Dokumen - Tips Tif Denture Model Analysis

Merz Dental Prosthetic Training
Total prosthetics in function (TiF)

According to Karl-Heinz Körholz, MDT
Part 1: Model analysis
© Merz Dental GmbH, Germany 1

Cast analysis steps according to TiF®
Articulators and tools Stop line
Anatomic midpoints Summary – Steps 1–5
Anterior markings Outer and inner corrections
Basic statics Common setup areas
Largest masticatory unit Definitive setup line
Concept, graphics and texts: Martin J. Hauck based on the TiF method by Karl-Heinz Körholz

Recommended articulators and mounting
Free choice of articulator
TiF can be used independently of any specific articulator make or
model; some examples are:
 Artex  Finess A-C
 Artist  Handy II M
 Atomic  Protar
 Balance  Rational
 Contact  SAM
 Condylator  Simplex 2000 ff.
 Dentatus  Stratos 200 ff.
Mounting
 Occlusal plane (preferably using a thin round elastic thread)
 Maxillary cast positioner, e.g. for Protar (KaVo)
 Facebow

Time and objective of the study cast analysis
When?
 After mounting in the articulator
 Before placement of the setup stents
Why?
 Information about previous tooth positions
 Functional and aesthetic replacement tooth position
 Reproducible determination of structurally favorable areas

Tools for study cast analysis
Title – Tools
 A black pencil
 Red, green, blue colored pencils
 Profile compass REF 1030320
 Triangle
 Small sliding caliper

22,5/
 A 22.5° template (e.g. cardboard)

REF 1090390

Step 1
Anatomic midpoints

Anatomic midpoints
½ ½
½ ½
 Center of the incisal papilla  Frenulum of the tongue (lingual

 Midpoint of the distance between frenulum)
the maxillary tubers  Midpoint of the distance between the
retromolar pads
Step 2
Anterior markings

Mandible
Labial limit for the anteriors
Measure distance and indicate

on the front of the cast
Maxilla
Labial limit for the central incisors
7–8 mm

Maxilla
First large pair of palatine rugae
The palatine
rugae point in
the approximate
direction of the
canine position

Anterior markings
Summary
7–8 mm
The palatine
rugae point in
the approximate
direction of the
canine position
 Base of the central incisors: on the  Labial surfaces of the central incisors:
anterior crestal midline 7–8 mm anterior to the incisive papilla
 Canines in the approximate direction
 Labial surfaces not to protrude of the first large pair of palatine rugae
beyond the lowest point of the
mucolabial fold
Step 3
Basic statics

Purpose of basic statics
 Edentulous jaws are not

straight
 There are made to be straight
in actual practice
 They are nearly reference lines Lateral posterior crest
for the posterior setup midlines idealized as
straight lines
 Different levels of job atrophy
are disregarded
 Posterior teeth will be placed
too far buccally or vestibularly

Possible consequences:
 More severe ridge atrophy
 Encroachment on the tongue

space Lateral posterior
crestal midlines
idealized as straight
 Insufficient cheek support lines
 Impaired restorative function

Conclusion:
 Setting up the teeth along the crestal midline – as
in the days of the rubber denture – is not
appropriate
 Strive to duplicate the original tooth position
The most important steps in study cast analysis are:

 Basic statics
 Outer correction
 Inner correction

Basic statics
Static ideal line that takes individual ridge atrophy into

account
Maxilla: Ideal position of the palatal

cusps, except for the first premolars
Mandible: Ideal position of the central

fossae, except for the first premolars

Determining the basic statics
Maxilla: Ideal position of the palatal
Image, basic statics
Mandible: Ideal positions of the
cusps, except for the first premolars first premolars
 Position of the maxillary first  Position of the mandibular

premolars approximately one first premolars approximately
premolar width behind the at the extension of the buccal
ends of the palatine rugae frenulae or slightly behind
18
© Merz Dental GmbH, Germany
Step 4
Identifying the largest masticatory unit
“First molar position”

Tracing the lateral crest profile
To determine the largest masticatory unit, “first molar
position”
Guide the profile compass at right

angles to the ridge

To determine the largest masticatory unit,
“first molar position”

Crest profile line
Always guide the profile

compass at right angles
to the ridge
90°

Crest profile line
Always guide the profile

compass at right angles
to the ridge
90°

Position of the largest masticatory unit
Drawing a line parallel to the occlusal
plane
Occlusal plane

Determining the first molar position

90°

Tolerance range of the centric fossa
Tolerance range: 1 mm mesially or distally

Transferring the first molar position to the maxilla
Maxillary first molar position – Transfer

Transferring the first molar position to the maxilla
90°

Step 5
Stop line

Distalmost loadable tooth – stop line
22.5°

22.5°
 using a 22.5° template (e.g. cardboard)

 Average relation between the crest line and the occlusal
plane
 to prevent anterior sliding, according to Gerber
22.5°
If the crest is flat,

there will be no intersection
with the 22.5° template, so
that the setup ends at the
retromolar pad.
 using a 22.5° template (e.g. cardboard)

 Average relation between the crest line and the
occlusal plane
 to prevent anterior sliding, according to Gerber
Summary
Steps 1–5

At a glance
Summary – Steps 1–5
1. Anatomic midpoints 4. Largest masticatory unit/

2. Positions of anteriors first molar position
3. Basic statics/ 5. Distalmost loadable tooth (stop line)
Premolar positions

Step 6
Outer and inner correction

Outer and inner correction
Structural alignment of
the maxillary and
mandibular dentition
If the teeth are

positioned too far
buccally or orally, the
patient will bite
 his or her cheek or
 his or her tongue.

Mandible: Outer correction
Vestibular setup space

of the mandibular
buccal cusps

Mandible: Outer correction

Mandible: Inner correction
Setup space of the

mandibular lingual
cusps

Inner correction
Alternative: Mylohyoid line

Maxilla: Outer correction
Vestibular setup space

of the maxillary buccal
cusps

Maxilla: Outer correction for balancing
Balancing:
Outer contour of the alveolar crest
Mandibular Mandibular
first molar first molar
position position
Outer correction, functional support for buccal

cusps

Maxilla: Outer correction for lingualized occlusion
Lingualized occlusion according

to Gerber
Mandibular Mandibular
first molar first molar
position position
Outer correction according to Gerber,

exclusively functional support
for the palatal cusps (lingualized occlusion);
buccal cusps remain out of contact

Maxilla: Outer correction
Depending on occlusion concept
 Balanced occlusion
 Palatal and buccal cusps are equally
relevant for the static and dynamic
occlusion
 Lingualized occlusion
 Support on the working cusps, no
buccal cusp contacts

Maxilla: Inner correction
Inner correction

Predefined statics,, outer and inner correction areas
All lines are extended to the edges and outer surfaces of the cast
Basic statics Inner correction Outer correction

Step 7
Defining the
common setup areas

 All anterior marks
remain exactly
as they are.
 Common set up area

determined by averaging the
dorsal lines
 This requires viewing the

articulates this cast from
dorsally.
Outer correction Basic statics Inner correction

Definitive setup line:
Average of maxillary and mandibular
basic statics.
Defining the contact areas of the

maxillary palatal costs with the
mandibular posterior occlusal surfaces:
Always use the lines closest to the
definitive setup line.
Common outer Definitive Common inner

correction setup line correction

No contacts buccally
or orally of these
regions!
Common outer Definitive Common inner

correction setup line correction
Static lines – Definitive setup line
Definitive setup line:

 Main static reference line
 Can be moved in- or outward.
Decision criteria include:

 Freedom of tongue movement
 Positional stability
 Cheek support
 Ridge asymmetries
 Balanced occlusion or
 Canine/premolar guidance Common outer
correction
definitive setup
line
Common inner
correction

Static lines – Definitive setup line
 Ideal line
 Based on the individual atrophy

status
 Maxilla: Marks the ideal position

of the palatal (working) cusps,
except for the first premolars
 Mandible: Marks the ideal position

of the central fossae, except for
the first premolars

Static lines – Outer correction
Balancing:
 Offers a broad contact zone
 Marks the vestibular contact limit

of the maxillary and mandibular
buccal cusps
 If exceeded in the maxilla, the

cusps must be placed out of
contact to prevent rocking or tilting

Static lines – Outer correction
Lingualized setup according to Gerber
 Marks the vestibular contact limit

of the maxillary and mandibular
buccal cusps
 If exceeded in the maxilla, the

cusps must be placed out of contact
to prevent rocking or tilting

Static lines – Inner correction
 Delimits the positions of the

maxillary palatal cusps
 Delimits the lingualmost positions

of the mandibular central fossae
to allow freedom of movement of
the tongue, alternatively, the
mylohyoid line may be used

Merz Dental Prosthetics Training
Merz Dental GmbH

Eetzweg 20 · 24321 Lütjenburg · Germany
Phone +49 4381 403-0
Fax +49 4381 403-100
merz-dental.de
info@merz-dental.de
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Merz Dental Prosthetic Training

Total prosthetics in function (TiF)

© Merz Dental GmbH, Germany 1

Articulators and tools Stop line

Anatomic midpoints Summary – Steps 1–5

Anterior markings Outer and inner corrections

Basic statics Common setup areas

Largest masticatory unit Definitive setup line

© Merz Dental GmbH, Germany 2

© Merz Dental GmbH, Germany 3

 Reproducible determination of structurally favorable areas

© Merz Dental GmbH, Germany 4

 Red, green, blue colored pencils

 Profile compass REF 1030320

 Small sliding caliper

 A 22.5° template (e.g. cardboard)

© Merz Dental GmbH, Germany 5

© Merz Dental GmbH, Germany 6

 Center of the incisal papilla  Frenulum of the tongue (lingual

© Merz Dental GmbH, Germany 8

Measure distance and indicate

© Merz Dental GmbH, Germany 10

© Merz Dental GmbH, Germany 11

© Merz Dental GmbH, Germany 13

 Edentulous jaws are not

© Merz Dental GmbH, Germany 14

 Encroachment on the tongue

 Impaired restorative function

© Merz Dental GmbH, Germany 15

The most important steps in study cast analysis are:

© Merz Dental GmbH, Germany 16

Static ideal line that takes individual ridge atrophy into

Maxilla: Ideal position of the palatal

Mandible: Ideal position of the central

© Merz Dental GmbH, Germany 17

 Position of the maxillary first  Position of the mandibular

“First molar position”

© Merz Dental GmbH, Germany 19

Guide the profile compass at right

© Merz Dental GmbH, Germany 20

© Merz Dental GmbH, Germany 21

“first molar position”

Always guide the profile

© Merz Dental GmbH, Germany 22

“first molar position”

Always guide the profile

© Merz Dental GmbH, Germany 23

© Merz Dental GmbH, Germany 24

© Merz Dental GmbH, Germany 25

© Merz Dental GmbH, Germany 26

Tolerance range: 1 mm mesially or distally

© Merz Dental GmbH, Germany 27

Maxillary first molar position – Transfer

© Merz Dental GmbH, Germany 28

© Merz Dental GmbH, Germany 29

© Merz Dental GmbH, Germany 30

© Merz Dental GmbH, Germany 31

 using a 22.5° template (e.g. cardboard)

If the crest is flat,

 using a 22.5° template (e.g. cardboard)

© Merz Dental GmbH, Germany 34

1. Anatomic midpoints 4. Largest masticatory unit/

© Merz Dental GmbH, Germany 35