**Complete Dentures**
**Preclinical**
**Maxillo-Mandibular Relations**
**Clinical Steps Overview**
1. Examination
Review existing prosthesis
Extra --& Intra oral examination
2. Primary Impression
3. Secondary Impression (with border moulding)
4. **Base & Rim and MMR and Facebow**
5. Trial insertion
6. Insertion
7. Review
**Maxillo-Mandibular Relationships**
**Temporomandibular Joint**
* Hinge type synovial joint that connects the mandible to the rest of the skull:
* Provides an articulation between the mandibular fossa and articular tubercle of the temporal bone, and the condylar process of the mandible.
* Is atypical of a synovial joint in that its articular surfaces are lined by fibrocartilage rather than hyaline cartilage.
* The joint allows a range of movements of the lower jaw:
* Translational movements (protrusion/retraction and lateral deviation)
* Rotational movements (elevation/depression).
**Image Labels:**
**Articular eminence**
**Zygomatic arch**
**Coronoid process**
**Sup belly, lateral pterygoid**
**Ramus**
**THE UNIVERSITY OF WESTERN AUSTRALIA** | Oral Health Centre of Western Australia
**Articular Disc**
**Glenoid fossa**
**Superior compartment**
**Bilaminar zone, superior & inf struts**
**Inferior compartment**
**Condyle**
**Maxillo-Mandibular Relationships**
**Envelope of Mandibular Motion**
<br>
<br>
RCP
H
ICP
Pr
P
O
<br>
Retruded Contact Position
Maximum Hinge opening
Intercuspal Position (CO)
Maximal Protrusion
Rest Position
Maximum Opening
<br>
Posselt 1952
<br>
Opening
Lateral
Protrusive
Retrusive
50 – 60 mm
10 – 12 mm
8 – 11 mm
~ 1 mm
Maxillo-Mandibular Relationships
**Vertical Jaw Relationships**
• Rest Vertical Dimension
• Occlusal Vertical Dimension
• Interocclusal clearance
The postural position of the mandible when an individual is
resting comfortably in an upright position and the associated
muscles are in a state of minimal contractual activity
**Maxillo-Mandibular Relationships**
**Vertical Jaw Relationships**
* Rest Vertical Dimension
THE UNIVERSITY OF
**WESTERN** Oral Health Centre
**AUSTRALIA**
of Western Australia
* Occlusal Vertical Dimension
* Interocclusal clearance
The distance between two selected anatomic
or marked points (usually one on the tip of
the nose and the other on the chin) when in
maximum intercuspal position
**Maxillo-Mandibular Relationships**
**Vertical Jaw Relationships**
* Rest Vertical Dimension
THE UNIVERSITY OF
WESTERN Oral Health Centre
AUSTRALIA
of Western Australia
OVD
RVD
interocclusal clearance
* Occlusal Vertical Dimension
* Interocclusal Clearance
The The distance between the occluding surfaces
of the maxillary and mandibular teeth when
the mandible is in a specified position; i.e. rest
position. = RVD - OVD
**Maxillo-Mandibular Relationships**
**Horizontal Jaw Relationships**
* Retruded Contact Position
**THE UNIVERSITY OF**
**WESTERN**
**AUSTRALIA**
Oral Health Centre
of Western Australia
Contact of a tooth or teeth along the retruded path of
closure; initial contact of a tooth or teeth during closure
around a transverse horizontal axis.
* Intercuspal Position
* Eccentric Jaw Relations
* Protrusive Jaw Relation
* Left & Right Jaw Relations
Retruded Contact Position
Leaf Gage
Prematurity
Leaf Gage
**Maxillo-Mandibular Relationships**
**Horizontal Jaw Relationships**
* Retruded Contact Position
* **Intercuspal Position**
The complete intercuspation of the opposing
teeth independent of condylar position
* Eccentric Jaw Relations
* Protrusive Jaw Relation
* Left & Right Jaw Relations
**Intercuspal Position**
**Maxillo-Mandibular Relationships**
**Horizontal Jaw Relationships**
* Retruded Contact Position
* Intercuspal Position
* Eccentric Jaw Relations
* Protrusive Jaw Relation
* Left & Right Jaw Relations
**Christensen Phenomenon**
A registration of the mandible in relation to the maxillae
when both condyles are advanced in the glenoid fossae
– takes advantage of the Christensen Phenomenon
**Maxillo-Mandibular Relationships**
**Horizontal Jaw Relationships**
* Retruded Contact Position
* Intercuspal Position
* **Eccentric Jaw Relations**
* Protrusive Jaw Relation
* **Left & Right Jaw Relations**
A registration of the positional relationship of
opposing teeth or arches made in either a right or
left lateral position of the mandible
**THE UNIVERSITY OF**
**WESTERN** **Oral Health Centre**
**AUSTRALIA**
**of Western Australia**
**Laboratory Fabrication of Occlusal Rims**
**Maxillo-Mandibular Relationships**
**Laboratory Fabrication of Occlusal Rims**
1. Block out undercuts on master casts with
baseplate wax
2. Survey alveolar ridges on casts
3. Apply separating medium to bearing areas on
cast
(Use vaseline or alginate separating medium)
4. Fabricate baseplates
5. Attach wax rims to baseplates using survey lines
and average height measurements as a guide
THE UNIVERSITY OF
WESTERN Oral Health Centre
AUSTRALIA
of Western Australia
**Maxillo-Mandibular Relationships**
**Laboratory Fabrication of Occlusal Rims**
1. Block out undercuts on master casts with
baseplate wax
2. **Survey alveolar ridges on casts**
3. Apply separating medium to bearing areas on
cast
(Use vaseline or alginate separating medium)
4. Fabricate baseplates
5. Attach wax rims to baseplates using survey lines
and average height measurements as a guide
THE UNIVERSITY OF
WESTERN Oral Health Centre
AUSTRALIA
of Western Australia
Maxillo–Mandibular Relationships
**Laboratory Fabrication of Occlusal Rims**
1. Block out undercuts on master casts with
baseplate wax
2. Survey alveolar ridges on casts
3. Apply separating medium to bearing areas on
cast
(Use vaseline or alginate separating medium)
4. Fabricate baseplates
5. Attach wax rims to baseplates using survey lines
and average height measurements as a guide
**Maxillo-Mandibular Relationships**
**Laboratory Fabrication of Occlusal Rims**
Fabricate Baseplates
Polylux light-curing box
Palatray light-curing tray material
**Maxillo-Mandibular Relationships**
**Laboratory Fabrication of Occlusal Rims**
1. Block out undercuts on master casts with
Baseplate wax
2. Survey alveolar ridges on casts
3. Apply separating medium to bearing areas on
cast
(Use vaseline or alginate separating medium)
4. Fabricate baseplates
5. Attach wax rims to baseplates using survey lines
and average height measurements as a guide
THE UNIVERSITY OF
WESTERN Oral Health Centre
AUSTRALIA
of Western Australia
**Maxillo-Mandibular Relationships**
**Laboratory Fabrication of Occlusal Rims**
* **Maxillary Rim**
* Width 8 mm anteriorly,
* 10 mm posteriorly
* 2/3 of width Buccal &
* Labial to survey line
* on cast
* 15 mm high
* anteriorly,
* tapering to 13 mm
* posteriorly
* **Mandibular Rim**
* Width 8 mm anteriorly,
* 10 mm posteriorly
* Buccal width equals
* lingual width
* 14 mm high
* anteriorly and
* parallel to crest of
* the residual ridge
**Boley gauge**
**Figure of eight caliper**
5. Attach wax rims to baseplates using survey lines
and average height measurements as a guide
**THE UNIVERSITY OF**
**WESTERN**
**AUSTRALIA**
**Oral Health Centre**
**of Western Australia**
# <span style="color: #4472C4;">**Recording Jaw Relationships**</span>
# <span style="color: #363567;">**THE UNIVERSITY OF**</span>
# <span style="color: #363567;">**WESTERN**</span>
# <span style="color: #363567;">**AUSTRALIA**</span>
# <span style="color: #363567;">**Oral Health Centre**</span>
# <span style="color: #363567;">**of Western Australia**</span>
**Maxillo-Mandibular Relationships**
**Recording Jaw Relationships**
1. Check extension, retention and stability of upper and lower occlusal rims
2. Establish facial contour and occlusal plane by shaping the upper rim
3. Maxillary facebow record
4. Determination of vertical dimension of occlusion by modifying the mandibular rim only
5. Registration of centric and eccentric relations at accepted vertical dimension
6. Mark midlines, smile line and canine lines on rims
7. Tooth selection
**Maxillo-Mandibular Relationships**
**Recording Jaw Relationships**
**2. Establish Facial Contour & Occlusal Plane**
* Deficient contour
Overclosed
* Correct contour
Correct OVD
| | **anterior region** | **posterior region** |
| :------ | :--------------------------------------------------------------------------------------------------------------------------------------------- | :----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| **height** | - relation to upper lip (shape & age)
- existing denture as reference
- interpupillary line
- curve of the lower lip | - Parallel to Camper’s plane (ala-tragal line)
- compensating curve |
| **width** | - lip support (aesthetics)
- lower ridge | - buccal corridor
- neutral zone |
* Camper's Plane
* Occlusal Plane
Cephalometric analysis shows that the occlusal plane more closely parallels a line from the inferior border of the tragus to the inferior border of the ala.
Sharab et al, 2023
--- OCR Start ---
<span style='color: #4A90E2;'>M<span style='color: #1A1A1A;'>axillo-Mandibular Relationships</span></span>
<span style='color: #F5A623;'>R<span style='color: #1A1A1A;'>ecording Jaw Relationships</span></span>
<span style='color: #1A1A1A;'>2. Establish Facial Contour & Occlusal Plane</span>
<span style='color: #1A1A1A;'>Buccal Corridor</span>
<span style='color: #1A1A1A;'>Vertical height adjustment with hot paint scraper</span>
<span style='color: #1A1A1A;'><img src="Images/The University of Western Australia Logo.png" alt="THE UNIVERSITY OF WESTERN AUSTRALIA"></span>
<span style='color: #1A1A1A;'><img src="Images/Oral Health Centre of Western Australia Logo.png" alt="Oral Health Centre of Western Australia"></span>
--- OCR End ---
**Maxillo-Mandibular Relationships**
**Recording Jaw Relationships**
2. Establish Facial Contour & Occlusal Plane
Fox Plane
**Maxillo-Mandibular Relationships**
**Recording Jaw Relationships**
2. Establish Facial Contour & Occlusal Plane
THE UNIVERSITY OF
WESTERN AUSTRALIA
Oral Health Centre
of Western Australia
**Maxillo-Mandibular Relationships**
**Recording Jaw Relationships**
2. Establish Facial Contour & Occlusal Plane
THE UNIVERSITY OF
WESTERN
AUSTRALIA
Oral Health Centre
of Western Australia
**Maxillo-Mandibular Relationships**
**Recording Jaw Relationships**
2. Establish Facial Contour & Occlusal Plane
THE UNIVERSITY OF
WESTERN
AUSTRALIA
Oral Health Centre
of Western Australia
Occlusal plane too low
Occlusal plane reversed
**Maxillo-Mandibular Relationships**
**Recording Jaw Relationships**
2. Establish Facial Contour & Occlusal Plane
**Maxillo-Mandibular Relationships**
**Recording Jaw Relationships**
3. **Facebow Record**
**A facebow is an instrument**
**that records the relationship**
**of the maxilla to the hinge**
**axis of rotation of the**
**mandible**
Earbow
Kinematic
**Maxillo-Mandibular Relationships**
**Recording Jaw Relationships**
**3. Facebow Record**
**The Importance of Occlusion**
**ORBITAL-AXIS PLANE**
**The Articulator**
**PSA**
**EAB**
Understanding the correct relations between the static and functional
dental contacts is key to good clinical practice in restorative dentistry.
The articulator's primary function is to work as if it was a patient
'in-absence'.
The articulator is defined as "a mechanical instrument that represents
the temporomandibular joints (TMJs) and jaws, to which maxillary and
mandibular casts may be attached to simulate some or all mandibular
movements" (Academy of Denture Prosthetics 1977).
**Maxillo-Mandibular Relationships**
**Articulator** – a mechanical instrument that represents the temporomandibular joints and jaws, to which maxillary and mandibular casts may be attached to simulate some or all mandibular movements.
| Type | Synonym | Description |
|-----------|------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Class I | Non-adjustable | A simple holding instrument capable of accepting a single static registration; vertical motion is possible |
| Class II | Semi-adjustable | An instrument that permits horizontal as well as vertical motion but does not orient the motion to the temporomandibular joints |
| Class III | Semi-adjustable | An instrument that simulates condylar pathways by using averages or mechanical equivalents for all or part of the motion; these instruments allow for orientation of the casts relative to the joints and may be arcon or non-arcon instruments |
| Class IV | Fully adjustable | An instrument that will accept 3D dynamic registrations; these instruments allow for orientation of the casts to the temporomandibular joints and simulation of mandibular movements |
**Image Content:**
**Simple Hinge**
**Mean Value**
**Class II**
**Class III**
**Class IV**
**Articulators**
**The non-adjustable articulator**
**Hinge**
**Mean Value**
**Semi-adjustable articulator**
**Arcon**
**Non-Arcon**
**Fully adjustable articulator**
**Panto-graphic tracing**
**Sterio-graphs**
**Maxillo-Mandibular Relationships**
**Recording Jaw Relationships**
**4. Occlusal Vertical Dimension – Pre-extraction Evaluation**
* **Measurements of intra-oral dimensions**
* Measuring the distance between points marked by the treating clinician with tattoo dots
* Measuring the distance between maxillary and mandibular fixed landmarks
* Fabricating the denture(s) on pre-existing mounted diagnostic casts
* **Profile tracing**
* Fabricating a template that traces the profile of the lower third of the face
* **Cephalometric approach**
* Pre-extraction and post- extraction cephalometric radiographs are obtained. The latter with the occlusal rims in place which are adjusted accordingly
* **Pre-extraction phonetics**
* **Pre-extraction photographs**
* **Oro-facial device**
* Measures the angle between the Frankfort plane and the border of the mandible
**Maxillo-Mandibular Relationships**
**Recording Jaw Relationships**
4. Occlusal Vertical Dimension - Post-extraction Evaluation
The OVD is not an immutable reference, but rather a dynamic dimension within a zone of physiological tolerance
Vertical changes in the OVD have biological, biomechanical, aesthetic, and three-dimensional (3D) functional implications
Among the most commonly accepted techniques to determine the OVD in edentulous patients are:
* **Morphological or facial proportions**
* External appearance of the face
* Conformation of nasolabial folds
* Harmony between lower third and the other thirds of the face (Turner & Fox, 1928)
* Distance from outer corner of eye to labial commissure was equal to distance from base of nose to chin [Willis Face Guide] (Willis, 1930)
* **Physiological**
* Freeway space (interocclusal clearance) should average 3mm (Niswonger, 1934)
* **Phonetic methods**
* Pronunciation of certain sounds should identify the smallest vertical dimension of pronunciation (Silverman, 1951)
* Use of “s” sound based on fact that jaw had a memory of the vertical and horizontal position of “S”sound phonation (Pound, 1951)
* **Salivary swallowing** (Shanahan, 1955)
* **Cephalometric** (Pyott and Schaeffer, 1954)
Calamita et al, 2019
As none of these techniques has been shown to be sufficiently consistent and accurate to be used alone, the clinician
should understand their principles and make use of an association of them to ensure greater accuracy in accordance
with the patient’s case requirements
**Maxillo-Mandibular Relationships**
**Recording Jaw Relationships**
**5. Registration of Centric and Eccentric Relations**
* Place a V-shaped notch bilaterally on the occlusal surface of the wax rim in the area of the second premolar
* The notches should be 1 – 1.5 mm deep with no undercuts and have their horizontal axes angled posteriorly at about 45° to the midline
**THE UNIVERSITY OF**
**WESTERN**
**AUSTRALIA**
**Oral Health Centre**
**of Western Australia**
**Too Shallow**
**no undercuts**
* Lubricate the occlusal surfaces of the mandibular teeth with Vaseline
* Apply a thin film of PVS adhesive to posterior occlusal surfaces of maxillary rim and allow to dry
* Apply layer of Regisil to posterior occlusal surfaces of maxillary rim and close articulator pin onto the incisal guide
**Maxillo-Mandibular Relationships**
**Recording Jaw Relationships**
5. Registration of Centric and Eccentric Relations
THE UNIVERSITY OF
WESTERN
AUSTRALIA
Oral Health Centre
of Western Australia
<p><b>Maxillo-Mandibular Relationships</b></p>
<p><b>Modified Procedure for Technique Class</b></p>
<p><b>Verify Articulator settings</b></p>
<ul>
<li>Set incisal guide pin to zero (dark circle on pin flush with upper member of articulator)</li>
<li>Set condylar guidance to 25°</li>
<li>Set Bennett angle to O°</li>
<li>Lock articulator in centric position</li>
</ul>
<p><b>Adjust the occlusal rims</b></p>
<ul>
<li>Check that maxillary base fits the maxillary cast on the articulator</li>
<li>Adjust facial and occlusal contours of maxillary rim as follows:</li>
<ul>
<li>The labial surface of the maxillary rim should be approximately parallel to the incisal pin</li>
<li>The occlusal level of the maxillary rim should be parallel to the occlusal plane with the<br>incisal pin about 1.5 mm open (off the incisal guide table)</li>
<li>The distal ends of the rim should be clear of their respective retromolar pads</li>
<li>Cut a step in the anterior occlusal surface of the maxillary rim from the palatal to allow<br>anterior overlap and reduce the posterior occlusal surface, distal to the canine teeth,<br>so that the posterior rim just contacts the cusp tips of the opposing teeth, and the<br>articulator pin is in <font color="#ed1c24">contact</font> with the incisal guide</li>
</ul>
<li>Mark the centreline, smile line and canine line on the maxillary rim</li>
</ul>
<p> Occlusal Rim </p>
<p> Incisal Guidance Angle </p>
<p> Vertical Overlap </p>
<p> Horizontal </p>
<p> Overlap </p>
**Maxillo-Mandibular Relationships**
**6. Marking of reference lines**
THE UNIVERSITY OF
WESTERN Oral Health Centre
AUSTRALIA
of Western Australia
Smile line
Midline
Canine line
**Maxillo-Mandibular Relationships**
**7. Tooth Selection**
To be continued
But in the meantime:
**Journal of** **Oral Rehabilitation**
Journal of Oral Rehabilitation 2017 44; 896–907
**Review**
Determination of occlusal vertical dimension for complete
dentures patients: an updated review
M. N. ALHAJJ*†, N. KHALIFA*‡, J. ABDUO§, A. G. AMRAN¶ &
I. A. ISMAIL* *Department of Oral Rehabilitation, Faculty of Dentistry, Khartoum University, Khartoum, Sudan, †Department
of Prosthodontics, Faculty of Dentistry, Thamar University, Dhamar, Yemen, ‡Department of General and Specialist Dental Practice, College
of Dental Medicine, University of Sharjah, Sharjah, UAE, §Restorative Section, Melbourne Dental School, Melbourne University, Melbourne,
Australia and ¶Department of Periodontics, Faculty of Dentistry, Thamar University, Dhamar, Yemen
