Fabr

the

com

Sivakumar Jayach

Presented at the Indian Dental Asso

aNHS and Private practice, BirminghbProfessor of Dental Education, FacUniversity of Manchester.

Jayachandran and Grey

ication of occlusal rims to record

maxillomandibular relation for

plete dentures

andran, BDS, MDSa andNicholas Grey, BDS, MDSc, DRD, MRD, FDS, RCS, PhDb

School of Dentistry, University of Manchester, UK

This article describes an alternative method to establish the inclination of the occlusal plane by using the hamular notch,incisive papilla plane. By using this plane, the fabrication of occlusal rims that conform to an ideal relationship maymake chairside trimming of the rims more straightforward. (J Prosthet Dent 2014;112:383-386)

1 Maxillary custom tray with lip supported handle.

Determination of the inclination ofthe occlusal plane is an important stepin the fabrication of equilibrated com-plete dentures.1 Various anatomiclandmarks have been reported to locatethe occlusal plane.2-5 Many of these arelocated on the soft tissues intraorallyand extraorally, and it requires clinicalexperience to use the landmarks becauseirregularities and asymmetry of the faceadversely affect their accuracy. Arbitraryuse of these landmarks to orient theocclusal plane may compromise thedefinitive prosthesis.6 The hamularnotch, incisive papillae plane (HIP),which can be marked on the cast, isreported to be parallel to the occlusalplane.6 The hamular notch is thepalpable notch formed by the junctionof the maxilla and the pterygoidhamulus of the sphenoid bone.7 Theincisive papilla is the elevation of softtissue that covers the foramen of theincisive or nasopalatine canal.7

This plane has been studied since1960 and proved to be parallel to theocclusal plane.8,9 This article describesa technique for making occlusion rimsby using the resting lip, HIP, corner ofthe mouth, and the retromolar pad.This method simplifies the modificationof the occlusal rim during the jaw

ciation Co

am, UK.ulty Assoc

relation procedure for complete den-tures and may also reduce clinical time.

PROCEDURE

1. Fabricate a maxillary custom trayfrom the preliminary cast with autopo-lymerizing acrylic resin (GC Ostron 100;GC Europe). Design the lip-supportedtray handle, which corresponds withthe approximate width, height, andinclination of the central incisors (Fig. 1).

2. Fabricate the mandibular cus-tom tray from autopolymerizing resin(GC Ostron 100; GC Europe). Designthe handle with the approximate shape

nference held at Tamilnadu, India, November

iate Dean for Teaching and Learning, National

of the future occlusion rim, which ex-tends from the canine to canine region(Fig. 2).

3. Evaluate the custom trays intra-orally for correct border extensions andensure that adequate lip support isachieved with the tray handles. Trim thehandles as needed.

4. Border mold the maxillary trayand make the impression (Aquasil ultratray material, Monophase; DentsplyCaulk). If the lip support is insufficientwith the tray handle alone, this can beimproved by adding elastomeric putty(Aquasil hand putty; Dentsply Caulk) tothe labial surface of the handle. Before

2004.

Teaching Fellow, School of Dentistry,

3 Tray handle modified with elastomeric putty for lip sup-port and anterior occlusal plane marked.

4 Mandibular anterior occlusal plane marked on trayhandle by using clinical reference.

5 Upper anterior reference (UAR) marked on the cast at3 cm distance from anterior occlusal plane.

2 Mandibular custom tray with handle, resemblinganterior teeth.

384 Volume 112 Issue 2

removing the impression from themouth,mark the incisal level in relation to theresting lip line with an indelible pencil(Dr Thompson’s Sanitary Color TransferApplicators; Great Plains Dental Prod-ucts Co Inc) (Fig. 3).

5. Once the mandibular impressionis made, mark the anterior height byusing the esthetic guidelines and thecorner of the mouth (Fig. 4).2,5

6. Pour the casts after beading andboxing (Hydrocal Denture ModelStone, Type III; Kerr, UK). Before sepa-rating the casts from impressions,measure a fixed distance from theincisal level markings (3 cm in the pa-tient shown) and mark it with anindelible pencil on the sides of the casts(for easier understanding, the referenceon the maxillary cast is named UAR and

The Journal of Prosthetic Dentis

on the mandibular cast is named LAR)(Figs. 5, 6).

7. Separate the casts from the im-pressions. On the maxillary cast, markthe deepest point of the hamularnotches and the center of the incisivepapilla. On the mandibular cast, mark,with an indelible marker, the junction ofthe anterior two-thirds and the posteriorthird of the retromolar pad.

8. Measure the distance from UARto the incisive papilla (2 cm in the pa-tient shown). Measure and mark thesame distance from the hamular notches onboth the sides of the cast (for easierunderstanding, this is named as upperposterior reference [UPR]). Join theUAR and UPR on both sides to form aplane. Note that this plane is paralleland 2 cm above the HIP and the

try

occlusal plane, if made parallel to thisplane, therefore, would be parallel tothe HIP (Figs. 7, 8).

9. Fabricate the maxillary occlusionrim (Dental wax products; KemdentDental Products Ltd). Keep the heightof the rim at 3 cm from the UAR-UPRplane. Use the other measurementssuch as anterior rim at 8 to 10 mmanterior to the center of the incisivepapilla and posterior rim on or slightlybuccal to the ridge (Fig. 9 ).10-15

10. Fabricate the mandibular occlu-sion rim with an anterior height of 3 cmfrom LAR and in the posterior at thelevel up to the anterior two-thirds of theretromolar pad (Fig. 10).16

11. Verify the occlusion rims intra-orally and record themaxillomandibularrelations (Fig. 11).

Jayachandran and Grey

8 Upper posterior reference (UPR) is marked from hamularnotch by using measurement obtained from Figure 7, andreferences joined by line.

9 Maxillary occlusal plane fabricated with occlusalplane parallel and at 3-cm height to line marked inFigure 8.

10 Mandibular occlusal rim fabricated with anterior heightof 3 cm from lower anterior reference (LAR), and posteriorheight in relation to retromolar pad.

11 Occlusal rims in mouth with no or minimal adjustment,showing parallelism with ala-tragal line.

6 Lower anterior reference (LAR) marked on the cast at3 cm distance from mandibular occlusal plane.

7 Distance from upper anterior reference (UAR) to incisivepapilla is measured.

August 2014 385

Jayachandran and Grey

386 Volume 112 Issue 2

REFERENCES

1. Urbano AS, Maria JM. The occlusal planeindicator: a new device for determining theinclination of the occlusal plane. J ProsthetDent 1998;80:374-5.

2. Lundquist DO, Luther WW. Occlusal planedetermination. J Prosthet Dent 1970;23:489-98.

3. Yasaki M. The height of the occlusion rimand the interocclusal distance. J ProsthetDent 1961;11:26-31.

4. Ismail YH, Bowman JF. Position of theocclusal plane in natural and artificial teeth.J Prosthet Dent 1968;20:407-11.

5. Zarb G, Bolender C, Eckert S, Jacob R,Fenton A, Mericske-Stern R. Prosthodontictreatment for edentulous patients. 12th ed.St Louis: Mosby; 2004. p. 262-4.

6. Jayachandran S, Ramachandran CR,Varghese R. Occlusal plane orientation: astatistical and clinical analysis in differentclinical situations. J Prosthodont 2008;17:572-5.

The Journal of Prosthetic Dentis

7. The glossary of prosthodontics terms.J Prosthet Dent 2005;94:10-92.

8. Cooperman HN. HIP plane of occlusion inoral diagnosis. Dent Surv 1975;51:60-2.

9. Rich H. Evaluation and registration of theH.I.P. plane of occlusion. Aust Dent J1982;27:162-8.

10. Nissan J, Barnea E, Zeltzer C, Cardash HS.Relationship between occlusal plane de-terminants and craniofacial structures. J OralRehabil 2003;30:587-91.

11. Harper RN. The incisive papilla. J Dent Res1948;27:661-8.

12. Hickey JC, Boucher CO, Woelfel JB. Re-sponsibility of the dentist in complete den-ture construction. J Prosthet Dent 1962;12:637-53.

13. Schiffman P. Relation of the maxillary ca-nines to the incisive papilla. J Prosthet Dent1964;14:469-72.

try

14. Ortman HR, Tsao DH. The relationship ofthe incisive papilla to the maxillary centralincisors. J Prosthet Dent 1979;42:492-6.

15. Watt DM, MacGregor AR. Designing partialdentures. Oxford: Butterworth-Heinemann;1984. p. 184-99.

16. Winstanley RM, Barsby MJ, Ogden AR,Welfare RD. Guidelines in prosthetic andimplant dentistry. London: QuintessencePublishing Co. Ltd., 1996.

Corresponding author:Dr Sivakumar Jayachandran15 Quinton RoadHarborne, Birmingham B17 0PPUNITED KINGDOME-mail: sivajsk1975@yahoo.com

Copyright ª 2014 by the Editorial Council forThe Journal of Prosthetic Dentistry.

Jayachandran and Grey