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complete dentures
jodhpur dental college,general hospital

Feb. 24, 2018 • 219 likes • 71,501 views

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! Jaw relation in complete dentures

1. Powerpoint Templates Page 1 Powerpoint Templates
2. Powerpoint Templates Page 2 Introduction Jaw
relations are defined as any one of the many relations of
the mandible to the maxillae Maxillomandibular
relationship is defined as any spatial relationship of the
maxillae to the mandible; any one of the infinite
relationships of the mandible to the maxilla.
3. Powerpoint Templates Page 3 Jaw
relation/maxillomandibular relation Types: 1.
Orientation relation 2. Vertical relation 3. Horizontal
relation centric relation eccentric relation—protrusive
records ---lateral records.
4. Powerpoint Templates Page 4 Clinical significance of
jaw relation • To re-establish the functional position of the
mandible. • Comfort • Esthetics • Phonetics • Functional
e!iciency • Structural balance.
5. Powerpoint Templates Page 5 TRIMMING THE UPPER
RECORD BLOCK When trimming the rim there are four
main considerations and they must be taken in the order
given. Labial fullness: The lip is normally supported by the
alveolar process and teeth which, at this stage, are
represented by the base and rim of the record block.
Therefore, the labial surface must be cut back or added to
until a natural and pleasing position of the upper lip is
obtained.
6. Powerpoint Templates Page 6 2. The height of occlusal
rim: It should be trimmed vertically until it represents the
amount of anterior teeth intended to show below the lip
at rest. The average adult shows approximately 3mm of
upper central incisors when the lips are just parted, but
there are many variations from this amount which should
be accepted as a guide rather than a rule A greater length
of tooth than normal may be shown if the patient has: A
short upper lip a. Superior protrusion b. An Angle’s Class II
malocclusion of natural teeth And less will be shown: a.
With a long upper lip b. In most old people, owing to
attrition of natural teeth and some loss of tone of the
orbicularis oris muscle
7. Powerpoint Templates Page 7 3. Anterior plane:
Generally the plane to which the anterior teeth should be
set, and to which the rim must be trimmed, is parallel to
an imaginary line joining the pupils of the eyes or a line at
right angles to the midsagittal plane of the face.
8. Powerpoint Templates Page 8 4. The anteroposterior
plane: This plane indicates the position of occlusal
surfaces of the posterior teeth and is obtained in
conjunction with the anterior plane. The rim is trimmed
parallel to Ala-tragus line (an imaginary line running from
the external auditary meatus or tragus of the ear to the
lower border of ala of the nose). Thus when the rim has
been trimmed to these planes it indicates the place of
orientation for setting the artificial teeth.
9. Powerpoint Templates Page 9 GUIDELINES 1. The centre
line or midline In the normal natural dentition, the upper
central incisors have their mesial surfaces in contact with
an imaginary vertical line which bisects the face and, for
esthetic reasons, it is desirable that the artificial
substitutes should occupy the same position. The
following aids are suggested as a help in deciding where
to mark a vertical line on the labial surface of the upper
rim • Where it is crossed by an imaginary line from the
centre of the brows to the centre of the chin. •
Immediately below the centre of the philtrum •
Immediately below the centre of the labial tubercle
10. Powerpoint Templates Page 10 2. High lip line This is a
line just in contact with the lower border of the upper lip
when it is raised as high as possible unaided, as in smiling
or laughing. It is marked on the labial surface of the rim
and indicates the amount of denture which may be seen
under normal conditions, and thus assists in determining
the length of tooth needed. 3. Canine lines These mark
the corners of the mouth when the lips are relaxed and
are supposed to coincide with the tips of the upper canine
teeth but are only accurate to within 3 or 4 mm. These
lines give some indication of the width to be taken up by
the six anterior teeth from tip to tip of the canines.
11. Powerpoint Templates Page 11 TRIMMING THE LOWER
RECORD BLOCK Trim the lower block so that it occludes
evenly with the upper, the mandible will be separated
from the maxilla by the same distance that it was when
the natural teeth were in occlusion. The location of the
occlusal plane posteriorly will ultimately be determined
by the height of the mandibular anterior teeth and
anterior 2/3 rd of retromolar pads. A"er recording the
tentative occlusal vertical relation and the centric relation
position, the maxillary occlusion rims are oriented to the
opening axis of the jaws with the help of the face bow.
12. Powerpoint Templates Page 12 ORIENTATION
RELATIONS Orientation relations are those that orient the
mandible to the cranium in such a way that when the
mandible is kept in its most posterior unstrained position,
the mandible can rotate in the sagittal plane around an
imaginary transverse axis passing through or near the
condyles
13. Powerpoint Templates Page 13 THE FACE BOW A
caliper like instrument used to record the spatial
relationship of the maxillary arch to some anatomic
reference point or points and then transfer this
relationship to an articulator; it orients the dental cast in
the same relationship to the opening axis of the
articulator. Types of Face bow: There are two types of face
bows. 1. KINEMATIC face bow 2. ARBITRARY face bow -
Facial type -Earpiece type
14. Powerpoint Templates Page 14 KINEMATIC FACE BOW
The Kinematic face bow is initially used to accurately
locate the hinge axis. It is attached to a clutch, which in
turn attaches to the mandibular teeth. As the mandible
makes opening and closing movements the condylar styli
move in an arc. Their position is adjusted until they
exhibit pure rotation and not translation, when the
mandible is opened and closed. The points of rotation are
marked on the skin and this determines the true hinge
axis. The mandibular clutch is removed and the face bow
is attached to the maxillary arch. The true rotation points
are again used to orient the tips of the condylar styli .
15. Powerpoint Templates Page 15 ARBITRARY FACE BOW
The arbitrary type of face bow is so called because it uses
arbitrarily located marks on the skin at the condyle points
as the hinge axis position. 1. Facia type: In the facia type
the condyle rods are positioned on a line extending from
the outer canthus of the eye to the superior inferior center
of the tragus and approximately 13mm anterior to the
distal edge of the tragus of the ear. This locates the
condyle rods within 5mm. of the true center of the
16. Powerpoint Templates Page 16 2. Ear piece type: The
earpiece face bow is designed to fit into the external
auditory meatuses. Here also the fork is attached to the
maxillary occlusion rim.
17. Powerpoint Templates Page 17 Vertical jaw relation •
Amount of separation b/w maxilla & mandible. • Acc GPT –
8. – Distance b/w two selected points one on a fixed and
one on a movable member or – The vertical dimension of
face b/w any two arbitrary selected points located one
above and one below the mouth,usually in the midline.
18. Powerpoint Templates Page 18 Classification 1)
Vertical dimension of occlusion 2) Vertical dimension of
rest 3) Vertical dimension in the other positions. Vertical
dimension of occlusion: (GPT-8) The distance b/w two
points when the occluding members are in contact. OR It
is the relation of the mandible to the maxilla when the
occlusal stops are provided by the teeth/occlusion.
Vertical dimension of rest: The distance b/w two selected
point measured when the mandible is in the physiologic
rest position.
19. Powerpoint Templates Page 19 INTEROCCLUSAL
DISTANCE /INTEROCCLUSAL REST SPACE. • Di!erence b/w
the resting vertical dimension and vertical dimension of
occlusion. • First studied by Dr.M E Niswonger • 2-4mm. •
Verticentric : involves the simultaneous recording of
vertical dimension of occlusion with the jaws in centric
relation. • Vertical dimension of speech: the distance
measured b/w two selected points –occluding members-
closest proximity during speech.
20. Powerpoint Templates Page 20 Common factors to
consider while recording vertical jaw relation Position of
mandible – influenced by gravity Patient should be calm,
cool, & relaxed Di!icult in neuromuscular disturbances
No one method –accepted.
21. Powerpoint Templates Page 21 Methods for recording
vertical jaw relation 1) Mechanical methods: i. Ridge
relation: a) distance of incisive papilla from mandibular
incisors b) parallelism of ridges ii. Measurement of former
dentures iii. Pre-extraction records- Profile radiographs
Profile photographs Casts of teeth in occlusion
Facial measurements 2) Physiologic methods
Physiologic rest position Phonetics & esthetics as
guide Swallowing threshold Tactile sense
22. Powerpoint Templates Page 22 Methods for
determining VDO • Niswonger’s method: (1934) –
interocclusal distance : 2- 4mm at first premolar region. •
Two marks- – Base of nose – Chin • Disadvantages; –
Marks on skin – move – di!icult – constant measurement.
– Lack of permanent reference points.
23. Powerpoint Templates Page 23 E!ect of increased
vertical dimension 1) Increased risk of trauma- clenching
of teeth. 2) Discomfort to patient 3) Teeth are liable to
contact – causing clicking during speech 4) Trauma & pain
– basal seat areas of denture 5) Loss of freeway space-
muscular fatigue 6) Clicking sound 7) Elongated
appearance of face 8) Bone resorption 9) Loss of retension
& stability of dentures 10) Generalised hyperemia.
24. Powerpoint Templates Page 24 E!ect of decreased
vertical dimension 1) Reduced masticatory e!iciency 2)
Poor esthetics 3) Cheek biting/ tongue biting/ lip biting 4)
Denture look 5) Angular chelitis 6) Pain in TMJ 7) Coston’s
syndrome 8) prognathism
25. Powerpoint Templates Page 25 Tests to aid in
confirming correct vertical relation Judgement of facial
support Visual observation of space b/w rims Observation
– sibiliant words.
26. Powerpoint Templates Page 26 Horizontal jaw
relations Centric relation Eccentric relation Protrusive
record Lateral record Centric relation: -- GPT -8 Centric
relation is defined as a maxillomandibular relationship in
which the condyles articulate with the thinnest avascular
portion of their respective disks with the complex in the
anterior superior position against the shapes of articular
eminences. This position is independent of tooth contact.
This position is discernible when mandible is directed
superiorly and anteriorly and restricted to a purely
rotatary movement about a transverse horizontal axis.
27. Powerpoint Templates Page 27 Methods of recording
centric relation Boucher's : A) static methods-
Interocclusal record Central bearing device Tracing
devices B)functional methods—chew – in technique
Needles technique House technique Essig technique
Patterson technique
28. Powerpoint Templates Page 28 Static method Causes
minimal displacement of recording bases Intraoral
interocclusal records- without central bearing point –
using plaster/wax.
29. Powerpoint Templates Page 29 Preparing Occlusion
Rims – Place 3 widely separated lines between the rims in
the centric position – CRITICAL! Check that record base
heels/rims do not touch – Eliminate contact with record
bases
30. Powerpoint Templates Page 30 Registering Centric
Relation Max & Mand Occusion Rims – Two sharp “V”-
shaped notches in the molar/premolar area of each sided
wax – Depth 1-2 mm 1-21-2 mmmm
31. Powerpoint Templates Page 31 Ensure Adequate
Notch Depth Too Shallow - no undercuts
32. Powerpoint Templates Page 32 Registering Centric
Relation – Rehearse making the record without recording
medium – Place occlusion rims intraorally – PVS
registration material (Memoreg) over entire occlusal rim
33. Powerpoint Templates Page 33 Thin Layer of Material
Too Thick Good
34. Powerpoint Templates Page 34 Thin Layer • Want flat
record, no excess on sides of rims • Excess material
recording of the sides of the rim can cause deflection
when checking record
35. Powerpoint Templates Page 35 Making the Record •
Have patient close into record • Ensure smooth arc of
closure, no horizontal deviations • Use index fingers to
stabilize lower record base
36. Powerpoint Templates Page 40 Registering Centric
Relation Patient opens, relaxes, and slowly closes
37. Powerpoint Templates Page 41 Registering Centric
Relation – Patient closes until rims are almost touching (1
mm separation) – Ask patient to stop as soon as this
position has been reached – Some may not be able to tell
when they contact
38. Powerpoint Templates Page 42 Registering Centric
Relation • Never instruct the patient to bite firmly • Causes
translation or inaccuracy in the record
39. Powerpoint Templates Page 43 Registering Centric
Relation • Hold position until set 1-2 min • Remove both
rims together • Separate
40. Powerpoint Templates Page 44 Registration Should be
Sharp, Not Rounded
41. Powerpoint Templates Page 45 Registering Centric
Relation Mounting the Mandibular Cast • Ensure record is
repeatable • Increase the height of incisal pin 1 mm, invert
articulator • Place wax rims together, lute with sticky wax -
4 spots
42. Powerpoint Templates Page 46 Eccentric relation
record Protrusive relation record Lateral relation record
43. Powerpoint Templates Page 47 Methods for recording
eccentric jaw relation Functional method- needles- house
& patterson technique Graphic method Tactile / direct
check record methods
44. Powerpoint Templates Page 48 Protrusive relation
Christensen’s phenomenon Due to downward
displacement of the condlyes along the articular slope.
Protrusive records are made of- Direct protrusive check
record Graphic method Functional procedures
45. Powerpoint Templates Page 49 Lateral jaw relations •
Common methods: – Graphic method – With check bites
of wax – With positional records of stone/plaster –
Pantography – Hanau’s formula: – L = H/8 + 12 L=lateral
condylar inclination H=Horizontal condylar inclination
46. Powerpoint Templates Page 50 Consequences of
incorrect centric relation recording Natural dentition–
damage to periodontal structure, hypersensitivity,
excessive attrition, hypermobility of teeth. Pain &
dysfunction of masticatory muscle, headache, neck&
shoulder pain. Dentures- not in centric relation—
premature contact. TMJ dysfunction— condyle press
upon peripheral vascular & innervated part of articular
disc. Mucosal irritation & soreness. Spasm of muscle of
mastication Resorption of residual alveolar ridges.
47. Powerpoint Templates Page 51

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