Beruflich Dokumente
Kultur Dokumente
1/15/2014
Introduction
Mouth comprising maxilla and mandible and the two Temporo-Mandibular Joints is the best articulator. A mechanical device simulating these anatomic structures is needed for ease of work and comfort of the patient. This device is called an ARTICULATOR.
Definition
Articulator is defined as a mechanical instrument that represents the TMJ and jaws to which maxillary and mandibular casts may be attached to simulate some or all mandibular movements. -GPT 7 & 8
History
1756 Philip Pfaff
1805 -
J.B. Garriot
LADMORES ARTICULATOR
In 1864, Bonwill introduced the dental profession to theory of tooth guided (balanced ) occlusion along with the anatomical articulators.
1899 - Evens, Hayes, and Bonwill - are the early examples of articulator with Vertical stop. 1902 - Kerr Brothers introduced the KERR Articulator with 1) Fixed protrusive and lateral movements. 2) Hinge in the same plane as occlusal planes
Kerr articulator
1910 - ACME articulator was introduced which was elaboration of George B. Snows articulator.
1912 - Gysi Adaptable articulator fixed 45-degree incisal guide table. Gysi continued the exact incisal guide design in his Simplex articulator, an average value version of the Adaptable. He suggested that the slope of Simplex incisal table could be altered with use of metal plate and modelling plastic.
Adaptable by Gysi
1922 - Hanau model H110 1923 - Rudolf L. Hanau - Hanau Model M. Kinoscope Has double condylar posts on each sides, each one for horizontal and lateral condylar guidance. 1927 - modified H110
Hanaus Kinoscope
1928 - Gysi patented Trubyte articulator which had incisal table with guiding lateral edges that could be set to follow incisor point gothic arch tracings. It was the first articulator with an adjustable incisal guide assembly. It had 10 lateral wings called as FISCHER ANGLE.
TRUBYTE by GYSI
TRUBYTE
1929 - Stansberry tripod: Before 1929, articulators could not accept all the positional records. In this instrument, maxillary cast is mounted in an arbitrary position, later the mandibular cast is mounted with centric relation in plaster. The articulator reproduces positions, not movements.
1952 - TRANSOGRAPH - BY PAGE : It is a split axis instrument designed to allow each condylar axis to function independent of the other.
1955 - THE DENTOGRAPH - Designed by KILE - was primarily used for complete denture construction. The vertical dimension of occlusion is established by use of carborundum and plaster occlusal rims developed in a generated path by the Patterson method
Dentograph
1955 - THE STUART ARTICULATOR The Stuart gnathologic computer was designed by C.E Stuart in 1955(GNATHOSCOPE).
Features: 1. The upper frame carries all cams that direct the rotations and slidings of the condylar elements and the fossae. 2. The lower frame carries the condylar elements and simulate mandible. 3. The intercondylar distances is adjustable to each patient. 4. The fossa cup can be adjusted 5. The plastic eminence can be altered according to that of the patient if the protrusive and lateral path difference is there. 6. The operating parts are devoid of set screws. 7. The side shift (Bennett) and its timings is cut in to lateral wings. The instrument receive pantograms made in the 3 planes. It also records the amount and character of movements in one plane and in relation to other planes.
1965 - THE DUPLIFUNCTIONAL ARTICULATOR - by Irish - Primarily for use in complete denture construction. It has 2 main purposes; first it records each patients mandibular movements and then without further convertive procedures serves a 3D tripod type of articulator upon which dentures may be constructed and then occlusion balanced.
TRUBYTE SIMPLEX: The new simplex uses average movements: 1) The condylar guides are inclined at 30 2) Bennett movement of 7.5 3) The incisal guide table adjusts from 0-30 A mounting jig which doubles to level the occlusal plane is used for arbitrary mounting of upper cast. Alternatively a plane orientation jig positions the lower cast first and it is used for positioning the gothic arch transfer useful in complete denture construction.
1960 - NEY ARTICULATOR - by Dr. D. Pietro. - It was an arcon instrument. 1. This is the first articulator to have condylar housings that contained adjustable rear, medial and top walls in one assembly. 2. Intercondylar distance is adjustable.
NEYs ARTICULATOR
DENTATUS: This is another adjustable articulator designed in 1944 in Sweden. The condylar elements are attached to upper member and the condylar path is straight. 1) Bennett angle is calibrated to 40 2) Inter condylar distance is fixed. 3) This receives hinge axis face bow transfer. Its features are similar to Hanau Model H.
THE SIMULATOR ARTICULATOR: It was designed by Ernest Granger. It was set with a conventional pantograph. A minigraph could be used when full mouth pantographic tracings is not feasible. It consisted of only two anterior recording plates which were related to casts mounted to the hinge axis. Tracings of protrusive and lateral movements were made. Its Bennett guide can be set by adjustment only and cannot be customized.
Simulator Articulator
CLASSIFICATION OF ARTICULATORS:
I. ARTICULATORS BASED ON THEORIES OF OCCLUSION:
1) BONWILLS THEORY OF OCCLUSION: W.G.A. Bonwill It is proposed that the teeth move in relation to each other as guided by the condylar controls and the incisal point. It was also known as the theory of the equilateral triangle in which there was a 4 inch (10cm) distance between condyle and between each condyle and the incisal point.
Articulators
BONWILL 1854 4
Bonwills articulator
2) CONICAL THEORY OF OCCLUSION: This proposed that the lower teeth move over the surfaces of the upper teeth as over the surface of cone, generating angle of 45. And with the central axis of cone tipped at 45 angle to the occlusal plane e.g. Hall automatic anatomic articulator designed by R.E. Hall Teeth with 45 cusps were necessary for constructing dentures on this articulator
ALLIGATOR
3) SPHERICAL THEORY OF OCCLUSION: It proposes that the lower teeth move over the surface of the upper teeth as over the surface of sphere with a diameter of 8 inches (20cm). The center of the sphere is located in the region of the glabella and the surface of the sphere passes through the glenoid fossae along the articular eminences or concentric with them. It was proposed by G.S. Monson in 1918.
The draw back of this classification is that provision was not made for variation from the theoretical relationship that occurs in different persons.
II. ARTICULATORS BASED ON THE TYPES OF RECORDS USED FOR THEIR ADJUSTMENT:
Three general classes of records are used for transferring maxillo-mandibular relationship from the patient to the articulator. 1. Inter occlusal records 2. Graphic records 3. Hinge axis records. Some articulators are designed for use with only one record where as others can use two or three types of records in combination.
(At International Prosthodontic workshop on complete denture occlusion at the University of Michigan in 1972). Class I : Simple holding instruments capable of accepting a single static relationship. Vertical motion is possible, only for convenience. Eg. Slab articulator, hinge joint articulator, barn door hinge.
Class II: Instruments that permit horizontal as well as vertical motion but do not orient the motion to TMJ via a face bow transfer. A) Eccentric motion permitted is based on average or arbitrary value e.g. Gysi simplex articulator. B) Eccentric motion permitted is based on theories of arbitrary motion. Eg. Monson maxillo-mandibular articulator. C) Eccentric motion permitted is determined by the patient using engraving methods e.g. Howarth articulator, Dentograph. .
Class III: The instruments that simulate condylar pathways, using average or mechanical equivalents for all or part of the motion. Allow joint orientation of the casts via face bow transfer Hanau mate A) Instruments that accept a static protrusive registration and use equivalents for the rest of motion. Eg. Hanau model H, Dentatus, Bergstrom. B) Instruments that accept static lateral, protrusive registrations and use equivalents for the rest of motion e.g Trubyte articulator, Ney, Kinoscope, Hanau 130-21, Panadent & Stansberry tripod.
Class IV: Instruments that will accept 3 dimensional dynamic registrations. These allow for joint orientation of casts via a face bow transfer. A) The cams representing the condylar paths are formed by registrations engraved by the patient. E.g. TMJ articulator. B) Instruments that have condylar paths that can be angled and customized either by selection from a variety of curvatures or by modification or both e.g. Denar D4A, Denar 5A (current & simulator.).
CLASS II: They do not receive the stereograms. Type 1 (Hinge): This type is capable of opening and closing in a hinge movement, a few limited non-adjustable excursive like movements. Type 2 (Arbitrary): This is designed to adapt to specific theories of occlusion or is oriented to a specific technique. Type 3 (Average): This type is designed to provide condylar element guidance by mean of averages, positional records of mini recorder systems. Type 4 (Special): This type is designed to be used primarily for complete dentures.
Class I McCollums Gnathoscope. Granger Gnathoscope. Hanau Kinoscope Cosmex Stuart Gnathologic computer TMJ stereographic Denar D5A
Class II (Type 1) : Barn Door hinge Stephens Gariot Crescent Gysi Trubyte Simplex ACME Twinstage occluder Bonwill
Type 2 : Monson Handy II The Correlator Transograph The Gnathic Relator Verticulator
Type 3: House Dentatus Hanau (several models) Whipmix Denar Mark II and Omni model TMJ mechanical fossa & molded fossa models Panadent Type 4: Stansberry tripod Kile dentograph Irish Dupli-Functional
Becks (1962)
-Suspension instrument-The axis-The tripod
REQUIREMENTS OF AN ARTICULATOR
-It should hold casts in correct horizontal and vertical relationship. -It should provide a positive anterior vertical stop (incisal pin) -It should accept a face bow transfer record utilizing anterior reference point. -It should open and close in a hinge movement. -It should allow protrusive and lateral jaw motion. -The moving parts should move freely and be accurately machined. -The non-moving parts should be a rigid construction made of non corrosive material. -The patients casts must be easily removable and attachable to the articulator without losing their correct horizontal and vertical relationship. -The design should be such that there is adequate distance between the upper and lower members and that vision is not obscured from rear. -The articulator should be stable on laboratory bench and not too bulky and heavy.
ADDITIONAL REQUIREMENTS: -Adjustable horizontal and lateral condylar guide elements. -The condylar elements as a part of lower frame and condylar guides as a part of upper frame. -A mechanism to accept a third reference point from a face bow transfer record. -A terminal hinge position locking device. -Removable mounting plates that can be repositioned accurately. -An adjustable incisal guide table. -Adjustable intercondylar width of the condylar elements.
USES:
Primary Purpose: To hold opposing casts in a predetermined fixed relationship. To open and close. To produce border and intra-border diagnostic sliding motions of the teeth similar to those in the mouth.
Other uses: a) To diagnose if the patient has TMJ problem. b) To plan dental procedures that involve positions, contours and relationships of both natural and artificial teeth as they relate to each other. c) To aid in fabrication of dental restorations and lost dental parts. d) To correct and modify completed restorations eg. In cast crown. e) Can be helpful in teaching and studying of occlusion and mandibular movements.
ADVANTAGES:
The patients mouth is the best articulator. The final test for a dental restoration is the occlusal harmony obtained when the restoration is placed in the patients mouth. But still mechanical articulators have many advantages over the mouth. 1. Better visualization of the patients occlusion, especially from lingual view. 2. Patient co-operation is not a factor. 3. The refinement of complete denture occlusion in the mouth is extremely difficult because of shifting denture bases and resiliency of the supporting tissues. 4. Reduced chair time and patient appointment time 5. More procedures can be delegated to auxiliary personnel. 6. The patients saliva, tongue & cheeks are not the limiting factors.
LIMITATIONS:
1). An articulator is a mechanical instrument made of metal. 2). The articulator is subject to error in tolling and errors resulting from metal fatigue and wear. 3). It is unlikely for any articulator to duplicate condylar movements in the TMJ. 4). The movements simulated are empty mouth sliding motions, not functional movements.
These complicated articulators pose some problems for use in making complete dentures because of the resiliency of the soft tissues of the basal seat on which recording bases must rest. As the resiliency permits some movement of the bases in relation to the bone, the records made are not necessarily records of the true path movement of the bone.
restorations
68
Amount of adjustment
Difficulty of use
Cost
none
none
S-A
Fully Adjustable
Beck (1956) states that the constant relation of occlusal plane and arcon guides exists at any position of the upper member and thus duplication of mandibular movement is more accurate in arcon type. Weinberg (1963) concluded that the arcon and non arcon type produce the same guidance.
4. The (lateral guidance side shift) adjustments can be adjusted from 0-20 degrees. This was calculated by Hanau in formula L = H/8 + 12 {L = Lateral condylar angle in degrees. H = Horizontal condylar inclination in degrees} The derivations for this equation are not known and so the validity is questionable since large changes in the horizontal condylar inclination angle will result in only a few degrees change in the side shift angle. 5. Also accepts a face bow transfer.
Hanau Model H
130-22 MODEL:
Non-arcon used for the restoration of natural teeth . Variable intercondylar width settings of 94-150 mm. Upper and lower members can be separated.
130-28 MODEL: Arcon check-bite articulator. For standard fixed and removable prosthodontic situations. Intercondylar adjustment is 94-150mm. Condylar inclination adjustment of 0-60 degrees, lateral adjustment of 0-40 degrees.
Whipmix Articulator
Normal Features: (1) Intercondylar distance is adjustable S(96mm), M(110mm) and L(124mm) by means of removable condylar guidance spacers along the instruments horizontal axis.
(2) Horizontal condylar inclinations are set by means of lateral or protrusive interocclusal records.
(3) Amount of Bennett movement is set by lateral interocclusal records. (4) The upper and lower members are mechanically attached by means of spring latch assembly.
Condyle elements are moved to center holes of lower frame to correspond to the medium registration.
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Model 8300
MODEL 8340
The casts are interchangeable between articulators through a special fixture called as accumount with which a special mounting plate table is precisely attached to the lower frame. The relationship is then checked to verify precise alignment between upper and lower frames
Model 8340
MODEL 8800:
an additional space to mount the maxillary cast.
MODEL 9000:
Similar to 8800 except the lower frame is taller to provide more space for mounting the mandibular cast.
MODEL 9800:
Combines the upper frame of model 8800 with the lower frame of model 9000 to provide the greatest distance between the upper and lower frames. These models can have condylar locking screws which can be positioned against condylar elements to permit only hinge action and helps in mounting procedures. Models with this feature are designated as 8500 A, 8800 A, 9000 A and 9800 A.
The latest version of Whip Mix articulators have been designated model DB 2000 and DB 2200. There is also an interchangeable 2240 model. The posterior viewing and access space has been increased. The additional inter-frame distance has been increased to 114mm (41/2inches) to provide more space for bulky casts. A quick-acting centering latch system
Bilateral heavy elastics connect the condylar assemblies to the vertical frames of the lower member. These elastics Prevent separation of the upper and lower frames during excursive movements. Maintain the orbiting condylar element against the medial wall of the condylar assembly during a lateral movement Tend to return the condylar element back to CR after releasing lateral movement pressure and Provide a positive feel to any excursive movement during laboratory manipulation.
Whipmix 2240
MODEL 2000:
The model 2000 articulator is the same as the model 2200 except that The medial wall is curved at its end to provide for a curvilinear movement of the orbiting condylar path. Shims of 1 and 2mm thickness are provided. The 1mm shim, when in place allows 1mm of curvilinear side shift in the first millimeter of advancement. The 2mm shim allows for 2mm of curvilinear side shift in the first 2mm of advancement. The unused shims are stored in a compartment of a special designed Hex wrench.
PANADENT ARTICULATORS: introduced in 1978 by Robert Lee and current models were introduced in 1983
arcon; with fixed intercondylar distance 110 mm. It utilizes interchangeable, preformed, curved analog fossae for condylar pathway. The progressive side shift varied from 5-7 degrees generally with an average of 6 degrees. Fossae analogs are available with average lateral pathways and immediate side shifts from 0.5 2.5 mm. Lateral interocclusal records or the Axi-path recorder are utilized to determine the amount of side shift and the steepness of the horizontal condylar inclination. The latest modification is Dynalink panalock mechanical latch which permits an opening movement of 180 degrees.
Panadent articulator
3 models are available: SL, PSL & PCL. The later two models are machined to within 0.01 mm accuracy that permits the interchanging of mounted casts between different articulators. PSL model has a less complicated straight incisal guide pin as does the SL model. Both a plastic and an adjustable metal incisal guide table are available with all 3 models.
SL
Selection of an Analog: Quick analyzer tracing extraoral device is used to determine condylar path inclination. Different analogs can be mixed for each side if different amount of side shift is present. The analogs and their angulation can be determined with positional lateral records.
TMJ ARTICULATORS:
Kenneth Swanson and introduced in 1965. Condylar inclinations adjustment from 10 55 degrees Progressive side shift adjustment of 0-35 degrees. The superior wall has a 3 degrees slant which produces FISHER ANGLE when the mediotrusive pathway portion is steeper than the protrusive pathway. The incisal guide pin is curved both a plastic and an adjustable mechanical incisal table. A mechanical guidance fossa accessory is available and can be easily inserted in the articular fossa housing. A series of 5 pre made fossae analogs are available with curvilinear superior surfaces based on average from an analysis. Hinge opening of the locking device is 115 degrees.
Each set contains pairs of fossae with inclinations of 28, 35, 40, 45 and 50 degrees in different colours for easy identification. Each analog has a 0.5 mm pre current side shift with a 7 degree progressive angle. Custom analog fossae are formed from intraoral stereographic tracings and is called as stereographix. Blank fossae boxes are filled with acrylic resin and curvilinear guidance paths and side shift are produced. The articulator has a spring latch to return upper frame to centric relation position. Mini-articulator: Smaller version. The intercondylar distance is limited from 110-150 mm and has straight incisal guide pin.
Denar 5A
PROGRAMMED FROM TRACINGS MADE WITH A PNEUMATICALLY CONTROLLED PANTOGRAPH. Advantage : Saves time and effort needed to manually transfer the recordings and to program the articulator.
Denar Mark II
AUTOMARK
nonadjustable articulator with fixed guidances. The medial wall has a 7 progressive angulation. The lower frame is similar to that of the Mark II Four types of incisal guide tables and incisal guide pins combinations are available and are interchangeable from one articulator model to another.
AUTOMARK
Once the face-bow record has been made on the patient, the side arms are removed and set aside. The transfer jig is then inserted into the incisal guide table slot and attached to the lower member of the articulator. The face-bow fork is now properly related to the articulator for mounting of the maxillary cast. The advantage of this face-bow is that the same bow can be used with additional face-bow forks and transfer jigs for taking multiple face-bow records. Whipmix, Hanau and Panadent have introduced similar systems. To help in infection control measures, the disposable Best-Bite System is available. It is composed of a wax bite fork and nonmetal components in the transfer jig.
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VIRTUAL ARTICULATORS
Virtual Articulators are also called as SOFTWARE articulators. They are not concrete but exist only as a computer program. They comprise of virtual condylar and incisal guide planes. Guide planes can be measured precisely using jaw motion analyser or average values are set in the program like average value articulator.
The Virtual Articulators are able to design prostheses kinematically. They are capable of simulating human mandibular movements, by moving digitalized occlusal surfaces against each other and enabling correction of digitalized occlusal surfaces to produce smooth and collision-free movements. There are two types of Virtual Articulators A. Completely adjustable virtual articulator B. Mathematically simulated virtual articulator
Programming of Virtual Articulators Pre requisite for visualization on screen is 3D scanning/digitizing of tooth surface or restorations or denture models using 3D scanner.
CONCLUSION
Since a number of articulators are available for the fabrication of dental prostheses, there is considerable controversy as to which articulator is the best for a particular dental procedure. However, the success or failure of the final restoration is more dependent on the operator of the articulator than on the articulator itself. It must be recognized that the person operating the instrument is more important than the instrument. If dentists understand articulators and their deficiencies, they can compensate for their inherent inadequacies. - Carl O. Boucher