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R E S T O R AT I V E O TR I AS TT IRVY E D E N T I S T R Y
ARTICULATORS
a b
Articulators (Figure 5) are mechanical
devices that hold casts to allow the
examination of occlusal relations and the
fabrication of restorations in the
laboratory. Articulators may be
classified into the following groups:5
l simple hinge;
c d
l average value;
l semi-adjustable – arcon or non-
arcon;
l fully adjustable.
Simple Hinge
The simple hinge articulator allows
rotational movement only, around a
Figure 5. Articulators: (a) simple hinge, (b) semi-adjustable non-arcon, (c) semi-adjustable arcon, horizontal axis that bears little
(d) fully adjustable. relationship to the patient’s terminal
hinge axis because a facebow transfer is
not used. This is adequate when other
unprepared teeth on the working cast
difficulty will be experienced in occlusal coverage of the upper teeth. In maintain ICP. Restorations can be made
recording the maxillomandibular acting as a diagnostic appliance it aims only in ICP and intra-oral adjustment
relationship at the position in which the to achieve muscle relaxation and allow may be necessary in lateral and
occlusal interference occurs. This condylar repositioning so the retruded protrusive movements unless there is
should be suspected when the patient axis position can be located. steep anterior guidance leading to
resists attempts to manipulate the immediate posterior disclusion.
mandible by forcibly holding the jaw in
one position and is unable to make easy Discrepancy Between RCP and
voluntary movements. It is often ICP Average Value
necessary to have several attempts to The mandible is manipulated into RCP Average value articulators allow a
educate a patient to relax. A cotton wool and the patient instructed to slide his limited range of protrusive and lateral
roll placed between the patient’s front or her teeth together until they meet in movements based, as the name
teeth for a few minutes (Figure 4) is a ICP or in the position that feels correct suggests, on the average patient
useful technique to help at the initial to them. This is identified using through a fixed condylar guidance
assessment. articulating paper. Lateral excursions mechanism.
However, to identify the occlusal are then made to detect the nature of
interference in RCP accurately, the the guidance and finally protrusive
proprioceptive feedback mechanism movement is used to demonstrate the Semi-adjustable
must be de-programmed from its habitual type of anterior guidance. Semi-adjustable articulators can be set
path of closure so the casts can be to simulate mandibular movements well
mounted on the retruded axis. An
anterior acrylic jig3 or full maxillary
coverage acrylic splint4 may be used.
Although each is designed differently, a b
the aim is the same. The anterior jig can
also usefully be incorporated into an
interocclusal record. In principle the jig,
which covers the upper central incisors,
is shaped to have contact with the lower
central incisors in RP and create a
posterior separation of 2 mm. The acrylic
Michigan splint, which is also Figure 6. (a) Denar Slidematic facebow, (b) Dentatus facebow.
constructed in RP, uses complete
Single anterior unit (C) None, ICP Not usually necessary/simple hinge RCP, protrusive
Single posterior unit (C) None or ICP Not usually necessary/simple hinge RCP, protrusive
Last standing molar (C) ICP Simple hinge RCP, lateral, protrusive
Multiple anterior units (C) ICP, protrusive Semi-adjustable plus customized incisal guidance Minimal
Multiple posterior units in one (a) ICP or Average value or RCP, lateral, protrusive
arch (RO) (b) ICP, lateral/protrusive Semi-adjustable plus facebow transfer RCP
Multiple units in both arches (RO) RCP, lateral/protrusive Semi-adjustable plus facebow transfer or fully Minimal
adjustable
A semi-adjustable articulator is suitable for most patients. C: conformative approach; RO: reorganized approach.
Table 1. Indication for occlusal records and type of articulator.
enough for many clinical situations. They are set using either interocclusal new restorations avoided.
Their condylar guidance mechanisms are records or a pantographic tracing and a Readers should refer to more detailed
set from lateral and protrusive records record of the true terminal hinge axis to texts5 for in-depth descriptions of each
and the maxillary cast is related to the duplicate mandibular movement with a type of articulator.
hinge axis of the articulator using a high degree of accuracy.
facebow transfer. There are two types of Articulators are set using
semi-adjustable articulator: interocclusal records. Semi-adjustable THE FACEBOW TRANSFER
machines use the lateral and protrusive The facebow (Figure 6) records the
l The arcon (articulator–condyle) records to set the condylar elements to relationship between the patient’s
type, for example the Denar Mark II replicate some of the posterior terminal hinge axis, whether it is true
(Denar Corporation, Anaheim CA, determinants of the occlusion (condylar (accurate) or arbitrary (imprecise) and
USA), has an adjustable condylar guidance, the Bennett angle and the maxillary teeth are enabling this to
fossa mechanism that sits on a fixed movement). RCP records allow the casts be transferred to the articulator, so
condylar sphere, attached to the to be mounted so that an existing slide relating the hinge axis of the articulator
lower member, on which it is free to between RCP and ICP can be duplicated to the maxillary cast. Casts are
move. The upper member is and potential occlusal interferences from articulated in RCP then brought together
detachable from the rest of the
articulator. It maintains the fixed
relationship of the maxillary
occlusal plane to the condylar a b
guidance angle.
l Most non-arcon types, such as
Dentatus (Pro-Care Europe Ltd,
Bradford, UK), have a moving
condylar sphere set in an adjustable
condylar track, which is not
removable.
Fully Adjustable
Figure 7. (a) Softened interocclusal wax record. (b) Buccal cusps visible on record. (c) Record
Fully adjustable instruments are of the relined with temporary cement. (d) Rigid, stable, accurate record.
arcon design and are very sophisticated.
RCP and the vertical dimension – so l Tripodized occlusal contacts. masticatory system. The implication is
reducing the space between opposing l Canine disclusion. that individuals do not necessarily fit into
teeth and producing problems in l Importance of posterior a prescribed occlusal concept but that
identifying the correct positions for the determinants. each occlusion should be considered
restorations. l Anterior teeth concave palatally. separately and treatment needs to be
l Posterior teeth form a parabolic tailored to individual requirements.
curve.
THEORIES FOR ACHIEVING l Use of fully adjustable articulator.
OPTIMAL OCCLUSAL l All restorations done together.
CONTACT REFERENCES
1. Posselt U. Terminal hinge movement of the
There are many different occlusal
Pankey–Mann–Schulyer mandible. J Prosthet Dent 1957; 7: 787–797.
philosophies and treatment concepts that 2. Posselt U. Studies in the mobility of the human
aim to deliver optimum occlusal contact (PMS)10 mandible. Acta Odontol Scand 1952; Suppl 10.
and hence health in both the natural and l Long centric (or freedom in centric). 3. Pameijer Jan HN. Periodontal and Occlusal
Factors in Crown and Bridge Procedures.
restored dentitions. Diverse opinions l Anterior guidance all important.
Amsterdam: Dental Centers for Postgraduate
have led to much controversy as to l Group function then canine rise Courses, 1985; pp.306–309.
which concept is the best to use. Two after 1 mm of movement. 4. Geidrys-Leeper E. Night guards and occlusal
main concepts have existed in the past. l Posterior teeth flatter. splints. Dent Update 1990; 17: 325–329.
5. Hobo S, Shillingburg HT, Whitsett LD.
One is the prosthetic concept of a l Lower posteriors restored first then Articulator selection for restorative dentistry.
balanced occlusion with bilateral tooth functionally generated path J Prosthet Dent 1976; 36: 35–43.
contacts in lateral and protrusive technique. 6. Simpson JW, Hesby RA, Pfeifer DL, Pellen GB.
excursions to ensure functional stability. l Anterior teeth ledged to provide Arbitrary mandibular hinge axis location.
J Prosthet Dent 1984; 51: 819–822.
The other theory is orthodontically occlusal stops. 7. Warren K, Capp N. A review of the principles
oriented to achieve particular static cusp- and techniques for mounting working casts. Int J
fossa relationships. These two theories Devotees of these philosophies adhere Prosthodont 1990; 3: 341–348.
of ideal standards and that of dynamic strictly to them but in the past few 8. Mullick SC, Stackhoyse JA, Vincent GRV. A study
of interocclusal record materials. J Prosthet Dent
occlusal relationships are outlined below. decades a third concept – the ‘dynamic 1981; 25: 304–307.
individual occlusion’ – has emerged. The 9. Mohl ND, Zarb GA, Carlsson G, Rugh J. A
criteria for diagnosing occlusal problems Textbook of Occlusion. Chicago: Quintessence,
Gnathology9 and the indications for treatment are 1988; pp.161–175.
10. Dawson PE. Evaluation, Diagnosis and Treatment of
l Point centric – obtainable and based on an assessment of the health Occlusal Problems. St Louis: C.V. Mosby, 1989;
reproducible. and function of each individual’s pp.261–263.
BOOK REVIEW available. In its eight chapters, two are recent range of rotary preparation
devoted to basic concepts of devices and obturation techniques
Rational Root Canal Treatment in pathogenesis and diagnosis of pulpal being marketed. They will therefore
Practice. J.M. Whitworth. conditions, but the science is clearly value the description of traditional
Quintessence Publishing Co. Ltd, New related to subsequent management. hand-preparation techniques, which is
Malden, 2002 (134pp., £28.00). ISBN 1– The next five chapters cover the followed by a concise and clear
85097–055–6. traditional phases of endodontic section on newer modalities, including
therapy. Well placed emphasis is put how they are best used. A final
Designing a book which will appeal to on the importance of access, and section on realistic assessment of
general dental practitioners is not an diagrams of ideal access cavities for all success and failure rounds off this
easy task. GDPs are a heterogeneous teeth are included. Throughout the excellent book.
group, and it is difficult to identify text there are practical tips and This is not an academic treatise nor
correctly what these different problem-solving ideas, for example is it a basic manual. It contains much
individuals want or require from a text. accessing calcified teeth and rubber more than just the essentials and
However, this book will, in my opinion, dam placement. Good use is made of should be well received by all general
succeed by its choice of content and photographs, and the many line practitioners who wish to improve or
by achieving a good balance between drawings complement the text. A maintain their endodontic treatment
the practical and the scientific. shortlist of additional sources of abilities.
Although this is a short volume, it is information completes each chapter. Dominic Stewardson
primarily concise and gets across a lot Many practitioners will be interested The University of Birmingham School
of information within the space in, but also perhaps confused by, the of Dentistry