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Improved occlusal equilibration of complete dentures by augmenting occlusal anatomy of acrylic resin denture teeth
DENTAL TECHNOLOGY SECTION
DANIEL
EDITOR
H. GEHL
Improved occlusal equilibration of complete dentures by augmenting occlusal anatomv of acrvlic resin denture teeth Anthony
R. Ruffino, D.D.S.*
New York University, College of Dentistry, New York, N.Y.
0
cclusal balance of artificial teeth is a vital characteristic of complete dentures.‘” Variations in occlusion caused by processing changes often result in traumatic occlusion, nonuniform distribution of occlusal stresses to underlying tissues, and the concomitant compromise of function, comfort, and masticatory efficiency (Fig. 1, A).46 A technique designed to minimize the trauma of the period of occlusal adjustment by augmenting the occlusal anatomy of the acrylic resin denture teeth is described (Fig. 1, B).
MATERIAL A material was needed that would adhere to acrylic resin denture teeth but wear faster than acrylic resin denture teeth.’ In laboratory tests it was found that autopolymerizing acrylic resin (Ortho-Resin, L. D. Caulk Co. Milford, Del.) applied over a thin film of cyanoacrylate adhered to the denture teeth and withstood stress, warmth, and moisture. The autopolymerizing acrylic resin will wear at a rate 4.8 times faster than the denture teeth when subjected to 185,000 strokes at a pressure of 200 gm.
TECHNIQUE 1. Fabricate new complete maxillary and mandibular dentures with conventional clinical procedures. The posterior teeth are made of acrylic resin and are of the 33-degree (anatomic) variety. 2. Insert the finished dentures. 3. Make occlusal markings in centric relation at the time of first insertion (Fig. 2) and after preliminary occlusal adjustments for prematurities (Fig. 3). 4. Make an intraoral centric relation wax registration. 5. Remount the dentures on a Hanau articulator (Hanau Engineering Co. Inc., Buffalo, N.Y.) with the wax record. *Assistant Professor, Departments of Removable Prosthodontics and Family Practice.
300
6. Cleanse the occlusal surfaces of the mandibular denture teeth. 7. Lubricate the occlusal table of the maxillary denture with silicone spray and petroleum jelly. 8. Treat the occlusal surfaces of the mandibular posterior teeth with a thin film of cyanoacrylate kept within the buccal and lingual cusp heights. 9. Add sufficient autopolymerizing acrylic resin to fill the space between the cusp heights of the mandibular posterior teeth. 10. Close the articulator to allow the lubricated cusps of the maxillary teeth to form a custom fit into the unpolymerized acrylic resin. 11. Make lateral movements to ensure that no acrylic resin remains to obstruct lateral excursions during function. 12. Remove excessmaterial with a periodontal knife before final polymerization. 13. Clean the anatomy of the mandibular teeth of any excess resin that remains lateral to the cusp heights after polymerization, with care being taken to avoid any occlusal-bearing area. The occlusal surfaces of the “augmented” teeth are not polished (Fig. 4).
POSTINSERTION
FOLLOW-UP
1. Return the dentures to the mouth. 2. Centric and lateral jaw relation markings are made with thin articulating paper (Fig. 5). The markings show a wider distribution of occlusal contact points than were seen before augmentation of the mandibular posterior teeth, with no significant prematurities. 3. After 2 days, the dentures are remounted with intraoral wax registration, and the occlusal markings are made again.’ At the first postinsertion visit there usually are no changes noted in the occlusal markings. 4. Additional checks are made after 2, 6, and 16 weeks. Correction of prematurities should be made at this time. They are usually minor, and often no change
AUGUST 1984
VOLUME 52
NUMBER 2
AUGMENTATION
FOR IMPROVED
OCCLUSION
forces
distributed
augmented surface of mandibular tooth
Fig. 1. A, Sketch shows lateral or tipping forces during contact after processing and before augmentation. B, Sketch shows wider distribution of occlusal forces during contact with augmented mandibular denture teeth.
Fig. 4. Augmentation completed.
of mandibular
posterior
teeth
Fig. 2. Occlusal markings on maxillary denture before augmentation of mandibular occlusal surfaces.
Fig. 3. Occlusal markings on maxillary denture preliminary adjustment to relieve prematurities.
THE JOURNAL
OF PROSTHETIC
DENTISTRY
after
Fig. 5. Occlusal markings on maxillary denture after augmentation of mandibular occlusal surfaces; initial insertion visit.
301
RUFFINO
“break-in period” for complete dentures can be reduced and required adjustments can be minimized. Additional studies are warranted to seek a similar technique for use with porcelain denture teeth. REFERENCES
Fig. 6. Occlusal markings 16 weeks postinsertion. is evident and a generally balanced occlusion in centric and lateral positions is seen (Fig. 6).
CONCLUSIONS The results of augmenting the occlusal anatomy of acrylic resin teeth indicate that the tiauma of the
1. Thomson, H.: Occlusion in Clinical Practice. Bristol, England, 1981, John Wright & Sons, Ltd., p 135. 2. Schulman, A., and Pentel, L.: The rational use of materials in occlusion. Dent Clin North Am Z&462, 1981. 3. Lauciello, F. R.: Articulator-generated amalgam stops for complete dentures. J PROSTHETDENT 41:16, 1979. 4. Thomson, H.: Occlusion in Clinical Practice. Bristol, England, 1981, John Wright & Sons, Ltd., p 123. 5. Heartwell, C. M.: Syllabus of Complete Dentures. Philadelphia, 1968, Lea & Febiger, p 324. 6. Schneider, R. L.: Custom metal occlusal surfaces for acrylic resin denture teeth. J PROSTHETDENT 46:98, 1981. 7. Thomson, H.: Occlusionin Clinical Practice. Bristol, England, 1981, John Wright & Sons, Ltd., p 132. Reprint requests to: DR. ANTHONK R. RUFFINO MOHICAN CT. SALISBURYMILLS, NY 12577
ARTICLES TO APPEAR IN FUTURE ISSUES Artificial
saliva reservoirs
A. Vissink, D.M.D., E. J. ‘s-Gravenmade,Ph.D., A. K. Panders, D.M.D., Ph.D., A. Olthof, D.D.S., A. Vermey, M.D., F.A.C.S., M. C. Huisman, and L. L. Visch, D.D.S.
Custom shade guide Ormond H. Ware, D.M.D.
A method for determining crown preparations
adequate resistance form of complete cast
R. M. Weed, D.D.S., and R. J. Baez, D.D.S.
Enhanced retention for the distal extension-base removable partial denture using a heat-cured resilient soft liner J. A. Whitsitt, D.D.S., L. W. Battle, D.D.S., and C. J. Jarosz
Cranial and maxillofacial epithesis treatment on osseointegrated implants: Concepts and principles Evtim Yontchev, D.S., S.O.S.O., U.D.D., S.O.M.F.P.
Average maximum post lengths in endodontically
treated teeth
Richard M. Zillich, D.D.S., MS., and John F. Corcoran, D.D.S., MS. 302
AUGUST
19134
VOLUME
52
NUMBER
2
DANIEL
EDITOR
H. GEHL
Improved occlusal equilibration of complete dentures by augmenting occlusal anatomv of acrvlic resin denture teeth Anthony
R. Ruffino, D.D.S.*
New York University, College of Dentistry, New York, N.Y.
0
cclusal balance of artificial teeth is a vital characteristic of complete dentures.‘” Variations in occlusion caused by processing changes often result in traumatic occlusion, nonuniform distribution of occlusal stresses to underlying tissues, and the concomitant compromise of function, comfort, and masticatory efficiency (Fig. 1, A).46 A technique designed to minimize the trauma of the period of occlusal adjustment by augmenting the occlusal anatomy of the acrylic resin denture teeth is described (Fig. 1, B).
MATERIAL A material was needed that would adhere to acrylic resin denture teeth but wear faster than acrylic resin denture teeth.’ In laboratory tests it was found that autopolymerizing acrylic resin (Ortho-Resin, L. D. Caulk Co. Milford, Del.) applied over a thin film of cyanoacrylate adhered to the denture teeth and withstood stress, warmth, and moisture. The autopolymerizing acrylic resin will wear at a rate 4.8 times faster than the denture teeth when subjected to 185,000 strokes at a pressure of 200 gm.
TECHNIQUE 1. Fabricate new complete maxillary and mandibular dentures with conventional clinical procedures. The posterior teeth are made of acrylic resin and are of the 33-degree (anatomic) variety. 2. Insert the finished dentures. 3. Make occlusal markings in centric relation at the time of first insertion (Fig. 2) and after preliminary occlusal adjustments for prematurities (Fig. 3). 4. Make an intraoral centric relation wax registration. 5. Remount the dentures on a Hanau articulator (Hanau Engineering Co. Inc., Buffalo, N.Y.) with the wax record. *Assistant Professor, Departments of Removable Prosthodontics and Family Practice.
300
6. Cleanse the occlusal surfaces of the mandibular denture teeth. 7. Lubricate the occlusal table of the maxillary denture with silicone spray and petroleum jelly. 8. Treat the occlusal surfaces of the mandibular posterior teeth with a thin film of cyanoacrylate kept within the buccal and lingual cusp heights. 9. Add sufficient autopolymerizing acrylic resin to fill the space between the cusp heights of the mandibular posterior teeth. 10. Close the articulator to allow the lubricated cusps of the maxillary teeth to form a custom fit into the unpolymerized acrylic resin. 11. Make lateral movements to ensure that no acrylic resin remains to obstruct lateral excursions during function. 12. Remove excessmaterial with a periodontal knife before final polymerization. 13. Clean the anatomy of the mandibular teeth of any excess resin that remains lateral to the cusp heights after polymerization, with care being taken to avoid any occlusal-bearing area. The occlusal surfaces of the “augmented” teeth are not polished (Fig. 4).
POSTINSERTION
FOLLOW-UP
1. Return the dentures to the mouth. 2. Centric and lateral jaw relation markings are made with thin articulating paper (Fig. 5). The markings show a wider distribution of occlusal contact points than were seen before augmentation of the mandibular posterior teeth, with no significant prematurities. 3. After 2 days, the dentures are remounted with intraoral wax registration, and the occlusal markings are made again.’ At the first postinsertion visit there usually are no changes noted in the occlusal markings. 4. Additional checks are made after 2, 6, and 16 weeks. Correction of prematurities should be made at this time. They are usually minor, and often no change
AUGUST 1984
VOLUME 52
NUMBER 2
AUGMENTATION
FOR IMPROVED
OCCLUSION
forces
distributed
augmented surface of mandibular tooth
Fig. 1. A, Sketch shows lateral or tipping forces during contact after processing and before augmentation. B, Sketch shows wider distribution of occlusal forces during contact with augmented mandibular denture teeth.
Fig. 4. Augmentation completed.
of mandibular
posterior
teeth
Fig. 2. Occlusal markings on maxillary denture before augmentation of mandibular occlusal surfaces.
Fig. 3. Occlusal markings on maxillary denture preliminary adjustment to relieve prematurities.
THE JOURNAL
OF PROSTHETIC
DENTISTRY
after
Fig. 5. Occlusal markings on maxillary denture after augmentation of mandibular occlusal surfaces; initial insertion visit.
301
RUFFINO
“break-in period” for complete dentures can be reduced and required adjustments can be minimized. Additional studies are warranted to seek a similar technique for use with porcelain denture teeth. REFERENCES
Fig. 6. Occlusal markings 16 weeks postinsertion. is evident and a generally balanced occlusion in centric and lateral positions is seen (Fig. 6).
CONCLUSIONS The results of augmenting the occlusal anatomy of acrylic resin teeth indicate that the tiauma of the
1. Thomson, H.: Occlusion in Clinical Practice. Bristol, England, 1981, John Wright & Sons, Ltd., p 135. 2. Schulman, A., and Pentel, L.: The rational use of materials in occlusion. Dent Clin North Am Z&462, 1981. 3. Lauciello, F. R.: Articulator-generated amalgam stops for complete dentures. J PROSTHETDENT 41:16, 1979. 4. Thomson, H.: Occlusion in Clinical Practice. Bristol, England, 1981, John Wright & Sons, Ltd., p 123. 5. Heartwell, C. M.: Syllabus of Complete Dentures. Philadelphia, 1968, Lea & Febiger, p 324. 6. Schneider, R. L.: Custom metal occlusal surfaces for acrylic resin denture teeth. J PROSTHETDENT 46:98, 1981. 7. Thomson, H.: Occlusionin Clinical Practice. Bristol, England, 1981, John Wright & Sons, Ltd., p 132. Reprint requests to: DR. ANTHONK R. RUFFINO MOHICAN CT. SALISBURYMILLS, NY 12577
ARTICLES TO APPEAR IN FUTURE ISSUES Artificial
saliva reservoirs
A. Vissink, D.M.D., E. J. ‘s-Gravenmade,Ph.D., A. K. Panders, D.M.D., Ph.D., A. Olthof, D.D.S., A. Vermey, M.D., F.A.C.S., M. C. Huisman, and L. L. Visch, D.D.S.
Custom shade guide Ormond H. Ware, D.M.D.
A method for determining crown preparations
adequate resistance form of complete cast
R. M. Weed, D.D.S., and R. J. Baez, D.D.S.
Enhanced retention for the distal extension-base removable partial denture using a heat-cured resilient soft liner J. A. Whitsitt, D.D.S., L. W. Battle, D.D.S., and C. J. Jarosz
Cranial and maxillofacial epithesis treatment on osseointegrated implants: Concepts and principles Evtim Yontchev, D.S., S.O.S.O., U.D.D., S.O.M.F.P.
Average maximum post lengths in endodontically
treated teeth
Richard M. Zillich, D.D.S., MS., and John F. Corcoran, D.D.S., MS. 302
AUGUST
19134
VOLUME
52
NUMBER
2