Académique Documents
Professionnel Documents
Culture Documents
So
1
sL
We check Lhe verLlcal dlmenslon ln Lhe same way we place Lhe
upper and Lhe lower denLure ln Lhe paLlenLs mouLh we place a
reference polnL aL Lhe nose and Lhe chln measure aL resL wlLh Lhe
paLlenL relaxlng back M sound llck hls llps and sallow any way
Lo geL Lhem Lo relax and Lake dlmenslon aL resL
1hen puL Lhe denLure ln and Lell Lhem Lo close down and see how much
room Lhere ls beLween Lhe verLlcal dlmenslon of occluslon and Lhe
verLlcal dlmenslon aL resL
Many Llmes durlng Lhe [aw relaLlonshlp record appolnLmenL whlch ls
very long Lhe paLlenL geLs Llred and canL relax and your measuremenLs
would be lncorrecL lf you donL recheck Lhem aL Lhls sLage you mlghL
have a problem
WhaL do you do lf Lhe paLlenL doesnL have enoughLoo much free way
space?
?ou repeaL Lhe lnLerocclusal records and you reseL Lhe LeeLh oC
?ou deLermlne where Lhe problem ls ls lL ln Lhe upper arch Lhe lower
arch or ln boLh arches and dependlng on where Lhe error ls you reseL
Lhe LeeLh and someLlmes you even remounL ln Lhe wax Lryln denLure
we Lake a new cenLrlc relaLlon records and we remounL lL on Lhe
arLlculaLor
Pow can we check Lhe verLlcal dlmenslon of occluslon or Lhe correcL
amounL of free way space uslng speclflc Lypes of check durlng [aw
relaLlonshlp records we sald Lhere are number of phoneLlcs checks
whlch you can use
We sald LhaL LeeLh come LogeLher very closely durlng speaklng cerLaln
leLLers buL Lhey never Louch we Lalked abouL Lhe S sound Lhe CP
and Lhe ! usually we ask Lhe paLlenL Lo counL from 6070 ln Arablc or
Lngllsh qulckly lf Lhe paLlenL speaks and we look aL Lhe space beLween
Lhe canlne and Lhe premolar area lf Lhere ls a 1mm 13mm 2mm space
Lhen probably weve glven Lhe paLlenL enough free way space
lf Lhe paLlenLs LeeLh sLarL cllcklng LogeLher whlle speaklng Lhls means l
have Lo reseL Lhe LeeLh accordlng Lo whlch [aw ls lncorrecL
Lven lf you check lL ln [aw relaLlonshlp record you have Lo check lL ln wax
Lryln sLage because Lhere ls a dlfference beLween wax and LeeLh
LeeLh are smaller Lhan Lhe wax rlm Lhe wax rlm ls bulgy lL doesnL glve
Lhe paLlenL enough space Lo speak or funcLlon normally so Lhls ls a flne
Lonlng of our checks!
We have Lo check Lhe cenLrlc relaLlon record we usually do Lhls by
asklng Lhe paLlenL Lo llck Lhelr llps sallow and puL Lhe mandlble ln Lhe
posLerlor parL of Lhe mouLh we can gulde Lhe paLlenL by dolng
blmanual manlpulaLlon we puL our flngers aL Lhe buccal shelf area on
boLh sldes and we relax Lhe [aw and Lell Lhe paLlenL Lo close aL Lhls
cenLrlc relaLlon poslLlon
We sald one of Lhe cenLrlc relaLlon poslLlon ls LhaL lL ls a repeaLable
poslLlon
As long as Lhe paLlenL closes aL Lhls poslLlon Lhe sLarL polnL he wlll
always open and close aL Lhls polnL
1he way LhaL you know LhaL Lhe denLure ls correcL ls LhaL Lhe paLlenL
always opens and closes ln Lhls poslLlon when Lhe [aw ls relaxed
lf you Lell Lhe paLlenL Lo open and close and Lhen he closes ln a more
posLerlor poslLlon ln Lhe wax Lryln denLure LhaL means LhaL Lhe record
LhaL you Look ln [aw relaLlonshlp record ls lncorrecL
lf Lhe paLlenL closes Lo one slde or Lhe oLher LhaL means LhaL Lhe record
you Look aL [aw relaLlonshlp record ls lncorrecL
AnoLher reason for problem for Lhe cenLrlc relaLlon record ln Lhe wax
Lryln denLure ls noL someLhlng LhaL you dld ln Lhe cllnlc lL could be when
Lhe denLal Lechnlclan mounLed Lhe casL on Lhe arLlculaLor Lhe mounLlng
was lncorrecL wheLher we pald aLLenLlon or noL someLlmes Lhe casLs
or Lhe lnLerocclusal wax can shlfL sllghLly Lhere are many areas LhaL
can hurL ln Lhe lab ln addlLlon Lo Lhe ones ln Lhe cllnlc so Lhe mounLlng
wlll be lncorrecL Lhe seLLlng lncorrecL and so Lhe cenLrlc relaLlon and
Lhe horlzonLal records golng Lo be lncorrecL also
lf Lhe LeeLh are closlng on one slde and we have a space on Lhe oLher
LhaL means we have problems wlLh Lhe cenLrlc relaLlon records LhaL
means we have Lo repeaL Lhe lnLerocclusal cenLer relaLlon record and
reseL Lhe LeeLh agaln beLLer Lo do lL now Lhan afLer we process Lhe
denLure
We can puL a speclal Lype of wax on Lop of LeeLh elLher on Lhe upper or
lower arch usually we use a speclal Lype of wax Lhe problem of
modellng wax whlch you use ln Lhe lab ls LhaL when you heaL lL up lL
Lakes a long Llme Lo heaL up and a long Llme Lo cool down whlch
means lL sLays sofL for a long Llme whlch ls good ln Lhe lab because you
need Llme Lo puL Lhe LooLh ln Lhe rlghL poslLlon ln Lhe cllnlc l need Lhe
paLlenL Lo close and Lhe wax Lo cool down rlghL away because lf Lhe
paLlenL closes and Lhe wax ls sLlll sofL maybe afLer Lhey close down Lhe
[aw wlll shlfL sllghLly Lo Lhe lefL or Lhe rlghL or forward
1o be honesL ln Lhe cllnlcs Lhey use Lhe same wax Lhey use ln Lhe lab
whlch can creaLe error Lhere are speclal waxes and lnLer occlusal
records whlch are made of speclal waxes or slllcon LhaL heaL up and cool
down qulckly and Lhey are rlgld maLerlals Lhe example LhaL l gave you
durlng [aw relaLlonshlp records ls a wax called Alu wax whlch ls a
greenlsh gray Lype of wax lL looks almosL meLalllc because lL ls regular
wax buL mlxed wlLhln lL alumlnum powder wax ls poor heaL conducLor
buL alumlnum ls a beLLer heaL conducLor so when you heaL lL lL
becomes llquld almosL lmmedlaLely and also when you puL lL ln Lhe
paLlenLs mouLh lL also cools down almosL lmmedlaLely ln abouL 310 sec
so Lhere wlll be no chance of mlsLake or Lo shlfL Lo lefL rlghL or
forward we have Alu wax lnLerocclusal reglsLraLlon slllcon and we
have blLe reglsLraLlon ZCL noL llke Lhe one LhaL we use for lmpresslons
we have speclal ZCL for blLe reglsLraLlon ZCL LhaL ls used for Lhls seLs
ln abouL 30 sec noL Lhe same as Lhe one used for lmpresslons mosL of
Lhe maLerlals LhaL are used for lmpresslon could be used for [aw
reglsLraLlons as well buL Lhe dlfference ls LhaL one of Lhem seLs fasL and
Lhe oLher Lakes more Llme
We ask Lhe paLlenL Lo close down before Lhe LeeLh Louch Lhe problem
LhaL l have ls LhaL Lhe denLure has a relaLlve movemenL and whaL
conLrols Lhe poslLlon of LeeLh ls Lhe gum and Lhe LeeLh Lhemselves lf l
ask Lhe paLlenL Lo close hls mouLh and Lhe LeeLh lnLerfere for example
one cusp on Lhe Lop Louches Lhe lower cusps on Lhe boLLom Lhe base
of Lhe denLure ls noL LhaL much sLable because lL sLands on sofL Llssues
and Lhe LeeLh are hard now Lhe paLlenL closes down and Lhe cenLrlc
relaLlon LhaL we made ln Lhe wax Lryln denLure ls noL correcL
When Lhe paLlenL closes down (normally) Lhe Llp of Lhe cusp ln Lhe fossa
lnsLead of LhaL whaL happened ln our case ls LhaL Lhe Llp meeLs Lhe Llp
lf Lhe cenLrlc relaLlon ln Lhe mouLh ls noL Lhe same as we made ln Lhe
wax Lryln denLure Lhe paLlenL wlll close down and Lhe cusp Llp wlll close
on an lncllne Lhe LeeLh lnslde Lhe denLure wonL be movlng Lhe
weakesL llnk here wlll move whlch Lhe mandlbular denLure lL wlll
move Lo flL Lhe LooLh
8uL Lhe movemenL ls so small l canL see lL and we say oh lL ls greaL
buL now Lhe flLLlng ls beLLer Lhan ln Lhe wax Lryln denLure! 1he
permanenL acryllc ls golng Lo be more flrm and sLable ya3ne afLer
processlng when Lhe paLlenL closes down Lhere wlll be no where for Lhe
rlgld denLure Lo move and Lhen hls LeeLh wonL close properly
lL was good ln Lhe wax Lryln buL Lhe mlsLake ls now vlslble ln Lhe
denLure dellvery
So how can l do Lhe record keeplng Lhe facL LhaL Lhe bases are relaLlvely
loose or noL very sLable aL Lhe wax Lryln sLage? whaL you do ls noL a
cenLrlc record you make a precentric record l ask Lhe paLlenL Lo blLe buL
before Lhe LeeLh Louch wlLh 03mm Lo sLop LeeLh from Louchlng so LhaL
Lhey wonL move Lhe denLure because of Lhelr lnLeracLlon we wanL Lo
prevenL Lhe LeeLh from lnLerdlglLaLlng wlLh each oLher so before Lhe
LeeLh Louch we sLop Lake Lhe LeeLh ouL wlLh Lhe wax beLween Lhem and
l remounL lL on Lhe arLlculaLor so lf Lhere ls a mlsLake ln Lhe LeeLh
seLLlng l do a percenLrlc record and you wlll learn ln Lhe dellvery as
well Lhere wlll be a precenLrlc record
%
?ou may ask yourself when l dld Lhls Lhe paLlenL dld noL close all Lhe way
down Lhen here l lncreased Lhe verLlcal dlmenslon 031 mm you
wlll learn ln Lhe lab Lo flx Lhls problem l elevaLe Lhe pen of Lhe
arLlculaLor 03mm
So Lhe precenLrlc record ls Lo avold Lhe shlfLlng of Lhe wax Lryln
denLures whlch are noL as sLable as Lhe flnal denLures Lhey are called a
Lype of check records so Lo assess and Lo make sure LhaL Lhe cenLrlc
relaLlon ls correcL
And usually l avold all Lhe grooves ln Lhe buccal and Lhe llngual l [usL
wanL Lhe cusp Llps l donL wanL Lhe wax LhaL ls beLween Lhe LeeLh Lo
lnLeracL and make problems
We ln Lhe lab dld noL make any exLrlnslc records we only made Lhe
cenLrlc records we used Lhe arLlculaLor as a hlnge (opens and closes
only) buL we know LhaL mosL of our paLlenLs chew Lhey donL [usL open
and close some paLlenLs are choppers and some are chewers some
eaL llke crocodlles and some eaL llke cows respecLlvely
MosL people chew we move rlghL and lefL ln naLural we have a
worklng slde and nonworklng slde buL ln arLlflclal LeeLh we have a
worklng slde and a balanclng slde slmply lf you ln Lhe denLure chew ln
one slde Lhe oLher slde would have a space and fall down lf Lhere ls no
conLacL and we dld only cenLrlc sLaLlc record we dld noL make a
proLruslve record whaL can l do? l can Lake Lhe proLruslve rlghL and
lefL records exLrlnslc aL Lhe wax Lryln sLage
AfLer l seL Lhe LeeLh l puL Lhe denLure ln Lhe paLlenLs mouLh l puL
wax beLween Lhe [aws l ask Lhe paLlenL Lo proLrude hls lower [aw 3 6
mm edge Lo edge
ChrlsLensens phenomena ls a phenomena ln whlch when Lhe lower [aw
moves forward and because Lhe condyle ls lnslde Lhe glenold fossa
Lhe condyle wlll come forward and downward LeeLh Louch ln Lhe fronL
ln Lhe back we wlll have a Lrlangle whlch ls wlder ln Lhe back and
narrower ln Lhe fronL Lhls space ls called ChrlsLensons phenomena why
%
ls lL useful for me? 8ecause dependlng on how sLeep Lhe angle ls Lhe
condyle comes down Lhe Lrlangle wlll shape
Lveryone has a dlfferenL condyle angle whlch wlll vary Lhe amounL of
angle ln ChrlsLensons phenomena
1he Lrlangle wlll be blgger ln paLlenLs wlLh greaLer condyler guldance
emlnence and paLlenLs wlLh less condyler guldance emlnence Lhe space
wlll be less because Lhe condyle wonL come down LhaL much
Pow Lo know Lhls angle of Lhe condyle wlLhouL havlng Lo open Lhe
paLlenLs face? We can do lL wlLh CAu CAM scannlng buL lL ls noL
pracLlcal for every paLlenL and unhealLhy 8u1 Lhere ls a very slmple
way we puL wax beLween Lhe LeeLh and ask Lhe paLlenL Lo move
Lhelr [aw forward and Lo blLe down Lhe wax wlll flll Lhe space beLween
Lhe upper and Lhe lower [aw fllllng Lhe space creaLed by ChrlsLensons
phenomena
Lvery paLlenL wlll have a dlfferenL shape of wax dependlng on Lhe
condyler angle l can Lake Lhls angle and ad[usL lL on Lhe arLlculaLor
Lab3n Lhls cannoL be done on our arLlculaLor whlch ls seL up aL 30
8uL lf l have a semlad[usLable arLlculaLor where Lhe condyler angle can
change l puL Lhe wax on Lhe arLlculaLor and rlse and lower Lhe angle unLll
lL ls equal Lo Lhe amounL of wax ln Lhe denLure
lL ls someLhlng LhaL you are golng Lo see ln Lhe lab buL you should
undersLand LhaL we Lake advanLage of ChrlsLensons phenomena Lo
reglsLer someLhlng LhaL ls called proLruslve exLrlnslc record
now afLer l seL Lhe whole LeeLh l loosen Lhe condyles on Lhe arLlculaLor
and move Lhe lower [aw Lo Lhe rlghL and Lhe lefL and forward l have Lo
go back and ad[usL each LooLh so lL Louches on Lhe rlghL slde and Lhe lefL
slde aL Lhe same Llme so LhaL l would have a worklng slde and a
balanclng slde
We donL do Lhls here aL !uS1 because you are uslng average value
arLlculaLor you have Lo know Lhe sLeps because everywhere else
especlally ln Lhe wesL Lhey do lL
MosL of Lhe Llme LeeLh donL look naLural you can do Lhls sllghL
modlflcaLlon Lo produce lrregularlLy mosL of Lhe Llme we see
lrregularlLy ln Lhe upper laLeral lnclsors and Lhe lower anLerlor LeeLh
As long we donL affecL occluslon and we have Lhe balance you can make
Lhose modlflcaLlons because lL ls beLLer Lhan lf you donL
1he lasL Lhlng we do durlng wax Lryln ls Lhe posLerlor palaLal seal Lhe
vlbraLlng llne ls aL Lhe end of Lhe posLerlor palaLal seal we can do lL aL
a prevlous sLage and we wlll Lalk abouL Lhls ln Lhe lab!
Pow we do lL?
l have a casL LhaL have a flaL posL dam Lhe denLure ls golng Lo Lake Lhe
same shape as Lhe casL we sald for reLenLlon l need perlpheral seal all
around Pow am l golng Lo have seal from behlnd posLerlor? we
have Lo cheaL a blL lf Lhe denLure was flaL lL ls noL golng Lo press on
Lhe vlbraLlng llne area! '-= '- " ` " -=' ~ as Lhe paLlenL blLes alr
wlll enLer from behlnd and Lhe denLure wlll fall
WhaL l do ls LhaL on Lhe casL l make someLhlng llke a spoon shaped l dlg
ln Lhe casL a hole LhaL looks llke a spoon deep posLerlorly and
shallower anLerlorly when we do Lhe denLure Lhls space ls golng Lo be
fllled wlLh wax and converLed Lo acryllc when we puL lL ln Lhe paLlenLs
mouLh Lhe end of Lhe denLure push Lhe sofL Llssues ln Lhe back
And we make lL deeper ln Lhe back Lhan Lhe fronL because posLerlorly
Lhe Llssue ls more compresslble
1he space ls spoon shaped from Lhe slde buL when l look from above
lL ls golng Lo be a buLLerfly shape because ln Lhe hamular noLch area
Lhere ls Lhe Lendons aLLachmenL for Lensor and laveLor vell palaLanl l
canL press Lhere Lhe area ls golng Lo be small 3mm wldLh and 3mm
lengLh
AL Lhe area of Lhe mld palaLlne raphe Lhe bone ls very Lhln l can make lL
wlde maybe 1mm and no deeper Lhan maybe 3mm
When l come Lo Lhe area aL Lhe mlddle of Lhe vlbraLlng llne where l am
golng Lo dlg lL ls compresslble moderaLely compresslble and very