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DENTURE POLISHED SURFACE
AND JAW RELATION RECORD
ASSISTANT PROFESSOR
DR. SHOAIB RAHIM
BDS, FCPS
DEPARTMENT OF PROSTHODONTICS
DENTURE SURFACES
 Impression/ intaglio surface
 Polished surface
 Occlusal surface
TRIAL DENTURE BASE
 Provisional substitutes for denture base
 Support wax rims
 Must be rigid, accurate, and stable
 Made from:
 Hard baseplate wax
 Auto polymerizing acrylic
 Light cured acrylic
 Heat cured acrylic
DENTURE BASE IDEAL PROPERTIES
 Biocompatible: nontoxic, nonirritant
 Adequate physical and mechanical properties:
 High flexural, transverse and impact strength
 High modulus of elasticity for better rigidity
 Long fatigue life
 High abrasion, creep and craze resistance
 Good thermal conductivity
 Low density
 Low solubility and sorption of oral fluids
 Softening temperature higher than that of oral fluids and food
DENTURE BASE IDEAL PROPERTIES
 Adequate physical and mechanical properties:
 Dimensionally stable and accurate
 Superior esthetics and color stability
 Radiopacity
 Good bond with denture teeth and liners
 Ease of fabrication with minimum expenses
 Easily repaired if fractured
 Readily cleansable
DENTURE BASE MATERIALS
 Heat Activated PMMA
 Rapid Cure Type Resins
 Chemically Activated Resins
 Pour or Fluid Resin Technique
 Microwave Activated Resins
 Light Activated Resins (VLC)
 Modified Resin Base Materials
HEAT ACTIVATED PMMA
 Polymer and monomer are mixed in the proper ratio of 3 : 1 by volume
or 2.5 : 1 by weight
 The mixed material goes through four stages:
 Wet sand like mixture
 Tacky fibrous stage
 Smooth dough like stage
 Rubbery stage
POLYMERIZATION CYCLE
 One technique involves placing the flask in a constant– temperature
water bath at 74° C (165° F) for 8 hours or longer without a terminal boil
at 100° C
 Another technique processes the base at 74° C for 8 hours or more
followed by a terminal boil at 100° C for 1 hour
 A shorter cycle involves processing the resin at 74° C for approximately
2 hours then boiling at 100° C for 1 hour or more
DENTURE BASE POROSITY
 Presence of minute surface or subsurface voids in a denture that has
been processed is relatively uncommon nowadays, considering the high
technical standards that are followed in dental laboratories
 Porous denture would increase liability for staining and calculus deposits,
and would promote adhesion of fungal and bacterial biofilms (dental
plaque), which could adversely affect the health of the denture-
supporting tissues
DENTURE BASE POROSITY
 Gaseous porosity occurs as a result of rapid heating of the flask, leading
to monomer evaporation; this appears as fine uniform subsurface
spherical pores, localized more often in the thicker portions of the
denture
 Inadequate pressure during flask closure or insufficient amount of
dough present upon packing of the mold can lead to denture porosity.
The voids are large, irregular in shape, and abundant. The resulting
denture appears lighter and more opaque in color
DENTURE BASE POROSITY
 Inadequate mixing of powder/liquid components also may result in
denture porosity. The areas that contain more monomer tend to shrink
more than the adjacent areas. This localized polymerization shrinkage
leads to the production of large voids that are uniformly spread
throughout the base
RAPID CURE TYPE RESINS
 Polymerized by rapidly heating the packed dough in boiling water for 20
minutes
 Materials are hybrid PMMA, in which activation of the polymerization
reaction is carried out through both chemical and heat activators allowing
rapid polymerization without porosity
 After placing the denture in boiling water, the water is boiled at 100° C for
20 minutes
 The popularity and relative simplicity of the compression molding technique
is usually overshadowed by the high processing stresses that are induced in
the resins during polymerization
RAPID CURE TYPE RESINS
 Stresses result from various factors:
 Polymerization shrinkage occurs as polymer chains are formed. This accounts for
a volumetric shrinkage of about 7%
 Thermal shrinkage then follows as the resin cools
 Differences in thermal contraction of the resin and gypsum mold collectively
yield residual stresses in the resin
 Occlusal errors that are commonly encountered following processing are
effectively corrected and the predetermined vertical dimension of occlusion
restored through routine laboratory remount and selective grinding
BOND BETWEEN HEAT CURE DENTURE BASE
AND RESIN TEETH
 Excellent bond with resinous denture teeth
 Results from the increased rate of diffusion of the monomers into the
polymerized teeth at the high temperatures
 Simplifies the procedures of grinding and set up of teeth even in cases
of limited inter arch space
 Porcelain teeth are mechanically attached to the bases
 Treatment of the ridge lap area of porcelain teeth with organosilane
compounds has been used to overcome the problem of teeth
dislodgement
BIOCOMPATIBILITY OF METHACRYLATE
RESINS
 Concerns regarding the biodegradation:
 Enzymes present in saliva
 Chewing
 Occlusal forces
 Thermal and chemical dietary changes
 Possible adverse biologic effects of these compounds range from:
 Chemical irritations
 Ulcerations
 Burning mouth syndrome
 Denture stomatitis to more toxic effects
RESIDUAL MONOMER CONTENT
 Processing dentures at temperatures that are too low or for shorter times
increases the residual monomer content in the processed denture base
 The small size and hydrophilic nature of this monomer allows for its fast diffusion
into the oral cavity and the body
 Major advantage of conventionally heat-cured resin bases is that they have
significantly lower residual monomer contents
 Terminal boiling of the flasks at 100° C for at least 1 hour decreases the monomer
content to a clinically acceptable level (approximately 0.2% to 0.5%)
RESIDUAL MONOMER CONTENT
 The plasticizing effect of excess monomer has been shown to adversely
affect the mechanical properties and dimensional stability of dentures
 Unbound monomer and other additives are mostly eluted within the first
24 hours after processing, followed by a slow and moderate release
over a long period of time
 Storage of the dentures in water is a major factor in releasing residual
monomer from the bases
PHYSICAL AND BIOLOGIC CONSIDERATIONS
PHYSICAL AND BIOLOGIC CONSIDERATIONS
 Denture bases undergo water absorption
by diffusion resulting in linear expansion,
which favorably offsets polymerization
shrinkage
 Denture bases also dry out in dry hot
conditions
 Methacrylate resin (PMMA) dentures have a
low thermal conductivity
CLINICAL IMPLICATIONS
 Patients are advised to store dentures in
tepid water when out of the mouth
 Placing dentures in hot water (>35° C)
results in the release of internal residual
stresses, leading to significant distortion
 Portrayed as a substantial decrease of
thermal stimulation
 Source of inconvenience for first-time
denture wearers
PHYSICAL AND BIOLOGIC CONSIDERATIONS
PHYSICAL AND BIOLOGIC CONSIDERATIONS
 Denture base resins are subjected to a
variety of stresses during function:
 Midline fractures of dentures during function
are considered a flexural fatigue failure due to
cyclical deformation of the base during
function. This is usually more evident in ill
fitting or poorly designed dentures
 Impact fracture may result from patients
accidentally dropping the dentures
CLINICAL IMPLICATIONS
 Periodical recalls of the patient by the dentist are
required to address problems that may arise from
long-term denture wearing, such as bone
resorption that may affect the fit of the dentures
 Patients are advised on the proper handling of
their dentures, such as cleaning them over a sink
full of water, to avoid fracture if dropped
 Use of rubber-reinforced methacrylate bases in
cases of repeated fractures has been advocated
 Metal bases also can be used for maximum
strength
PHYSICAL AND BIOLOGIC CONSIDERATIONS
PHYSICAL AND BIOLOGIC CONSIDERATIONS
 Biocompatibility of denture base methacrylate
resin to the surrounding oral environment is
considered an attribute to the material.
However, water sorption, cracks, surface
imperfections, and micro porosity of the bases
are usually associated with the ability of certain
organisms to colonize the fitting and other
surfaces of the denture, mostly in the absence
of adequate oral hygiene
CLINICAL IMPLICATIONS
 Frequent cleansing or soaking the dentures in
chemical cleansers is usually sufficient to minimize,
but not totally resolve, this problem
 Temporary treatment of resin surface with Nystatin
and use of CHX have been recommended to
effectively reduce the colonization of C. albicans
 Minimizing adhesion of C. albicans to denture bases
has been attempted by incorporating negative
charges in the resin surface
 Coating the resin surfaces with a self-bonding
protective polymer, such as poly(dimethyl siloxane),
also has been implemented to discourage microbial
attachment
PHYSICAL AND BIOLOGIC CONSIDERATIONS
PHYSICAL AND BIOLOGIC CONSIDERATIONS
 Low abrasion resistance of resin bases and
teeth lead to wear if cleaning of dentures is
carried out with a stiff brush or using
abrasive agents
 Soluble in organic solvents thus upon
exposure to alcohol or acetone, the polymer
network swells as the resin dissolves, leading
to irreversible damage to the resin surface
CLINICAL IMPLICATIONS
 Patients are advised to clean their dentures
with soap and water using a soft brush
 Patients who frequently drink alcoholic
beverages can benefit from cross-linked
polymeric base
RADIOPACITY OF DENTURE BASES
 Use of metal inserts, radiopaque salts and fillers, and organometallic compounds
 Accompanied by adverse effects on:
 Esthetics
 Increased water sorption
 Flexural strength of the denture base resins
 Cytotoxic effects
 Radiopaque terpolymer synthesized which contains (2,3,5 tri-o-benzoyl)-ethyl
methacrylate, methyl methacrylate, and 2-hydroxyethyl methacrylate
INJECTION MOLDING TECHNIQUE
 The resin mix is injected into closed sprued flask under continuous pressure
 Shown to improve the level of fit and adaptation of the processed resins to
the underlying stone casts and tissues thus minimizing the need for further
postinsertion occlusal adjustments
 Exhibited less polymerization shrinkage and greater accuracy and
dimensional stability than those processed by standard compression
molding techniques
CHEMICALLY ACTIVATED RESINS
 Referred to as cold-curing, self-curing or auto polymerizing resins
 Less frequently used for denture fabrication as compared with the heat-
activated
 Processing of the resins could be carried out by compression molding in a
flask where initial hardening of the resin occurs within 30 minutes of flask
closure, or it can be poured in a fluid consistency that is termed the “pour-
type resin technique.”
PROPERTIES OF CHEMICALLY ACTIVATED
RESINS
 Contain higher residual monomer contents of 3% to 5% as compared with
heat-activated resins
 Incomplete polymerization leads to inferior mechanical properties of the
resins and dramatically compromises their biocompatibility
 They exhibit higher solubility in oral fluids and water sorption
 Inferior color stability due to oxidation of the amine accelerator
 High creep rates under increased stresses
 Less polymerization shrinkage
Reduction in the residual stresses during polymerization leads to greater
dimensional stability of the resins
POUR OR FLUID RESIN TECHNIQUE
 Principal difference in the chemical composition of these resins and the
compression molded chemically activated resins is the smaller size of the
powder particles necessary to ensure fluidity of the mix
 Involves pouring the fluid mix into a sprued mold
 Flask is placed under pressure at room or higher temperature (45° C)
 Polymerization is completed in about 30 to 45 minutes
POUR OR FLUID RESIN TECHNIQUE
 Technique is simpler and cleaner in regard to flasking and deflasking, as
compared with the conventional compression-molding technique
 Use of a hydro-flask increases atmospheric pressure around the mold,
minimizing air inclusions in the mix and thus yielding a denser resin base
 The main drawback of this technique is the increased tendency of the
denture teeth to shift position during pouring of the fluid MMA mix into the
mold
MICROWAVE ACTIVATED RESINS
 Activate polymerization process of methacrylate base resin by using a special
glass fiber–reinforced plastic flask, suitable for use in a microwave oven
 composition of liquid monomer is usually modified to control the boiling of
monomer, in a very short curing cycle of about 3 minutes at 500 to 600
W/cycle
 Careful control of the time and wattage of the oven is essential to yield
porous-free resins and still ensure a complete polymerization cycle that
enhances the intrinsic characteristics of the resin
PROPERTIES MICROWAVE ACTIVATED RESINS
 The technique is more time efficient and cleaner than the conventional technique
 Microwave-activated resins have comparable physical and mechanical properties to
conventionally heat-activated resins, with reportedly lower incidences of denture tooth
movements
 Claims of greater dimensional stability and improved denture base adaptation to the
underlying tissues have been attributed to adequate temperature control in the resin;
equal distribution of temperature throughout the resin and gypsum mold, respectively;
and increased homogeneity of the dough
 Limitations, however, are relatively due to its cost effectiveness for a wide production base,
particularly because of high equipment expenses and fragility of the plastic flasks that are
more prone to fracture than the conventional metal flasks
LIGHT ACTIVATED RESINS
 Copolymers of urethane dimethacrylate and methacrylate resin along with microfine
silica fillers
 Alternative to heat activated and microwave-activated resins
 Polymerization process is activated by placing the premixed, moldable resin on the
master cast on a rotating table in a light chamber and exposing it to high intensity
visible light of 400 to 500 nm for an appropriate time period of about 10 minutes
 The resin is coated with a nonreactive barrier compound to prevent oxygen
inhibition of the polymerization process
PROPERTIES LIGHT ACTIVATED RESINS
 Light-activated resins are indicated for PMMA sensitive patients because they
contain no methyl methacrylate monomer
 They exhibit smaller polymerization shrinkage, reportedly half that of
conventional resins, because of the presence of high molecular weight
oligomers. Intimate adaptation of the bases to the underlying tissues is a great
asset of the material
 The physical and mechanical properties of the resins compare well to
conventional heat-activated resins, particularly in regard to transverse and
impact strengths and hardness.
PROPERTIES LIGHT ACTIVATED RESINS
 Elastic modulus and flexural strength are lower than conventional resins,
which could increase deformation of the dentures during function
 Inferior bond strength of VLC resins to resin denture teeth has been reported
frequently but has greatly improved with the use of bonding agents
 Biocompatibility of VLC denture base resins raises concern, with reports of
possible hypersensitivity reactions and cytotoxic effects in epithelial cells in
culture
MODIFIED RESIN BASE MATERIALS
 Water sorption, an inherent weakness in the structure of methacrylate-based
resins, leads to dimensional changes in the denture bases
 It is influenced by the type of resin, its thickness, and amount of cross-linking of
the polymer
 Heat-activated resins reach their water saturation levels longer than their
chemically activated counterparts because of their lower water diffusion
coefficients
 Reducing water sorption of methacrylate resins has been attempted by the
incorporation of fluoro-substituted and styrene-type monomers in the polymer
structures
MODIFIED RESIN BASE MATERIALS
 Chemical modification to produce graft copolymer resins through the incorporation of
a rubber consists of a matrix of PMMA in which is dispersed an interpenetrating
network (IPN) of rubber and PMMA
 The resins absorb more energy at higher strain rates before fracture occurs, resulting in
a significant increase in impact strength
 This modification has been shown to be accompanied by a reduction in the stiffness or
rigidity of the resins
 High cost of the material may limit its routine use for widespread denture fabrication
MODIFIED RESIN BASE MATERIALS
 Mechanical reinforcement of methacrylates also has been attempted through the
inclusion of fibers such as glass, carbon, aramid (Kevlar) fibers, nylon, and ultrahigh
modulus polyethylene (UHMWPE) polymers, as well as metal inserts (wires, plates,
fillers)
 The incorporation of (triethoxyvinylsilane) treated fillers and oligomers in the polymer
structure improved the mechanical properties of fiber-reinforced resin bases
 The resulting resins have increased impact and flexural strength and significant
improvement in fatigue resistance, effectively minimizing denture fractures
LIMITATIONS OF REINFORCED DENTURE
BASE RESINS
 Tissue irritation can occur from protruding glass fibers
 Poor esthetics is associated with dark carbon fibers (black) or straw colored Kevlar
fibers
 Require increased production time
 Difficulties in handling, orientation, placement or bonding of the fibers within the
resin
 Metal inserts have been associated with failures due to stress concentration
around the embedded inserts
WAX RIMS
CAST AND BASE PLATE SPECIFICATIONS
WAX RIM SPECIFICATIONS
MAXILLARY WAX RIM MODIFICATION
MANDIBULAR WAX RIM MODIFICATION
JAW RELATION
RECORD
TYPES
 Orientation relations
 Vertical relations
 Horizontal relations
VERTICAL RELATION
 Rest vertical dimension
 Occlusal vertical dimension
 Inter occlusal space/ Freeway space
METHODS OF DETERMINING VERTICAL
RELATION
Mechanical Methods
 Ridge relations
 Distance from incisive papilla
 Parallelism of ridge
 Measurements from former dentures
 Pre-extraction records
 Radiographs
 Profile photographs
 Articulated casts
 Facial measurements
METHODS OF DETERMINING VERTICAL
RELATION
Physiologic Methods
 Physiologic rest position test
 Parting lips after swallowing
 Niswonger's method
 Phonetics
 Facial expressions and esthetics
 Swallowing threshold
 Tactile sense
 Electromyography
RIDGE RELATIONS
 Incisive papilla
The vertical distance of maxillary incisal edge should be around 6mm
 Ridge parallelism
Correct vertical relation is at a point where both jaws are parallel with 5 degree
opening in the posterior region
Disadvantages:
 Not reliable in cases of marked resorption
 When teeth are lost at irregular intervals the residual ridges are not parallel
MEASUREMENTS FROM FORMER DENTURE
FACIAL MEASUREMENTS
PHYSIOLOGIC REST POSITION TEST
 Swallow and Relax
Lips are parted gently by holding the jaws still with
2-4mm of space in premolar region
 Niswonger’s Method
Two markings are made and patient told to swallow
and relax and the distance is measured
PHONETICS
 Using “m sound”
 Using “ch, s and j sounds”
 Using “f, v sounds”
 Using “thirty three”
 Silverman’s closest speaking space
ESTHETICS
 Facial Esthetics
Facial appearance, skin tone etc.
 Willis Method
Distance between the outer canthus of the eye and the corner of the mouth
should be equal to the distance between the lower border of the septum of
nose and lower border of chin
SWALLOWING THRESHOLD
 Cones of soft wax having excessive height are placed
 Patient is instructed to swallow
 Repeated swallowing reduces the height of wax to the
occlusal vertical dimension
Disadvantages:
 Non consistent results
 Affected by the length of time swallowing motion is
performed
TACTILE SENSE
 Patient’s tactile sense
 Boos bimeter
 Lytle’s method
BOOS BIMETER
 Maximum biting force occurs at OVD
 Measures the biting force
 Adjustable screw to change the vertical dimensions
 Measurement recorded on dail
LYTLE’S METHOD
 Use of central bearing plate and pin
 Vertical dimension increased beyond physiologic
rest position
 Height reduced till over closure
 Height increased till patient indicates comfortable
position
EFFECTS OF DECREASED VERTICAL
DIMENSION
 Decreased chewing efficiency
 Cheek biting
 Appearance
 Angular cheilitis
 TMJ pain
EFFECTS OF INCREASED VERTICAL
DIMENSION
 Discomfort
 Trauma to underlying mucosa
 Increased ridge resorption
 Clicking of teeth
 Increased wear of acrylic teeth
 Strained appearance
SCRIBING WAX
HORIZONTAL JAW RELATIONS
 Centric Relation
 Eccentric Relation
 Protrusive Relation
 Laterotrusive Relation
 Left lateral
 Right Lateral
SIGNIFICANCE OF CENTRIC RELATION
 Artificial teeth best occlude evenly
 Stable position independent of teeth contact
 Recordable and reproducible
 Stable retentive dentures
PROBLEMS IN RETRUDING MANDIBLE
 Biologic Difficulties
 Due to lack of muscular coordination
 Development of habitual protrusive position after complete edentulism
 Development of habitual position due to wear of teeth or previous wrong
centric position
 Neuromuscular disease
 Psychological Difficulties
 Mechanical Difficulties
METHODS FOR RETRUDING MANDIBLE
 Relax the jaw, pull back and slowly close
 Push the upper jaw out and close
 Protrude and retrude mandible repeatedly while holding the chin
 Boos stretch-relax exercise
 Roll the tongue backwards towards the posterior border and close
 Swallow and close
METHODS FOR RETRUDING MANDIBLE
 Tapping the rims rapidly and repeatedly
 Tilting the head backwards
 Massaging the temporalis or masseter muscles to relax them
 Dawson’s bimanual manipulation
RECORDING CENTRIC RELATION
 Minimal pressure closure
 Heavy pressure closure
METHODS FOR RECORDING CENTRIC
RELATION
 Interocclusal Check Records
 Functional Methods
 Needle House Method
 Patterson’s Method
 Meyer’s Method
 Excursive Methods (Gothic Arch Tracing)
 Intra Oral Tracing
 Extra Oral Tracing
METHODS FOR RECORDING CENTRIC
RELATION
 Terminal Hinge Axis
 Other Methods
 Celluloid Strips
 Heating the Surface of one rim
 Deep heating or pooling method
 Softened Wax placed over occlusal surface
 Soft Cones of Wax placed on lower denture
INTEROCCLUSAL CHECK RECORDS
FUNCTIONAL METHOD
 Needle House Method
 Four metal styli fixed in maxillary rim
 Diamond shaped pathways carved in
mandibular rim
 Require needle house articulator
FUNCTIONAL METHOD
 Patterson’s Method
 Trench made in mandibular wax rim
 Filled with plaster and carborundum paste
 Compensating curves generated
 Meyer’s Method
 Use of soft wax to generate paths
 Plaster index is made
 Teeth setup within the index
GOTHIC ARCH TRACING
 Application
 To verify or confirm centric relation obtained by other methods
 Used to obtain protrusive and lateral record
 Types
 Intra oral tracing
 Extra oral tracing
 Assembly attached to maxillary and mandibular rims
GOTHIC ARCH TRACING
OTHER METHODS
 Strips of Celluloid
 Deep heating of posterior portions of mandibular rims
 Softened wax in the mandibular posterior region
 Swallowing technique
ECCENTRIC RELATIONS
 Functional Methods
 Graphic Methods
 Direct Check Records
CHRISTENSEN’S PHENOMENON
LATEROTRUSIVE RECORDS
Hanau’s Formula
L = H + 12
8
NEUTRAL ZONE
NATURAL TEETH OCCUPY A
ZONE OF EQUILIBRIUM, WITH
EACH TOOTH ASSUMING A
STABLE POSITION THAT IS THE
RESULT OF ALL THE VARIOUS
FORCES ACTING ON IT
SIGNIFICANCE
 Severely resorbed ridges
 Denture stability
 Functional acceptability
 When patient’s masticatory muscles are atrophied and neuromuscular ability
is lost then it is contraindicated
NEUTRAL ZONE IMPRESSION
 Swallowing (drinking a little water)
 Saying words that include “S”
(counting from 60 or 70)
 Licking the lips (licking the left and
the right lip corners)
 Blowing a whistle
CAST MOUNTING
AND PROGRAMMING
MOUNTING OF CAST
REQUIREMENTS OF ARTICULATOR
Minimum Requirements
 Open and close in hinge like fashion
 Hold cast in correct horizontal and vertical position
 Simulate protrusive and lateral jaw motions
 Moving parts should be accurately machined and move freely and
accurately
 Non moving parts should be rigid
 Should accept facebow transfer
REQUIREMENTS OF ARTICULATOR
Additional Requirements
 Adjustable horizontal and lateral guide elements
 Adjustable incisal guide table
 Adjustable intercondylar width
 Condylar elements in the lower frame
 Mechanism to accept the third reference point during
facebow transfer
 Removable mounting plates that can be repositioned
accurately
CLASSIFICATION OF ARTICULATORS
 Class I
Simple holding device capable of accepting single static registration
(example: hinge articulator)
CLASSIFICATION OF ARTICULATORS
 Class II
Permits horizontal as well as vertical motion but do not orient the motion to
TMJ with a facebow transfer
 II-A
Permits eccentric motion based on average or arbitrary values (example: grittman or
gysi’s simplex articulator)
 II-B
Permits eccentric motion based on arbitrary theories of motion (example: maxillo-
mandibular instrument designed by Monson based on spherical theory of occlusion)
 II-C
Permits eccentric motion based on engraved records obtained from patient (example:
hose articulator)
CLASSIFICATION OF ARTICULATORS
 Class III
Stimulate condylar pathways by using average or mechanical equivalents for all or
part of the motion and allow for joint orientation of the casts with facebow transfer
 III-A
Accepts facebow transfer and protrusive interocclusal record
 III-B
Accepts protrusive interocclusal records
CLASSIFICATION OF ARTICULATORS
 Class IV
Instruments that accept 3 dimensional dynamic registrations and
use facebow transfer
 IV-A
Condylar pathways are formed by registrations engraved by the patient
 IV-B
Condylar paths can be angled and customized
PROGRAMMING OF ARTICULATOR
PROGRAMMING OF ARTICULATOR
THANK YOU

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04. denture polished surface, jaw relation record and articulators

  • 1. DENTURE POLISHED SURFACE AND JAW RELATION RECORD ASSISTANT PROFESSOR DR. SHOAIB RAHIM BDS, FCPS DEPARTMENT OF PROSTHODONTICS
  • 2. DENTURE SURFACES  Impression/ intaglio surface  Polished surface  Occlusal surface
  • 3. TRIAL DENTURE BASE  Provisional substitutes for denture base  Support wax rims  Must be rigid, accurate, and stable  Made from:  Hard baseplate wax  Auto polymerizing acrylic  Light cured acrylic  Heat cured acrylic
  • 4. DENTURE BASE IDEAL PROPERTIES  Biocompatible: nontoxic, nonirritant  Adequate physical and mechanical properties:  High flexural, transverse and impact strength  High modulus of elasticity for better rigidity  Long fatigue life  High abrasion, creep and craze resistance  Good thermal conductivity  Low density  Low solubility and sorption of oral fluids  Softening temperature higher than that of oral fluids and food
  • 5. DENTURE BASE IDEAL PROPERTIES  Adequate physical and mechanical properties:  Dimensionally stable and accurate  Superior esthetics and color stability  Radiopacity  Good bond with denture teeth and liners  Ease of fabrication with minimum expenses  Easily repaired if fractured  Readily cleansable
  • 6. DENTURE BASE MATERIALS  Heat Activated PMMA  Rapid Cure Type Resins  Chemically Activated Resins  Pour or Fluid Resin Technique  Microwave Activated Resins  Light Activated Resins (VLC)  Modified Resin Base Materials
  • 7. HEAT ACTIVATED PMMA  Polymer and monomer are mixed in the proper ratio of 3 : 1 by volume or 2.5 : 1 by weight  The mixed material goes through four stages:  Wet sand like mixture  Tacky fibrous stage  Smooth dough like stage  Rubbery stage
  • 8. POLYMERIZATION CYCLE  One technique involves placing the flask in a constant– temperature water bath at 74° C (165° F) for 8 hours or longer without a terminal boil at 100° C  Another technique processes the base at 74° C for 8 hours or more followed by a terminal boil at 100° C for 1 hour  A shorter cycle involves processing the resin at 74° C for approximately 2 hours then boiling at 100° C for 1 hour or more
  • 9. DENTURE BASE POROSITY  Presence of minute surface or subsurface voids in a denture that has been processed is relatively uncommon nowadays, considering the high technical standards that are followed in dental laboratories  Porous denture would increase liability for staining and calculus deposits, and would promote adhesion of fungal and bacterial biofilms (dental plaque), which could adversely affect the health of the denture- supporting tissues
  • 10. DENTURE BASE POROSITY  Gaseous porosity occurs as a result of rapid heating of the flask, leading to monomer evaporation; this appears as fine uniform subsurface spherical pores, localized more often in the thicker portions of the denture  Inadequate pressure during flask closure or insufficient amount of dough present upon packing of the mold can lead to denture porosity. The voids are large, irregular in shape, and abundant. The resulting denture appears lighter and more opaque in color
  • 11. DENTURE BASE POROSITY  Inadequate mixing of powder/liquid components also may result in denture porosity. The areas that contain more monomer tend to shrink more than the adjacent areas. This localized polymerization shrinkage leads to the production of large voids that are uniformly spread throughout the base
  • 12. RAPID CURE TYPE RESINS  Polymerized by rapidly heating the packed dough in boiling water for 20 minutes  Materials are hybrid PMMA, in which activation of the polymerization reaction is carried out through both chemical and heat activators allowing rapid polymerization without porosity  After placing the denture in boiling water, the water is boiled at 100° C for 20 minutes  The popularity and relative simplicity of the compression molding technique is usually overshadowed by the high processing stresses that are induced in the resins during polymerization
  • 13. RAPID CURE TYPE RESINS  Stresses result from various factors:  Polymerization shrinkage occurs as polymer chains are formed. This accounts for a volumetric shrinkage of about 7%  Thermal shrinkage then follows as the resin cools  Differences in thermal contraction of the resin and gypsum mold collectively yield residual stresses in the resin  Occlusal errors that are commonly encountered following processing are effectively corrected and the predetermined vertical dimension of occlusion restored through routine laboratory remount and selective grinding
  • 14. BOND BETWEEN HEAT CURE DENTURE BASE AND RESIN TEETH  Excellent bond with resinous denture teeth  Results from the increased rate of diffusion of the monomers into the polymerized teeth at the high temperatures  Simplifies the procedures of grinding and set up of teeth even in cases of limited inter arch space  Porcelain teeth are mechanically attached to the bases  Treatment of the ridge lap area of porcelain teeth with organosilane compounds has been used to overcome the problem of teeth dislodgement
  • 15. BIOCOMPATIBILITY OF METHACRYLATE RESINS  Concerns regarding the biodegradation:  Enzymes present in saliva  Chewing  Occlusal forces  Thermal and chemical dietary changes  Possible adverse biologic effects of these compounds range from:  Chemical irritations  Ulcerations  Burning mouth syndrome  Denture stomatitis to more toxic effects
  • 16. RESIDUAL MONOMER CONTENT  Processing dentures at temperatures that are too low or for shorter times increases the residual monomer content in the processed denture base  The small size and hydrophilic nature of this monomer allows for its fast diffusion into the oral cavity and the body  Major advantage of conventionally heat-cured resin bases is that they have significantly lower residual monomer contents  Terminal boiling of the flasks at 100° C for at least 1 hour decreases the monomer content to a clinically acceptable level (approximately 0.2% to 0.5%)
  • 17. RESIDUAL MONOMER CONTENT  The plasticizing effect of excess monomer has been shown to adversely affect the mechanical properties and dimensional stability of dentures  Unbound monomer and other additives are mostly eluted within the first 24 hours after processing, followed by a slow and moderate release over a long period of time  Storage of the dentures in water is a major factor in releasing residual monomer from the bases
  • 18. PHYSICAL AND BIOLOGIC CONSIDERATIONS PHYSICAL AND BIOLOGIC CONSIDERATIONS  Denture bases undergo water absorption by diffusion resulting in linear expansion, which favorably offsets polymerization shrinkage  Denture bases also dry out in dry hot conditions  Methacrylate resin (PMMA) dentures have a low thermal conductivity CLINICAL IMPLICATIONS  Patients are advised to store dentures in tepid water when out of the mouth  Placing dentures in hot water (>35° C) results in the release of internal residual stresses, leading to significant distortion  Portrayed as a substantial decrease of thermal stimulation  Source of inconvenience for first-time denture wearers
  • 19. PHYSICAL AND BIOLOGIC CONSIDERATIONS PHYSICAL AND BIOLOGIC CONSIDERATIONS  Denture base resins are subjected to a variety of stresses during function:  Midline fractures of dentures during function are considered a flexural fatigue failure due to cyclical deformation of the base during function. This is usually more evident in ill fitting or poorly designed dentures  Impact fracture may result from patients accidentally dropping the dentures CLINICAL IMPLICATIONS  Periodical recalls of the patient by the dentist are required to address problems that may arise from long-term denture wearing, such as bone resorption that may affect the fit of the dentures  Patients are advised on the proper handling of their dentures, such as cleaning them over a sink full of water, to avoid fracture if dropped  Use of rubber-reinforced methacrylate bases in cases of repeated fractures has been advocated  Metal bases also can be used for maximum strength
  • 20. PHYSICAL AND BIOLOGIC CONSIDERATIONS PHYSICAL AND BIOLOGIC CONSIDERATIONS  Biocompatibility of denture base methacrylate resin to the surrounding oral environment is considered an attribute to the material. However, water sorption, cracks, surface imperfections, and micro porosity of the bases are usually associated with the ability of certain organisms to colonize the fitting and other surfaces of the denture, mostly in the absence of adequate oral hygiene CLINICAL IMPLICATIONS  Frequent cleansing or soaking the dentures in chemical cleansers is usually sufficient to minimize, but not totally resolve, this problem  Temporary treatment of resin surface with Nystatin and use of CHX have been recommended to effectively reduce the colonization of C. albicans  Minimizing adhesion of C. albicans to denture bases has been attempted by incorporating negative charges in the resin surface  Coating the resin surfaces with a self-bonding protective polymer, such as poly(dimethyl siloxane), also has been implemented to discourage microbial attachment
  • 21. PHYSICAL AND BIOLOGIC CONSIDERATIONS PHYSICAL AND BIOLOGIC CONSIDERATIONS  Low abrasion resistance of resin bases and teeth lead to wear if cleaning of dentures is carried out with a stiff brush or using abrasive agents  Soluble in organic solvents thus upon exposure to alcohol or acetone, the polymer network swells as the resin dissolves, leading to irreversible damage to the resin surface CLINICAL IMPLICATIONS  Patients are advised to clean their dentures with soap and water using a soft brush  Patients who frequently drink alcoholic beverages can benefit from cross-linked polymeric base
  • 22. RADIOPACITY OF DENTURE BASES  Use of metal inserts, radiopaque salts and fillers, and organometallic compounds  Accompanied by adverse effects on:  Esthetics  Increased water sorption  Flexural strength of the denture base resins  Cytotoxic effects  Radiopaque terpolymer synthesized which contains (2,3,5 tri-o-benzoyl)-ethyl methacrylate, methyl methacrylate, and 2-hydroxyethyl methacrylate
  • 23. INJECTION MOLDING TECHNIQUE  The resin mix is injected into closed sprued flask under continuous pressure  Shown to improve the level of fit and adaptation of the processed resins to the underlying stone casts and tissues thus minimizing the need for further postinsertion occlusal adjustments  Exhibited less polymerization shrinkage and greater accuracy and dimensional stability than those processed by standard compression molding techniques
  • 24. CHEMICALLY ACTIVATED RESINS  Referred to as cold-curing, self-curing or auto polymerizing resins  Less frequently used for denture fabrication as compared with the heat- activated  Processing of the resins could be carried out by compression molding in a flask where initial hardening of the resin occurs within 30 minutes of flask closure, or it can be poured in a fluid consistency that is termed the “pour- type resin technique.”
  • 25. PROPERTIES OF CHEMICALLY ACTIVATED RESINS  Contain higher residual monomer contents of 3% to 5% as compared with heat-activated resins  Incomplete polymerization leads to inferior mechanical properties of the resins and dramatically compromises their biocompatibility  They exhibit higher solubility in oral fluids and water sorption  Inferior color stability due to oxidation of the amine accelerator  High creep rates under increased stresses  Less polymerization shrinkage Reduction in the residual stresses during polymerization leads to greater dimensional stability of the resins
  • 26. POUR OR FLUID RESIN TECHNIQUE  Principal difference in the chemical composition of these resins and the compression molded chemically activated resins is the smaller size of the powder particles necessary to ensure fluidity of the mix  Involves pouring the fluid mix into a sprued mold  Flask is placed under pressure at room or higher temperature (45° C)  Polymerization is completed in about 30 to 45 minutes
  • 27. POUR OR FLUID RESIN TECHNIQUE  Technique is simpler and cleaner in regard to flasking and deflasking, as compared with the conventional compression-molding technique  Use of a hydro-flask increases atmospheric pressure around the mold, minimizing air inclusions in the mix and thus yielding a denser resin base  The main drawback of this technique is the increased tendency of the denture teeth to shift position during pouring of the fluid MMA mix into the mold
  • 28. MICROWAVE ACTIVATED RESINS  Activate polymerization process of methacrylate base resin by using a special glass fiber–reinforced plastic flask, suitable for use in a microwave oven  composition of liquid monomer is usually modified to control the boiling of monomer, in a very short curing cycle of about 3 minutes at 500 to 600 W/cycle  Careful control of the time and wattage of the oven is essential to yield porous-free resins and still ensure a complete polymerization cycle that enhances the intrinsic characteristics of the resin
  • 29. PROPERTIES MICROWAVE ACTIVATED RESINS  The technique is more time efficient and cleaner than the conventional technique  Microwave-activated resins have comparable physical and mechanical properties to conventionally heat-activated resins, with reportedly lower incidences of denture tooth movements  Claims of greater dimensional stability and improved denture base adaptation to the underlying tissues have been attributed to adequate temperature control in the resin; equal distribution of temperature throughout the resin and gypsum mold, respectively; and increased homogeneity of the dough  Limitations, however, are relatively due to its cost effectiveness for a wide production base, particularly because of high equipment expenses and fragility of the plastic flasks that are more prone to fracture than the conventional metal flasks
  • 30. LIGHT ACTIVATED RESINS  Copolymers of urethane dimethacrylate and methacrylate resin along with microfine silica fillers  Alternative to heat activated and microwave-activated resins  Polymerization process is activated by placing the premixed, moldable resin on the master cast on a rotating table in a light chamber and exposing it to high intensity visible light of 400 to 500 nm for an appropriate time period of about 10 minutes  The resin is coated with a nonreactive barrier compound to prevent oxygen inhibition of the polymerization process
  • 31. PROPERTIES LIGHT ACTIVATED RESINS  Light-activated resins are indicated for PMMA sensitive patients because they contain no methyl methacrylate monomer  They exhibit smaller polymerization shrinkage, reportedly half that of conventional resins, because of the presence of high molecular weight oligomers. Intimate adaptation of the bases to the underlying tissues is a great asset of the material  The physical and mechanical properties of the resins compare well to conventional heat-activated resins, particularly in regard to transverse and impact strengths and hardness.
  • 32. PROPERTIES LIGHT ACTIVATED RESINS  Elastic modulus and flexural strength are lower than conventional resins, which could increase deformation of the dentures during function  Inferior bond strength of VLC resins to resin denture teeth has been reported frequently but has greatly improved with the use of bonding agents  Biocompatibility of VLC denture base resins raises concern, with reports of possible hypersensitivity reactions and cytotoxic effects in epithelial cells in culture
  • 33. MODIFIED RESIN BASE MATERIALS  Water sorption, an inherent weakness in the structure of methacrylate-based resins, leads to dimensional changes in the denture bases  It is influenced by the type of resin, its thickness, and amount of cross-linking of the polymer  Heat-activated resins reach their water saturation levels longer than their chemically activated counterparts because of their lower water diffusion coefficients  Reducing water sorption of methacrylate resins has been attempted by the incorporation of fluoro-substituted and styrene-type monomers in the polymer structures
  • 34. MODIFIED RESIN BASE MATERIALS  Chemical modification to produce graft copolymer resins through the incorporation of a rubber consists of a matrix of PMMA in which is dispersed an interpenetrating network (IPN) of rubber and PMMA  The resins absorb more energy at higher strain rates before fracture occurs, resulting in a significant increase in impact strength  This modification has been shown to be accompanied by a reduction in the stiffness or rigidity of the resins  High cost of the material may limit its routine use for widespread denture fabrication
  • 35. MODIFIED RESIN BASE MATERIALS  Mechanical reinforcement of methacrylates also has been attempted through the inclusion of fibers such as glass, carbon, aramid (Kevlar) fibers, nylon, and ultrahigh modulus polyethylene (UHMWPE) polymers, as well as metal inserts (wires, plates, fillers)  The incorporation of (triethoxyvinylsilane) treated fillers and oligomers in the polymer structure improved the mechanical properties of fiber-reinforced resin bases  The resulting resins have increased impact and flexural strength and significant improvement in fatigue resistance, effectively minimizing denture fractures
  • 36. LIMITATIONS OF REINFORCED DENTURE BASE RESINS  Tissue irritation can occur from protruding glass fibers  Poor esthetics is associated with dark carbon fibers (black) or straw colored Kevlar fibers  Require increased production time  Difficulties in handling, orientation, placement or bonding of the fibers within the resin  Metal inserts have been associated with failures due to stress concentration around the embedded inserts
  • 38. CAST AND BASE PLATE SPECIFICATIONS
  • 40. MAXILLARY WAX RIM MODIFICATION
  • 41. MANDIBULAR WAX RIM MODIFICATION
  • 43. TYPES  Orientation relations  Vertical relations  Horizontal relations
  • 44. VERTICAL RELATION  Rest vertical dimension  Occlusal vertical dimension  Inter occlusal space/ Freeway space
  • 45. METHODS OF DETERMINING VERTICAL RELATION Mechanical Methods  Ridge relations  Distance from incisive papilla  Parallelism of ridge  Measurements from former dentures  Pre-extraction records  Radiographs  Profile photographs  Articulated casts  Facial measurements
  • 46. METHODS OF DETERMINING VERTICAL RELATION Physiologic Methods  Physiologic rest position test  Parting lips after swallowing  Niswonger's method  Phonetics  Facial expressions and esthetics  Swallowing threshold  Tactile sense  Electromyography
  • 47. RIDGE RELATIONS  Incisive papilla The vertical distance of maxillary incisal edge should be around 6mm  Ridge parallelism Correct vertical relation is at a point where both jaws are parallel with 5 degree opening in the posterior region Disadvantages:  Not reliable in cases of marked resorption  When teeth are lost at irregular intervals the residual ridges are not parallel
  • 50. PHYSIOLOGIC REST POSITION TEST  Swallow and Relax Lips are parted gently by holding the jaws still with 2-4mm of space in premolar region  Niswonger’s Method Two markings are made and patient told to swallow and relax and the distance is measured
  • 51. PHONETICS  Using “m sound”  Using “ch, s and j sounds”  Using “f, v sounds”  Using “thirty three”  Silverman’s closest speaking space
  • 52. ESTHETICS  Facial Esthetics Facial appearance, skin tone etc.  Willis Method Distance between the outer canthus of the eye and the corner of the mouth should be equal to the distance between the lower border of the septum of nose and lower border of chin
  • 53. SWALLOWING THRESHOLD  Cones of soft wax having excessive height are placed  Patient is instructed to swallow  Repeated swallowing reduces the height of wax to the occlusal vertical dimension Disadvantages:  Non consistent results  Affected by the length of time swallowing motion is performed
  • 54. TACTILE SENSE  Patient’s tactile sense  Boos bimeter  Lytle’s method
  • 55. BOOS BIMETER  Maximum biting force occurs at OVD  Measures the biting force  Adjustable screw to change the vertical dimensions  Measurement recorded on dail
  • 56. LYTLE’S METHOD  Use of central bearing plate and pin  Vertical dimension increased beyond physiologic rest position  Height reduced till over closure  Height increased till patient indicates comfortable position
  • 57. EFFECTS OF DECREASED VERTICAL DIMENSION  Decreased chewing efficiency  Cheek biting  Appearance  Angular cheilitis  TMJ pain
  • 58. EFFECTS OF INCREASED VERTICAL DIMENSION  Discomfort  Trauma to underlying mucosa  Increased ridge resorption  Clicking of teeth  Increased wear of acrylic teeth  Strained appearance
  • 60. HORIZONTAL JAW RELATIONS  Centric Relation  Eccentric Relation  Protrusive Relation  Laterotrusive Relation  Left lateral  Right Lateral
  • 61. SIGNIFICANCE OF CENTRIC RELATION  Artificial teeth best occlude evenly  Stable position independent of teeth contact  Recordable and reproducible  Stable retentive dentures
  • 62. PROBLEMS IN RETRUDING MANDIBLE  Biologic Difficulties  Due to lack of muscular coordination  Development of habitual protrusive position after complete edentulism  Development of habitual position due to wear of teeth or previous wrong centric position  Neuromuscular disease  Psychological Difficulties  Mechanical Difficulties
  • 63. METHODS FOR RETRUDING MANDIBLE  Relax the jaw, pull back and slowly close  Push the upper jaw out and close  Protrude and retrude mandible repeatedly while holding the chin  Boos stretch-relax exercise  Roll the tongue backwards towards the posterior border and close  Swallow and close
  • 64. METHODS FOR RETRUDING MANDIBLE  Tapping the rims rapidly and repeatedly  Tilting the head backwards  Massaging the temporalis or masseter muscles to relax them  Dawson’s bimanual manipulation
  • 65. RECORDING CENTRIC RELATION  Minimal pressure closure  Heavy pressure closure
  • 66. METHODS FOR RECORDING CENTRIC RELATION  Interocclusal Check Records  Functional Methods  Needle House Method  Patterson’s Method  Meyer’s Method  Excursive Methods (Gothic Arch Tracing)  Intra Oral Tracing  Extra Oral Tracing
  • 67. METHODS FOR RECORDING CENTRIC RELATION  Terminal Hinge Axis  Other Methods  Celluloid Strips  Heating the Surface of one rim  Deep heating or pooling method  Softened Wax placed over occlusal surface  Soft Cones of Wax placed on lower denture
  • 69. FUNCTIONAL METHOD  Needle House Method  Four metal styli fixed in maxillary rim  Diamond shaped pathways carved in mandibular rim  Require needle house articulator
  • 70. FUNCTIONAL METHOD  Patterson’s Method  Trench made in mandibular wax rim  Filled with plaster and carborundum paste  Compensating curves generated  Meyer’s Method  Use of soft wax to generate paths  Plaster index is made  Teeth setup within the index
  • 71. GOTHIC ARCH TRACING  Application  To verify or confirm centric relation obtained by other methods  Used to obtain protrusive and lateral record  Types  Intra oral tracing  Extra oral tracing  Assembly attached to maxillary and mandibular rims
  • 73. OTHER METHODS  Strips of Celluloid  Deep heating of posterior portions of mandibular rims  Softened wax in the mandibular posterior region  Swallowing technique
  • 74. ECCENTRIC RELATIONS  Functional Methods  Graphic Methods  Direct Check Records
  • 77. NEUTRAL ZONE NATURAL TEETH OCCUPY A ZONE OF EQUILIBRIUM, WITH EACH TOOTH ASSUMING A STABLE POSITION THAT IS THE RESULT OF ALL THE VARIOUS FORCES ACTING ON IT
  • 78. SIGNIFICANCE  Severely resorbed ridges  Denture stability  Functional acceptability  When patient’s masticatory muscles are atrophied and neuromuscular ability is lost then it is contraindicated
  • 79. NEUTRAL ZONE IMPRESSION  Swallowing (drinking a little water)  Saying words that include “S” (counting from 60 or 70)  Licking the lips (licking the left and the right lip corners)  Blowing a whistle
  • 82. REQUIREMENTS OF ARTICULATOR Minimum Requirements  Open and close in hinge like fashion  Hold cast in correct horizontal and vertical position  Simulate protrusive and lateral jaw motions  Moving parts should be accurately machined and move freely and accurately  Non moving parts should be rigid  Should accept facebow transfer
  • 83. REQUIREMENTS OF ARTICULATOR Additional Requirements  Adjustable horizontal and lateral guide elements  Adjustable incisal guide table  Adjustable intercondylar width  Condylar elements in the lower frame  Mechanism to accept the third reference point during facebow transfer  Removable mounting plates that can be repositioned accurately
  • 84. CLASSIFICATION OF ARTICULATORS  Class I Simple holding device capable of accepting single static registration (example: hinge articulator)
  • 85. CLASSIFICATION OF ARTICULATORS  Class II Permits horizontal as well as vertical motion but do not orient the motion to TMJ with a facebow transfer  II-A Permits eccentric motion based on average or arbitrary values (example: grittman or gysi’s simplex articulator)  II-B Permits eccentric motion based on arbitrary theories of motion (example: maxillo- mandibular instrument designed by Monson based on spherical theory of occlusion)  II-C Permits eccentric motion based on engraved records obtained from patient (example: hose articulator)
  • 86. CLASSIFICATION OF ARTICULATORS  Class III Stimulate condylar pathways by using average or mechanical equivalents for all or part of the motion and allow for joint orientation of the casts with facebow transfer  III-A Accepts facebow transfer and protrusive interocclusal record  III-B Accepts protrusive interocclusal records
  • 87. CLASSIFICATION OF ARTICULATORS  Class IV Instruments that accept 3 dimensional dynamic registrations and use facebow transfer  IV-A Condylar pathways are formed by registrations engraved by the patient  IV-B Condylar paths can be angled and customized

Editor's Notes

  1. Copolymerization with methacrylic acid, creates a surface-modified PMMA (mPMMA) that alters the ionic interaction between the resin bases and candidal hyphae, potentially decreasing adhesion of the microorganisms to the bases
  2. compression molded methacrylate resins considered too laborious, is relatively prone to errors, and carries a risk of contact dermatitis to dental technicians
  3. To overcome shortcomings in the physical and mechanical properties of conventional heat-activated methacrylate resins, modifications have been introduced into the structure of the polymers. The aim was to reduce water sorption and improve mechanical properties such as flexural, tensile, and impact strengths, as well as fatigue resistance of the resins
  4. Coston syndrome not associated