. www.indiandentalacademy.com
  51. 51. MANDIBULAR TEETH SETTING ♦ Mandibular premolar setting ♦ Teeth manipulated into position so that the occlusal height matches the plane established by the mandibular anterior teeth. ♦ Buccal and Lingual cusps are horizontal and are made to touch the maxillary occlusal rim ♦ The central fossae should be in line with anteroposterior reference line www.indiandentalacademy.com
  52. 52. MANDIBULAR TEETH SETTING Contd…….. ♦ Final Considerations ♦ 1)Alignment and cuspal heights must be symmetric on both sides. ♦ 2)Marginal ridges of adjacent teeth should be at same height to present a smooth transition from side to side. www.indiandentalacademy.com
  53. 53. NORMAL RIDGE RELATIONSHIP MAXILLARY POSTERIOR TEETH SETTING ♦ PREREQUISITES ♦ Incisal guide pin set and checked for proper occlusal vertical dimension ♦ Incisal guide pin adjusted to provide for anterior clearance in lateral and protrusive excursions ♦ Lateral inclination of incisal guidance should never be steeper than the bucco-lingual inclination of modified anatomic teeth ♦ Incisal guide inclination –never be steeper than inclination of the condylar path ♦ Shallower incisal guidance makes obtaining balanced occlusion easier www.indiandentalacademy.com
  54. 54. GRINDING MAXILLARY POSTERIOR TEETH ♦ MODIFICATIONS BEFORE SETTING 1)All transverse ridges eliminated that would cause mesiodistal interlocking and interferences 2)Maxillary lingual cusps blunted,shaped and smoothened-to fit into common central fossa of lowers. 3)Buccal cusps of anatomic teeth progressively shortened by grinding from 1st premolar to 2nd molar(gives buccal cusp clearance in CO and during lateral movements. www.indiandentalacademy.com
  55. 55. MAXILLARY TEETH SETTING GENERAL CONSIDERATIONS ♦ 1.SET THEM FOR PROPER CUSP POSITION AND STATIC CUSP CONTACT IN “CR” ♦ 2.CHECK AND REFINE DYNAMIC CUSP CONTACT IN WORKING,BALANCING AND PROTRUSIVE MOVEMENTS www.indiandentalacademy.com
  56. 56. MAXILLARY FIRST MOLAR SETTING AND ARTICULATING (CENTRIC OCCLUSION) ♦ 1)Ridge of the mesio-buccal cusp of upper first molar rests in the anterior buccal groove of the lower first molar ♦ 2)Distal inclined plane of upper first molar touches the mesio-buccal cusp of the lower second molar www.indiandentalacademy.com
  57. 57. MAXILLARY FIRST MOLAR CONTD (CENTRIC OCCLUSION) ♦ 3)Mesio-lingual cusp of the upper first molar fits squarely into the central fossa of the lower first molar. ♦ 4)Disto-lingual cusp of the upper first molar touches the mesial ridge of the lower second molar www.indiandentalacademy.com
  58. 58. MAXILLARY FIRST MOLAR WORKING SIDE CONTACTS 1)Buccal cusps of the upper first molar contact buccal cusps of lower first molar and mesial slope of lower second molar. 2)Mesiolingual cusp contacts ridges formed by protrusive and retrusive lingual planes of lower first molar. 3)Distal slope of the upper distolingual cusp touches the mesial slope of the lower second molar www.indiandentalacademy.com
  59. 59. MAXILLARY FIRST MOLAR BALANCING SIDE CONTACTS ♦ 1)Mesiolingual cusp of upper first molar slides through the distobuccal groove of the lower first molar ♦ 2)Distolingual cusp of the upper first molar contacts the mesiobuccal cusp of the lower second molar www.indiandentalacademy.com
  60. 60. MAXILLARY 2ND PREMOLAR SETTING AND ARTICULATING (CENTRIC OCCLUSION) 1) Tip of the buccal cusp of the upper second premolar contacts the mesiobuccal ridge of the buccal cusp of the lower first molar and the distobuccal ridge of the lower second premolar 2)Lingual cusp of upper second premolar is at the embrasure between the lower first molar and the lower second premolar. www.indiandentalacademy.com
  61. 61. MAXILLARY 2ND PREMOLAR CONTD (CENTRIC OCCLUSION) 3)Distal ridge contacts the mesiolingual cusp of the lower first molar 4)Mesial ridge contacts the distal slope of the lower second premolar www.indiandentalacademy.com
  62. 62. MAXILLARY 2ND PREMOLAR (WORKING SIDE CONTACTS) ♦ 1)Distobuccal slope of the upper 2nd premolar contacts the mesiobuccal slope of the lower 1st molar. ♦ 2)Mesiobuccal slope of the upper 2nd premolar contacts the distobuccal slope of the lower 2nd premolar ♦ 3)Lingual cusp of the upper 2nd premolar closes the embrasure formed by the lower 1st www.indiandentalacademy.com molar and lower 2nd premolar
  63. 63. MAXILLARY 2ND PREMOLAR BALANCING SIDE CONTACTS ♦ 1)Lingual cusp of the the upper second premolar contacts the mesiobuccal cusp of the lower first molar www.indiandentalacademy.com
  64. 64. MAXILLARY SECOND MOLAR SETTING AND ARTICULATING (CENTRIC OCCLUSION) 1)The ridge of the mesiobuccal of the upper second molar rests in the buccal groove of the lower second molar. 2)The mesiolingual cusp of the upper second molar fits squarely into the central fossa of the lower second molar www.indiandentalacademy.com
  65. 65. MAXILLARY 2ND MOLAR CONTD(CENTRIC OCCLUSION) 2) The mesiolingual cusp of the upper second molar fits squarely into the central fossa of the lower second molar www.indiandentalacademy.com
  66. 66. MAXILLARY SECOND MOLAR (WORKING SIDE CONTACTS) 1)The buccal cusps of the lower second molar are in contact with the buccal cusps of the upper second molar and with the distal slopes of the upper first molar. www.indiandentalacademy.com
  67. 67. MAXILLARY SECOND MOLAR WORKING SIDE CONTACTS CONTD 2)The mesiolingual cusp of the upper second molar is in contact with the ridges formed by the protrusive and retrusive lingual planes of the lower second premolar. 3)The mesiolingual slope of the lower second molar touches the distolingual cusp of the upper first molar. www.indiandentalacademy.com
  68. 68. MAXILLARY SECOND MOLAR (BALANCING SIDE CONTACTS) 1)The mesiolingual cusp of the upper second molar slides through the distobuccal groove of the lower second molar. 2)The distolingual cusp of the upper first molar contacts the mesiobuccal cusp protrusive plane of the lower second molar www.indiandentalacademy.com
  69. 69. MAXILLARY 1ST PREMOLAR SETTING AND ARTICULATING (CENTRIC OCCLUSION) ♦ 1)Tip of buccal cusp of upper 1st premolar contacts the distobuccal ridge of the lower first premolar and the mesiobuccal ridge of the lower second premolar. www.indiandentalacademy.com
  70. 70. MAXILLARY 1ST PREMOLAR CONTD (CENTRIC OCCLUSION) ♦ 2)the lingual cusp of the upper first premolar is at the embrasure between the lower first and second premolars. ♦ 3)The mesial ridge of the upper first premolar contacts the distal slope of the lower first premolar. ♦ 4)The distal ridge of the contacts the mesial slope of the lower second premolar. www.indiandentalacademy.com
  71. 71. MAXILLARY 1ST PREMOLAR (WORKING SIDE CONTACTS) ♦ 1) The disto buccal slope of the upper first premolar contacts the mesiobuccal slope of the lower second premolar. ♦ 2)The mesiobuccal slope of the upper first premolar contacts the distobuccal slope of the lower first premolar. www.indiandentalacademy.com
  72. 72. MAXILLARY FIRST PREMOLAR WORKING SIDE CONTACTS CONTD…. ♦ 3)The lingual cusp of the upper first premolar closes the embrasure formed by the lower first and second premolars www.indiandentalacademy.com
  73. 73. MAXILLARY 1ST PREMOLAR (BALANCING SIDE CONTACTS) ♦ 1)The lingual cusp of the upper first premolar contacts the buccal cusp of the lower second premolar www.indiandentalacademy.com
  74. 74. COMPLETED SETUP After obtaining a proper static cusp contact(CO) in CR ,balancing of the occlusion is then carried out www.indiandentalacademy.com
  75. 75. TEETH SETTING IN ABNORMAL JAW RELATIONS ???? ♦ Upper-lower ridge relationship is an individual problem for each complete dentutr patient ♦ ABNORMAL RIDGE RELATIONS – NEED TO MODIFY NORMAL GUIDELINES NECESSARY TO FULFILL ALL www.indiandentalacademy.com DEMANDS
  76. 76. CLASS II JAW RELATIONS www.indiandentalacademy.com
  77. 77. MAXILLARY PROTRUSION PROBLEMS FACED & ARRANGEMENT OF TEETH 1)INCREASED OVERJET Leads to Abnormal upper and lower canine tooth relationship-no attempt to reduce it by moving upper teeth palatally or lower teeth labially 2)DISCREPANCY IN CANINE RELATIONSHIP Normally distal surface of canine tooth –(located at) tip of the cusp of upper canine,whereas in Max.prognathism it leads to the lower canine tooth finishing anywhere from the tip to distal surface of upper canine & Excessive prognathism leads to distal incline of cusp of lower canine posterior to distal surface of upper canine tooth www.indiandentalacademy.com
  78. 78. PROBLEMS FACED IN CLASS-II JAW RELATIONS-CONTD…… 2)DISCREPANCY IN CANINE RELATIONSHIP Normally distal surface of canine tooth – (located at) tip of the cusp of upper canine,whereas in Max.prognathism it leads to the lower canine tooth finishing anywhere from the tip to distal surface of upper canine & Excessive prognathism leads to distal incline of cusp of lower canine posterior to distal surface of upper canine tooth www.indiandentalacademy.com
  79. 79. CLASS-II RIDGE RELATION ARRANGEMENT OF POSTERIOR TEETH ♦ IF, Discrepancy is slight Upper teeth moved slightly pallataly – To provide working occlusal contact with the lower teeth{limited application} www.indiandentalacademy.com
  80. 80. CLASS – II RIDGE RELATION POSTERIOR TEETH ARRANGEMENT Contd…… MUCH WIDER UPPER ARCH Method 1: a)Lower posterior teeth are correctly placed on crest of the ridge b)Upper teeth are then set so that they occlude well with the lower teeth c)Buccal contours-Wax built up d)Wax replaced by Tooth colored acrylic resin (ESTHETIC AND CHEEK SUPPORT FULFILLED www.indiandentalacademy.com
  81. 81. Method 2 ♦ 1)Upper Posterior teeth first arranged-esthetic demands met ♦ 2)Lower teeth kept on crest of ridge ♦ 3)Unfavorable occlusal relationship results ♦ 4)to obtain functional oclusal contact-wax is added on the palatal aspect of upper posteriors ♦ 5)Wax-replaced by tooth colored resin ♦ (FUNCTIONALLY EFFECTIVE,OCCLUSAL CONTACT OBTAINED + ESTHETIC BUCCAL SURFACE CONTOUR OF UPPER TEETH OBTAINED) www.indiandentalacademy.com
  82. 82. SETTING UPPER POSTERIOR TEETH IN CLASS-II RELATION ♦ UPPER FIRST PREMOLAR SETTING ♦ 1)Flattened lingual cusp occludes with flattened buccal cusp of lower first premolar ♦ 2)Large buccal horizontal overlap occurs in first bicuspid area when teeth are set to proper arch form. www.indiandentalacademy.com
  83. 83. CONTD…….. ♦ UPPER SECOND PREMOLAR SETTING ♦ 1)Upper 2nd premolar is set with its flattened lingual cusp occluding with the flattened buccal cusp of the lower second premolar ♦ 2)There is less buccal overlap and a larger area of contact is possible between this teeth www.indiandentalacademy.com
  84. 84. SETTING UPPER MOLARS ♦ 1)The upper molars are set with their lingual cusp in the modified central fossa of the lower teeth. ♦ Contacts are checked for deflective inclines and if found are grinded . www.indiandentalacademy.com
  85. 85. EVALUATION OF COMPLETED SETUP ♦ 1)Posteriors should have a centric occlusion with stable nondeflective stops. ♦ 2)Only lingual cusps are the occluding elements on the upper teeth-They contact the flattened buccal cusps of the lower premolars and the central fosa of the lower molars. ♦ 3)After the primary requirement (STABLE ♦ CENTRIC OCCLUSION) is obtained,balancing of occlusion is carried out www.indiandentalacademy.com
  86. 86. ARRANGEMENT OF TEETH IN CLASS-III JAW RELATIONS ♦ PROBLEMS ASSOCIATED WITH CLASS-III RELATIONS ♦ Condition is characterized by the lower anterior ridge being forward in relation to maxillary ridge ♦ 1)may vary from edge to edge relation ♦ or ♦ 2)marked prognathism www.indiandentalacademy.com
  87. 87. MANAGEMENT OF PROBLEMS ASSOCIATED WITH CLASS III RELATIONS ♦ 1)Ridges are edge to edge-then incisal edges of upper and lower incisors and cuspids also meet in edge to edge www.indiandentalacademy.com
  88. 88. ♦ Upper and lower teeth are placed ♦ as near as possible to the labial plates of bone in their respective ridges ♦ (normal horizontal overlap should not be attempted when ridge relation does not permit-if done then stability of denture will be greatly hampered.). ♦ edge to edge relation enhances stability www.indiandentalacademy.com
  89. 89. ♦ EXTREME PROTRUSION OF THE MANDIBLE ♦ 1)Negative or reverse horizontal overlap should be used.(magnitude depends on degree of protrusion ) ♦ Other associated problems ♦ Wider lower arch-leads to problems in selecting size of teeth(I.e both arch teeth cannot be selected from the same mold) www.indiandentalacademy.com
  90. 90. ♦ Other associated problems ♦ Wider lower arch-leads to problems in selecting size of teeth(i.e both arch teeth cannot be selected from the same mold);if done so then spaces between lower anterior teeth will occur and esthetics will be reduced www.indiandentalacademy.com
  91. 91. ♦ Solutions ♦ 1.if reverse horizontal overlap is negligible,then spacing will not be very obvious. ♦ 2.in gross cases ♦ a.use slightly larger lower tooth mold for the lowers ♦ b.use slight overlapping in the uper anterior teeth(if esthetically acceptable)-automatically narrows lower arch space and eliminates spacing ♦ c.use an extra lower incisor to avoid spaces(least acceptable-’coz some amount of spacing should be present for the already prominent arch) www.indiandentalacademy.com
  92. 92. ♦ Canine relationship in CLASS III cases: ♦ Relationship –does not pose much of a problem ♦ Distal surface of lower canine coincides with the tip of the upper canine ♦ If it finishes mesial to the canine tip,the discrepancy can be rectified using small spaces between the lower anterior teeth so that the canine will have normal relation www.indiandentalacademy.com
  93. 93. ARRANGEMENT OF POSTERIOR TEETH IN CLASS III CASES ♦ PROBLEMS FACED ♦ 1.Crest of lower arch is located further buccally than that part of the upper residual ridge.(vary little to marked)-Leads to problem of developing an adequate occlusal relationship between upper and lower teeth www.indiandentalacademy.com
  94. 94. ♦ SOLUTIONS ♦ 1.Difference in size is slight and upper posterior ridge is well formed: ♦ Upper posterior teeth can be et slightly buccal to the crest of the ridge ,a position that correctly placed lower teeth can make an effective occlusal contact with antagonists… www.indiandentalacademy.com
  95. 95. ♦ 2.Non-Anatomic teeth may be used ♦ a.allows more fredom in buccolingual placement ♦ b. still provides adequate occlusal contact between upper snd lower teeth. ♦ c.Teeth can stil be kept on the crests of the respective ridges without losing desired occlusal contacts. www.indiandentalacademy.com
  96. 96. ♦ LOWER ARCH IS TO WIDE: ♦ 1.Interchange using upper teeth on the lower denture and lower teeth on the upper denture. ♦ 2.Interchange is made across the arch as well.(for ex.. Right upper teeth are placed on left lower ridge,left lower teeth are placed on right upper arch ….) www.indiandentalacademy.com
  97. 97. ♦ A.First lower teeth are placed on upper ridge. ♦ B.First premolar is eliminated from upper arch to develop correct intercuspal relationship. ♦ C.Second premolar,first molar and second molar(lower teeth) are set on upper ridge ♦ D.once upper teeth are set on the lower arch they are made to set against the lower teeth on the upper arch www.indiandentalacademy.com
  98. 98. ♦ D)once upper teeth are set on the lower arch they are made to set against the lower teeth on the upper arch ♦ a.Mesiobuccal cusp of (now)lower molar(I.e upper molar’s) fits into buccal groove of (now) upper first molar (lower molar) thus maintaining the anatomic relations of theteeth,though inverted. ♦ b.other teeth are set in usual manner www.indiandentalacademy.com
  99. 99. ♦ Results of such a arrangement ♦ 1.buccal cusps of the lower first and second molar overlap the upper teeth-I.e reverse buccal overlap is set. ♦ 2/however In premolar region this horizontal overlap is eliminated by setting thelower teeth such that their buccal cusps are between inclines of the buccal cusps of upper teeth(necessary b’coz lower residual ridgeis narrowwr in molar region www.indiandentalacademy.com
  100. 100. SEQUENTIAL STEPS OF ARRANGING TEETH IN CLASS III JAW RELATIONS ♦ 1.Setting lower posterior teeth ♦ Same criteria is used as that used in setting teeth in normal ridge relationship ♦ 2.Grinding modifications for lower teeth ♦ No variations are made in grinding procedures in the initial modification.additional spot grinding will be necessary when upper posteriors are set. www.indiandentalacademy.com
  101. 101. Grinding modifications for upper posterior teeth 1.each tooth is modified before setting 2.all transverse ridges are eliminated to eliminate mesiodistal interlocking www.indiandentalacademy.com
  102. 102. Special individual tooth grinding 1.depends on the tooth that initiates the crossing over of the occlusion-when this occurs upper tooth is flattened on both buccal and lingual cusps to establish a stable centric occlusion 2.Teeth in crossbite relation need additional modification by grinding on the upper buccal cusps-(roundening ) www.indiandentalacademy.com
  103. 103. SETTING UPPER POSTERIOR (CLASS III) 1 2 3 ♦ 1-UPPER FIRST PREMOLAR Usually set to a typical anatomic relationship-this is anterior to crossbite relationship www.indiandentalacademy.com
  104. 104. CONTD….. 2-UPPER SECOND PREMOLAR Usually the transition tooth where the crossover starts. Upper buccal and lingual cusps are flattened. ♦ Lower teeth are also flattened on their buccal and lingual cusps ♦ Upper and lower premolars are set buccalto -buccal and lingual -to –lingual www.indiandentalacademy.com
  105. 105. ♦ 3-UPPER MOLAR TEETH 1.Set in a cros-bite relation(with rounde upper buccal cusps in lower central fossa) After complete checking balancing of occlusion is done www.indiandentalacademy.com
  106. 106. SUMMARY ♦ ARRANGEMENT OF TEETH IS AN ART BASED UPON BIOMECHANICAL FACTORS GOVERNING THE ULTIMATE SUCCES OF DENTURES. ♦ AN UNDERSTANDING OF THE INTERPLAY OF THE FACTORS IS THEREFORE NECESSARY TO THE WHOLE PROCEDURE OF TEETH SETTING www.indiandentalacademy.com
  107. 107. ♦ THUS TO DEVELOPA WORKABLE ARRANGEMENT ,NECESSARY CHANGES SHOULD BE INTRODUCED WHENEVER NECESSARY,WHICH ALONE WILL COPE UP WITH THE VARIOUS JAW ABNORMALITIES FACED IN EVERYDAY CLINICAL PRACTICE www.indiandentalacademy.com
  108. 108. THANK YOU www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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