Braz J Oral Sci. April/June 2004 - Vol.

3 - Number 9

Double-blind study for evaluation of complete dentures made by two techniques with and without face-bow.
Daniela Fernandes Figueira Nascimento 1 Renata Beatriz Luz Patto 1 Leonardo Marchini 1,2 Vicente de Paula Prisco da Cunha1,3
1 School of Dentistry, University of Vale do Paraíba - São José dos Campos - SP - Brazil 2 Implantology Professor, School of Dentistry, University of Taubaté - São José dos Campos - SP - Brazil 3 Prosthodontics Professor, School of Dentistry, University of Taubaté - São José dos Campos SP - Brazil

Received for publication: September 24, 2003 Accepted: March 2, 2004

Abstract The aim of this article was to compare complete dentures made by two techniques: with and without face-bow. Five edentulous subjects were selected and each one received two pairs of complete dentures. Dentures were made from duplicated casts and each one followed different techniques. One technique used face-bow and artificial teeth. Teeth were set using individualized wax ridges as guides. The other technique used an articulator, which avoids face-bow and teeth were set by the cast-analysis method. The number of occlusal contacts in centric relation and excursive movements were registered, as well as the opinion of patients regarding denture bearing during oral functions. Both groups presented balanced dentures, but the technique that avoids face-bow presented better results regarding to esthetics, comfort and stability. Balanced occlusion was provided even without face-bow and could be an alternative to obtain adequate complete dentures. Key Words: complete dentures, articulators, occlusion.

Correspondence to:
Leonardo Marchini Av. Adhemar de Barros, nº1136 apto. 153 122245-010 - São José dos Campos - SP Brazil Phone: 01155 12 3943 2360 Fax: 01155 12 3922 1555 e-mail:leomarchini@directnet.com.br

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The second used a semi-adjustable articulator (Stratos 200. dentists have not used facebows for 20 years. demand knowledge on equipment and long chairside time5. they not necessarily produce better clinical results11. it is necessary to reproduce centric relation and use an adequate articulator1-3. which were mounted in two different arcon semi-adjustable articulators. 1 . 2 .Brazil) were used. in some areas such as Scandinavia.Braz J Oral Sci. This article compared two different techniques of complete dentures construction. Fig. which avoids the use of face-bow and Paterson technique. It is claimed that there is no sufficient evidence that the use of face-bow results in increased clinical quality12. However. Lower casts were then fixed in the articulator. compensating curves were registered and the wax ridges were fixed on centric relation position. Casts were then separated in two groups. Face-bow is widely used to transfer the patient‘s occlusal plane inclination to the semi adjustable articulators7. Bennett and condylar path angles were individualized by following the individual compensating curves (Figure 2). Functional casts were duplicated with laboratory silicone (Figure 1). Ivoclar. Brazil). using facebow and Paterson technique could be troublesome in cases of elderly and ill patients9-10. All ethical aspects were considered and respected. In fact. but do not allow to obtain a balanced occlusion and dentist spend much time on occlusal adjustments. Liechteinstein). The casts of Group A were mounted using a face-bow. comprising individual characteristics of each patient6. as well as first and second impressions. After wax try-in. full adjustable articulators are not practical. for 08 hours. nonadjustable articulators are easy to handle. 440 . On the other hand. using an average mounting based upon patient casts analysis. Material and Methods Edentulous subjects were selected at the dental clinic of the University of Vale do Paraíba. in a Bio-Art articulator (BioArt. Group B casts were mounted without face-bow in a Stratos 200 articulator (Ivoclar. Liechteinstein). Although the use of a facebow presents many theoretical advantages. In the same manner. These articulators are easy to handle and allow a full balanced occlusion during mandibular excursions. The first used face-bow. Brazil). 4 and 5). semi adjustable articulators seem to present the most adequate effectiveness/handing relation for complete dentures. improves denture efficiency and stability. Paterson technique is used to get the individual compensating curves. The sample was composed by four women and one man. since it was previously approved by the Committee of Ethics in Research of the aforementioned University (Protocol Number 039/2001/ CEP). 3(9): 439-445 Double-blind study for evaluation of complete dentures made by two techniques with and without face-bow. An adequate occlusal scheme allows better distribution of masticatory forces. Group A technique After mounting the upper cast by face-bow technique. since they present high cost. Teeth were mounted following the wax ridges (Figures 3. Paterson technique and a semi-adjustable articulator (Bio-Art. 4 However. the same type of teeth (VIPI . Introduction One of the most important requirements for successful complete dentures is a balanced articulation. Articulators reproduce patient characteristics with more accuracy. Considering the aforementioned statements. Initial examinations were done.13 Fig.Casts mounted in the Bio-Art articulator with face-bow (Group A). In order to achieve this. all dentures were processed by water bath under a temperature of 74ºC. For both groups. following patient path angles for mandibular movements8.Casts duplicated with laboratory silicone.

3(9): 439-445 Double-blind study for evaluation of complete dentures made by two techniques with and without face-bow.Measurement of the distance between upper and lower fornix. After that. 15.Upper teeth mounting in the Bio-Art articulator following the wax ridges. and balanced occlusion (Figures 14. Then. Half of this measurement was transferred to the mobile front shaft of a horizontal guide.Teeth mounting concluded in the Bio-Art articulator. technique based upon average values. in which they were used for teeth mounting. Upper and lower wax ridges were fixed together and positioned in the patient‘s mouth in centric relation position and vertical dimension of occlusion. This procedure is useful for positioning the lower cast. Group B technique Before mounting teeth in Group A. 441 . like palatal and retromolar pad. over retromolar pad of the cast (Figure 7). its posterior part. So. wax ridges were first used to mount Group B casts at Stratos 200. At the final stage. Liechteinstein). 4 . specific from this equipment. the distance between upper and lower labial fornix was measured with the ard of a scale (Figure 6). Fig. wrinkles and maxillary tuber (Figures 11. without using wax ridges guides. positioning the upper cast. 6 . The horizontal guide was positioned over labial frenula and. 5 . according to Angle Classification of the patient. 16 and 17). Fig. Fig. using a Fig. The technique described by the manufacturer uses cast analysis. 12 and 13)14. Then it was mounted over a fix board united to the upper part of articulator (Figure 8). Lower casts were fixed first and it was necessary to set out the retromolar pad and labial frenula. Articulator was then adjusted arbitrarily in 15º for Bennett angle and 30º for condylar guide. lower cast was fixed to the inferior part of articulator with plaster. the wax ridges were repositioned in Bio-Art articulator (Group A). which was also fixed with plaster (Figures 9 and 10). This technique was developed to avoid the use of face-bow and is specific for this articulator. the wax ridges in centric relation obtained for Group A (before mounting teeth) were placed over the lower cast. as well as the relation between dental arches and anatomic criteria.3 .Braz J Oral Sci. allourny excursive movements. because it permits to describe an arbitrary occlusal plane. Teeth mounting in Group B followed the technique of the Biofunctional Prosthetic System (Ivoclar. These procedures were performed observing adequate overbite.Lower teeth mounting in the Bio-Art articulator.

Braz J Oral Sci. Fig.Upper cast analysis: incisors positioned next to the anterior papilla. Fig. Fig. a horizontal guide of the Stratos 200 articulator was positioned over the lower cast. 442 . 12 .Lower cast analysis for teeth mounting in the Stratos 200 articulator: a) median line b)lateral lines trough the canine areas Fig.Wax ridges positioned over the lower cast previously fixed with plaster. 10 . Fig. 11 . 7 .Lower cast positioned in the Stratos 200 articulator (Group B). 8 . 9 .After setting the retromolar pads and lower labial frenula. 3(9): 439-445 Double-blind study for evaluation of complete dentures made by two techniques with and without face-bow. Fig.Upper cast fixed with plaster to the Stratos 200 articulator.

17 . Patients were instructed to return after 10 days and then answered the Group A part of an appropriate questionnaire (Appendix 1). Fig. Results assessments At denture delivery appointment. what was also signed.Position of lower canines according to the upper anterior teeth. After wearing period. Occlusal contacts were registered with carbon. only one of the pairs were given to the patient (nor patients or operator knew from which group was the first pair entrusted to the patient – only the technician knew that Group A was composed by dentures made with face-bow and Paterson Technique and Group B. 15 . 13 . Results concerning about questionnaire and number of contacts of groups A and B were statistically analyzed by 443 . 16 .Upper anterior teeth mounting following the horizontal guide positioned at the lower part of Stratos 200 articulator.Braz J Oral Sci. 3(9): 439-445 Double-blind study for evaluation of complete dentures made by two techniques with and without face-bow. Fig. The second pair of dentures were then delivered and procedures were repeated. patients were asked to choose one of those pairs. confirmed at the lower cast and signed. Fig. To minimize errors. 14 . contacts were done twice in each person.Teeth mounting at Stratos 200 articulator concluded.Upper canines positioned 2 millimeters after palatal wrinkes. Fig.Horizontal guide is repositioned to the upper part of Stratos 200 and position the posterior lower teeth. in a total of 10 samples. made without face-bow). Fig. They were counted at the superior cast.

331) for protrusive movements (Table 1). 3(9): 439-445 Double-blind study for evaluation of complete dentures made by two techniques with and without face-bow. Group B was made using the teeth mounting guide of Stratos 200. According to questionnaire. Wilcoxon Test was used to verify occlusal contacts and Test of Proportion Analysis was made for questionnaire answers. stability and less stress to the supporting tissues come from an adequate balanced occlusion15. Considering all movements analyzed. all patients preferred dentures from this group. There was no significant difference between groups of dentures (p=0. which reproduces individual characteristics. obtained greater number of occlusal contacts than dentures from group A.005) and left lateral movement (p=0.233) in relation to group B (Table 3). However. 3. there was no significant difference between denture groups both for anterior (p=0. which shows an inherent difficulty: the resin bases have not enough retention at the time of obtaining individual compensating curves. due to the proximity of p-value established of 6%.8 Therefore. Group B received more favorable answers than Group A for chewing and speaking functions. Considering the methodology applied and the sample analyzed. Thus. whereas protrusive movements were separated in anterior and posterior contacts. This procedure avoids the errors due to Paterson technique as described in the above paragraph. Stability and safety: Bearing during speaking: Bearing during chewing: Evaluation of Group B dentures: 1.057) there was a statistically significant difference between groups A and B (Table 5).725) and posterior contacts (p=0. This result confirms that comfort. since Group B presented greater esthetics and comfort. at right movements (p=0. To access differences between the groups about these criteria. A different situation was found in the non-working side. 4. as a rule. the occlusal planes could be inadequately related to alveolar ridges.010). Group A mounting depends on dentist and technician ability to achieve all esthetic requirements during wax ridges individualization.373). dentures A presented worse results than dentures B. 3. Slightly better results could be seen for Group B. 2. Annex 1 Questionnaire about complete denture bearing Patient ID number:________________ Evaluation of Group A dentures: 1. the Test of Proportion analysis and Wilcoxon Test with a significance level of 6%. No significant differences were observed for right movement (p=0. one can conclude that both groups obtained balanced occlusion and occlusal contacts in all mandibular excursions.017) and “Very Good” (p=0. despite dental staff aesthetic abilities. without face-bow and Paterson technique. dentures from group B. it could be observed that group A was composed by dentures made with face-bow and Paterson technique and group B . even without face-bow. After the analysis. It could be due to the technique used to mount teeth. At right lateral movement there was a tendency of group B to present higher number of contacts (p=0. It might be due to Paterson technique. establishing a balanced articulation. Group B presented better esthetic than Group A. 444 . Group B presented better results than Group A. it was observed that denture B had better acceptance by patients. in which group B presented the great number of contacts. Both groups presented similar results in excursive jaw movements. made without face-bow. 4. Comfort during wearing period: Date: __/__/__ ! Bad ! Bad ! Bad ! Bad ! Satisfactory ! Satisfactory ! Satisfactory !Satisfactory !Very Good !Very Good ! Very Good !Very Good Date: __/__/__ Regarding to protrusive movement (Table 4). Group B mounting respects cast analysis. Stratos 200 articulator presented an unexpected performance and could be used as a resource to obtain balanced occlusion during complete denture making. on average. which allows to obtain an arbitrary occlusal plane at the moment of teeth mounting. 2. but at left lateral movement. Comfort during wearing period: !Bad !Bad !Bad !Bad !Satisfactory !Satisfactory !Satisfactory !Satisfactory !Very Good !Very Good !Very Good !Very Good Stability and safety: Bearing during speaking: Bearing during chewing: Preference: ˜ Denture A ˜ Denture B Patient’s signature: Results Occlusal contacts presented a significant statistically difference between the average of Groups A and B for centric relation (p=0. Lateral movements were subdivided in work and non-work sides. due to the answers “Bad” (p=0. probably referred to the same inaccuracy related to the application of Paterson technique added to the use of standard guides for teeth mounting.102) as shown in Table 2.007). Discussion It was observed that Group B. in which Group A obtained worse results at left lateral movement (p=0. there was no significant difference (p=0.065). Concerning work side at lateral movements. presented higher number of occlusal contacts in centric relation than Group A for all mandibular positions.Braz J Oral Sci.023).

725 Anterior Group A Group B 4.Number of occlusal contacts in groups A and B.010 15. 8. 65: 489-94. 24: 929-35.10 10 Left lateral movement Group A Group B 12. 1997.736 0.06 10 Protrusive movement Group A Group B 15.60 3. Contacts Centric relation Group A Group B Average Variance n p-value n= sample size. Shodadai SP. Landa JS. 29:389-94. 20: 740-5. 14.work side in groups A and B.331 17. Aust Orthod J 1984. p.40 24. Oclusão Integração clínico-protética. Philadelphia: WBSaunders. Colonization of dental plaque by respiratory pathogens in medical intensive care patients. Table 1. p. 13: 303-10. Philadelphia: Mosby. Improved occlusion anatomy of acrylic resin denture teeth. Schouver J. Shay K. Denture base resins. Gondim NFR. Answer Bad Satisfactory Very good Group A 25% 35% 40% Group B 0% 30% 70% p-value 0. 40: 53-70.40 6. Predicted incidence of excursive occlusal errors in common modes of articulator adjustment.70 8.90 10 Posterior Group A GroupB 11. Morneburg T. Table 5.90 6.77 10 0.71 10 0. J Am Dent Assoc 1962. Adrien P. Quintessence Int 1998.005 19. Kawano F. Protrusive movement Average Variance N p-value n= sample size. Carlsson GE. Boucher’s prosthodontic treatment for edentulous patients. Work side Left lateral movement Group A Average Variance N p-value n= sample size.40 25. The importance of occlusion balance in the control of complete dentures.70 14. 1996. White GE. 10. Biological and clinical considerations in making jaw relation records.Number of occlusal contacts at non. In: Zarb GA.233 Group B 7. 13.50 20. Hüe O. 3(9): 439-445 Double-blind study for evaluation of complete dentures made by two techniques with and without face-bow. Work side Average Variance N p-value n= sample size Left lateral movement Group A 6. Tchikawa T. Pasiek S.197-219. 4.20 3.34 10 0.373 12.23 10 12. In: Paiva HJ. Matsumoto N. 3. Barnett FC. Dental spectrum 1999.60 18.90 6. Int J Prosthod 1999. Table 4. Mariani P. Influence of occlusal scheme on the pressure distribution under a complete denture. Philip’s science of dental materials. 2.70 4.Patients answers regarding to dentures bearing.93 10 Right lateral movement Group A 6. Ohguri T. Crit Care Med 1992. In: Anusavice KJ. 8: 128-30. Int J Prosthod 2000. 14: 517-22. Gerds T. 11. Articulator mounting and adjustments.017 0. 12: 353-8. São Paulo: Santos. Akerly WB. Ruffino AR. Dental management considerations for institutionalized geriatric patients.66 10 0.34 10 Right lateral movement Group A Group B 12. 9.10 7. J Prosthet Dent 1994. J Oral Rehabil 1997. p.237-71.007 Group B 8. 1997.82 10 0. Table 3.96 10 0.023 Group B 7. Pröchel PA. Is there a benefit of using na arbitrary facebow for the fabrication of a stabilization appliance? Int J Prosthod 2001.93 10 0. Maul T. 5.40 7. 5.057 445 . J Prosthet Dent 1984. 4. 52: 300-2. Scannapieco FA.Number of occlusal contacts at work side in groups A and B. 5:367-378.102 Group B 7. Paiva HJ.70 17.90 10 Right lateral movement Group A 6. Anusavice KJ.Number of occlusal contacts at protrusive movements between groups A and B.38 10 0.99 10 0.065 15. 15.88 10 6. 11. Dent Clin North Am 1996. Strub JR.60 6. Oclusão: noções e conceitos básicos.Braz J Oral Sci.155-94.82 10 References 1.10 3. Recording jaw relationships in edentulous patients. Biologic significance of occlusion and balanced articulation in complete denture service.93 10 Table 2. Methods for minimizing the errors in mandibular model mounting on an articulator. Carlsson GE. Türp JC. Mylotte JM.30 27.50 6. Stewart EM. Dubojska AM.10 10.06 10 0. 7. Bolender CL. O Sistema de Prótese Biofuncional (BPS) Um novo método para a confecção de próteses totais. 72: 510-6.

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