interocclusal record instructions 1 · curved arrow). normal physiologic centric relation position...

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ITEMS USED FOR PROCEDURE:

1. Quick Drying Impression Tray Adhesive 2. Adhesive Brush 3. Baby Oil 4. Bowl of Warm Water 5. Bowl of Ice Water 6. Alcohol Torch 7. Matches or lighter 8. Bite-Trays (Panadent) 9. Soft Toothbrush10. Compound Stick11. Leaf Gauge (Panadent)12. Scissors13. Rubber Wheel on Mandrel14. Marking Ribbon and Holder15. Zip-lock Plastic Bags16. Cotton Roll17. 2x2 Gauze Pads18. Sharp Scalpel19. Bite Registration Material20. Paper Mixing Pad21. Cement Spatula

INTEROCCLUSAL RECORD INSTRUCTIONS

M Panadent Corporation580 S. Rancho Avenue • Colton, California 92324, USATel: (909) 783-1841 • USA & Canada (800) 368-9777 h 1210, 1211, 1230, 1231

These instructions apply to thefollowing items:

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Remove Panadent Bite-Trays from package.

Although Bite-Trays have been manufactured ina sanitary manner, trays should be sterilized priorto patient use. Sterilization of Bite-Trays may beby autoclave, chemclave or cold sterilizingsolution.

Paint Bite-Tray to be used with fast dryingimpression adhesive (e.g., Impergum) on bothsides in perforated areas only.

If maxillary cast of patient's teeth is available,place cast on Bite-Tray with incisors against up-turned anterior flange. Cut off extending portionof tray distal to second molars. Tray should coverfirst and second molars and distal extensionedentulous areas. Third molars should only beincluded if they are to be needed as bridgeabutments etc.

The first phase of maxillary registration is thesame (generic) as all types of interocclusalrecords (e.g., centric relation, protrusive as wellas lateral border).


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If maxillary cast is not available at time of recordmaking, place tray in patient's mouth to determinelength. Cut off distal end of tray extending beyondsecond molar areas.

Hold Bite-Tray with thumb and index finger atserrated areas on lateral edges of tray for placingtray in patient's mouth (arrows).

Remove any sharp edges of Bite-Tray withsandpaper disc, round stone, or abrasive rubberwheel.

Center tray laterally against patient’s maxillaryteeth with anterior up-turned flange restingagainst labial surface of incisors. Align midlinemark on up-turned flange with midsagittal ofmaxilla. With mandible retruded, have patient"bite down hard" on tray to adapt it to occlusalsurface of teeth (arrows).


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Mix bite registration paste. Spread about 1mmthick on maxillary side of tray in perforated areasonly.

Wipe off excess registration paste that flowsthrough perforations onto madibular side of traywith gauze pad.

Note: For patients with deep anterior verticaloverlap, (for example, class II div. 2), cutcompletely across perforated occlusal areas oftray on both sides just anterior to serratedgripping areas (arrow). Have patient "bite down"hard on tray to adapt it to teeth. This will causemetal to overlap in canine areas, thus allowingposterior teeth to come closer together.

After removing crushed tray from patients mouth,dry tray with compressed air.


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OPTIONAL: Dip entire bite tray briefly in bowl ofcold water before placing in the mouth.

Have patient use tongue to quickly lubricate teethwith saliva. Place loaded Bite-Tray in mouth andhold lightly against maxillary teeth (arrows).Instruct patient to tap mandibular teeth (inretruded position) against tray to assure tray isproperly repositioned.

While continuing to hold Bite-Tray in contact withmaxillary teeth (arrows) have patient open mouthslightly to separate mandibular teeth from tray.Hold tray against maxillary teeth in steady passivemanner until registration-paste hardens.

To remove Bite-Tray from patient’s mouth withoutwarping it, grasp tray with thumbs and indexfingers firmly on right and left flanges at premolararea; then shake tray vertically to break seal toteeth (arrows). Spraying mouth with cold watermay also be helpful in separating registration trayfrom teeth.

It is okay if maxillary occlusal and incisal contactsare made with the tray because tray is being heldin passive fashion against maxillary teeth.


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Trim excess material on maxillary side of Bite-Traywith sharp scalpel. Leave impressions of cusptips approximately 1mm deep. Also, remove anyhardened material that may have oozed out ontolower surface of tray.Note: If proper amount of registration paste wasused, above procedure is seldom necessary.

Remove all loose registration material fromocclusal areas with soft toothbrush under coldrunning tap water and dry record withcompressed air.

Clean all registration paste from patient's teethand face. Replace occlusal registration inpatient’s mouth to assure proper fit to maxillaryteeth. If registration does not fit perfectly to teeth,reline record with thin layer of registration materialor repeat total procedure using new Bite-Tray.

Place Bite-Tray in cold water (e.g. ice water) afew minutes to increase hardness of registrationmaterial.

Caution: Extreme care must be used whentrimming registration material to avoid warpingrecord.

Note: Magnification should be used to be sureall loose particles of material have been removedfrom record before proceeding.


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While rotating compound stick heat 3cm end untilstick begins to slump.

Spread hot compound about 2cm long and 1cmwide in anterior-posterior direction on Bite-Trayin area of mandibular incisors.

If compound should harden too quickly, reheatwith alcohol torch pressurized air stream.

Dry both sides of Bite-Tray thoroughly withcompressed air syringe. Especially dry loweranterior area of tray where hot compound is tobe added.

INTEROCCLUSAL RECORD (CENTRIC RELATION)

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Dip compound end of Bite-Tray about3-5 seconds in warm water (125°F / 40°C) totemper before placing in patient’s mouth.

While compound is still warm and pliable fitregistration to maxillary teeth. Hold tray againstmaxillary teeth with thumb and index finger ofone hand at lateral serrated areas of tray (bilateralarrows). Use thumb of other hand to hold lowerlip away from teeth. Place end of same thumbagainst labial surface of mandibular teeth.“Shake” mandible quickly two or three times whilepushing distally on lower anterior teeth to “break”muscle tension.

Have patient “relax jaw.” Continue to push distallywith forearm aligned in midsagittal plane ofpatient (this procedure may not be applicable forpatients with TMJ pain). Tell patient, “Do notbite, I will close your teeth for you”. Graduallyocclude teeth until mandibular incisors contactsoft compound (center vertical arrow) withoutposterior teeth touching tray.

As soon as mandibular incisors make properimpression in soft compound, instruct patient to“open your mouth quickly” (center arrow).Carefully remove tray from mouth withoutdisturbing soft compound.

Note: The following procedure is shown for righthanded operators. This should be consideredwhen done by left handed operators.

(If mandibular posterior teeth touching tray beforeanterior teeth touch compound, add morecompound to increase vertical dimension.However, keep vertical dimension to a minimumfor most accurate results.)


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Quickly harden compound by dipping Bite-Trayin bowl of cold water (e.g. ice water) for severalseconds.

It is recommended that a cotton roll, leaf gaugeor CR occlusal splint be placed between incisorsto keep posterior teeth separated to avoidneuromuscular reprogramming when record isnot in mouth.

Cut back excess cold compound with sharpstraight edged scalpel leaving mandibular incisorimpression no more than 1 mm deep (retrudedincisor registration).

Remove loose particles of compound fromretruded incisor registration with soft toothbrushand/or compressed air.


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Replace Bite-Tray in mouth to verify thatmandibular incisors were in most retrudedposition. If incisors can be made to touch behindoriginal indentions, warm compound with alcoholtorch and repeat procedure.

Check right and left sides of bite-tray with thickocclusal ribbon (e.g. .5mm) for absence ofmandibular posterior tooth contacts. If there iscontact, add more compound to increase verticaldimension and repeat procedure.

Note: If patient has unstable TM Joints, condylesmay go to higher position in fossae during brieftime patient is biting on hardened compoundregistration, thus causing lower posterior teethto come into contact with Bite-Tray.

Hold record firmly against maxillary teeth andhave patient tap mandibular incisors into retrudedcompound registration without assistance fromoperator to be sure index is comfortable,repeatable position for patient.

Note: Effects of head posture may be tested atthis time by having patient tip their head farbackward and far forward while tapping intoincisor registration to see if there are anydifferences.

Remove Bite-Tray from mouth and replace withcotton roll between incisors.

Note: There should only be mandibular incisaledge contact in compound (no labial or lingualcontacts).


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Add sufficient amount of bite registration paste(depending upon space between mandibularteeth and tray) to mandibular side of Bite-Tray tomake contact with mandibular posterior teeth.

OPTIONAL: Pending bite registration materialinstructions, dip entire tray 1-2 seconds in waterbefore placing in patient’s mouth.

Stand or sit behind patient (patient may be in asitting, straight up, 45°, or supine position). PlaceBite-Tray in patient's mouth and hold againstmaxillary teeth with index fingers at serratedflange areas (arrows). Have patient retrudemandible and place anterior teeth in retrudedcompound record. Instruct patient to hold teethin compound record with firm pressure, withoutclenching, until registration material hardens. (Itis important that patients do not clench whileregistration paste is setting in order to avoidflexing mandible and/or intruding lower anteriorteeth.) Do Not manipulate the mandible.

Note: The hardened anterior compound record(small horizontal arrow) represents apex of lateralborder movements and acts as a fulcrum. Largevertical arrows represent muscle forces whichseat condyles in superior anterior direction (smallcurved arrow). Normal physiologic centric relationposition may be defined as anywhere on the arcof closure with the condyles bilaterally seatedagainst the thin central bearing areas of theirrespective bi-concave discs in their most superior,anterior, medial position.


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Place cotton roll between teeth to keep posteriorteeth separated until record accuracy has beenverified.

Place record in a bowl of cold water (e.g. icewater) a few minutes to produce maximumhardness. Record can also be placed inrefrigerator to maximize hardness.

With sharp straight edge scalpel, cut back excessregistration material on mandibular side of trayuntil only cusp tip imprints about 1 mm deepremain.

Warning: must be used when cutting off excessregistration material to avoid warping or distortingthe record. (Handle record as though it were asfragile as an egg shell.)

To release mandibular teeth from registrationmaterial without warping tray; hold tray firmlyagainst maxillary teeth with fingers of both handsalong flanges (bilateral upward arrows); theninstruct patient to open mouth (downward arrow).In this way the chances of the teeth sticking inthe registration material and warping the Bite-Trayare greatly reduced.


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Remove loose registration particles from recordwith soft toothbrush under cold running tap water.

Dry centric relation record with compressed airand inspect finished product.

Note: Use magnification to be sure all loosematerial has been removed.

Replace finished record in patient's mouth andverify its accuracy.

Remove any artifacts from casts such as cusp orincisal edge impression perforations and bubbles.Fit previously made stone casts of patients teethinto impressions in centric relation record. If castsdo not fit registration impression in centric relationrecord, it is usually due to faulty casts rather thaninaccuracies in record, since record fit to teethwas verified.


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Clean residual material from patient’s face andlips with baby oil on a gauze pad.

If centric relation record is acceptable, place inair tight, zip-lock plastic bag with moist 2 x 2gauze pads soaked in sterilizing solution. Storerecord in protective cool place until ready for use.

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To make protrusive interocclusal record, firstrepeat figures 2-20 of interocclusal recordinstructions on a separate Bite-Tray to obtainregistration of maxillary teeth.

Verify fit of registration to maxillary teeth. Ifregistration does not fit perfectly, reline with thinlayer of fresh registration paste or discard record.Have patient practice retruding and protrudinghis/her “lower jaw” on command “forward” and“backward” so patient will understand thecommands when the anterior compound recordis made.

Note: Remove tray from mouth. Be sure to drylower side of tray with compressed air.

While rotating compound stick, heat about 3cmuntil stick begins to slump.

Spread hot compound approximately 1cm wideand 3cm long (on thoroughly dried Bite-Tray) inanterior posterior direction. Bring compoundanteriorly completely to flange.

INTEROCCLUSAL RECORD (PROTRUSIVE)

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Temper hot compound about 3 - 5 seconds inwarm water (125°F / 40°C) before placing inpatient’s mouth.

Note: The following procedure is shown for righthanded operators, which should be consideredwhen done by left handed operators.

Place upper-side impression carefully ontomaxillary teeth. Hold Bite-Tray firmly againstmaxillary teeth with thumb and index finger ofleft hand at second pre-molar flange areas(bilateral arrows). Place thumb of right handagainst mandibular incisors to hold mandible inmost retruded position (vertical arrow).

Have patient close slowly in most retrudedposition enough to make slight contact ofmandibular incisors with soft compound (arrow).

As soon as mandibular incisors contact softcompound, have patient immediately open mouth(vertical arrow). Note retruded impression ofteeth.

With teeth separated a few millimeters (arrow 1),have patient protrude mandible approximately 5-7mm(arrow 2).


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With mandible protruded (avoid lateral deviation),instruct patient to bring teeth slowly together untilmandibular incisors make impression in softcompound (vertical arrow).

Have patient open mouth immediately (arrow).Note two impressions in compound (retruded andprotruded).

Remove tray carefully from patient's mouth to avoidtouching pliable compound and distorting it.

Inspect protrusive compound record to see thatit is approximately 5 - 7mm anterior to retrudedimpression. If record is unsatisfactory, warmcompound with alcohol torch and repeatrecording procedure.

Dip anterior end of tray immediately into bowl ofcold water (e.g. ice water) to harden compoundquickly.


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With sharp straight edge scalpel, cut back excesscompound, leaving rather deep (3mm) protrusiveimpression of anterior teeth. (The reason forleaving the protrusive imprint deep is to help thepatient quickly relocate the recorded position withtheir mandibular incisors when the final stage ofthe recording is being done.)

Remove loose compound particles with softtoothbrush or air syringe.

Replace record in patient’s mouth to be sure itfits teeth. Make sure there are no mandibularposterior tooth contacts with Bite-Tray. Alsodetermine amount of registration paste neededto make contact between mandibular posteriorteeth and tray.

Check right and left sides with thick ribbon (e.g..5mm) for absence of mandibular posterior toothcontacts with Bite-Tray. If there is contact, addmore compound to increase vertical dimensionof record and repeat procedures.


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Dip tray briefly in cold water before placing inmouth.

Hold tray firmly against maxillary teeth bi-laterallyat pre-molar areas (arrows). Have patient placemandibular anterior teeth in protrusive index.Instruct patient to bite firmly in index untilregistration material hardens. Continue to holdtray against maxillary teeth while registrationmaterial is setting to prevent posterior end of trayfrom separating from maxillary posterior teeth.

To release mandibular teeth from registrationmaterial without warping tray; hold tray firmlyagainst maxillary teeth with fingers of both handsalong flanges (bilateral upward arrows); theninstruct patient to open mouth (downward arrow).In this way the chances of the teeth sticking inthe registration material and warping the Bite-Tray are greatly reduced.

Mix an adequate amount of registration paste.Apply to right and left mandibular posterior areasof Bite-Tray. (Add excess amounts for distaledentulous areas in order to contact ridge.)


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Cut back excess registration material with sharpscalpel, leaving impression of cusp tipsapproximately 1mm deep.

Remove loose registration particles with softtoothbrush under cold running tap water. Drywith compressed air. Inspect with magnificationto be sure all loose particles have been removed.

Place record in cold sterilizing solution. Sealrecord in Zip-lock bag with moist 2x2 gauze padsoaked in sterilizing solution. Store record inprotected cool place until ready to use.

Clean residual material from patient's face andlips with Baby Oil on gauze pad.24


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To make left lateral interocclusal record, firstrepeat figures 2-20 of interocclusal recordprocedure on a separate Bite-Tray to obtainregistration of maxillary teeth.

Verify fit of impression to maxillary teeth. Ifimpression does not fit teeth, impression mustbe relined or redone. If impression is acceptable,dry lower side of tray thoroughly with compressedair.

While rotating compound stick, heat 3cm end untilstick slumps.

Spread 3cm portion of hot compound onmandibular side of dry Bite-Tray at left canine areajust anterior to serrated finger grips on edge oftray.

INTEROCCLUSAL RECORD (LEFT LATERAL)

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Temper compound two or three seconds in warmwater before placing in patient's mouth.

Seat Bite-Tray registration completely againstmaxillary teeth and hold in place with thumb andindex finger of one hand at pre-molar flangeareas. Place thumb of other hand againstmandibular incisors and hold patient in retrudedposition with teeth separated. Instruct patient tomove mandible slowly to the left (arrow).

Stop lateral jaw movement about 3mm (caninetip to tip). Have patient close slowly untilmandibular canine makes imprint 2-3mm deepin soft compound (vertical arrow).

As soon as mandibular canine has madeapproximately a 3mm imprint in soft compound,have patient "open mouth" immediately (verticalarrow).


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Carefully remove tray from mouth. Hardencompound quickly by dipping registration in bowlof ice water. With sharp straight edge scalpel,remove all tooth imprints except canine cusp tip.Shave back canine imprints so it is between2-3mm deep.

Remove loose compound material with softtoothbrush under cold running water. Drycompound index with compressed air.

Clean all loose material from patient's teeth.Replace tray in mouth to make sure there are nomandibular posterior tooth contacts with tray.Have patient close into left lateral compoundindex to check fit of index to canine cusp tip.

Check both right and left sides to be sure thereis interocclusal space. A thick marking ribbon maybe used between mandibular teeth and tray tosee that there are no posterior contacts on eitherside. Also determine amount of registrationmaterial needed to make contact between trayand mandibular teeth.


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Place adequate amount of bite registration pasteon mixing pad.

Be sure to add more paste to Bite-Tray oncontralateral (non-working) side and positionpaste somewhat lingually to register molars oncontralateral side (arrows). Add more than usualamount of material to register any distaledentulous ridge areas.

OPTIONAL, depending on operating timeneeded. Dip Bite-Tray briefly in cold water beforeplacing in patient's mouth to accelerate settingtime of bite registration paste in mouth.

Fit upper side registration carefully to maxillaryteeth and hold tray firmly against teeth with thumband index finger at pre-molar areas. Place wristand forearm against patient's forehead (arrows)to stabilize head against head-rest on dentalchair. Instruct patient to move mandible to theleft and place mandibular canine in compoundindex.


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While patient holds mandibular left canine incompound index (fulcrum), the operator's indexfinger is placed under the angle of the mandibleto keep the condyle from subluxating while thethumb is placed against the lateral side of themandibular angle. The vector of force is in linetoward the ipsilateral (working) condyle. Operatorpushes with firm pressure upward and inwardagainst angle of mandible (small arrow) to inducemaximum Bennett shift. Hold with constantpressure against angle of mandible until pastehardens.

Dotted lines illustrate Bennett shift of condyles.Compound index prevents anterior teeth frommoving beyond 3mm and also acts as fulcrumpoint so that full Bennett path of condyles canbe achieved without posterior tooth interferences.

Note: The contralateral (non-working) condylemoves downward and forward while it movesmedially. While the ipsilateral (working) condylebasically shifts laterally.

Remove hardened record from mouth. Clean allresidual bite-registration paste from patient's face,lips and teeth with baby oil.

With sharp straight edge scalpel (Bard-Parker),cut back all excess material, leavingapproximately 1mm deep impressions of cusptips and/or edentulous ridge areas on both rightand left sides.


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Remove loose registration particles with softtoothbrush under cold running water.

Dry completed registration with compressed airand make final inspection.

Wrap finished record in sterilizing solution soaked2x2 gauze. Place in sealed plastic bag. Storebag in sturdy plastic box for protection until readyto use.


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Verify fit of upper impression to maxillary teeth.If impression does not fit teeth, impression mustbe relined or redone. If impression is acceptable,dry lower side of tray thoroughly with compressedair.

While rotating compound stick, heat 3cm end untilstick slumps.

Spread 3cm por tion of hot compound onmandibular side of dry Bite-Tray at right caninearea just anterior to serrated finger grips on edgeof tray.

To make right lateral interocclusal record, firstrepeat figures 2-20 of interocclusal recordprocedure on a separate Bite-Tray to obtainregistration of the maxillary teeth.

INTEROCCLUSAL RECORD (RIGHT LATERAL)

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Temper compound two or three seconds in warmwater before placing in patient's mouth.

Seat Bite-Tray registration completely againstmaxillary teeth and hold in place with thumb andindex finger of one hand at pre-molar flangeareas. Place thumb of other hand againstmandibular incisors and hold patient in retrudedposition with teeth separated. Instruct patient tomove mandible slowly to the right (arrow).

Stop lateral jaw movement about 3mm (caninestip to tip). Have patient close slowly untilmandibular canine makes imprint 2-3mm deepin soft compound (vertical arrow).

As soon as mandibular canine has madeapproximately a 3mm imprint in soft compound,have patient "open mouth" immediately (verticalarrow).


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Carefully remove tray from mouth. Hardencompound quickly by dipping registration in bowlof ice water. With sharp straight edge scalpel,remove all tooth imprints except canine cusp tip.Shave back canine imprints so it is between2- 3mm deep.

Remove loose compound material with softtoothbrush under cold running water. Drycompound index with compressed air.

Clean all loose material from patient's teeth.Replace tray in mouth to make sure there are nomandibular posterior tooth contacts with tray.Have patient close into right lateral compoundindex to check fit of index to canine cusp tip.

Check both right and left sides to be sure thereis interocclusal space. A thick marking ribbonmay be used between mandibular teeth and trayto see that there are no posterior contacts oneither side. Also determine amount of registrationmaterial needed to make contact between trayand mandibular teeth.


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Place adequate amount of bite registration pasteon mixing pad.

Be sure to add more paste to Bite-Tray oncontralateral (non-working) side and positionpaste somewhat lingually to register molars oncontralateral side (arrows). Add more than usualamount of material to register any distaledentulous ridge areas.

OPTIONAL, depending on operating timeneeded. Dip Bite-Tray briefly in cold water beforeplacing in patient's mouth to accelerate settingtime of bite registration paste in mouth.

Fit upper side registration carefully to maxillaryteeth and hold tray firmly against teeth with thumband index finger at pre-molar areas. Place wristand forearm against patient's forehead (arrows)to stabilize head against head-rest on dentalchair. Instruct patient to move mandible to theright and place mandibular canine in compoundindex.


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Dotted lines illustrate Bennett shift of condyles.Compound index prevents anterior teeth frommoving beyond 3mm and also acts as fulcrumpoint so that full Bennett path of condyles canbe achieved without posterior tooth interferences.

Note: The contralateral (non-working) condylemoves downward, foreward and medially whilethe ipsilateral (working) condyle basically shiftslaterally.

Remove hardened record from mouth. Clean allresidual bite-registration paste from patient's face,lips and teeth with baby oil.

With sharp straight edge scalpel (Bard-Parker),cut back all excess material leaving approximately1mm deep impressions of cusp tips and/oredentulous ridge areas on both right and leftsides.

The operator's index finger is placed under theangle of the mandible (pointing anteriorly) to keepthe condyle from subluxating while the thumb isplaced against the lateral side of the mandibularangle. The vector for inducing the Bennett shiftis in a line toward the ipsilateral (working) condyle.While patient holds mandibular right canine inindex, push medially with firm steady pressureagainst angle of mandible on contralateral (non-working) side to induce maximum amount ofBennett shift. Hold constant pressure againstmandible until paste is hard.


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Remove loose registration particles with softtoothbrush under cold running water.

Dry completed registration with compressed airand make final inspection.

23 Wrap finished record in sterilizing solution soaked2x2 gauze. Place in sealed plastic bag. Storebag in sturdy plastic box for protection until readyto use.


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interocclusal record instructions 1 · curved arrow). normal physiologic centric relation position...

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