PROS 5 - Jaw Relation

Occlusal Rims and Jaw Relation
Dr Adam Husein
Outline
Introduction Objectives Terminologies Materials Procedures Recording jaw relation
Introduction
Laboratory stage following secondary impression is the construction of bases and rims Secondary impressions master/working casts bases occlusal rims Bases and rims are then used for recording jaw relation (JR) or bite registration or maxillo-mandibular recording (MMR)
Introduction
Construction of occlusal rims or bite block is a laboratory stage Jaw relation record (JR) is the clinical stage
Base
Same or different materials
Rim
Different materials
Materials for Bases

Acrylic resin
Cold cure Light cure
Thermoplastic material Wax

Do not use not stable
Bases
Well adapted and conform closely to the master cast Stable on the cast in situ Free of voids and surface projections on the impression surface No more than 1 mm thick over the residual ridge to prevent the base interfering with the placement of the denture teeth
Bases
2 mm thick in the post dam area of the maxillary denture (and 2 mm thick in the lingual flange of the mandibular denture) to impart rigidity Easily removed from the cast Smooth and rounded so as to reproduce the contours of the master cast Constructed in materials that are stable
Common materials used as bases
Summary of stages
Stages Clinical History and exam Primary Secondary JR Try in Issue review Laboratory Study model or primary model Master cast Working cast Bite blocks Teeth arrangement Processing Wax up Flasking Trimming and polishing
Objectives
Creating and outlining the form of the upper denture Recording of intermaxillary relations Selection of teeth
Occlusal registration stage

Three components
Creating and outlining the form of the upper denture Recording of inter-maxillary relations Selection of teeth
Clinical Procedures
Correct patient Inspect the prosthesis properly done or not polishing and finishing
Following prescription
Ensure that the rim is well adapted to the master cast Disinfection appropriately Try in patients mouth
Summary of steps in JR
1. 2. 3. 4. 5. 6. 7. 8. Lip support Incisal plane Occlusal plane VDR, VDO and freeway space Lower rim Recording JR Midline, smile line and canine line Shade and mould
1.Lip Support
Restoration of the vermilion border Restoration of the philtrum 90 vertical naso-labial angle
Naso-labial Angle
The angle between the columella of the nose and anterior surface of upper lip in the sagittal plane (Patnaik et al, 2003) A preliminary study of determining nasolabial angle for Malay subjects (Ramasamy and Husein, 2005)
12 males and 12 females Mean angle for male 73 degrees Mean angle for female 72 degrees
Vermilion border Philtrum
2. Incisal Plane
Determine the upper anterior plane
Upper anterior six is usually parallel to the interpupillary line
Foxs occlusal plane guide or any device e.g. a wooden spatula
Incisal Show
Determine the position of the incisal point relative to the resting lip
Usually 2 mm below, but should suit individual case
Younger patients 4-5 mm Elderly level with the resting lip or 1 mm above
In general, incisal point should correspond to the vermilion border of the lower lip
3. Occlusal Plane
Using the canine points on the upper rim as reference points, the right and left posterior planes are formed
Accepted guideline this plane is parallel to the line drawn from the inferior border of the alar cartilage to a position two-thirds of the way up the tragus
4. VDR, VDO and Freeway Space

VDR/RVD vertical dimension at rest/rest vertical dimension VDO/OVD vertical dimension of occlusion/occlusal vertical dimension Freeway space (FWS) or inter-occlusal distance (IOD)
FWS or IOD
Determined by a balance between the elevator and depressor muscles attached to the mandible, and the elastic nature of the surrounding soft tissue in a natural dentition Resting vertical dimension vertical dimension of occlusion (OVD) = FWS
How to measure RVD

Facial measurements Swallowing methods Biting force measurements Phonetic methods Tactile methods Electromyographic measurements Combinations are recommended
Excessive OVD
Increased risk of trauma to the underlying tissues
Lack of FWS continuous clenching Painful mucosa
Muscle soreness (especially masseter) Clicking Phonetic problems TMD may develop
Reduced OVD
Lack of support of the angles of the mouth
Dribbling Angular cheilitis
Reduced masticatory efficiency Poor esthetics Chin protrusion on closure
5. Lower Rim
Trim to fit upper rim Even contact with upper rim Contact at established OVD Tongue position can be used as a guide
6. Recording MMR/JR
Retruded contact position (RCP) or centric relation
Reproducible Present with or without the presence of natural teeth Curl the tongue back to touch the back of the palate
Methods
Wax Bite registration paste Tracing Staples
Methods chosen must be repeatable
Materials
ZnOE or bite registration paste
7. Midline, Smile and Canine lines

Determine the positions of the mid points of the upper canine
Extend dental floss from the inner canthus of the eye, via the lateral border of the alar cartilage (with the patient smiling) onto the incisal edge of the upper rim
For completion, the following should be clearly marked on the upper rim
Centre line High smile line Canine points
8. Teeth Selection
Dentists responsibility should not assign the task to the technician Categories
Shape or mould Shade
Guide
Pre-extraction record
Photographs
Natural teeth or dentures admired by them
Casts
Patients wishes (spacing or crowding)
Teeth selection
Guide
Measurement from canine to canine Inverted shape of the face Shape of the edentulous maxillary arch
Both have no scientific credence
Posterior teeth
Teeth with cusps Teeth without cusps Hybrid teeth
Color and Shade

Careful and deliberate consultation with patients Considerations
Age (teeth tend to become darker with age although this is not always absolute) Patient preference Skin color (usually darker skin whiter teeth) Canine teeth slightly darker than incisors
Summary of Teeth Selection

Dentists responsibility Photographs or favored dentures if possible Select lower to complement the upper Fulfill esthetic and functional requirements Good practice to produce study models prior to extracting all teeth for FF
Infection Control
Disinfect properly before sending the work to the lab
Conclusion
JR is probably the most critical stage in denture construction Carefully follow all the steps Ensure to recheck the recording prior to discharging the patient
Thank You

PROS 5 - Jaw Relation

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Occlusal Rims and Jaw Relation

Same or different materials

Materials for Bases

Thermoplastic material Wax

Common materials used as bases

Occlusal registration stage

Vermilion border Philtrum

Foxs occlusal plane guide or any device e.g. a wooden spatula

4. VDR, VDO and Freeway Space

How to measure RVD

Reduced masticatory efficiency Poor esthetics Chin protrusion on closure

Methods chosen must be repeatable

7. Midline, Smile and Canine lines

Patients wishes (spacing or crowding)

Color and Shade

Summary of Teeth Selection

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