Anterior deprogramming device fabrication using a thermoplastic material
Martin F. Land, DDS, MSD,a and Alejandro Peregrina, DDS, MSDb
School of Dental Medicine, Southern Illinois University, Alton, Ill
This article presents a simple and efficient technique to fabricate an anterior deprogramming device
using a thermoplastic material. The material, softened by heating, is adapted to the maxillary incisors
while moldable. The operator guides the mandible into closure as the material stiffens. The device is
then trimmed, and a posterior centric relation record is made using the recording material of choice.
(J Prosthet Dent 2003;90:608-10.)
F or some patients the centric relation position does
not coincide with the maximum intercuspation position.
In making a maxillomandibular record, the dentist must
select a patient-defined habitual intercuspal position or
an operator-defined positional registration of the man-
dible. Use of an anterior programming device allows
separation of the posterior teeth immediately prior to
centric relation record fabrication.1 This results in the
patient “forgetting” established protective reflexes that
are reinforced each time the teeth come together, mak-
ing mandibular hinge movements easier to reproduce.2
Properly executed, use of a deprogramming device al-
lows the patient to close into an operator-defined re-
peatable position unassisted.3
Various techniques to separate the posterior teeth
include positioning cotton rolls between the incisors,
use of a plastic leaf gauge, or a small anterior deprogram-
ming device made of autopolymerizing acrylic resin (oc-
casionally referred to as a Lucia Jig).4,5 The resulting
anterior stop acts as a fulcrum, allowing the directional
force provided by the elevator muscles to seat the con-
dyles in a superior position within the fossae. The tech-
nique can be coupled with the bilateral mandibular ma-
nipulation technique6 and has been shown to result in
greater mandibular displacement from the intercuspal
position than with a centric relation record alone.7
This article presents a simple, efficient, and effective
technique to fabricate an anterior deprogramming de-
vice using a thermoplastic material. The material is easily
molded and adapted at a temperature that is comfort-
able to the patient, with good stability, following cool-
ing. Heat generated when trimming with rotary instru-
ments causes distortion, but a scalpel blade works well.
At a thickness exceeding 1 mm, material rigidity makes
cutting more difficult. It is not practical to cut the ma-
terial while still soft because distortion results.
a
Professor, Section of Fixed Prosthodontics.
b
Associate Professor, Sections of Fixed and Removable Prosthodon-
tics.
608 THE JOURNAL OF PROSTHETIC DENTISTRY
TECHNIQUE
1. Soften a thermoplastic disk (Matrix Button; Advan-
tage Dental Products, Inc, Lake Orion, Mich) in a
65°C water bath for approximately 90 seconds. (Al-
ternatively, heat the material in a cup of water in a
microwave). The material is translucent when soft-
ened (Fig. 1).
2. Remove the translucent disk from the water bath and
roll it into a ball. If a water bath is not used, use
wetted gloves to prevent the material from sticking to
the glove.
3. Adapt the softened material to the maxillary central
incisors, ensuring coverage of the lingual surfaces
while folding it over the incisal edges, and slightly
extend the material onto the facial surface of the
teeth (Fig. 2). Shape the lingual portion to minimize
the amount of contact with the mandibular incisors.
Alternatively, apply the material to a tin-foil substi-
tute-coated Type IV stone cast; allow to solidify, and
reheat the material for 20 to 30 seconds in the water
bath immediately before use.
4. Guide the patient into closure until incisal contact
occurs on the device and the posterior teeth are
about 1 mm apart and slight mandibular incisor in-
dentations occur (Fig 3). If necessary, mark the ex-
tent to which the device is to be trimmed with an
explorer while the material remains slightly soft.
Cool with an air-water spray for approximately 10
seconds until the material becomes opaque.
5. Confirm that there is no posterior occlusal contact.
6. If necessary, resoften the device slightly by brief re-
immersion in the water bath, and repeat the above
procedures as necessary.
7. Trim excess material with a sharp scalpel blade until
there is no interference during closure (Fig. 4). Con-
firm that only minimal contact occurs on the device
(Fig. 5).
8. Proceed with posterior centric relation record fabri-
cation with the recording material of choice (Fig. 6).
SUMMARY
Fabricating an anterior deprogramming device from
thermoplastic resin provides a quicker alternative than
VOLUME 90 NUMBER 6
LAND AND PEREGRINA THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 1. Two matrix buttons. At room temperature, material is Fig. 2. Adaptation to maxillary central incisors; lingual is
opaque (Left), but after heating, turns translucent (Right). shaped to minimize number of contacts with mandibular
incisors.

Fig. 3. Mandibular central incisors should make shallow Fig. 4. Completed device after trimming. Only minimal con-
indentations. tact with mandibular incisors remains.

Fig. 5. Posterior occlusal contact has been eliminated while Fig. 6. Centric relation record made with registration mate-
mandibular incisor contact occurs on anterior programming rial interposed between posterior quadrants while mandibu-
device. lar incisor contact occurs on anterior programming device.

DECEMBER 2003 609

THE JOURNAL OF PROSTHETIC DENTISTRY LAND AND PEREGRINA

the use of autopolymerizing resin and minimizes the 4. Lucia VO. A technique for recording centric relation. J Prosthet Dent
1964;14:492-505.
noxious odor associated with intraoral acrylic resin po- 5. Carroll WJ, Woelfel JB, Huffman RW. Simple application of anterior jig or
lymerization. Because the completed device retains leaf gauge in routine clinical practice. J Prosthet Dent 1988;59:611-7.
some flexibility, it is possible to remove it from moderate 6. Okeson JP. Management of temporomandibular disorders and occlusion.
5th ed. St. Louis: Elsevier; 2002. p. 283-4.
undercuts without patient discomfort. 7. Karl PJ, Foley TF. The use of a deprogramming appliance to obtain centric
Thermoplastic materials do not lend themselves to relation records. Angle Orthod 1999;69:117-24.
trimming with rotary instruments but should be
Reprint requests to:
trimmed with a sharp blade. With some practice, a stable DR MARTIN F. LAND
and functional anterior deprogramming device can be SOUTHERN ILLINOIS UNIVERSITY
made in about 3 to 4 minutes. SCHOOL OF DENTAL MEDICINE
2800 COLLEGE AVE
BLDG. 284
ALTON, IL 62002
REFERENCES FAX: (618) 475-7150
1. Urstein M, Fitzig S, Moskona D, Cardash HS. A clinical evaluation of E-MAIL: mland@siue.edu
materials used in registering interjaw relationships. J Prosthet Dent 1991;
65:372-7. Copyright © 2003 by The Editorial Council of The Journal of Prosthetic
2. Rosenstiel SF, Land MF, Fujimoto J. Contemporary fixed prosthodontics. 3rd Dentistry.
ed. St. Louis: Elsevier; 2000. p. 38. 0022-3913/2003/$30.00 ⫹ 0
3. Hunter BD 2nd, Toth RW. Centric relation registration using an anterior
deprogrammer in dentate patients. J Prosthodont 1999;8:59-61. doi:10.1016/j.prosdent.2003.09.011

Residual ridge resorption in the edentulous maxilla in

Noteworthy Abstracts patients with implant-supported mandibular overdentures:
of the An 8-year retrospective study
Current Literature Kreisler M, Behneke N, Behneke A, d’Hoedt B. Int J
Prosthodont 2003;16:295-300.

Purpose. This retrospective study radiologically investigated alveolar bone resorption in the eden-
tulous maxilla in patients with implant-supported mandibular overdentures.
Materials and Methods. This study consisted of 35 healthy, completely edentulous patients with
a mean age of 59.7 years. They had received 2 implants between the mental foramina. New
bar-retained mandibular overdentures and maxillary complete dentures were fabricated. Standard-
ized panoramic radiographs taken subsequent to loading and at annual recall visits for up to 8 years
were measured for alveolar bone loss in the maxilla. Bone areas and areas of reference not subject to
resorption were measured with a planimetry program. The proportional value between both was
expressed as a ratio (R). Bone loss was expressed as a change in R between 2 time points. Differences
in the resorption rate between the anterior and posterior parts of the maxilla were investigated.
Results. Residual ridge resorption continued during the follow-up period and revealed high
individual variability. With a range of 5% to 11% (median) loss in the original bone height, it was
significantly (P⬍.031) more pronounced in the anterior than posterior maxilla (2%-7%) from the
second through eighth years. Regression analysis of the medians revealed a relatively high correla-
tion between time and bone loss in both anterior and posterior parts of the maxilla.
Conclusion. The anterior anchorage of mandibular overdentures by means of 2 implants and an
ovoid bar was associated with slightly higher resorption in the anterior than in the posterior part of
the edentulous maxilla.—Reprinted with permission of Quintessence Publishing.

610 VOLUME 90 NUMBER 6