Anterior deprogramming device fabrication using a thermoplastic material

Martin F. Land, DDS, MSD,a and Alejandro Peregrina, DDS, MSDb

School of Dental Medicine, Southern Illinois University, Alton, Ill
This article presents a simple and efficient technique to fabricate an anterior deprogramming device
using a thermoplastic material. The material, softened by heating, is adapted to the maxillary incisors
while moldable. The operator guides the mandible into closure as the material stiffens. The device is
then trimmed, and a posterior centric relation record is made using the recording material of choice.
(J Prosthet Dent 2003;90:608-10.)

or some patients the centric relation position does

not coincide with the maximum intercuspation position.
In making a maxillomandibular record, the dentist must
select a patient-defined habitual intercuspal position or
an operator-defined positional registration of the mandible. Use of an anterior programming device allows
separation of the posterior teeth immediately prior to
centric relation record fabrication.1 This results in the
patient forgetting established protective reflexes that
are reinforced each time the teeth come together, making mandibular hinge movements easier to reproduce.2
Properly executed, use of a deprogramming device allows the patient to close into an operator-defined repeatable position unassisted.3
Various techniques to separate the posterior teeth
include positioning cotton rolls between the incisors,
use of a plastic leaf gauge, or a small anterior deprogramming device made of autopolymerizing acrylic resin (occasionally referred to as a Lucia Jig).4,5 The resulting
anterior stop acts as a fulcrum, allowing the directional
force provided by the elevator muscles to seat the condyles in a superior position within the fossae. The technique can be coupled with the bilateral mandibular manipulation technique6 and has been shown to result in
greater mandibular displacement from the intercuspal
position than with a centric relation record alone.7
This article presents a simple, efficient, and effective
technique to fabricate an anterior deprogramming device using a thermoplastic material. The material is easily
molded and adapted at a temperature that is comfortable to the patient, with good stability, following cooling. Heat generated when trimming with rotary instruments causes distortion, but a scalpel blade works well.
At a thickness exceeding 1 mm, material rigidity makes
cutting more difficult. It is not practical to cut the material while still soft because distortion results.

Professor, Section of Fixed Prosthodontics.

b
Associate Professor, Sections of Fixed and Removable Prosthodontics.
608 THE JOURNAL OF PROSTHETIC DENTISTRY

TECHNIQUE
1. Soften a thermoplastic disk (Matrix Button; Advantage Dental Products, Inc, Lake Orion, Mich) in a
65C water bath for approximately 90 seconds. (Alternatively, heat the material in a cup of water in a
microwave). The material is translucent when softened (Fig. 1).
2. Remove the translucent disk from the water bath and
roll it into a ball. If a water bath is not used, use
wetted gloves to prevent the material from sticking to
the glove.
3. Adapt the softened material to the maxillary central
incisors, ensuring coverage of the lingual surfaces
while folding it over the incisal edges, and slightly
extend the material onto the facial surface of the
teeth (Fig. 2). Shape the lingual portion to minimize
the amount of contact with the mandibular incisors.
Alternatively, apply the material to a tin-foil substitute-coated Type IV stone cast; allow to solidify, and
reheat the material for 20 to 30 seconds in the water
bath immediately before use.
4. Guide the patient into closure until incisal contact
occurs on the device and the posterior teeth are
about 1 mm apart and slight mandibular incisor indentations occur (Fig 3). If necessary, mark the extent to which the device is to be trimmed with an
explorer while the material remains slightly soft.
Cool with an air-water spray for approximately 10
seconds until the material becomes opaque.
5. Confirm that there is no posterior occlusal contact.
6. If necessary, resoften the device slightly by brief reimmersion in the water bath, and repeat the above
procedures as necessary.
7. Trim excess material with a sharp scalpel blade until
there is no interference during closure (Fig. 4). Confirm that only minimal contact occurs on the device
(Fig. 5).
8. Proceed with posterior centric relation record fabrication with the recording material of choice (Fig. 6).

SUMMARY
Fabricating an anterior deprogramming device from
thermoplastic resin provides a quicker alternative than
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THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 1. Two matrix buttons. At room temperature, material is

opaque (Left), but after heating, turns translucent (Right).

Fig. 2. Adaptation to maxillary central incisors; lingual is

shaped to minimize number of contacts with mandibular
incisors.

Fig. 3. Mandibular central incisors should make shallow

indentations.

Fig. 4. Completed device after trimming. Only minimal contact with mandibular incisors remains.

Fig. 5. Posterior occlusal contact has been eliminated while

mandibular incisor contact occurs on anterior programming
device.

Fig. 6. Centric relation record made with registration material interposed between posterior quadrants while mandibular incisor contact occurs on anterior programming device.

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the use of autopolymerizing resin and minimizes the

noxious odor associated with intraoral acrylic resin polymerization. Because the completed device retains
some flexibility, it is possible to remove it from moderate
undercuts without patient discomfort.
Thermoplastic materials do not lend themselves to
trimming with rotary instruments but should be
trimmed with a sharp blade. With some practice, a stable
and functional anterior deprogramming device can be
made in about 3 to 4 minutes.
REFERENCES
1. Urstein M, Fitzig S, Moskona D, Cardash HS. A clinical evaluation of
materials used in registering interjaw relationships. J Prosthet Dent 1991;
65:372-7.
2. Rosenstiel SF, Land MF, Fujimoto J. Contemporary fixed prosthodontics. 3rd
ed. St. Louis: Elsevier; 2000. p. 38.
3. Hunter BD 2nd, Toth RW. Centric relation registration using an anterior
deprogrammer in dentate patients. J Prosthodont 1999;8:59-61.

Noteworthy Abstracts
of the
Current Literature

LAND AND PEREGRINA

4. Lucia VO. A technique for recording centric relation. J Prosthet Dent

1964;14:492-505.
5. Carroll WJ, Woelfel JB, Huffman RW. Simple application of anterior jig or
leaf gauge in routine clinical practice. J Prosthet Dent 1988;59:611-7.
6. Okeson JP. Management of temporomandibular disorders and occlusion.
5th ed. St. Louis: Elsevier; 2002. p. 283-4.
7. Karl PJ, Foley TF. The use of a deprogramming appliance to obtain centric
relation records. Angle Orthod 1999;69:117-24.
Reprint requests to:
DR MARTIN F. LAND
SOUTHERN ILLINOIS UNIVERSITY
SCHOOL OF DENTAL MEDICINE
2800 COLLEGE AVE
BLDG. 284
ALTON, IL 62002
FAX: (618) 475-7150
E-MAIL: mland@siue.edu
Copyright 2003 by The Editorial Council of The Journal of Prosthetic
Dentistry.
0022-3913/2003/$30.00 0
doi:10.1016/j.prosdent.2003.09.011

Residual ridge resorption in the edentulous maxilla in

patients with implant-supported mandibular overdentures:
An 8-year retrospective study
Kreisler M, Behneke N, Behneke A, dHoedt B. Int J
Prosthodont 2003;16:295-300.

Purpose. This retrospective study radiologically investigated alveolar bone resorption in the edentulous maxilla in patients with implant-supported mandibular overdentures.
Materials and Methods. This study consisted of 35 healthy, completely edentulous patients with
a mean age of 59.7 years. They had received 2 implants between the mental foramina. New
bar-retained mandibular overdentures and maxillary complete dentures were fabricated. Standardized panoramic radiographs taken subsequent to loading and at annual recall visits for up to 8 years
were measured for alveolar bone loss in the maxilla. Bone areas and areas of reference not subject to
resorption were measured with a planimetry program. The proportional value between both was
expressed as a ratio (R). Bone loss was expressed as a change in R between 2 time points. Differences
in the resorption rate between the anterior and posterior parts of the maxilla were investigated.
Results. Residual ridge resorption continued during the follow-up period and revealed high
individual variability. With a range of 5% to 11% (median) loss in the original bone height, it was
significantly (P.031) more pronounced in the anterior than posterior maxilla (2%-7%) from the
second through eighth years. Regression analysis of the medians revealed a relatively high correlation between time and bone loss in both anterior and posterior parts of the maxilla.
Conclusion. The anterior anchorage of mandibular overdentures by means of 2 implants and an
ovoid bar was associated with slightly higher resorption in the anterior than in the posterior part of
the edentulous maxilla.Reprinted with permission of Quintessence Publishing.

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