CHAPTER 12

using the same criteria; this generally takes

only a few additional adjustments.
Once the appliances occlusion is adjusted,
contour the sides of the appliance. Patients
generally appear not to need more than
7 mm for their anterior guidance, so remove
any unnecessary portion of the guidance
ramp. Most patients also seem to prefer to
have the line angles of the occlusal surface
rounded and the buccal and lingual
occlusogingival curvature similar to the tooth
that it covers.
If any portion of the appliances sides are
thicker than 1 mm, consider thinning these
areas, especially if the patient plans to wear
the appliance during the day. Thinner flanges
make the appliance feel less obtrusive and
enable the patient to speak better when
wearing the appliance.
Once the appliance is adjusted satisfactorily,
ask the patient to insert it. Inform the patient
that it will be smoothed further, but that you
want to ensure that the posterior teeth hit the
appliance as evenly as possible and determine
whether the patient knows of anything that
can be done to make the appliance more
comfortable. Once the appliance meets with
the patients approval, smooth its sides and
ask whether it feels satisfactorily smooth.

Maxillary Acrylic Stabilization Appliance

The principles for the maxillary appliance are
almost identical to those for the mandibular
appliance. There are two prominent
differences: (1) the excursive movements are
in the opposite directions on the appliance, so
the anterior guidance ramp will be lingual to
the anterior teeth; and (2) the opposing
supporting cusps that provide the appliances
posterior centric contacts are the maxillary
lingual cusps for the mandibular appliance,
whereas they are the mandibular buccal cusps
for the maxillary appliance.

STABILIZATION APPLIANCE

179

For the fabrication of this appliance, make

impressions of the maxillary and mandibular
teeth and an interocclusal record. Once the
laboratory has fabricated the maxillary acrylic
stabilization appliance, attempt to insert it
into the patients mouth with a moderate
amount of force. If the appliance does not
seat fully or causes an uncomfortable pressure,
then its internal surface needs to be adjusted.
After the appliance seats fully and fits
comfortably, the mandible is manipulated into
the desired position and the appliances
occlusion is adjusted. Using two sheets of
black Accufilm, mark the centric contacts,
repeatedly adjusting the marks so at least one
centric mark from each posterior tooth and
light to no marks from the anterior teeth are
obtained. The canine marks may be in
harmony with the anterior or posterior marks
(Figure 12.26).
While adjusting the occlusion, practitioners
may find it necessary or more expedient to
reline a portion of the occlusal surface. While
obtaining the desired centric contacts,
periodically ask the patient to close on the
appliance and to say whether the left or right
side hits first or harder. Adjust the appliance
so the patient feels that both sides hit evenly
and each side of the appliance has uniform
centric marks independent of the other side.
After obtaining the desired centric contacts,
adjust the excursive movement. The appliance
should allow the patient to easily slide the
mandible into the excursive positions,
disoccluding the posterior teeth with the
closest posterior contact being 1/21 mm from
the appliance. Prior to initiating the excursive
movement adjustments, observe the distance
the posterior teeth separate as the patient
slides the mandible into these positions. This
provides an estimate of how much the
anterior guidance ramp will need to be
adjusted in each direction.
Mark the excursive movements with two
sheets of red Accufilm and ask the patient to