Maxillomandibular Relationship Research Articles

Trueness of Maxillomandibular Relationship in 3D-printed and Conventional Casts

To compare the trueness of maxillomandibular relationship between articulated 3D-printed and conventional diagnostic casts in maximum intercuspation (MIP). Reference casts were articulated in MIP, and scanned using a Coordinate Measurement Machine (CMM, n=1). Digital scans were made from the reference casts by using an intraoral scanner (IOS, n=10) (Trios 4; 3Shape A/S). IOS scans were processed to create 3D-printed casts by using MAX UV385 (Asiga) and NextDent 5100 (3DSystems) 3D-printers. The conventional workflow implemented vinylpolysiloxane (VPS) impressions and Type IV stone. Stone and 3D-printed casts were articulated and digitized with a laboratory scanner (E4; 3Shape A/S). The 3D-printed casts were scanned on two occasions: with and without positioning pins. Inter-arch distances and 3D-contact area were measured and compared. Statistical tests used were Shapiro-Wilk, Levene's, Welch's t-test, and 2-way ANOVA (α=.05). IOS group showed similar or better maxillomandibular relationship trueness than stone casts and 3D-printed casts (p<0.05). 3D-contact area analysis showed similar deviations between 3D-printed and stone casts (p>0.05). The choice of 3D-printer and presence of positioning pins on the casts significantly influenced maxillomandibular relationship trueness (p<0.05). Articulated 3D-printed and stone casts exhibited similar maxillomandibular relationship trueness. Although 3D-printing methods can introduce a considerable amount of deviations, the maxillomandibular relationship trueness of articulated 3D-printed and stone casts in MIP can be considered similar.

Effects of modified twin block appliance in growing Class II high angle cases: A cephalometric study

Background Class II malocclusions represent anteroposterior dysplasia usually resulting from mandibular retrusion. Along with a retropositioned mandible, it can be associated with either upward or backward jaw rotation. High angle cases are often associated with a short ramal height, steeper mandibular plane, and large gonial angle. Twin block is a commonly used myofunctional appliance that incorporates bite planes that direct the occlusal forces in a more favorable direction for correction of the retrognathic mandible. We aimed to evaluate skeletal, dental, and soft tissue changes following modified twin block appliance therapy in high-angle cases. Methods A cephalometric study was performed on 15 growing (10-14 years) high angle (Frankfort mandibular angle 28-35°) Class II Division I malocclusion patients undergoing twin block therapy. Skeletal, dental, and soft tissue changes were evaluated by cephalometric analysis using Dolphin software. Results Pre- and post-treatment changes in cephalograms were assessed by analysis of variance and paired t-test. Significant changes in the position of the mandible (angle between Sella-Nasion-Point B [SNB] increased by 3.9 degrees, P=0.02), Wits appraisal (decreased by 1.54 mm, P=0.04), maxillo-mandibular relationship (angle between Point A-Nasion-Point B [ANB] decreased by 3.74 degrees, P=0.02) were observed. Soft tissue changes like the nasolabial angle were also significant, increasing by 3.8 degrees (P=0.04) and lower lip relation to E-line (reduction in lower lip protrusion) by 2 mm (P=0.04). Vertical parameters showed non-significant changes, like the Frankfort mandibular angle (FMA) increased by 0.07 degrees, (P=0.67), the angle between Sella-Nasion and Gonion-Gnathion (SN-Go-Gn) increased by 0.33 degrees, (P=0.67), Y-axis increased by 0.2 degrees, (P=0.32). The upper incisor inclination decreased non-significantly from 115.27±1.33 to 113.42±1.65 degrees, (P=0.12) and lower incisor increased non-significantly from 100.13±2.23 to 101.80 ±1.37 degrees, (P=0.08). Conclusions Modified twin block appliance can be used to successfully treat Class II Division I high angle cases with good vertical control.

A New Approach for the Assessment of True Maxillomandibular Sagittal Relationship: A Zeta Angle.

The assessment of sagittal skeletal dysplasia is crucial for accurate diagnosis and treatment planning, thus necessitating a thorough evaluation. A novel cephalometric parameter, known as the Zeta angle, was proposed in this study for the evaluation of the maxillomandibular relationship in the sagittal plane. This observational study was carried out using 291 pre-treatment lateral cephalograms of participants aged between 15 and 25 years, categorized into skeletal class I, II, and III relationships based on Wits appraisal, ANB angle, and Beta angle. The individuals reported to the Department of Orthodontics from January 2021 to October 2023, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies, Faridabad. The Zeta angle was constructed using three skeletal reference points as point Pt (pterygoid), point M (center of premaxilla), and point Pm (suprapogonion)and was measured perpendicular to point M on the Pt-Pm line and the M-Pm line to determine the severity and type of maxillomandibular discrepancy in the sagittal plane. Statistical tests were used to obtain the mean values for the Zeta angle. Analysis of variance (ANOVA), followed by the Bonferroni post-hoc test, was used to assess skeletal differences between the groups. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity of this angle. The results indicated that a Zeta angle between 57° and 64° had a class I skeletal jaw pattern, a Zeta angle less than 57° indicated a class II skeletal jaw pattern, and a Zeta angle greater than 64° indicated a class III skeletal jaw pattern. ROC curves showed that a Zeta angle less than 57.5° had 80% sensitivity and 82.5% specificity in distinguishing class II from the class I subset. A Zeta angle greater than 64.5° has a sensitivity and specificity of 92.5% in distinguishing class III from the class I subset. The Zeta angle may serve as an additional diagnostic tool for the reliable determination of sagittal jaw relationships due to its establishment based on stable anatomical points, thus remaining unaffected by jaw rotations and orthodontic treatments.

Auxiliary occlusal devices for IO scanning in a complete digital workflow of implant-supported crowns: a randomized controlled trial

ObjectivesTo compare the crown accuracy and time efficiency of a complete digital workflow, utilizing an auxiliary occlusal device and IO scanning, with a conventional workflow, for multiple implant-supported single crowns.Materials and methods24 patients with two adjacent posterior implants were included. 12 patients were randomly assigned to digital workflow group, involving intra-oral scanning with an auxiliary occlusal device and manufacture of customized abutments and zirconia single crowns (test group). The other 12 were assigned to the conventional workflow (control group), involving conventional impression and CAD-CAM crowns based on stone casts. Crown scanning was done before and after clinical adjustment using an intraoral scanner. Two 3D digital models were overlapped to assess dimension changes. Chair-side and laboratory times for the entire workflow were recorded and a linear mixed model and Independent-sample t tests were used for the statistical analysis.ResultsThe maximum occlusal deviation was 279.67 ± 112.17 μm and 479.59 ± 203.63 μm in the test and control group, respectively (p < 0.001). The sizes of the occlusion adjustment areas were 12.12 ± 10.51 mm2 and 25.12 ± 14.14 mm2 in the test and control groups, respectively (p = 0.013). The mean laboratory time was 46.08 ± 5.45 and 105.92 ± 6.10 min in the test and control groups, respectively (p < 0.001).The proximal contact adjustment and mean chair-side time showed no statistically significant difference between two groups.ConclusionsA digital workflow for two implants-supported single crowns using an auxiliary device required fewer occlusal crown adjustments, and less laboratory time compared to conventional workflow.Clinical RelevanceThe use of auxiliary occlusal devices in IOS enhances the accuracy of virtual maxillomandibular relationship in extended edentulous spans. Consequently, employing a digital workflow for multiple implants-supported crowns using IO scanning and an auxiliary occlusal device proves to be a feasible, accurate and efficient approach.

Maxillomandibular relationship and virtual facebow integration in complete-arch intraoral implant scan: A novel clinical technique.

This clinical report introduces a novel clinical technique to create a 3D virtual patient for transferring the edentulous maxillary arch position with maxillomandibular relationship by using a facial scan device and an intraoral scanner and omitting CBCT imaging.

Novel complete-arch pillar system (CAPS) to register implant position and maxillomandibular relationship in one single visit

ObjectivesThis article presents a novel complete-arch pillar system (CAPS) to register implant position and maxillomandibular relationship in one single visit for implant-supported fixed complete dental prostheses (IFCDPs). Material and MethodsThe novel system presents a 3-unit toolset comprising intraoral scan bodies (ISBs), lateral pillar attachments (LPAs) and occlusal pillar attachments (OPAs). A 2-stage single visit workflow by an intraoral scanner (Trios 5) was introduced. The first stage “Screw-Scan-Done” was used to describe complete-arch intraoral implant scanning using LPAs. The second stage “Screw-Occlude-Done” involved virtual occlusal recording using OPAs. Two patients with one single edentulous arch were selected for this study. In the first patient, 6 bone level implants (Bone Level Tapered, Straumann) were placed in the edentulous maxilla at positions 12, 14, 16, 22, 24 and 26. In the second patient, 4 bone level implants (NobelActive CC, Nobel Biocare) were placed in the edentulous mandible at positions 32, 35, 42 and 45. A CAD-CAM procedure was initiated with the acquired IOS data to fabricate an interim IFCDP at the same day. Periapical radiographs were obtained of the implant-prosthetic connection of the definitive IFCDPs to verify the passive fit. Metrology software (Geomagic Qualify, 3D Systems – Matlab, Mathworks) was used to assess the implant analogs position in the 3D-printed casts used for fabricating the definitive IFCDPs. A quantitative occlusal relationship analysis was performed with IOS. ResultsRadiographic examination revealed no gaps at implant-prosthetic connection of the definitive IFCDPs. The 3D-printed casts showed an overall average distance deviation within the clinically acceptable range of errors of 150 µm. Quantitative occlusal relationship analysis with IOS showed well-distributed contacts. ConclusionWithin the limitations of this study, the following conclusions can be drawn:(1) A 3-unit toolset with ISBs, LPAs and OPAs allows to register the implant position and maxillomandibular relationship in one single visit;(2) the 2-stage clinical workflow with the CAPS system facilitates the IOS data acquisition for fabrication of an interim IFCDP at the same day;(3) a passive fit was demonstrated for the interim and the definitive IFCDPs. Clinical significanceThe CAPS system can help clinicians to register the implant position and the maxillomandibular relationship in one single visit for the fabrication of an IFCDP.

Mandibular guiding flange prosthesis to guide mandibular deviation following partial mandibulectomy and partial maxillectomy for squamous cell carcinoma: A case report.

Squamous cell carcinoma is one of the most prevalent cancers affecting the oral cavity. Rehabilitation following surgical treatment requires a multidisciplinary approach and care. Multiple disabilities such as dysarthria, dysphagia, unesthetic appearance, and psychosocial disorders following the surgery for carcinoma can greatly impact the quality of life of such patients, thereby necessitating multidisciplinary intervention. The clinician has to wait for the healing of the lesion and the effects of radiotherapy to be dwindled in case a secondary osseous grafting is planned. During this time lag until a more definitive prosthesis is planned, an interim prosthesis is must to correct the mandibular deviation due to the unilateral muscular pull. This case presentation describes the utilization of guiding flange prosthesis (GFP) as an interim modality for the establishment of a stable and functional maxillomandibular relationship following combined ipsilateral partial mandibulectomy and maxillectomy.

Implementing an optical jaw tracking system to locate centric occlusion: A dental technique

Optical jaw tracking systems are designed to record the static maxillomandibular relationship and the mandibular motion of a patient, including excursive movements and mastication pattern. This digital data acquisition technology can be integrated into diagnostic and treatment planning procedures, as well as into designing dental prostheses. A step-by-step protocol to record a patient’s digital data, including the repeatable reference position of the jaw or centric relation, by using an intraoral scanner, Kois deprogrammer, and optical jaw tracking system is described. The data are then processed in the software program of the jaw tracking system to locate centric occlusion.

Skeletal, Dental and Soft Tissue Effects of Twin Block Appliance in Different Facial Divergence Cases

IntroductionClass II malocclusions refer to a discrepancy in the sagittal plane associated with either backward or upward rotation of the jaw. A backwardly positioned mandible is usually managed using a Twin block appliance which contains a bite plane to direct the occlusal forces in a more favorable direction. Our aim was to evaluate skeletal, dental, and soft tissue changes using twin-block appliance therapy in different facial divergence patients. MethodsA cephalometric study was conducted among two groups with 15 patients in each group. Group 1 have a Frankfort Mandibular plane Angle (FMA) of 18-25 degree while Group 2 have an FMA of 28 to 33 degree with Class II Division I malocclusion. All of them were treated with twin block appliances with modifications done according to FMA. Cephalometric analysis was done using Dolphin software (Dolphin Imaging 11.95) to evaluate skeletal, dental, and soft tissue changes after twin block therapy. ResultsAnalysis of variance and paired t-test were used to evaluate pre and post-treatment changes in cephalograms. The position of the mandible, maxillomandibular relation, and mandibular length was changed by 3.99 degrees, 5.23 degrees, and 4.04mm respectively in horizontal growers, while by 2.9 degrees, 1.74 degrees, and 1.07mm respectively in vertical growers. An increment in FMA by 4.59 degrees in horizontal growers with good vertical control and a little increment in FMA by 1.07 degrees in vertical growers were seen. Conclusions The twin block appliance is effective in skeletal, dental, and soft tissue correction in patients with different facial divergences.

Association among craniofacial morphology, ethnicity, and risk of pediatric sleep-related breathing disorders: A multicenter study

Craniofacial morphology and ethnicity may be risk factors for sleep-related breathing disorder (SRBD) in children but have not yet been assessed in an international multicenter study. The objectives of this study were to assess the association among craniofacial features, self-reported ethnicity, and risk of SRBD in children undergoing orthodontic treatment. Children aged 5-18 years who presented for orthodontic evaluation were enrolled in the United States, South Africa, South Korea, Saudi Arabia, and Japan. The risk of SRBD was defined as answering ≥0.33 positive responses to the Pediatric Sleep Questionnaire. Craniofacial features included measurements in sagittal and vertical dimensions to evaluate the cranial base, maxillomandibular and dental relationships, and nasopharyngeal airway dimensions. Logistic regression was performed to assess the association among craniofacial features, ethnicity, age, body mass index, and risk of SRBD. Data were obtained from 602 patients from 5 sites. A total of 76 patients (12.6%) had a risk of SRBD. The mean age was 12.5 years. Male gender (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.0-3.4; P= 0.041), Middle Eastern ethnicity (OR, 10.2; 95% CI, 4.1-25.4; P= 0.001), body mass index (OR, 1.1; 95% CI, 1.04-1.10; P= 0.001), gonial angle (OR, 0.91; 95% CI, 0.85-0.98; P= 0.011), and inferiorly positioned hyoid (OR, 1.1; 95% CI, 1.0-1.2; P= 0.002) were significantly associated with the risk of SRBD. In an ambidirectional cohort study across 5 sites, male gender, Middle Eastern ethnicity, body mass index, gonial angle, and inferiorly positioned hyoid were associated with the risk of SRBD in children undergoing orthodontic treatment.

Non-extraction Treatment of Class Ii Division 1 Malocclusion using the Forsus Fatigue Resistant Device – Case Report

Devices commonly used for correction of Class II malocclusions can be classified as extra-oral (headgear), intra-arch or inter-arch. The intra-arch devices are either removable (Cetlin or sagittal appliance) or fixed appliances (Distal-jet, Jones-jig, etc). Fixed intra-arch appliances often depend on a Nance button for anchorage. Interarch devices, which use the mandibular arch for anchorage, can be removable or fixed. They can pull (Class II elastics) or push (Frankel, Herbst, Japer jumper). The Forsus Fatigue resistant device is an inter-arch push spring that produces 200g of force when fully compressed, the force levels being comparable to heavy Class II elastics. The Forsus FRD has be effective in correcting Class II division 1 malocclusions without the need for patient compliance and considerably reducing chair-side time. The optimum force levels increase patient comfort and provides faster resolution of Class II skeletal base maxillo-mandibular relationship.

Recording the maxillomandibular relationship with the Aqualizer system prior to occlusal splint therapy for treating temporomandibular disorders: a randomized controlled trial

Temporomandibular disorders (TMD) present a public health issue and are one of the most common musculoskeletal conditions causing chronic pain. This study compares the outcomes of occlusal splint therapy in patients with TMD following two different maxillomandibular relationship (MMR) registration techniques. 40 TMD patients were randomly allocated to MMR registration with the Aqualizer system (AQU) or with chin point guidance (CPG) prior to fabricating occlusal splints. TMD symptoms, subjective pain intensity, and quality of life (QoL) were recorded at baseline and after 3 and 6 months. The treatment led to an overall reduction of TMD symptoms in both groups (Conover test, p < 0.00001). TMJ sounds, TMJ pain with palpation and muscle pain with palpation subsided regardless of the type of MMR registration method used (Cohen’s d > 0.8). AQU-based occlusal splints led to a better improvement of TMJ pain with maximum opening compared to CPG-based occlusal splints (Cohen’s d = 0.9; CPG d = 0.13). In both groups, occlusal splint treatment had little to no effect on correcting lateral mandible deviation or improving restricted jaw opening. After 6 months occlusal splints in both groups had a large effect on improving subjective pain intensity (Cohen’s d > 0.8), however, patients reported a higher QoL in the AQU group compared to the CPG group (Mann–Whitney-U-test, p < 0.05). The results of this study support the premise that occlusal splints are effective in relieving pain-related TMD symptoms. The Aqualizer can be considered for determining MMR in cases, where guided registration techniques are not possible.Trial registration: DRKS00031998.

Does increasing vertical dimension of occlusion in centric relation affect muscular activity? An electromyographic study.

In many esthetic treatments, clinicians may consider the option to modify the maxillo mandibular position. A raise of the vertical dimension of occlusion (VDO) may help restore esthetics, increase the space for dental materials, and reduce the invasiveness of dental procedures. Traditionally, VDO increases are done by using the centric relation (CR) position. Despite a long history of use, the neuromuscular effects of different maxillo mandibular relations are not fully studied. The aim of this study was to investigate the effect of alterations of maxillo-mandibular relation from maximal intercuspal position (MIP) to a raised VDO CR position on jaw-elevator muscle activity. Fifteen healthy individuals were asked to carry out maximal voluntary clenching (MVC) in MIP and in CR on individual splints. Electromyographic (EMG) activity of the masseter and anterior temporalis muscles was assessed in μV as the root mean square of the amplitude. Specific indexes and ratios were also computed. Data analyzed in MIP and CR were compared by paired student's t-tests. MVC levels were not negatively affected by a VDO increase in CR position. On the contrary masseter muscles showed a statistically significant increase (p < 0.005). No significant effect on the anterior temporalis was observed. These results suggest that no immediate negative effect on maximum voluntary clenching was induced by a VDO increase in CR position. A slight increase observed in EMG clenching levels could be explained by the increase in VDO when clenching on the splint. The results of this study support the use of CR position as a pragmatic reference position due to the absence of relevant or negative changes in neuromuscular function.

Fuctional balancing in complete dentures- A case report revisiting the paterson’s technique

: A good occlusion is the key to the comfort and longevity of a prosthesis. : This case report presents a 63 year old male patient who reported with the complaint of difficulty in chewing since past 3 months.: On examination, the patient presented with completely edentulous upper and lower arch. A detailed case history was recorded followed by, primary and secondary impressions. The maxillo-mandibular relation was recorded conventionally on wax occlusal rims. A trough was then made in the wax and filled with a mixture of dental plaster and carborundum. The mix was kept 2mm above the plane. The rims were inserted and the patient was instructed to perform lateral and protrusive movements resulting in the incorporation of the compensating curves. The recorded plaster index served as a guide for the teeth arrangement. The denture was processed and delivered with very minimal need for post insertion corrections.: According to Paterson (1923), an articulator with lateral movements is not necessary to establish a balanced occlusion when using the functional technique. The teeth arrangement is entirely dependent on the established curves for obtaining balance.: Various techniques are cited throughout the literature to provide a successful prosthesis. With all the advances in the digital era, denture fabrication is not an automated procedure. It is pertinent that the clinicians master the fundamentals of prosthesis fabrication, without which any amount of technology and/or persistence might be in vain.

Use of Tens in the Diagnosis of Functional Mandibular Lateral Deviation

Introduction: The traditional diagnosis of functional lateral deviation is based on a clinical evaluation and dental casts, supported by an instrumental analysis through X-rays; however, these diagnostic techniques do not provide any information about the neuromuscular system. Several years ago, some authors stressed the importance of the mandibular rest position and its reproducibility as a diagnostic reference, and this became possible with the development of the Myomonitor, TENS. Aim: The aim of this study was to compare mandible position before and after the use of ultra-low-frequency transcutaneous electric nervous stimulation (ULFTENS) in children with diagnosed functional mandibular lateral deviation. Methods: This study was performed on 60 children, aged between 8 and 13 years, with a mean age of 10.1 years (SD 0.81), and with functional mandibular lateral deviation diagnosed clinically, who were referred to the dental clinic for pediatric dental care. Diagnostic neuromuscular registrations were made for all children, and their casts were mounted on a Galetti articulator at the myocentric position. These casts were then compared to those provided by a wax bite registration in the intercuspidal position. Results: Compared with the existing intercuspidal position, neuromuscular registration showed improvement in 30 (50%) patients, 18 patients (30%) showed no changes, and worsening of the tooth midline discrepancy was assessed in the remaining 12 (20%). The molar relationship did not follow the same trend of the midline because of the three-dimensional changes in the maxillo–mandibular relationship induced by TENS. After TENS, there was a significant correlation between the midline and right side deviation (r &gt; 0.65); there was no correlation between the midline and the left side (r &lt; 0.65). Furthermore, the right molar movement showed no correlation with the contralateral molar (r &lt; 0.65). The posterior areas of the arch moved in a very unpredictable way, resulting in the diagnosis and prognosis of mandibular lateral deviation as absolutely individual and unpredictable. Conclusions: This study suggests that TENS-recorded occlusion is an interesting diagnostic approach in orthodontics since it allows for visualizing the trends of the neuromuscular system.

Virtual occlusal records acquired by using intraoral scanners: A review of factors that influence maxillo-mandibular relationship accuracy.

This review aims to provide a comprehensive summary of how much progress has been made in the field of virtual occlusal records (VOR) obtained with intraoral scanners (IOSs), their accuracy, and what factors influence their accuracy. An electronic search was performed in MEDLINE via PubMed and Scopus databases in February 2023. Eligible articles were clinical or in vitro studies evaluating the accuracy of virtual occlusal records with intraoral scanners in completely dentate and partially edentulous arches. Virtual occlusal records have shown promising results in terms of accuracy, with some studies reporting a high level of agreement with traditional methods. Key factors influencing the accuracy of VOR through intraoral scanners were identified which encompass multiple parameters such as scanner brands, imaging technology, scan quality, best-fit alignment, software algorithms, intermesh penetrations, and the number of sections and dimensions of the virtual occlusal record. In partially edentate areas, the lack of landmarks in the edentulous area compromises the accuracy of VOR, thus limiting the use of IOS in patients with missing teeth. Understanding and recognizing these influencing factors will increase the predictability and reliability of dental treatments completed by using digital workflows. However, certain challenges need to be addressed which can influence its accuracy and limit its use in daily practice. Future research should focus on improving these factors to enhance the clinical applicability of virtual occlusal records.

3D printing technology to produce intraoral stents for head and neck radiotherapy: A scoping review.

Radiotherapy remains one of the main treatments for head and neck cancer; however, it is accompanied by acute and chronic adverse effects. Use of three-dimensional (3D) oral stents to modulate radiation intensity to specific target areas have been developed to minimize these adverse effects. This study aimed to present a scoping review of studies published on 3D printing of oral stents and their clinical applicability. MEDLINE/Pubmed, Scopus, Web of Science and CENTRAL Cochrane data bases were searched, studies selected, and data collected by three independent reviewers up to December 2022. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis-Extension for Scoping Reviews (PRISMA-ScR). The search resulted in 404 studies and 5 articles fulfilled the eligibility criteria and were considered for this review. Three-dimensional printed intraoral stents were produced for 56 patients with indication for radiotherapy. 3D-printed stents were well-tolerated by all tested patients and demonstrated great reproducibility of maxillomandibular relation, required less time for production and lower cost to manufacture. Two studies showed great protection of healthy tissues with 3D-printed stents during radiotherapy. Three-dimensional printing is promising for production of intraoral stents, however, more studies are needed to improve the technique and further investigate the safety and prevention of oral toxicities from radiotherapy.

Efficacy of a modified twin block appliance compared with the traditional twin block appliance in children with hyperdivergent mandibular retrognathia: protocol for a single-centre, single-blind, randomised controlled trial

IntroductionCompensatory mouth breathing, caused by nasopharyngeal obstructive diseases, is the main cause of hyperdivergent mandibular retrognathia in children. Such deformities require effective growth guidance before pubertal growth peaks. The traditional...

Altered reverse impression method involving extraoral digitalization of a verification jig for the fabrication of implant-supported prosthesis by using a complete-digital workflow.

The reverse impression method involves the extraoral digitalization of the interim implant-supported prostheses and intraoral digitalization of antagonist arch and maxillomandibular relationship. This technique allows the fabrication of implant-supported prostheses by using a complete-digital workflow. The scan analogs make the reverse impression method feasible. However, this method may not be recommended if the interim polymethyl methacrylate prosthesis does not have passive fit. The present manuscript describes an altered reverse impression technique that involves the extraoral digitalization of a conventional verification jig, which has attached scan analogs. With this technique modification, the implant positions captured using the verification jig are used to obtain the virtual definitive implant cast and fabricate the definitive implant-supported prosthesis.

[Rehabilitation of complete edentulism and temporomandibular joint].

Rehabilitation of complete edentulism is naturally related to temporomandibular joint (TMJ) since the proper functioning of complete denture depends on the normal movement of TMJ. This review briefly introduced the design of occlusion in complete denture, characteristic of different occlusal patterns, and key points in registration of maxillomandibular relationship and occlusal adjustment. This review emphasized the significance of complete denture restoration to the health of TMJ.