Prosthodontie Treatment for Edentulous Patients . ‘ Complete Dentures and Implant-Supported) Prostheses ZARB HOBKIRK dS ay JACOB Fenton - Finer - Chang - KokaChapter 9 the Dentures! Polished Surfaces, Recording Jaw Relations, and Theit Transfer to an Articulator 195 tnfreacty the geeliinary CR eecoed ian score, ce ars wragruned at this apoentenent W will howe it when a new he. This i tame comumine step art hopetully should not be repre However, i sine he fecal that chnical termination cof cocina ocrcpancies# mote teubly docereiie wath Trowthetc tet in pie han th FeoHlem can abeats e acti. lhl ab th ride and bhoratery time w request RELATING THE PATIENT TO THE ARTICULATOR Prowhetss tecth and thor suppenting denture bases ate signed eh to he estharially pleasng and to nae fatents to fenctwn comfemtably and conlently thon fut the requte) range of munbtubar movements. The shen teeth ant then denture bases ust thercfone he arangelikgnesd so thatthe artical dentinon’s occlu sestaces ean contact ata glide ser one anoeler eaathly, seithout dhkaleng the denture bases The mete peactnal tbs serve athe heat articulate Hever, tf Innpewuble to per iem anteastally many af the procedures involved in the construction of complete demutee This ohyective 9 preclale! By movement of the tal dentures, Mhculies pve by the presence of aiea, and the patents ablity to cooperate: The convenience for the patient, the Feats, ail the dental Lalsnatory tec hrsctrs dhcttes that niculaton, be use This eotails mountingthe accfusion rams ana thet supe cate of at atticulator, which ean be one wna frechand The tacetow wan electwvely wed snttament that carne the telmoeahip Hetwren the manllic ant the coeulyes from the patient to the attwulator Hos placed ot the fice, with the condyle tal bated aypronmutely in the rept af the hinge 4414 which sall be near the corde (Fa, 9-10) The facebow is a cabpertite device thi WO! 1 jig ah Facetene my ht ei nt each oar sais extemal auahtiny meats (ot che ive thew td place nip tthe rere an apyscnimate bene he alle Huge a” atthe ea gn, The bie Bik a plated on te lal apes peewee He ja atl the axn of muvemeRt, arcuate wae ocehusees tem aul cae the a ronuliyp betwen the pws and the (C) so an to tac the ects soak temporomanhule joints (TMIs}, except to the extent ona sekctal arcan type ameter that the axis of movement micht happen to be new the TMJs (Many dentity and dental eahiniciany abo comseter the facchow a convenient instument for supyoeting the Jlethey are Feing ument conuts of 3 Ushaped frame of anembly that196 __Part A Clinical Protocols for Diverse Treatment Scenios Box 91 Summary of the Clinical Steps Required to Develop the Polished Surfaces and Prepare the Occlusion Rims for Teansfer to an Articulator nore welling tani, and vable TDs Te retention may accasiorlly have tbe aided lth 3 dente afore Oval stsiay wil enhancer ate desig athe ach ho, meatal [stablah the neu gane by contckving the Kollonmne * Arch hams cation prvi dette i Prevent + An ascsument ofthe amex an pat of tone bons + Used anatomical Lins 4 Prehewnary esthetic eealutvon Deter the henght a he occa plane 6 the mankblar occhann re Use conor ofthe mouth a the antennt lunndraihy 1 Use the retromota pd tr thet ep] asthe pester lindas 1 how all our pooes wach a et, oad wan spatula {sabloh the VDO by mithyang the hers ofthe ‘occlavion ren while trun he tallow 1 An even meting of bet i in CR postion An mienite his tance hat the ed aes avery func telly aes few te te questi Prepare nm for a CR regntatinn with grooves in the mtullary wan and epyoung bee ahaped areas the mandir wa Fetus the occ hic rn the mut record w mace rec aad remade espa unt 2 petite Ck recat established The nccluuen eam ate re Casts ae transis hea at lan of ee (with or wathout emphoying a faces fr the cake of canyermence atl are rane tea Ke he seg of the poner fei wall inadvertently juite the path of the mance as it ayprakhes the pant of the watic resort On the other hand, once at, the rooting matertal rut hive wtficient sreerutls and naxdty to eetarn the rlancnsbup between the cxeluson rims anal supper the mals dune the mowing rrocess Several registration materi ate acceptable fo tha repose. ane the selection os wally made an thie fs of convenience anfearetience. All these maheh arebeliev el to be accurate and wetul but the pecterrod metho w the static techniyue hecawe of wy ene of reptalucility and fepeatalliys The technapse (we Fig 93, © and DY w arred uta fallow Themandhulisoccluwn rims tothe mmo pasts of prenonnty described an ark fight and left corners ef the tah and a point ew thio the way up the tettemalat path The mail eae rem next melted wath ah spans ‘cents with the mandibular alae rim and at the ddeuted level axjulgedy the deste clinical metho inthe text all ($104 mm deep) Vahapel eraoves ate placed Fataterally nthe hrst molars! premolar ecw of the manilary wcclusion nm. These ates ate libeiated voth a petioleurs jelly ard the moanllary occlancr ry Is plied in the mouth. We asters rims ate alo in contact as posuble to ptepate a igalar groxve an the inet the manllary central mca Roweshaped areas (2 40) Vi deep) inthe co Ing oppo ateas cf the maradtblar exclaim rim are ft prepated al thea filed with the chown reqstra twee materal fg wftene| beeswax), The nian hular sechasice rim i next placed in the moat The comfortably veatol and upche p her beat wupyeatad by a sate heskew The Jenene fuses the patient's marvbtle ysto-a CR postion fale seatiang he manu bbubar and hur of ne hard and aunethe tha ant tinge of the her lanl to quake the mandible. The fags tabling the base ast can be mowed aps tty lise the maxilliy hive, respec Br ths manner, he hase’ wibifiy 6 emuted and the mandiMe can be fede while syutohty a retaines Alternative hard onions are abated by tase witb the forint ferent circus The patient aot hanes mut he kept nmobile while the material setting This mas:snly tt be pose fe tome panents epeciily whete manBhular redual fie reweptioa s extensive or nevremucub contd tw compromsed Cleat, unplint of maturl teeth ahutment-stahiled eceluyon mimy seve this probtem, gure ends, The alvantage of 4 wax revonng tbat Ties in ay allowing the oferatoe tor gutke mans ‘penang anal chore into the st wax to very the recons acute Ivcpraknt tirehcane the previwnnly esctthel mancurens telite the teconting mekum is actully intrakised The trol bases shoul te taken ont of the moth, exse recot sng materul remuwel, and the drtal areas of the bases checks! ws etre that they she nt contact tay This A freqment ate foe recotdans errs The axcuracy of this Aadvwbl he checked an] rheakel before proche an artcubatot mounting. The wee of trent teal che sures, plan a peactical al metcubah applied technique, wll Well accurate realis Any abt checks of tess that ensure an accurate CR record ate strongly sdenied192. Part IV Clinical Protocols for Diverse Treatmert Scenarios nifthe teeth eck ienvon is probably wens o peobally tos great Ei together during speech, the wer MECHANICS Albewral methaal hular relations at thew teal ones sucb as the flowing «+ Relatorshipe sare The snc han ges changes Infooethe Incisive Papilla t» Mlarsbbalar Incl parilla oa sable Landnatk, that emyarnively Inve in gue of neweytive aticent ulveolar nj The dotance of the teeth on dazrontc eats aveeners apgeitately 4 tn lennon The insu ehtes of the mail Lary central inetas ate an average of 6 nim Rel the Therctore the # tnithe nats sn rina enerlap of tricia fH the af crwes w abvut 2 qu (Fig 9 nisampertarttesterneenber tat thew ate average mea surements with conuadralesnh stented They sh year to be tke to Paral the manillty and ma illvlae tuksevotten 6 arprepnare amuunt ef jw separanon, Sance emercd theanterioe am gentenioe teeth have nea AL be wed with they do os fevant in patients with severe tewual allel of ol the Ridgvst When presen, remealtenbtaleave the tesib tural) teh other Th pat scours frnpucety, prosaled there has teen malsbarge nth hanced penadmral dea oe erouly oveetipred teeth, Ridke fatale os totale from a mochanicl rg ot the etures tales Leh tocar lide ater 0 fonter eal. Minkever, ah must peuple the teeth ate ht at Stterent sme ara hen a pers tally Recommender tulont often observedthat the rsibal ra loeicer parlel ads, the een e an! maillae will eccane pwoerewvely more neve sanclsart ot wah, wt Arcane will nt panera Bw apyree the me yeh an appropriate MEO ts rite therfore 19 we we ve mee of the methal ny teat the syyropeatenes othe relator: mated When diferent methinl wed for apftonenute the telatucnsp ant then tune ete to indepen ten shop a Aetcem this eed! yrelaminaty} estanate should be tegatdol a the vertical heght at whals teh boul te set. The next sep of masking a feniontal centne jaw tebnen recor eng the VIO appear to sachd seralar reales wl he vahete at this vervial santa dhs excur yin se oct the wax tral dents CX coune, a futher anewment atl condemat Setermination. will crate he te Vik) i0 cetsied in the mouth. At that time, these cars again be used to confirm the VIO before ion of the dentures THE PRELIMINARY CENTRIC RELATION RECORD (BOX 9-1) The vertical al h commpunents wf the ( nosed the jaws are integral sn irvedentulnn patients This wal plane ste the eration that all he accused bythe arricta teeth ars sisuey ot the complete dentures and nterocclinal ypace has been extabishedd The tim thers ate swe to ental a prelnaniey CR J for teanter eo an ahweany mung, of by means he re There iv eatenuve dental Ltetature which concerts Lebanon, atl net cee the bene recor are dieu) Even duch thete are nuny varie opinions on details there ser sonic CR wveertil inthe constriction ea comennin tht a “ 1 Many dettutes tal Peeasne the exe the manubte that the eelatcauhip v4 cass rwauted in CK It apyeats th aablrewne the dente’ thtd oon teed mnie empoctance Therefore it recommends that fan artateary facchon ts ed of 1 fecal ot whet the CR recoal shoal he male at op wey che to the seleerel'VIR) The whe ponent ertns fret hain i telixel recat a tha hinge axis ate ete Fiashermmice, sit cl ce that the actual metho cé teandernng a Centra yaw relation revoed tothe denies amculator of cheace a arguily ielevant 5 hoc ators Several excelent mesh ot techies ate availa, bat inthat the tevor i correstly mvuntel in the Tetere proaceding with the setting up af the he Thaeetone th shat ponthets ts cal ene, Went be Jecntet a tnuak with The mare bate” sd matenal anterpne et cers the fw ras. wer (¢. Max} hate to provide a “check thick stale and wery easy to ase. The consteney of the reconhing mater tof se runt ut offer tewstance duning marcbbulatChapter 9 The Dentures! Polished Surlaces, Recording Jaw Relations. and Their Framer to an Articulator 193Chapter 9 The Dentures’ Polished Surfaces, Recording ae Relations, and Their Transfer to an Articulator 19 igure 9 The cman of tavieabie sin fone and comet ar cen in A an! Ben pace ery ta irespecine ol thew aye or geraky Al the arta yim apgenntment fe the pated mB, i became clear that the anteyne toe ‘overall extetc outcome © Note he ms elt ide as opposed to the me cree protexet pal eg eri et bh etn ae pate wth 3 yt edie he deed the ght sede Tha co stig) tay wo congue Scrangrerente very teat and ke tothe pctevd reals 0B eyeruivon the snininuc tracture al the wepport behind them Therefore the dentist man nterfunteti tut fs fof the denture: Thu contoured sattace sald replace ot restore the tissue support peated by the ates write the hp ae ot properly supported antertety, they wall he rune neva vertical than when supysted by the natural ‘uses fy sk a situation he tenuleray 4 0 anceease the VO to provide support forthe Lips, and thie cary dead te cexceuive lower face etch =f 490 we tethe tig fs scours han the antenve tee ve iter ah Jiecthy unter and alment wactung the means that oe rectly placed. th Fenton neath Upper anewors H the dotaeice ssall 4 VEO may have Beers established H the asters tecth touch when thee sunk ate male, the vera Kaduse.com190___ Part WV Clinical Protocols for Diverse Treatment Scenrias parallel the as-tragu kne on the bans of the grninion of natural egalaal planes Then the het chit 6 alusted to moet evenly with the sper rim and rediced until sufficient wnteroccltal distance hat teen obtained. ‘This provedure w» seported a aksyuste for many patients anu wally prod tony tevalte ESTABLISHING THE DESIRED ‘VERTICAL DIMENSION OF OCCLUSION The LTO is est hel in the presence of 4 healthy of the process of paw clevelopment and maturation, Howeve are kat are so orn kon that they hae tle length, while othe rmunnvain thet fall stinacad aroas length even paicnty wha bangs can bs Clinical crown ranner that ve poently al teeth may not be a result, preextracticn vertical measwtements relable andicatory of the demenuon to be mcexyetared a tnmeiate or new gemnplcte dentines On the oth soy preexiraction anformatica avaiable cans phatographs oe press de ana puble clue an the determanation of WDO fot an, clentubous parent The most frequently wel tests that ail the dente tw euaHlhing the correct VDO by means of exclusion 1. Vial obsereanon of the space herween the nmi when the manic wun as physislogisal test pasbon. 2 Jaalement of the ovetall exthetie facal aappeet J. Phonetic tete that include cbservatins when the *¢7 1 enuncusted ascutately anid geyeatedty—the average raking space {i mun be emphastod that these tots are parriculaly effec tive af the patient's oll dentures ate ne foe comps OU dentures eat he value fot ptoeriontic purpuies ese cally of they ate wed with treatment kners to recover primal VIX, OM ki have ther fasta surfaces selectively ancmientell with a sft w ot the dentoa in awewing the tented coumetc sppent frm the dentures’ poluhed wafaces The m ses als Me's phywadngca anon ot the approprute WOO because it unetets loner. The ditctence between ance ot so-called “sceway 1 prwtion skmenuon rechual 4 mum when observedat the po premolars This 1 net an exact guile; crother methinbs tebtion of the he tied asa earning pose derminshon of the ete: manhble 10 the matlic, One metho 1 (0 have the oo ating ivan wright Islaned poison an the had finaippowted After memion ofthe sutibly contouted wane cxehition rims, the patient swallows an lets the pw a, When relation a aw the ly ate pated to teveal how much space # procnt Reteeen the eccnkin tin The putin an gt ts eptae the bys without moving the jnver lps eeatpinito hep the dem The interoccheat dvesnce at the tet poten shoal fe fetween Zand 4 min when viewed at the premolat tees The intetarch space ane ret jenitans can be measared by means of indelible dety ot adhesive tape en the face. If the Aifcence neater than d 1: clinal vertical dimen: jon 4 probably tor gteat, The wxclanen the dentit y satudil sith the atest euiremerite of an acer t- nto have Feet eltaunel, soc ay patient J phonenc ant etheic consdersrnns as ae vertical si Son noting that the presence ot alvence of lentates ot cxcluwon gm an the math cam atfect the vercal diene thiwebsneal eo ts ronan this dro 8 ‘shen excl ruatly an the patient's mouth. The actast {or stern the portion Ket telaxaren st honetics) abo may’ meahiy ata vertical kel, an dentits must Leep this in mind when wang the rest postion asa cutfetorestattohine vertical maxilenanihbu: far relatwin This exestaal that an adsjute sitenmclonal stance cm when the marchHe 0 mn as plynlagical eeu panes derjermmerval esearch have chosen tate cats be place fe relevant when amend with skentares inetlyal valli shuts the aa rapid vertical dimen tration of a new dntetexchusal shstance, This seems tu Teakng to another teat potion and ct even aleranancrene that was pe he thal intersect stance Such ndings indicate that fest potion anew fit a tchable Fs fon the determi ood antler relations en! that al are sn of the verueal denon ate ot 4 cic Bechine the al ally 1 ore toy appleesd, ps nling clenlim given the ete tite lajve potential ESTHETICS The verncal relation of the marble to the marillae slur acets evtheticn A stay of the shin of the lips compsrest with the shin over other party of the face can he use as a Nowmally the tee ef the facil aban shouhl be the sme theoughine [steve must be realised that the rela ve antctorenterice poutiors ofthe tecth are at Heat esl as involved in the vertical relation of the jews as a the testoration of shin tone (Fig. 9.9), The contout ef the hi