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Stabilized occlusion rims for small interarch spaces
DENTAL SECTION
TECHNOLOGY
EDITOR
DANIEL
H. GEHL
Stabilized
occlusion
D. Ray McArthur,
D.D.S.,
University
of North Carolina,
rims for small interarch
M.S.* School of Dentistry,
Chapel Hill, N. C.
T
he use of stabilized occlusion rims for obtaining maxillomandibular relations and a trial denture is an accepted procedure in complete denture construction. The dental laboratory technician and the dentist who arrange artificial teeth will occasionally encounter a lack of space at the recorded vertical dimension of occlusion. The lack of space will often necessitate removing the acrylic resin base in the offending part and adapting tinfoil to the master cast to obtain the needed space for the artificial teeth. If the lack of space can be determined before the fabrication of the stabilized occlusion rims, they can be fabricated to aid the laboratory technician or dentist in arranging and articulating the artificial teeth. This article describes three methods of modifying the fabrication of the stabilized occlusion rim to facilitate the arrangement of artificial teeth for small interarch spaces. Two of the methods yield the same results but differ in the method of fabrication.
METHOD
A
1. Block-out the undercuts on the master cast (Fig. 1). 2. Draw an outline of the ridge and facial and buccal to the ridge from the second molar region to the second molar region on the maxillary cast (Fig. 2). Draw an outline of the lower ridge that stops just anterior to the retromolar pads (Fig. 3). 3. Adapt warm baseplate wax (shim) to the casts and trim the wax to the outline (Fig. 4). 4. Adapt a wax baseplate matrix that extends 2 to 3 mm short of the border roll over the first layers of baseplate wax (shim) (Fig. 5). 5. Remove and separate the wax matrix and the wax shim (Fig. 6). Coat the cast with tinfoil substitute or petroleum jelly. 6. Replace the wax shim on the cast. Mix autocuring acrylic resin to manufacturer’s directions. Usual*Assistant
Professor
0022-3913/79/120683
of Removable
+ 07$00.70/O@
spaces
Prosthodontics.
1979
The C. V. Mosby
Co.
ly 15.0 cc of polymer to 7.5 cc of monomer is sufficient for one baseplate. Flow the liquid acrylic resin into the low portions of the cast and into the low portions of the wax matrix. Place the matrix on the cast and gently press it to place. Remove the excess acrylic resin on the land area of the cast before the acrylic resin cures. 7. Allow the acrylic resin to cure. Gently remove the stabilized baseplate from the master cast and trim the excess acrylic resin. Examine the tissue side of the baseplate. Note the wax shim which will facilitate the arrangement of the artificial teeth (Fig. 7). 8. Construct the wax occlusion rim component to the stabilized baseplate (Fig. 8).
METHOD
B
1. Construct a typical stabilized baseplate as follows: a. Block-out undercuts on the master cast. b. Adapt a baseplate matrix 2 to 3 mm short of the border roll. c. Coat the cast with tinfoil substitute or petroleum jelly. d. Mix the autocuring acrylic resin, load, and place the wax shim as in method A. e. Allow the autocuring resin to set. Remove the stabilized baseplate and trim the excess cured acrylic resin. 2. Remove the wax on the polished side of the stabilized baseplates in a horseshoe configuration as in method A (Fig. 9). 3. Remove the acrylic resin over the ridge with an acrylic bur (Fig. 10). 4. Adapt 0.001 inch tinfoil to the cast in the area corresponding to the window in the baseplate (Fig. 11). 5. Return the stabilized baseplate to the cast (Fig. 12) and adapt warm baseplate wax on the cast and into the window (Fig. 13). 6. Allow the wax to cool. Remove the stabilized
THE JOURNAL
OF PROSTHETIC
DENTISTRY
683
McRRTHI!R
Fig. 1. The undercuts
are blocked-out
on the master casts
Fig. 2. The outline drawn on the maxillary master cast extends from second molar region to second molar region.
Fig. 3. The outline drawn on the mandibular master cast, extending from just anterior to the retromolar pads.
baseplate and examine the tissue side (Fig. 14). If the wax shim is well adapted internally, return the baseplate onto the cast. Construct the wax occlusion rim component to the stabilized baseplate.
ine the tissue side. If the wax baseplate appears to be well adapted on the tissue side, return the wax baseplate to the master cast. If the wax baseplate is stable on the master cast, construct the wax occlusion rim component to the stabilized baseplate.
METHOD
C
I. Block-out significant undercuts on the master cast. Slight undercuts may remain on the cast. 2. Coat the cast with petroleum jelly or, alternatively, soak the cast in water. 3. Adapt two layers of hard baseplate wax to the cast. The baseplate wax should also form the border roll (Fig. 15). 4. Chill the all-wax baseplate. Remove and exam-
684
DISCUSSION Methods A and B differ in technique but yield similar results. Method A probably provides slightly easier fabrication than method B. The all-wax occlusion rim produced by method C is quicker and, easier than the stabilized baseplate produced by methods A and B. The all-wax baseplate produced by method C requires more care in
DECEMBER
1979
VOLUME
42
NlJMSER
6
STABILIZED
OCCLUSION
RIMS
Fig. 4. Warm baseplate wax adapted to the cast and trimmed mandibular casts.
Fig. 5. Wax baseplate roll.
matrix adapted
Fig.
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
6.
to the outline on maxillary
and
over the shim and 2 to 3 mm short of the border
The shim and the wax matrix separated,
685
McARTHUR
Fig. 7. The tissue side of the stabilized
Fig. 8. The finished stabilized
Fig. 9. The wax removed on the polished (horseshoe) configuration.
686
baseplates. Note the wax shims.
occlusion
rims on the master casts.
side of the stabilized
baseplates in an arch-shaped
DECEMBER
1979
VOLUME
42
NUMBER
6
STABILIZED
OCCLUSION
RIMS
Fig. 10. The acrylic casts.
Fig. Il.
Tinfoil
resin removed
OF PROSTHETIC
the shims. Baseplate
returned
to the master
is adapted to the master cast in the region of the arch-shaped
Fig. 12. The stabilized
THE JOURNAL
within
DENTISTRY
baseplates returned
windows.
to the master casts.
687
.ZlcARTHLlR
Fig. 13. The warmed
baseplate wax adapted
Fig. 14. The tissue side of the stabilized
into the arch-shaped
windows.
baseplates. Note the wax shims.
Fig. 15. The all-wax baseplates.
DECEMBER
1979
VOLUME
42
NUMBER
6
STABILIZED
OCCLUSION
RIMS
handling to prevent damage and distortion of the wax. The all-wax rim is possibly less stable in the patient’s mouth and on the master cast than the stabilized occlusion rims. The stabilized occlusion rims produced by methods A and B are more stable than the all-wax rim but in some instances are probably less stable than a conventional stabilized baseplate. The dentist and the dental laboratory technician should be aware of their possible deficiencies.
spaces. To utilize these methods, the dentist must anticipate the lack of space and request that the rims be fabricated by one of the methods outlined prior to the maxillomandibular relations appointment. Reprint DR.
requests D. RAY
to. MCARTHUR
UNIVERSITY OF NORTH SCHOOL OF DENTISTRY CHAPEL
HILL,
N.
C.
CAROLINA 27514
SUMMARY ing
This article stabilized
describes three methods for fabricatocclusion rims for close interarch
IADR I’ROSTHODONTIC Three-diinensional
ABSTRACT
models of mandibular
occlusal gliding
movements
A. Joss University
of Bern,
Bern,
Switzerland
A method was developed to produce illustrative three-dimensional ,models of mandibular occlusal gliding movements. Two, human subjects received maxillary and mandibular removable splints with extraoral wire extensions carrying miniature infrared light emitting diodes (LED). The LED’s were tracked optoelectronically by a two-camera selective spot recognition system. The subjects were asked to perform random voluntary gliding movements. The resulting signals were recorded on a multichannel
This study was supported by National Science Foundation.
GrantNo.
3.2150.73
from
the Swiss
Reprinted from the Journal ef Dental 1978 (Abst No. lo)] with permission
Research 157 (Special Issue A), of the author and the editor.
THE JOURNAL
DENTISTRY
OF PROSTHETIC
PCM magnetic tape and transformed to topographical maps that served to construct three-dimensional model reliefs with a resolution of 0.1 mm. The shapes of the reliefs representing the three-dimensional contact movement surface were correlated with the observed clinical occlusal characteristics. In one subject, centric relation (CR) and centric occlusion (CO) coincided and’ appeared as a sharp pointed peak. In the other subject a natural occlusal interference in CR was eliminated by selective grinding. The models of the contact movement surface before and after adjustment showed distinct morphological differences. Intermediate adjustment steps as well as control measurements 10 days and 6 weeks after the last grinding were documented in all of the three planes. The control measurements showed a progressive profile change indicating a relapse.
689
TECHNOLOGY
EDITOR
DANIEL
H. GEHL
Stabilized
occlusion
D. Ray McArthur,
D.D.S.,
University
of North Carolina,
rims for small interarch
M.S.* School of Dentistry,
Chapel Hill, N. C.
T
he use of stabilized occlusion rims for obtaining maxillomandibular relations and a trial denture is an accepted procedure in complete denture construction. The dental laboratory technician and the dentist who arrange artificial teeth will occasionally encounter a lack of space at the recorded vertical dimension of occlusion. The lack of space will often necessitate removing the acrylic resin base in the offending part and adapting tinfoil to the master cast to obtain the needed space for the artificial teeth. If the lack of space can be determined before the fabrication of the stabilized occlusion rims, they can be fabricated to aid the laboratory technician or dentist in arranging and articulating the artificial teeth. This article describes three methods of modifying the fabrication of the stabilized occlusion rim to facilitate the arrangement of artificial teeth for small interarch spaces. Two of the methods yield the same results but differ in the method of fabrication.
METHOD
A
1. Block-out the undercuts on the master cast (Fig. 1). 2. Draw an outline of the ridge and facial and buccal to the ridge from the second molar region to the second molar region on the maxillary cast (Fig. 2). Draw an outline of the lower ridge that stops just anterior to the retromolar pads (Fig. 3). 3. Adapt warm baseplate wax (shim) to the casts and trim the wax to the outline (Fig. 4). 4. Adapt a wax baseplate matrix that extends 2 to 3 mm short of the border roll over the first layers of baseplate wax (shim) (Fig. 5). 5. Remove and separate the wax matrix and the wax shim (Fig. 6). Coat the cast with tinfoil substitute or petroleum jelly. 6. Replace the wax shim on the cast. Mix autocuring acrylic resin to manufacturer’s directions. Usual*Assistant
Professor
0022-3913/79/120683
of Removable
+ 07$00.70/O@
spaces
Prosthodontics.
1979
The C. V. Mosby
Co.
ly 15.0 cc of polymer to 7.5 cc of monomer is sufficient for one baseplate. Flow the liquid acrylic resin into the low portions of the cast and into the low portions of the wax matrix. Place the matrix on the cast and gently press it to place. Remove the excess acrylic resin on the land area of the cast before the acrylic resin cures. 7. Allow the acrylic resin to cure. Gently remove the stabilized baseplate from the master cast and trim the excess acrylic resin. Examine the tissue side of the baseplate. Note the wax shim which will facilitate the arrangement of the artificial teeth (Fig. 7). 8. Construct the wax occlusion rim component to the stabilized baseplate (Fig. 8).
METHOD
B
1. Construct a typical stabilized baseplate as follows: a. Block-out undercuts on the master cast. b. Adapt a baseplate matrix 2 to 3 mm short of the border roll. c. Coat the cast with tinfoil substitute or petroleum jelly. d. Mix the autocuring acrylic resin, load, and place the wax shim as in method A. e. Allow the autocuring resin to set. Remove the stabilized baseplate and trim the excess cured acrylic resin. 2. Remove the wax on the polished side of the stabilized baseplates in a horseshoe configuration as in method A (Fig. 9). 3. Remove the acrylic resin over the ridge with an acrylic bur (Fig. 10). 4. Adapt 0.001 inch tinfoil to the cast in the area corresponding to the window in the baseplate (Fig. 11). 5. Return the stabilized baseplate to the cast (Fig. 12) and adapt warm baseplate wax on the cast and into the window (Fig. 13). 6. Allow the wax to cool. Remove the stabilized
THE JOURNAL
OF PROSTHETIC
DENTISTRY
683
McRRTHI!R
Fig. 1. The undercuts
are blocked-out
on the master casts
Fig. 2. The outline drawn on the maxillary master cast extends from second molar region to second molar region.
Fig. 3. The outline drawn on the mandibular master cast, extending from just anterior to the retromolar pads.
baseplate and examine the tissue side (Fig. 14). If the wax shim is well adapted internally, return the baseplate onto the cast. Construct the wax occlusion rim component to the stabilized baseplate.
ine the tissue side. If the wax baseplate appears to be well adapted on the tissue side, return the wax baseplate to the master cast. If the wax baseplate is stable on the master cast, construct the wax occlusion rim component to the stabilized baseplate.
METHOD
C
I. Block-out significant undercuts on the master cast. Slight undercuts may remain on the cast. 2. Coat the cast with petroleum jelly or, alternatively, soak the cast in water. 3. Adapt two layers of hard baseplate wax to the cast. The baseplate wax should also form the border roll (Fig. 15). 4. Chill the all-wax baseplate. Remove and exam-
684
DISCUSSION Methods A and B differ in technique but yield similar results. Method A probably provides slightly easier fabrication than method B. The all-wax occlusion rim produced by method C is quicker and, easier than the stabilized baseplate produced by methods A and B. The all-wax baseplate produced by method C requires more care in
DECEMBER
1979
VOLUME
42
NlJMSER
6
STABILIZED
OCCLUSION
RIMS
Fig. 4. Warm baseplate wax adapted to the cast and trimmed mandibular casts.
Fig. 5. Wax baseplate roll.
matrix adapted
Fig.
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
6.
to the outline on maxillary
and
over the shim and 2 to 3 mm short of the border
The shim and the wax matrix separated,
685
McARTHUR
Fig. 7. The tissue side of the stabilized
Fig. 8. The finished stabilized
Fig. 9. The wax removed on the polished (horseshoe) configuration.
686
baseplates. Note the wax shims.
occlusion
rims on the master casts.
side of the stabilized
baseplates in an arch-shaped
DECEMBER
1979
VOLUME
42
NUMBER
6
STABILIZED
OCCLUSION
RIMS
Fig. 10. The acrylic casts.
Fig. Il.
Tinfoil
resin removed
OF PROSTHETIC
the shims. Baseplate
returned
to the master
is adapted to the master cast in the region of the arch-shaped
Fig. 12. The stabilized
THE JOURNAL
within
DENTISTRY
baseplates returned
windows.
to the master casts.
687
.ZlcARTHLlR
Fig. 13. The warmed
baseplate wax adapted
Fig. 14. The tissue side of the stabilized
into the arch-shaped
windows.
baseplates. Note the wax shims.
Fig. 15. The all-wax baseplates.
DECEMBER
1979
VOLUME
42
NUMBER
6
STABILIZED
OCCLUSION
RIMS
handling to prevent damage and distortion of the wax. The all-wax rim is possibly less stable in the patient’s mouth and on the master cast than the stabilized occlusion rims. The stabilized occlusion rims produced by methods A and B are more stable than the all-wax rim but in some instances are probably less stable than a conventional stabilized baseplate. The dentist and the dental laboratory technician should be aware of their possible deficiencies.
spaces. To utilize these methods, the dentist must anticipate the lack of space and request that the rims be fabricated by one of the methods outlined prior to the maxillomandibular relations appointment. Reprint DR.
requests D. RAY
to. MCARTHUR
UNIVERSITY OF NORTH SCHOOL OF DENTISTRY CHAPEL
HILL,
N.
C.
CAROLINA 27514
SUMMARY ing
This article stabilized
describes three methods for fabricatocclusion rims for close interarch
IADR I’ROSTHODONTIC Three-diinensional
ABSTRACT
models of mandibular
occlusal gliding
movements
A. Joss University
of Bern,
Bern,
Switzerland
A method was developed to produce illustrative three-dimensional ,models of mandibular occlusal gliding movements. Two, human subjects received maxillary and mandibular removable splints with extraoral wire extensions carrying miniature infrared light emitting diodes (LED). The LED’s were tracked optoelectronically by a two-camera selective spot recognition system. The subjects were asked to perform random voluntary gliding movements. The resulting signals were recorded on a multichannel
This study was supported by National Science Foundation.
GrantNo.
3.2150.73
from
the Swiss
Reprinted from the Journal ef Dental 1978 (Abst No. lo)] with permission
Research 157 (Special Issue A), of the author and the editor.
THE JOURNAL
DENTISTRY
OF PROSTHETIC
PCM magnetic tape and transformed to topographical maps that served to construct three-dimensional model reliefs with a resolution of 0.1 mm. The shapes of the reliefs representing the three-dimensional contact movement surface were correlated with the observed clinical occlusal characteristics. In one subject, centric relation (CR) and centric occlusion (CO) coincided and’ appeared as a sharp pointed peak. In the other subject a natural occlusal interference in CR was eliminated by selective grinding. The models of the contact movement surface before and after adjustment showed distinct morphological differences. Intermediate adjustment steps as well as control measurements 10 days and 6 weeks after the last grinding were documented in all of the three planes. The control measurements showed a progressive profile change indicating a relapse.
689