One of the best seminar of the author. Covered in detail regarding the increasing vertical dimension, centric relation, methods to record centric relation, philosophies of occlusion and in detail everything about full mouth rehabilitation.
Journal Club Presentation on Overlay Removable Partial DentureNeerajaMenon4
Overlay removable partial dentures (ORPDs), a subset of overdentures, are often referred to as an RPD that has part of their components covering the occlusal surface of the abutment teeth to restore them into a functional occlusion
One of the best seminar of the author. Covered in detail regarding the increasing vertical dimension, centric relation, methods to record centric relation, philosophies of occlusion and in detail everything about full mouth rehabilitation.
Journal Club Presentation on Overlay Removable Partial DentureNeerajaMenon4
Overlay removable partial dentures (ORPDs), a subset of overdentures, are often referred to as an RPD that has part of their components covering the occlusal surface of the abutment teeth to restore them into a functional occlusion
Twin block are simple bite blocks that effectively modify the occlusal inclined plane with the help of upper and lower bite blocks that engage occlusal inclined plane.
The main objective of Twin-block is to induce supplementary lengthening of the mandible by stimulating increased growth at the condylar cartilage.
Failures in Removable Partial Denture ProsthodonticsNaveed AnJum
This presentation gives the clinician a perspective towards various failures in removable partial prosthodontics. The presentation has been made by referring various books and articles related to prosthodontics.
Following the orientation of maxilla and determination of vertical
dimension, the final relation to be recorded is the horizontal relation.
This is the anteroposterior relation of the mandible to the maxilla in
the horizontal plane.
The horizontal relations can be classified as:
• Centric relation
• Eccentric relations – protrusive and lateral.
The maxillomandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective discs with the complex in the anterior–superior position against the slopes of the articular eminencies. This position is independent of tooth contact. This position is clinically discernible when the mandible is directed superiorly and anteriorly. It is restricted to a purely rotary movement about the transverse horizontal axis
Deals with timing of orthodontic treatment, Envelop of discrepancy, Setting up goals, Enlisting the treatment objectives, Assessment of growth potential, Assessment of etiological factors, Planning the final interincisal relationship, planning space requirements, planning extractions, planning anchorage, Selection of appliances, planning retention,re-evaluation.
Full mouth rehabilitation is a complex and multidisciplinary treatment approach aimed at restoring oral health, function, and esthetics in patients with extensive dental problems. In the present case, a 70- year-old female patient presented with multiple missing teeth and reduced vertical dimension of occlusion and wanted to resolve all her dental problems. After thorough clinical examination involving assessment of the dentition, periodontium, and temporomandibular joint, an individualized treatment plan was formed. The teeth with poor prognosis were extracted followed by correction of vertical dimension of occlusion using a night guard. The missing teeth were replaced with fixed partial dentures and the other teeth which required full coverage crowns were provided with crowns. The patient was satisfied with the results achieved and is presently attending follow-up appointments following the procedure. This article explains the process of full mouth rehabilitation of this patient in detail.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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7. NEED FOR OCCLUSAL REHABILITATION
Vascular Tissue of periodontium can be stimulated only by
teeth in function.
Mutilated mouths-This stimulation is lacking
Realigned teeth through full mouth reconstruction improves
the general tone of supporting structures
Function Improves
Teeth feel STRONGER
Source: Irving Goldman et al, The Goal of Full Mouth Rehabilitation, J. Pros. Den. 1952,
March, Vol 2, No. 2.
8. Aim:
To re-establish a state of functional as
well as biological efficiency where teeth
and their periodontal structures, the
muscles of mastication, and the
temporomandibular joint (TMJ)
mechanisms all function together in
synchronous harmony.
Source: Kazis H, Kazis AJ (1960) Complete mouth rehabilitation through fixed
partial denture prosthodontics. J Prosthet Dent 10:296–303
9. 1. To maintain the health of periodontal tissues.
2. When in need for extensive dentistry which
includes restoration of multiple teeth, which are
missing, worn, broken-down or decayed.
Indications of Occlusal Rehabilitation
11. • Malfunctioning mouths that do not need extensive
dentistry and have no joint symptoms should be best left
alone.
• Prescribing a full mouth rehabilitation should not be
taken as a preventive measure unless there is a definite
evidence of tissue breakdown.
• In short, it can be concluded that :
No pathology- No treatment.
Contra- Indications of Occlusal
Rehabilitation
12. Classification by Turner and Missirlain (1984)
The patients were classified into three categories –
• Category 1 - Excessive wear with loss of vertical
dimension.
• Category 2 - Excessive wear without loss of vertical
dimension of occlusion but with space available.
• Category 3 - Excessive wear without loss of vertical
dimension of occlusion but with limited space available
Classification of Patients requiring full
mouth rehabilitation
13. Classification by Charles Brecker In 1966
Group I
• Class I – Patients with collapse of vertical dimension of
occlusion because of shifting of existing teeth caused by
failure to replace missing teeth.
• Class II – Patients with collapse of vertical dimension of
occlusion because of loss of all posterior teeth in one or
both jaws with remaining teeth in unsatisfactory occlusal
relationship.
• Class III – Patients with collapse of vertical dimension of
occlusion because of excessive attritional wear of
occlusal surfaces.
14. Group II
• Class I – Patients with all or sufficient natural teeth
present, with satisfactory occlusal relationship.
• Class II – Patients with limited teeth present but in
satisfactory occlusal relationship requiring aid in the
form of occlusal rims.
Group III – Patients requiring maxillofacial surgery of
orthodontic treatment as an aid in restoring the lost
vertical dimension.
Group IV – Patients in whom sectional treatment is
required over extended periods of time because of status
of health of the patient, age or economic factor.
15. Certain biological considerations are necessary when
planning and carrying out occlusal rehabilitation.
1. The indications for reorganizing the occlusion
2. The choice of an appropriate occlusal scheme
3. The occlusal vertical dimension
4. The need to replace missing teeth
5. The effects of the material used on occlusal stability
6. Control of parafunction and TMD
Biological considerations for Occlusal
Rehabilitation
16. Occlusal Approach for Restorative
Therapy
Conformative approach
• Occlusion is
reconstructed according
to the patient’s existing
intercuspal position
• Occlusion is modified by
localized occlusal
adjustments before
tooth preparation
Reorganized approach
• New occlusal scheme is
established around a
suitable condylar
position which is the
centric relation position.
• Operator has
opportunity to optimize
patients occlusion.
Source: Celenza FV, Litvak H (1976) Occlusal management in conformative
dentistry. J Prosthet Dent 36:164–170
17. Certain biological considerations are necessary when
planning and carrying out occlusal rehabilitation.
1. The indications for reorganizing the occlusion
2. The choice of an appropriate occlusal scheme
3. The occlusal vertical dimension
4. The need to replace missing teeth
5. The effects of the material used on occlusal stability
6. Control of parafunction and TMD
Biological considerations for Occlusal
Rehabilitation
18.
19. Certain biological considerations are necessary when
planning and carrying out occlusal rehabilitation.
1. The indications for reorganizing the occlusion
2. The choice of an appropriate occlusal scheme
3. Increase in the occlusal vertical dimension
4. The need to replace missing teeth
5. The effects of the material used on occlusal stability
6. Control of parafunction and TMD
Biological considerations for Occlusal
Rehabilitation
21. Centric relation (CRCP, RCP, RAP)
Centric occlusion (ICP, MIP, acquired
position of the mandible)
22
22. IMPORTANCE OF RECORDING THE
UPPERMOST POSITION
• The only position that permits an interference free
occlusion.
Failure to completely seat the condyles when harmonizing
an occlusion
OR
When condyles must displace forward and down slope to
achieve maximum intercuspation
There is disharmony between occlusion and TMJs.
This results in a muscle braced condyle disc assembly
instead of a bone braced relationship.
23
23. Recording Centric Relation
1. Manipulation of the mandible
1. Patient Guided methods
1. Schuyler Technique
2. Physiological technique
3. Gothic arch or arrow point tracing
2. Operator Guided methods
1. Chin Point guided technique
2. Three finger point guided technique
3. Bilateral manipulation technique
2. Interocclusal bite records
24. Techniques for making centric interocclusal
record
1. Wax bite procedure
2. Anterior stop techniques
3. Use of preadapted bases
4. Central bearing point techniques
25
25. VDO refers to the vertical position of the mandible in
relation to the maxilla when the upper and lower teeth are
intercuspated at the most closed position.
26
VERTICAL DIMENSION
26. Principles Behind Increasing Vertical
Dimension
• It is obligatory that two principles have to be
pursued during the increase of OVD:
(1)Starting point for reconstruction/increase in
OVD must be within centric relation.
(2) Reconstruction to be within the range of the
patient’s neuromuscular adaptation
27
28. 1.In extremely worn occlusions to provide enough room for
restorations & Esthetic needs of the patient cannot be
satisfied without crown length being increased
2.If loss of anterior facial height due to condylar displacement
that cannot be corrected by occlusal equilibration procedures.
3. Some orthodontic results may be difficult to achieve without
increasing the VD.
29
29. 4.In case of severe arch malrelationships or extreme occlusal
plane problems.
5. Anterior open bite requires a reduction of VD in order to get
acceptable result
6.For temporarily relieving the symptoms in intracapsular TMJ
disorders
30
30. ANTERIOR GUIDANCE
31
Anterior teeth are not just the key to esthetics but also
the key factor in protecting the posterior teeth
Must Be In Harmony With The Envelope Of Function
31. DEF-’ An imaginary surface that theoretically touches the
incisal edges of the incisors and the tips of the
occluding surfaces of the posterior teeth.’
2 Basic requirements of a proper plane of occlusion:
• It must permit the anterior guidance to do its job of
discluding the posterior teeth when the mandible is
protruded.
• It must permit the disclusion of all teeth on the
balancing side when the mandible is moved laterally.
32
OCCLUSAL PLANE
32. • The curvatures of the posterior plane of occlusion
are divided into
A. An anteroposterior curve called the Curve Of Spee
B. A mediolateral curve, referred as the Curve Of Wilson
• The composite of the curve of Spee, the curve Wilson,
and the curve of the incisal edges is properly referred to
as the Curve of occlusion.
• The curvatures of the anterior teeth are determined by
establishment of an esthetically correct smile line on the
upper and the relationship of the lower incisal edges to
the anterior guidance and the requirements for phonetics
33
33. The Curve Of Spee
The anteroposterior curvature of
the occlusal surfaces, beginning at
the tip of the lower canine and
following the buccal cusp tips of the
bicuspids and molars and
continuing to the anterior border of
the ramus.
Ideally follows an arc through the
condyle.
The curvature of the arc would
relate, on average, to part of a
circle with a 4-inch radius.
34
34. • Curve of Spee too high in posterior: Forces the most
posterior teeth to carry the full stress imposed on them
by the musculature when the mandible is protruded.
• Curve of spee too low posteriorly:
It presents no problems, since it cannot interfere with
basic requirements of protrusive and balancing side
disclusion. If grossly overdone:
1. Create poor esthetic result
2. Excessive stress on upper teeth.
3. Reduce function by causing too much posterior teeth
separation in protrusion
35. The Curve Of Wilson
• The curve of Wilson is the
mediolateral curve that contacts
the buccal and lingual cusp tips
on each side of the arch.
• It results from inward inclination
of the lower posterior teeth,
making the lingual cusps lower
than the buccal cusps on the
mandibular arch.
37
38. Gnathological Philosophy
Stuart (1964)
Centric Relation Contact Position (CRCP)and The
Intercuspal Position (ICP) (Centric
Occlusion) are Coincident
• Canine Guided Lateral Excursions
• Posterior Disclusion In All Excursions.
• Lingual Concavity Of Anterior Teeth Is
Determined By Condylar Guidance
• Wax Up Done In Fully Adjustable Articulator.
• Good For Restoring Cases With Large Horizontal
Component Of CR and IP.
39. Pankey Man Schuyler Concept
In 1929 C.H. Schuyler stated that maximum intercuspation must occur in the
retruded mandibular position (centric relation) under all circumstances
Schuyler’s principles were
1. A static co-ordinated occlusal contact of the maximum number of teeth
when the mandible is in centric relation.
2. An anterior guidance that is in harmony with function in lateral eccentric
position on the working side.
3. Disclusion by the anterior guidance of all posterior teeth in protrusion.
4. Disclusion of all non-working inclines in lateral excursions.
5. Group function of the working side inclines in lateral excursions.
40. In order to accomplish these goals, the following sequence is advocated by
the P.M.S. philosophy:
PART 1:. Examination, diagnosis, treatment planning, prognosis
PART 2: Harmonization of the anterior guidance for best possible esthetics,
function, and comfort
PART 3: Selection of an acceptable occlusal plane and restoration of the
lower posterior occlusion in harmony with the anterior guidance in a manner
that will not interfere with condylar guidance.
PART 4: Restoration of the upper posterior occlusion in harmony with the
anterior guidance and condylar guidance.
41. The advantages of the technique are as follows:
• It is possible to diagnose and plan treatment for the entire
rehabilitation before preparing a single tooth.
• It is a well-organized, logical procedure that progresses
smoothly with less wear
• There is never a need for preparing or rebuilding more than
eight teeth at a time.
• It divides the rehabilitation into separate series of
appointments. It is neither necessary nor desirable to do the
entire case at one time.
• There is no danger losing the patient's present vertical
dimension. The operator knows exactly where he is at all times.
42. • The functionally generated path and centric relation are taken on the
occlusal surface of the teeth to be rebuilt at the exact vertical dimension
to which the case will be constructed.
• All posterior occlusal contours are programmed by and are in harmony
with both condylar border movements and a perfected anterior guidance.
• There is no need for time-consuming techniques and complicated
equipment.
• Laboratory procedures are simple and controlled to an extremely fine-
degree by the dentist.
43. YOUDELIS
SCHLUGER S et al
• For advanced periodontal cases.
• Cr and ip are coincident.
• Anterior disclusion for protrusive and canine disclusion for
lateral excursions.
• Lateral Contacts Are Arranged Such that if Canine Disclusion Is
Lost Through Wear /Tooth Movement-posterior Teeth Drop
Into Group Function.
• Both Fully /Semi Adjustable Articulators Can Be Used.
• Useful –Parafunction Cannot Be Controlled/Canine
Compromised Periodontally
44. Freedom In Centric
(Ramfjord Sp)
• Area Of Freedom between CR And IP-0.5mm.
• Either Canine Guidance/Group Function, but Ant. Guidance
Will Be Delayed During Posterior Contact In Area Of Freedom.
• Cusp To Fossa Occlusion.
• Useful For Cases With Large Horizontal Component Of Slide.
45. Nyman and Lindhe concept 1983
• Used in advanced periodontal disease.
• Clinically hypermobility of teeth, unfavorable distribution of
teeth.
• Bridge on such abutment teeth exhibit mobility
• But such bridge hypermobility can be tolerated, provided it
does not interfere with patients comfort or bridge function
• Such mobile bridge can further exaggerate the periodontal
weaking but can be prevented by designing occlusion in such
a way to obtain & maintain stability.
• Even and simultaneous contacts all over the dentition in ICP
and excursion.
46. • If distal abutment teeth are missing in a cross arch bridge with
increased mobility, balance and functional stability obtained
by cantilever units.
• However cantilevers increased risk of failure.
• If increased mobility is not observed, balancing contacts on
non working side should be removed.
• When bridge exhibit increased mobility- fulcrum identified,
occlusion designed so that forces exerted by masticatory
muscles meet the bridgework simultaneously with balanced
load on both side of fulcrum
47. HOBO TWIN STAGE CONCEPT
(Hobo St)
• Two Stage Procedure
1. Occlusal Morphology Of Posterior Teeth Reproduced Without
Ant. Segment.
2. Ant. Morphology Reproduced
and Ant. GUIDANCE produce standard amount of disclusion.
48. HOBO’S TWIN TABLE PHILOSOPHY
Dr. Sumiya Hobo
• He proposed Twin table concept which developed anterior guidance to
create a predetermined, harmonious disclusion with the condylar path.
• The technique utilizes 2 different customized incisal guide tables.
• The first incisal table is termed INCISAL TABLE WITHOUT DISCLUSION. It is
fabricated by preparing die systems with removable anterior and posterior
segments
• This table helps us achieve uniform contacts in the posterior restorations
during eccentric movements
• used to fabricate restorations for posterior teeth
49. • The other incisal table is made when the articulator can
simulate border movements by placing 3 mm plastic
separators behind the condylar elements. This is termed THE
INCISAL GUIDANCE WITH DISCLUSION.
• Used to achieve incisal guidance
50. POSTERIOR OCCLUSAL MORPHOLOGY
Planning of occlusal contours distribution of lateral
stresses. Three basic decisions to make regarding the design of
posterior occlusal contours:
1.Selection of the type of centric holding contacts
2.Determination of the type and distribution of contact in
lateral excursions
3.Selection of an appropriate Occlusal Scheme for providing
stability to the occlusal form.
52
51. 1.Types of centric holding contacts:
53
Surface to surface contact
Tripod contact
Cusp tip to fossa contact
52. 2.Determination of the type and distribution of
contact in lateral excursions
• The job of discluding the nonfunctioning side is always
the responsibility of the working side.
• The dentist must decide how all this is done by selecting
one of the following choices for working side occlusion:
1. Group function
2. Partial group function
3. Posterior disclusion
54
54. Posterior disocclusion
• Refers to no contact on any posterior teeth in any
position but centric relation.
• Two methods of accomplishing posterior disoccclusion:
1. Anterior guidance is harmonized to functional border
movements first, and then the lateral inclines of
posterior teeth are opened up so that they are
discluded.
2. Posterior teeth are built first and then disocccluded by
restriction of the anterior guidance. This method is
backward.
56
55. • Can be achieved by two different types of
anterior guidance:
a) Anterior group function
b) Canine protected occlusion
57
56. ANTERIOR GROUP
FUNCTION:
Distributes wear over more teeth.
Distributes the stresses to more
teeth.
Distributes stress to teeth that are
progressively farther from the
condyle fulcrum.
58
57. CANINE GUIDED
OCCLUSION
• In natural cuspid-protected occlusions,
the pattern of function is rather vertical
• Any attempt at lateral movement is felt
by the pressoreceptors around the
cuspids which redirect the muscles to
more vertical function.
• The density of proprioceptors is
supposed to impart a unique capacity
to the cuspid to redirect any functional
pattern that would be destructive.
59
58. Advantages of Canine guided occlusion
• The cuspids have extremely good crown - root ratios
• Long fluted roots are in some of the densest bone of the
alveolar process.
• Their position in the arch, far from the fulcrum, makes it
more difficult to stress them.
• In short, they are very strong teeth. If their upper lingual
inclines are in harmony with the envelope of function,
they are usually quite capable of withstanding lateral
stresses without help from other teeth.
60
74. Recording centric relation
1. MANIPULATION OF THE
MANDIBLE
Necessary for equilibration
procedures or examining for
premature contacts
2. INTEROCCLUSAL BITE
RECORDS
Correct articulation of
mounted casts
A)Patient guided methods
B)Operator guided methods
76
80. Bilateral manipulation
STEP 1
Recline the patient all the
way back; Point the chin up
STEP2
Working from a seated
position from behind the
patient; firmly stabilizes the
head 82
81. STEP 3
With the head firmly
stabilized, position the four
fingers of each hand on
the lower border of the
mandible
STEP 4
Bring thumbs together to form
a C with each hand
83
82. STEP 5
With very gentle touch,
the jaw is manipulated so
that it slowly hinges open
and close; no pressure
applied
STEP 6
Verify centric relation
position; Upward finger
pressure; downward
thumb pressure
84
83. STEP 7
When it is possible to freely and painlessly
arc the mandible while exerting firm
pressure; the dentist is ready to close the
mandible to the first point of contact. The
mandible should not translate off its
terminal hinge axis
85
84. Anterior guidance by a Lucia Jig:
Basis of the Lucia jig method
and the techniques that follow,
is to provide an anterior
reference point.
Forms a tripod with the
condyles.
With the teeth out of contact
all proprioceptive reception
from the teeth and
musculature is removed 86
85. 5.Anterior guidance
by a tongue blade :
6.Anterior guidance
by a Leaf Gauge:
7.Anterior guidance
by a OSU Woelfel Gauge:
87
86. Wax bite record
• Delar wax: brittle-
hard wax supplied in
sheets that are
thicker at the front
for more even
penetration teeth
from back to front.
88
105. Determinants to increase VD
Gnathological concept
This involves the use of fully adjustable
articulators to determine condylar path from the
hinge axis and setting this path for a 5 degree
increase to ensure no posterior interferences.
106. Bioaesthetics
This works via a fixed numerical value based on
the incisal relationship. The distance between
the gingival margins of 18-20mm in an unworn
class one occlusion with upper incisal length of
12mm, lower incisal length 10mm, 4mm
overbite and 1mm overjet.
Determinants to increase VD
107. Centric relation based
According to Dawson, Centric relation is defines
as when the heads o the condyles are in their
most superior position within their sockets,
lateral pterygoid muscle is relaxed and the
elevator muscles are contracted with the disc
properly aligned.
Determinants to increase VD
108. Neuromuscular
Based on the principles of muscle activity
determined by electromyography.
Determinants to increase VD
109. ANTERIOR GUIDANCE
111
Anterior teeth are not just the key to esthetics but also
the key factor in protecting the posterior teeth
Must Be In Harmony With The Envelope Of Function
110. • Definition: ‘It is the influence of the contacting surfaces of
the anterior teeth on tooth limiting mandibular
movements’
• PROTRUSIVE ANTERIOR GUIDANCE AND LATERAL
ANTERIOR GUIDANCE
• Condylar paths do not dictate anterior guidance
• During the terminal hinge axis closure of the mandible if
all the lower anterior teeth contact simultaneously
against stable centric stops at the correct vertical
dimension, then the first requirement of good anterior
relationship has been fulfilled.
112
111. Sequencing the determination of
anterior guidance
113
AIM- TO PRECISELY LOCATE THE CORRECT INCISAL EDGE
POSITION
112. • 1st STEP-The first decision
determines the relationship
of the lower incisal edges to
the upper anterior teeth.
• 2ND STEP- determine the
upper half of the labial
surface
• 3rd STEP- contouring the
surface back until the lower
lip can easily slide by the
incisal third to seal contact
with the upper lip.
114
113. • 4TH STEP-Determining the contour
of the incisal plane
• 5TH STEP- harmonizing the
anterior guidance/determining
the contour of anterior guidance
• 6TH STEP-Final matrix decision is
the contour from the centric
relation stop to the gingival
margin.
115
114. Harmonizing the anterior guidance
• Preliminary steps:
When indicated, the lower anterior teeth should be
reshaped or restored first.
If restorations are not needed on the posterior teeth, they
must be equilibrated before the anterior guidance can be
worked out.
All interferences to centric relation must be eliminated on
both anterior and posterior teeth to establish stable
contacts at the most closed position.
116
115. Eccentric interferences are then removed on
the remaining natural posterior teeth.
IF restorations are needed on posterior
teeth,take advantage of them for precise
harmonization of anterior guidance.
Prepare the posterior teeth in one arch before
completing the correction of anterior inclines.
117
116. FIVE STEPS TO
HARMONY
Step I. Establish
coordinated centric
relation stops on all
anterior teeth.
Step 2. Extend centric stops
forward at the same
vertical dimension to
include light closure from
the postural rest position
118
117. Step 3. Determine the incisal
edge position.
Step 4. Establish group
function in straight
protrusion.
Step 5. Establish ideal
anterior stress distribution
in lateral excursions 119