Occlusion Rims Research Articles

Simple technique to transfer occlusal vertical dimension and articulate a definitive implant cast for a full arch implant prosthesis

Papaspyridakos and Lal Papaspyridakos and Lal The dental literature is replete with techniques for registering maxillomandibular relationships and transferring them accurately to the articulator. For edentulous patients receiving implants, several methods have been described for articulating the definitive implant cast at the appropriate occlusal vertical dimension (OVD) in the centric relation (CR) position.1-6 Techniques available for mounting the definitive implant cast on the articulator include record bases with occlusion rims supported by the healing abutments, or screwretained record bases.1,2 Other options involve the use of a duplicated denture with acrylic resin as a custom impression tray, or even a duplicated denture with vinyl polysiloxane (VPS). 3-6 A time-saving chairside technique is presented for the articulation of the implant definitive cast, maintaining the established OVD, and subsequent fabrication of a silicone index to assist in prosthesis design, both performed in a single visit. The existing denture can then be easily converted into an interim fixed prosthesis on the articulator, thus minimizing chair time and increasing patient comfort and satisfaction.

Simplified versus comprehensive fabrication of complete dentures: Patient ratings of denture satisfaction from a randomized crossover trial

OBJECTIVE: To determine if patient ratings of their ability to chew are dependent on the method of complete denture fabrication. METHOD AND MATERIALS: Twenty edentulous patients participated in a randomized within-subject crossover trial. Each participant received 2 sets of new complete dentures. One pair (Gerber prosthesis) was manufactured based on tracings (to determine centric relation) and facebow transfer; semianatomic teeth with a lingualized and balanced occlusal pattern were used. The other set of complete dentures was made using a simplified procedure without facebow transfer; jaw relations were recorded with wax occlusion rims, and anatomic teeth were set with a canine and premolar guidance (Gysi prosthesis). The 2 dentures were delivered in randomized order, and each was worn for 3 months. Three months after insertion, patients' ratings of each new prosthesis were obtained on visual analog scales for general satisfaction, comfort, ability to speak, stability, esthetics, ease of cleaning, and ability to chew. RESULTS: Patients rated their general satisfaction, stability, and esthetic appearance significantly better for the Gysi prostheses ( P > .05). No significant differences between the 2 denture treatment methods were detected for ability to speak, comfort, chewing ability, and the ease of cleaning the dentures. CONCLUSION: A comprehensive method for the fabrication of complete dentures using lingualized teeth does not appear to positively influence patient ratings of denture satisfaction when compared to a simple procedure with anatomic teeth.

Investigation of Vertical Distance between Incisive Papilla and Incisal Edge of Maxillary Central Incisors

The aim of the present study was to determine the vertical distance between maxillary central incisors and incisive papilla. The vertical distance between incisal edges of maxillary central incisors and the centre of the incisive papilla was measured by a digital caliper on the stone casts that were obtained from dentate subjects. The mean vertical distance between maxillary central incisors and incisive papilla on the stone casts was 6.70+/-0.81 mm. The vertical distance range was 5.51 mm to 8.89 mm. The clinical relevance of this study lies in application to complete denture construction. The dentist and laboratory technician can be use the results of this study as a guideline in fabrication of maxillary occlusal rims and in determination of the position of the occlusal plane with the reference of other anatomical landmarks together. However, the wax rim should be modified intraorally to incorporate individual characteristics and the anterior tooth should be arranged on modified wax rim.

Transferring the existing occlusal vertical dimension using a duplicate denture

aClinical Lecturer, Biologic and Materials Sciences, Division of Prosthodontics. bProfessor, Biologic and Materials Sciences, Division of Prosthodontics. (J Prosthet Dent 2007;98:68-69) 1 A, Three-mm-high healing abutments in place. B, Close tray impression copings. In patients for whom a fixed complete denture is required, different techniques are described to determine the occlusal vertical dimension such as rigid, stable, and accurate record bases1, gold cylinders,2,3 healing abutments, and others.4 This article describes a procedure using a duplicated complete denture to replicate the occlusal vertical dimension in a patient with implants. Several techniques were used to determine the accuracy of this procedure, including determining the occlusal vertical dimension after the fabrication of new record bases and occlusal rims and measurements using extraoral landmarks. After using these techniques, it was determined that the procedure presented produced an accurate occlusal vertical dimension for the patient presented.

Effect of denture fabrication and wear on closest speaking space and interocclusal distance during deglutition

The accuracy of assessing maxillomandibular relationships for trial bases and dentures using phonetic and swallowing methods has not been compared to that observed with definitive prostheses. Thus, there is no evidence to prove whether measurements obtained through such methods remain the same after adaptation to dentures. This study investigated changes in the closest speaking space, interocclusal rest space, and interocclusal distance during deglutition in edentulous patients during and after complete denture treatment. Eighteen edentulous subjects participated in this study and measurements were performed after 7 intervals of time: (1) with occlusion rims and record bases following creation of the maxillomandibular relationship record, (2) with trial dentures, (3) at insertion of definitive complete dentures, (4) 1 week, (5) 2 weeks, (6) 1 month, and (7) 3 months after insertion. Recordings of interocclusal distances were made with a mandibular kinesiograph. Closest speaking space was measured during the pronunciation of the word 'seis'. The distance between postural rest position and centric occlusion, or interocclusal rest space, was measured using a kinesiograph. Interocclusal distance during deglutition was tested by recording the closest mandibular position recorded during swallowing of 20 mL of water. Data were analyzed using repeated-measure ANOVA, followed by the Student-Newman-Keuls test (alpha=.05). A significant (P<.01) reduction in the mean closest speaking space was found when it was evaluated using occlusion rims and record bases (4.6 mm) compared with other stages (3.0 to 3.4 mm). No significant differences were found in mean interocclusal rest space and interocclusal distance during deglutition among the time periods evaluated. The presence of occlusion rims can influence mandibular position during pronunciation of the /s/ sound. The arrangement of artificial teeth changes the closest speaking space. However, rest position and deglutition were not affected, either during denture fabrication or short-term use.

Patient ratings of chewing ability from a randomised crossover trial: lingualised vs. first premolar/canine‐guided occlusion for complete dentures

Complex procedures involving a facebow transfer and the use of lingualised teeth are deemed to have a positive influence on the chewing ability with complete dentures. To determine if patients' ratings of their ability to chew depend on the method of complete denture fabrication. Edentulous patients (n = 20) participated in a within-subject crossover trial. Each patient received two sets of new complete dentures. One pair was manufactured based on intraoral tracing of centric relation and facebow transfer; semi-anatomical teeth with lingualised occlusion denture (LOD) were chosen. The second pair was made using a simplified procedure without facebow transfer; jaw relations were recorded with wax occlusion rims, and anatomical teeth with a first premolar/canine-guidance (CGD) were selected. The dentures were delivered in randomised order, and each was worn for 3 months. Three months after delivery, patients' ratings of each new prosthesis were recorded on visual analogue scales for their ability to chew seven index foods. Repeated measurements analysis of variance was performed to investigate possible carry-over effects accounting for confounding by treatment period. When comparing the two treatments, participants rated their ability to chew in general, to masticate carrots, hard sausage, steak and raw apple in particular, was significantly better with the CGD (anatomical teeth) than with the LOD (p < 0.05). Comprehensive methods for the fabrication of complete dentures including semi-anatomical lingualised teeth and a full registration do not seem to influence the perceived chewing ability, when compared with more simple procedures. Chewing ability for tough foods appears to benefit from the use of anatomical teeth.

Comparison between skeletal, and facial measurements of vertical dimension in edentulous patients

Background: The use of dots on the nose, and chin as markers for measuring occlusal vertical dimension is common in complete denture construction. Therefore, it is important to evaluate the accuracy of facial measurements while assessing occlusal vertical dimension in edentulous patients. Materials and methods: The study was carried out on 28 edentulous patients. Occlusion rims were constructed, a central bearing-screw attached to the lower occlusion rim, and a central-bearing plate was attached to the upper occlusion rim. Then the occlusal vertical dimension was increased at predetermined amount (3, and 5 mm) by counting the number of flutes of the central bearing screw, and the corresponding facial measurements recorded by the use of a caliper device to the nearest 0.1 mm. Results: It was found that 3 mm increase in skeletal height corresponded to mean facial increase of 1.81 mm and ranged between 1-3.5 mm, while 5 mm increase in skeletal height, correspond to mean facial increase of 3.56 mm and ranged between 2.1-5.3 mm. Conclusions: Alteration of vertical skeletal relationships is corresponding with less alteration in facial movement between reference marks above, and below the mouth. This suggests that depending on facial marks when assessing occlusal vertical dimension is not very accurate.

Occlusion recording device for dental implant-supported restorations

The accurate transfer of the interocclusal relationship is essential for providing ideal occlusion. In unilateral distal extension situations, it may be difficult to hand-articulate the casts accurately. In these instances, record bases and occlusion rims are generally fabricated. For implant-supported restorations, the record base can be screwed directly on the implant during the interocclusal recording procedure at a separate appointment. 1 Hobo S. Ichida E. Garcia L.T. Osseointegration and occlusal rehabilitation. Quintessence, Chicago1989 Google Scholar Generally, the record base is attached to the gold cylinders, 1 Hobo S. Ichida E. Garcia L.T. Osseointegration and occlusal rehabilitation. Quintessence, Chicago1989 Google Scholar the healing abutments, 2 Rungcharassaeng K. Kan J.Y.K. Fabricating a stable record base for completely edentulous patients treated with osseointegrated implants using healing abutments. J Prosthet Dent. 1999; 81: 224-227 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar or secured with the use of impression copings. 3 Savabi O. Nejatidanesh F. Interocclusal record for fixed implant-supported prosthesis. J Prosthet Dent. 2004; 92: 602-603 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar The advantage of these methods is that there is no displacement of the implant during the interocclusal recording procedure, so an accurate record can be made. However, this procedure can be time consuming and requires additional visits to the dental office; furthermore, patients may experience discomfort from procedures such as the repeated removal of the healing abutments.

A photo guide for arranging artificial anterior teeth

After establishing a preliminary vertical dimension of occlusion with the maxillary and mandibular occlusion rims, the labial surface of the rims is corrected to harmonize with the contours of the cheeks and lips. The dentist shapes the occlusion rims as accurately as possible to determine the desired amount of lip support. The dentist or a technician will preliminarily arrange the anterior teeth as guided by the wax contour. The appearance and feel of the trial denture is much different than that of an occlusion rim of wax alone. The trial insertion proceduresmay take additional time if it is necessary to reset artificial anterior teeth. This article presents a technique for using a photo guide of artificial anterior teeth to verify the form and size of the artificial teeth.

Effects of polymerization shrinkage on the interfacial stress at resin–metal joint in denture-base: A non-linear FE stress analysis

The purpose of this study was to investigate the effects of polymerization shrinkage on stress at the interface between resin and metal in removable dentures. Three-dimensional finite element models of a denture-base were studied, which consisted of acrylic occlusal rims with different heights and metal frameworks. A relaxation modulus of 1.5 GPa for the resin and a Young's modulus of 220 GPa for the metal were used as the material properties. Each model was constrained at the edge of the framework on the palatal vault. Surface-to-surface contact elements were used to calculate the interfacial stress in a direction perpendicular to the bond surface under a linear shrinkage ranging from 0.41 to 0.65%. The principal stress within the resin was also calculated. The maximum interfacial and principal stresses within the denture-base increased with resin shrinkage. Under the lowest linear shrinkage, the mean area percentages in the resin-metal joint that showed interfacial tensile stresses over 10 and 20 MPa were 63.4 and 0%, respectively. While under the highest linear shrinkage, these mean area percentages were 98.8 and 38.1%, respectively. Negligible differences in the stresses were shown by occlusal heights. The polymerization shrinkage level has a significant influence on the residual stress at the resin-metal interface. Enhancement of the bond strength on the interface can reduce the failure probability at a resin-metal joint.

A simple technique for marking the ala-tragal line

During complete denture fabrication, it is often necessary to use facial landmarks to assist in the proper contouring of the occlusion rims. One of the parameters in determining the maxillomandibular relationship is identification of the occlusal plane. This may be achieved by using an occlusal plane guide, which, after adequate and proper contouring of the maxillary occlusion rim, is made parallel to the Camper's plane 1 The glossary of prosthodontic terms. J Prosthet Dent. 1999; 81: 56-57 Google Scholar (ala-tragal line). Rough visualization of the ala-tragal line is a method of determining parallelism of the wax occlusion rim with the Camper's plane, but this may be difficult to determine when holding a ruler with one hand and attempting to keep it stationary. A simple, quick, and predictable method of visualizing the Camper's plane is proposed in this article.

Predicting vertical dimension with cephalograms, for edentulous patients

To provide information on vertical dimension (VD), occlusal plane (OP), and size of future occlusal rims, through lateral Rx and cephalometric tracings that analyse and compare hard and soft tissue. To show that these measures are compatible with methods routinely used to prescribe for full. Ten patients age range 53-81. Lateral Rx, with and without dentures, were taken and traced cephalograms were used to compare hard and soft tissue angles and planes. Based on three cephalometric analyses: Rickets, and McNamara for skeletal, and Legan-Burstone for soft tissue, to identify the following landmarks: 13 skeletal points: N, ANS, PNS, Me, Xi, Pm, FC, Or, Po, A, B, Co, Gn and four soft tissue points: G, Gv, Sn, Me'; seven skeletal planes: HP, FP, NF, N-ANS-Me, A-B, ANS-Me, Co-Gn, and three soft tissue planes: G-Sn, Sn-Me', Sn-Gv, and six angles: N-FC-A, ANS-Xi-Pm, INF, IMP, 6NF, interincisor angle. Stability in skeletal VD was observed with the proportion of 0.8 +/- 0.2 being present, between the middle third and lower third facial heights, N-ANS/ANS-Me. In addition, soft tissue proportion remained near 1, G-Sn,/Sn-Me. The length and position of first upper molar, upper and lower incisors were used to predict the OP. When compared with cephalograms of the same patient with dentures, similar measurements were observed. It was possible to provide information on skeletal, facial proportions, VD, OP, and rim size using cephalograms for edentulous patients.

Exploring the distance between upper central incisor edge and incisive papilla in Taiwanese population

Incisive papilla is a significant anatomical landmark in locating upper anterior teeth position in partial or complete and implant prosthetic denture fabrication procedure. The objective of this study is to find the relationship of central incisor and canine to incisive papilla of Taiwanese population. Eighty-one study casts are selected. All selected study casts are analyzed. The distance from the center of incisive papilla to the labial incisal one-third of central incisor is between 7.18 to 11.51 mm, with the mean of 9.21 mm: the line drawn between canines pass middle of the incisive papilla is 72.84%, and pass posterior of the incisive papilla is 4.94%, and 22.22% between middle and posterior of incisive papilla. The result of this study can be used as a guide line in fabrication of the maxillary occlusion rim in Taiwanese population.

Physiologic jaw relations and occlusion of complete dentures

The physiologic concepts of jaw relations and occlusion are based upon studies of dental and oral physiology. The procedures involved are divided into three parts: (1) jaw relations, (2) centric occlusion, and (3) the removal of premature contacts from the paths leading to centric occlusion. The constant function of swallowing saliva is the basis for establishing the mandibular positions and occlusion. In swallowing saliva, the mandible rises to its habitual closing terminal, then, as the saliva is forced backward into the pharynx by the tongue, themandible is retruded to its physiologic centric relation (Fig. 1). These are the mandibular movements that are used in determining the vertical dimension and the centric relation for complete dentures. In practice, the vertical dimension is established by first determining the length of the upper teeth on the occlusion rim and then making a tentative vertical dimension determination by using the free-way space technique, or any of the usual methods, and mounting the casts on an articulator. To establish the physiologic vertical dimension, the lower occlusion rim is reduced 3 mm, and a cone of very soft wax is placed on top of the shortened occlusion rim at the median line. The upper and lower occlusion rims are placed in the mouth, and the patient is requested to swallow several times. As the patient swallows, the soft wax is reduced to the natural and physiologic vertical dimension (Fig. 2).

Accuracy of adaptation of thermoformed poly(methyl methacrylate).

Thermoformed poly(methyl methacrylate) (PMMA) sheet is used to produce a number of different dental appliances such as stents, occlusal splints and baseplates for occlusal rims. The purpose of the present study was to measure the accuracy of adaptation of Perspex PMMA sheet and to determine the effect of annealing on the accuracy of the thermoformed specimens. The results of the study showed that PMMA can produce specimens that are accurately adapted to the cast. Immersion in water resulted in an increase in the space between the cast and the specimen for both thermoformed and thermoformed and annealed acrylic resin. Annealing of the thermoformed specimens had significantly less increase in space between the cast and the specimens when immersed in water over a period of 3 months.

PENGARUH DIMENSI VERTIKAL OKLUSAL YANG BERBEDA TERHADAP KEKUATAN KONTRAKSI OTOT MASSETER SUPERFISIALIS DAN TEMPORALIS ANTERIOR (Analisis Kegiatan Listrik Otot Pengunyahan Dengan Menggunakan Elektromiografi dan Program Lab View 4.1) (Laporan Penelitian)

Occlusal vertical dimension of full denture's patient should be determined correctly to achieve an optimal result in function including aesthetic aspect of the denture. Differences of occlusal vertical dimension may influence the strength of musculus masseter and temporalis contraction. Electromyography could showed isometric contraction of both musculus. The aim of this study was to evaluate the influence of different occlusal vertical dimension to the contraction of both musculus. Denture base occlusal rims and Electromyography Neuropack MEM-7132 K (NIHON-KOHDEN) with evaluation program software Lab View 4.1 were used. A quasi experiment was done on patient chosen at Phrostodontics Clinics Faculty of Dentistry University of Indonesia age range from 50 – 72 years old who need full denture. Occlusal vertical dimension was determined contraction of musculus masseter and temporalis were measured using EMG. Data were analysed using One Way (ANOVA) with 95% different or p < 0,05. The result showed that at the proper occlusal vertical dimension, the strength of the musculus masseter and temporalis was the highest in the comparison to the higher and lower occlusal vertical dimension. It can be concluded that occlusal vertical dimension has significant influence to muscle contraction especially musculus masseter superficial and musculus temporalis anterior.

軟質裏装材が床下組織の応力分布に及ぼす影響 接触要素を導入した有限要素解析

The stress and strain distributions in denture-supporting tissues when using a soft lining material were evaluated by the finite element method. The finite element model consisted of a mandibular occlusion rim, mucosa, cortical bone, and cancellous bone. Gap and truss elements were employed as the contact elements in order to simulate the dynamic behavior between the occlusion rim and mucosa.The results were as follows:1. By applying the contact elements to construct the contact relation between the occlusion rim and mucosa, the components of upward stress and strain in mucosa were eliminated. The displacement of the occlusion rim was minimized, although it was expected to be excessively increased by using the contact elements.2. The stress components in denture-supporting tissues under the occlusion rim with soft lining material were reduced and distributed more evenly than those without lining.3. The strain components in denture-supporting tissues under the occlusion rim with soft lining material were also reduced and distributed more evenly than those without lining.The results demonstrated that gap and truss elements are valid contact elements for the finite element analysis. Furthermore, they indicated that complete dentures lined with a soft lining material can relieve and distribute the stress and the strain in denture-supporting tissues.

無歯顎患者における下顎体高とこう合床の高さとの関連について

A rotational panoramic radiography was used for quantitative analysis of mandibular bone resorption, and measurement of mandibular corpus height by new device of the mandibular positioner was made possible. The purpose of this study was to make a comparison between the mandibular corpus height and occlusal rim height.Twenty edentulous patients whose maxillomandibular relations had been recorded were selected as subjects. Eight metal tubes were vertically placed in the occlusal rim of each subject at the crest of the mandibular corpus, and the occlusal rim height where the metal tubes were located was directly measured by a digital readout caliper.A rotational panoramic radiograph was taken, the magnification rate of metal tubes was estimated by calculating, and the relationships between mandibular corpus height and occlusal rim height were investigated. The low residual ridge group tended to show high occlusal rim height, whereas the high residual ridge group showed the opposite tendency.These results suggested that the occlusal rim height was influenced by the mandibular corpus height. The measurement of mandibular corpus height by rotational panoramic radiography might be useful to determine the occlusal plane of an edentulous patient.

Two-piece occlusion rim for screw-retained implant prosthesis.

The record base for a multiple, implant-supported, fixed prosthesis may be attached to the implants by screws. The screw attachment provides a stable record base for recording maxillomandibular relationships. Extraoral adjustment of the occlusion rim requires that it be unscrewed to allow removal from the mouth. The rim must be reattached with screws for the next intraoral evaluation. Although this cycle of removal and replacement provides stability, retention, and accuracy, it is time-consuming and inefficient. To resolve this problem, a two-piece record base/occlusion rim can be used. The screw-retained record base remains intraoral for the duration of the clinical appointment. The occlusion rim is designed to fit over the record base, with retention and stability, without screw retention. Use of the two-piece record base/occlusion rim facilitates convenient removal, adjustment, and replacement of the occlusion rim.

A new method to simplify and increase the precision of maxillary cast mounting procedures in fully adjustable or semiadjustable articulators

This study introduces a new impression procedure that permits mounting the maxillary stone cast in an articulator for any patient treatment and is applicable to any dental arch with any impression material. A transfer tray was designed that makes it possible to transfer the patient's maxillary impression to the articulator in a one-stage procedure without the need for making record bases and occlusion rims or the need to use a face-bow bite fork. (J Prosthet Dent 1997;77:219-24.)