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FACULTY OF CIVIL AND ENVIRONMENTAL ENGINEERING DEPARTMENT OF STRUCTURE AND MATERIAL ENGINEERING LAB MATERIAL
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Freeway space - definition The space that exists between the upper and lower articul atory memb ers at rest
T heory of Freeway Spac e Ja w Re gistration
The difference between the vertical dimension o f occlusion an d the vertical dimension o f rest Inter-occlusal rest space
Speech • Say (out loud) the days of the week • Do teeth contact during speech? • What is the role of teeth during speech? – “Labio-dental” sounds (Friday) – “Linguo-dental” (Thursday) – “Alveolar” (Saturday )
TEETH DO NOT CONTACT DURING SPEECH IN THE NATURAL DENTITION
Freeway space in the natural dentition
Vertical dimensions – natural dentition In the natural dentition, a space exists between the teeth at rest i.e. teeth are not clen ched at rest Two vertical dimensions may be m easu red • Resting Vertical Dimension (RVD) • Occlus al Vertical Dim ension (OVD)
Freeway space in edentulous patients wearing dentures • “ Blank canvas” • Position of the upper and lower occlusal planes are prescribed by dentist as part of the jaw registration process • Usually try to provide a similar FWS to that which would exist in the natural dentition i.e. 2-4 mm • The concept of a negative FWS can exist in the edentulous patient i.e. if OVD > RVD
FWS typically 2-4mm in natural dentition
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Deficient vertical dimension problems
Excessive vertical dimens ion problems FWS too small, absent or negative
FWS too large
•
Functional difficulties, particularly eating
•
Functional difficulties, particularly eating
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Teeth contact during speech ⇒ “clicking” during speech, difficulty
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Poor aesthetics
forming some sound s
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Over closure ⇒ Pain and/or TMJ P D S symptoms
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Difficulty approximating lips
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Reduced masticatory efficiency
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Poor aesthetics
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Cheek biting due to bunching of tissues
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MO M constantly under stres s ⇒ Pain and/or TMJ P DS s ymptoms
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Dribbling at angles of mouth/angular chielitis because of inappropriate
Sequence for measuring FWS Wi ll is bi te gau ge & two sta bl e ref ere nce po ints Two Dots technique (nose/chin) Naso-labial
angle /underside of chin
RV D • Take one denture out • Patient relaxed, head in “neutral” position • Encourage patient to swallow, rest with lips just together • Take measurement
OVD • Both dentures in • Ask patient to close together (RCP) • Take measurement, ensuring same head position and same reference points
Factors affecting RVD Short term • Head position • Stress • Mouth contents (teeth/dentures) • Pain • Respiration (minor variations with inspiration and expiration) Long term • Age and health • Bruxism/parafunctional habits
FWS = RVD - OVD
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Important to get head position relaxed – not too far forward or back!
Jaw Registration
Sequence for C/C jaw registration
Jaw Registration - Objectives •
Creation of the form of the upper and lower dentures
•
As sess rims on casts prior to patient coming in
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Prescription of upper rim to include;
• • • • • •
Are they fit to go in the patients mouth? – modify if necessary Disinfect Upper – extension, retention, stability (modify) Lower – extension, retention, stability (modify) Prescribe upper rim Prescribe lower rim, in conjunction with upper, and establish the vertical dimension in RCP Relate lower rim to upper, in RCP Tooth selection Prescription & disinfection
– lip support – incisal level – centre lines – canine lines – occlusal planes – buccal corridors •
Relationship of upper rim to lower rim in three dimensions
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Tooth selection
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(Rela tio n sh ip o f u p p er ca st to co n d yles if a fa ceb o w tra n sfer is u sed )
Form of upper rim •
Aim is to position teeth and the periphery of the denture in a functionally stable and aesthetic position
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Must be in harmony with the proposed position of the lowers
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There may have to be a compromise between function vs aesthetics
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The position of teeth prior to extraction is, at best, only a guide and may not be reliable
• • •
Methods of determining previous tooth position • • • •
Photographs Radiographs Study casts, when patient had teeth Anatomical and fun ctional guidelin es
BUT – Prosthetic replacements are not necessarily placed in the same positions as that natural predecessors! THINK
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lip
support level centre lines canine lines occlusal planes buccal corridors incisal
Guidelines to tooth position • • • • • •
Verti cal naso -labi al angle Horizo ntal naso-l abial angl e Incisal point Incisal plan e Canine points Posterior occlusal plan e
Reproducible registration •“V” notches in upper •Build up wax in lower •Seal together in RCP •Chill •Separate •Check