qmul mclindent seminar a 14th september 2015 · interocclusal records for mounting working casts...
TRANSCRIPT
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Important things that we need to get right with Static Jaw
Registration
QMUL MClinDent Seminar A 14th September 2015
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What is the problem here?
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Jaw Registration – Removable
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Warren K. and Capp N. A review of Principles and Techniques for Making Interocclusal Records for Mounting Working Casts
Int J Prosthodont 1990; 3:341-348
May I suggest a
good paper on
the subject:
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Restorations conforming to existing
inter-cuspal relationship
• When enough tooth contacts and working conformatively most accurate record is with no intervening record (i.e. Hand-Help Articulation) Strohaver 1972
• The accuracy of the mounting can be improved by coating the posterior teeth with separating medium and rigidly ‘fixing them’ together with impression plaster Warren &
Capp 1990
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Restorations using existing intercuspal relationship
• Strohaver 1972 When enough tooth
contacts and working conformatively, the most accurate record is with no intervening Record (i.e. Hand-Help Articulation)
Strohaver R.A. A Comparison of articulator mountings made with centric and myocentric position records. J Prosthet Dent 1972;28:379-390
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The three-legged Stool
Take away one leg and it will fall down. I look at jaw registrations as returning one or more of the missing leg(s) to the stool. If the stool doesn’t fall down at the start then you
don’t need a jaw reg!
1992
2002
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How would you take your jaw registration to ensure that your chosen crown for LR6 is not
high or shy of occlusal contact?
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Beauty wax over the occlusal surface of
distal molar refine with Temp-bond
Kantor M.E. Silverman S.E. Garfinkel L. Centric relation recording
techniques - A comparative study J Prosthet Dent 1972;28:1165-1172
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Occlusal record packaged within safe environment for the UK post system
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How do I take a conformative Jaw Record?
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Take Away Message
• Accurate
• Stable at mouth temp
• Reproducable
• Verifiable
• Cheap
• Simple to use
• Simple to use in lab
• Simple to transport
• No bounce – solid material
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• No more use of the heated carding-wax sausage please from anyone in this room
• You need a material / wax that is absolutely firm at mouth temperature, dimensionally stable and allows simple verification
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Learning point: If the stool falls down you need to
put something between the teeth to ‘prop-it-up’
when the natural teeth are together in ICP
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Mrs R
Case Discussion
Clinical Examples
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Mrs R • Fit & well 45 year old
female • Existing maxillary bridges
10 years old • Bridges have never felt
comfortable but no acute pain
• In recent months fracture of porcelain off both bridges - metal now visible and unsatisfactory
Clinical Examples
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Mrs R • Why do you think that the
porcelain has fractured?
• What solutions can you suggest?
• What and where are the problems?
• How predictable will it be?
Clinical Examples
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Answers please Clinical Examples
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Mrs R Porcelain fracture
• Lack of metal support of porcelain
• Occlusal problem?
• Parafunctional activity?
Clinical Examples
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Mrs R Removing UL bridge
• Patients warned that we never know what might be found beneath the bridge(s)
Clinical Examples
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Removing PFMs – never tap off Clinical Examples
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Redo, Re-treat, Restore or Replace? • Where you are re-treating short teeth with limited
retention – consider PolyF as your temp cement of choice
Clinical Examples
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Mrs R Removing UR bridge
• Why has this happened and what’s the treatment?
Clinical Examples
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Jaw Reg for last molar in arch cases when removing / replacing occlusal coverage restorations
• Try and copy what you started – pre-op Index
• Do teeth in front first (if you can) • Leave part of the occlusal aspect
of the UR7 intact • Prepare more off the terminal
teeth to create the room? • Cement in high?
Clinical Examples
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Mrs R Try in & Fit of UL bridge
• Be prepared to adjust restorations in excursive movements
• However the static occlusal contacts should be very close / near
Clinical Examples
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Do we need to take a jaw registration and if so why?
Clinical Examples
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Clinical Examples
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• The interocclusal record needs only to cover the prepared teeth
• The record should not be supported by the soft tissues
• Can use many materials including: Waxes e.g.hard beauty wax, self-curing resins copings e.g. Duralay or silicones
• The jury is out as to whether one is better than the other
• It’s probably how well they are used
Quadrant Restoration (Removing one or two of the stool legs)
Kantor M.E. Silverman S.E. Garfinkel L. Centric relation recording techniques - A
comparative study J Prosthet Dent 1972;28:1165-1172
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Most of the time we need to use conformative jaw
registrations. Registration material should only be placed between your
preparations
Clinical Examples
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• Always taken at the vertical dimension you plan to place your restoration(s)
• Only exception is a Remount procedure or a pre-centric C/C check record
Principles of Working Jaw Registrations
1992
Clinical Examples
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I hope that this was helpful
The End Thanks for your attention and I hope you all
enjoy the rest of the conference