Beruflich Dokumente
Kultur Dokumente
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INTRODUCTION
• Recording of jaw relations in the treatment of edentulous patients
aims at facilitating the adaptation of the complete denture to the
masticatory system to give them an optimal and comfortable
function.
• To achieve this goal, the recording must include an approximate
vertical dimension of occlusion, stable occlusal contacts in harmony
with the existing TMJ and masticatory muscle functions.
.
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Definition
Maxillomandibular relationship - GPT VIII
• Any spatial relationship of the maxillae to the mandible;
• Any one of the infinite relationships of the mandible to the maxillae
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Classification of Jaw relations
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Definition
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Principle
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HISTORY
PROPONENT THEORY
HUNTER(1771) Lies in the middle of extremes of motion by which all the muscles
and ligaments are equally relaxed.
WALLISCH(1906) All muscle action eliminated
Mandible passively suspended
Opposing teeth no contact
NISWONGER(1934) -1st investigator to study extensively the rest position of mandible
Constancy concept of by recording measurements on patients.
face height -Rest position is a neutral position of the mandible since the
opening and closing muscles are in a state of equilibrium.
-Jaw relator-A gauge to measure the vertical dimension of the face
Thompson and Brodie Thomson believed that the rest position is determined by a
(1942) balance of tension in the musculature which suspends the
mandible and that the rest position is not affected by the
presence or absence of teeth. They stated, “The proportions of
face as far as vertical height is concerned, are constant
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Leof (1950) -Stressed that muscle tone rather than muscle length
controls the rest position, and that muscle tone can vary.
-Muscle tone can be increased by exercise and decreased by
excessive rest.
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2. Passive mechanism
Elastic elements of the musculature, and not any
muscle activity, balance the influence of gravity.
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Physiologic rest position
GPT-VIII
• 1: The mandibular position assumed when the head is in an
upright position and the involved muscles, particularly the
elevator and depressor groups, are in equilibrium in tonic
contraction, and the condyles are in a neutral, unstrained
position
• 2: The position assumed by the mandible when the attached
muscles are in a state of tonic equilibrium. The position is usually
noted when the head is held upright
• 3: The postural position of the mandible when an individual is
resting comfortably in an upright position and the associated
muscles
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are in a state of minimal contractual activity 11
Significance of Physiological Rest
position
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Textbook of complete dentures : Charles M. Heartwell Jr., Arthur O Rahn, 5th Edition
Vertical dimension of occlusion, GPT VIII
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Vertical Dimension at Rest
• Definition: -
• The distance between two selected points (one of which is on the middle of the face or
nose and the other of which is on the lower face or chin) measured when the mandible is in
the physiologic rest position-GPT-8
• It is essential to record the vertical dimension at rest as it acts as a reference point during
recording the vertical dimension at occlusion.
• The VD at rest should be recorded at the physiological rest position of the mandible.
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Inter-relationship
VDR-VDO=Freeway space or the
interocclusal rest space
Interocclusal rest space- GPT VIII
The difference between the
vertical dimension of rest and
the vertical dimension while
in occlusion.
It ranges from 2-4 mm in
vertical direction at the
position of the 1st premolar
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Gravity
Factors
considered
calm, cool and Neuromuscular
relaxed for rest disturbances
position
make
measurements
without delay
No one method for determining rest position can be accepted as being valid for all patients.
Several methods are available to confirm this record
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Syllabus of complete dentures : Charles M. Heartwell Jr., Arthur O Rahn, 4th Edition
Classification of the methods
• Mechanical : Physiological
1. Physiological Rest Position
• 1. Ridge relation
2. Phonetic and Esthetics as guides
A.Incisive papilla to mandibular incisors 3. Swallowing threshold
4.Tactile Sense
B. Parallelism of the ridges
• 2. Measurement of the former dentures
• 3. Preextraction records
A. Profile radiographs
B. Casts of teeth in occlusion
C. Facial mesurements
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MECHANICAL METHODS
RIDGE RELATIONS
• Individual variations
• Not relevant in patients with severe resorption
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PARALLELISM OF THE RIDGES
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MEASUREMENT OF THE FORMER DENTURES
• Problems:
• Loss of the ridges under the dentures results in an increase in
interocclusal distance.
Disadvantages:
• Radiation risks – So cannot be considered for
routine clinical use.
• Considerable time
• Unreliable-
-Inaccuracies that exist in the technique
-Inaccuracies in the method of comparing
measurements
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2.PROFILE PHOTOGRAPHS
• Made with the teeth in maximum occlusion
• Enlarged to life size
• Measurements of anatomic landmarks on the
photograph are compared with measurements
using the same anatomic landmarks on the face.
• These measurements can be compared when
the records are made and again when the
artificial teeth are tried in.
• Disadvantages :
Angulation of the photos might differ.
Photo enlargements cause inaccuracies.
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3.PROFILE
SILHOUETTES
• Lead wire adaptation along the
midline helps preparing a cardboard
cutout, which is preserved after
extraction.
• Repositioned to the face after the
vertical dimension has been
established at the initial recording
and/or when the artificial teeth are
tried in.
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4. CASTS OF TEETH IN OCCLUSION
• Practical method
• Measurements:
• - Incisive papilla and crest of the lower ridge
-Extended height of upper and lower buccal frena
-Hamular notch and retromolar pad
Disadvantages:
• Requires a great deal of time
• Extensive experience with the use of facial
impressions and casts.
• Different topography of face in erect and
recumbent posture. 26
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c.Willis guage.
• Pupil of the eye to rima oris = anterior nasal spine to inferior
border of mandible.
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PHYSIOLOGICAL METHODS
1.PHYSIOLOGICAL REST POSITION
• Indication of the appropriate vertical dimension at rest
• May not
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• METHOD :
-Patient relaxed, with trunk upright and
the head unsupported.
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2.PHONETICS
• Listening to speech sound production and observing the relationships of teeth during
speech.
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1. CH, S, AND J –
• Bring the anterior teeth close together.
• Lower incisors should move forward to a position nearly
directly under and almost touching the upper incisors.
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2. Have the patient repeat the name ‘Emma’ or ‘ Om’ until he is
aware of the contacting lips as the first syllable ‘m’ is
pronounced. When the patient has rehearsed this procedure,
ask him to stop all jaw movement when the lips touch. At this
time measure between the two points of reference.
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6.TACTILE SENSE PATIENT
A. PERCEIVED COMFORT
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B) Lytle’s Neuromuscular perception - Lytle RB in 1964
• It relies on patient’s perception of different vertical height.
• A central bearing device is attached to accurately adapted
record base
• Bearing pin is adjusted beyond the rest position, pin is
then lowered by half turn. Patient has to signify over-
closure.
• Pin is raised again till excess opening is seen.
• Appropriate vertical relation is judged by the patient.
• Disadvantage :
• it cannot be used in patients with poor neuromuscular
coordination.
• Presence of foreign objects in the palate and the tongue
space.
• Conflicting65 results on the precision of this method 43
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• 5.Soften a roll of baseplate wax in a
waterbath at 130o F and contour it in a
triangular shape with the base on the
occlusion rim and attach it to the
occlusal surface of the mandibular
occlusion rim.
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• 9.Reinsert the record and have
the patient close to maximum
occlusion. Measure the distance
between the points of reference
and compare with the
measurements made with the
mandible at rest.
• Instruct the patient to open and close until the teeth contact.
• Ask the patient if the teeth appear to touch too soon, if the jaws
seem to close too far before they touch, or if the teeth feel just
right.
• This
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method is not very effective with senile patients or with those 52
who have impaired neuromuscular coordination.
Swallowing followed by relaxing
1.With the dentures in place instruct the patient to wipe the lips with the tip
of the tongue, swallow and let the shoulders drop in a relaxed position.
2.Two small cones of a soft wax are placed, one in each central sulcus of the
mandibular first molars.
• Three, thirty-three : There should be enough space for the tip of the
tongue to protrude between the anterior teeth.
• Trauma and pain under the basal seat areas of dentures: The jarring
effect of the teeth coming into contact sooner than expected may not
only cause discomfort but in most cases it will also cause pain owing to
the bruising of the mucosa
• Loss of free way space : Muscular fatigue of any one or group of muscles
of mastication. In turn results in annoyance from the inability to find
comfortable resting position.
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Effects of decreased vertical relation
Inefficiency : Pressure which is possible to exert with teeth in
contact decreases considerably with over closure because the muscles of
mastication acting from attachments have been brought closer together.
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Angular cheilitis (perleche):
A reduced vertical dimension results in a crease at the
corners of the mouth beyond the vermilion border and the
deep fold thus formed becomes bathed in saliva thus
leading to infection and soreness.
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Costen’s syndrome (Mild catarrhal deafness):
There will be a tendency to push the tongue towards the throat, adjacent
tissues will be displaced, which may in turn result in occlusion of Eustachian
tubes which would interfere with function of ear which may cause ear
discomfort and impaired hearing.
• Tinnitus or snapping noises in joint.
• Tenderness to palpation overT.M.J.
• Dryness of the mouth.
• Various neurologic symptoms such as burning or picking sensation of the
tongue.
Prognathism :
Over the years as a result of resorption of ridges and abrasion of denture
teeth, there is a loss of occlusal vertical dimension. So the lower jaw over-
closes in a forward and upward direction.Then the patient may appear
prognathic.
Weinberg L, Role of condylar position in TMJ dysfunction-pain syndrome, J Prosthet 59
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Dent, Vol 41, 6, Jun 1979, Pages 636–643
REFERENCES
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Reestablishment of Occlusal Vertical Dimension in Complete Denture Wearing
in Two Stages
A 65-year-old woman came to a Dental School, Brazil, for assessment of a new complete denture.
The complete dentures were fabricated 23 years ago and her principal complaint was poor esthetics and ear pain.
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• Results: Bite force was maximum at the VDO in edentulous subjects. Maximum biting
force recorded at VDO was reduced with subsequent increase or decrease in VD.
• Clinically highest biting force could act as an aid in determining and verifying VDO for
edentulous patients
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REFERENCES AND CROSS REFERENCES
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REFERENCES AND CROSS REFERENCES
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