Deprogramer leaf gauge, cotton role, etc; discludes ant teeth

By Curtis Gonzales,2014-05-08 21:36
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Deprogramer leaf gauge, cotton role, etc; discludes ant teeth

Deprogramer: leaf gauge, cotton role, etc; discludes ant teeth; disable brain engrams (“MI/muscle memory” oppose dentist when

    manipulating into CR); Bi-manual (dawson), 1 handed, or leaf gauge technique;

Transferbow Assembly: 1) position earpieces into proper frame recess (inclined surface faces forward); 2) adjust earpiece to

    compensate for non-parallel ear canals; 3) insert nosepiece rod into nosepiece holder & position nosepad (rotating nosepiece gives additional 10 mm); 4) secure nosepiece holder into frame of TB; 5) position reference indicator (offset surface facing upward); 6)

    select bite fork; 7) make bite fork registration (not connected to facebow yet) in silicone registration material; 8) position TB to pt (pt

    places earpieces into ears canals) & secure set-screw; 9) position nosepiece into depression above pt’s nose (glabella) & secure set-

    screw (Dr’s hands free now); 10) position reference indicator to widest part of nose (ala); 11) frontally view pt & adjust earpieces if

    necessary to parallel the front member of TB to pt’s esthetic horizontal plane (inter-pupillary) & secure the earpiece set-screws; 12) attach bite fork to 3D registration joint; 13) replace bite fork registration into pt’s mouth & attach registration joint to TB (universal

    set-screw must be on pt’s left side, or it may interfere w/ registration joint holder when mounting to articulator); 14) remove TB from

    pt by releasing nosepiece & earpiece set-crews; 15) disconnect 3D registration joint from TB & transfer to articulator; 16) remove

    incisal pin & replace w/ plane indicator; 17) remove incisal guide table & replace w/ registration joint holder; 18) position magnetic

    bite fork support; 19) attach 3D registration joint to registration joint holder; 20) close articulator & position plane indicator to contact upper flange of registration joint holder; 21) elevate magnetic bite fork support until it contacts bite fork; 22) position Max cast into

    bite registration & mount;

     oooStratos 300 setting: condylar inclination at 30 or customize w/ right & left lateral bites; Bennett angel 15; Ant/Post shift at 0;

     Axis pin: on TB is used for direct mounting procedure only;

     oS100 Arcon: average intercondylar distance (value) 110mm (90-130); top wall= 19mm radius curvature; medial wall= 8-15; facebow; ocondylar guidance= 20-30; adjustable or custom;

    Mandibular movements: horizontal axis- condyle to condyle; elevate (close) & depress (open); vertical axis- through each condyle; lateral movements; sagittal axis- condyle to coronoid process; abduction & adduction

    Determinants of Mandibular movement: Condylar guidance- articular eminence slope (condylar inclination= top wall of articulator) is oo20-30 steeper than O plane (steepness determines degree of post teeth separation); condylar path is curved (19mm radius); CAN’T change; tooth guidance- post teeth provide vertical stop & Ant teeth disclude Post teeth in excursions (protrusive & lateral)= mutually

    protected occlusion (k9 protected occlusion); dentist can change; neuromuscular system- proprioceptors & mechanoreceptors in periodontium, muscles & joints; Man position & movement (voluntary control or involuntary reflexes)

Bennett movement: AKA (early) immediate lateral translation/side shift; ~86% of pts; working side condyle moves? laterotrusion,

    lateroprotrusion, lateroretrusion (articulator rear wall or alternative centric NM position), laterodetrusion, laterosurtrusion; due to slack

    ligaments on working side, shape of non-working condlye, or shape/position of non-working side medial fossa; L&W= 0-3 mm (1 mm); H&M= 0-2.6 (0.4mm);

    Bennett Angle: angle of mediotrusive path of nonworking condyle in horizontal plane; angle difference btw orbiting condyle path & sagittal plane as viewed in horizontal plane; AKA progressive side shift/lateral translation (toward working side as condlye moves ooooooforward); L&W= 6-8 (~7.5); H&M= 1.5-36 (~12.8);

    CR: musculoskeletally stable position of mandible; condyles superoanterior position in glenoid fossa; post slopes of articular eminence contact articular discs; ~10% of pts have same initial contact as MI; records should be stable of pt’s casts, reproducible on pt,

    & simultaneously align both joints on hinge axis; tooth depressions in interocclusal CR record should be shallow enough to visualize

    fit of cusp tips

    Semi & fully Adjustable Articulators: kinematic facebow= mount Max cast; CR record= mount Man cast; Pantographic or Stereographic tracing = set condylar top, medial, & back wall & set intercondylar distance & fabricate condylar inserts; *semi-

    protrusive record= condylar top wall; lateral record= condylar medial wall*

Protrusion: involves a little rotation as well

    Lateral movement: downward, forward, & inward movement in non-working condyle; non-working side= orbiting= mediotrusive; working side= rotating= laterotrusive;

    TMJ ligaments: temporomandibular (lax at CR/no role in determining CR), sphenomandibular, & stylomandibular; attach body of mandible to skull

    Articular Disc: dense collagen CT; avascular & no nerves in area of articulation (Ant displaced NV tissue will cause pain upon opening); posteriorly attached to loose vascularized CT? retrodiscal pad or bilaminar zone (superior elastic & inferior collagenous

    layer); collateral ligaments hold disc in place at medial & lateral poles so that the disc may rotate backwards & forwards on condyle; anteriorly fused w/ capsule & superior lateral pterygoid muscle (moves disc forward); follows condyle during hinging & translation

    Synovial cavities: above and below disc; capsule and synovial membrane border; filled w/ synovial fluid;

Articulating Surface: surface of condylar processes & fossae are covered w/ avascular fibrous tissue

Ginglymoarthrodial: both joints can be described as capable of hinging & gliding articulation

Lateral Pterygoid muscle: inserts on lateral surface of TMJ joint capsule, articular disc, & neck of condyle;

    Posterior ligament: non-elastic; stretched at maximum opening (as disc moves forward); prevents disc from rotating or being displaced too far anteriorly; if stretched or torn, the disc may displace forward;

    Superior elastic stratum: fibers bind disc; connects temporal bone; maintain tension on disc, toward the distal;

    Opening: at beginning, disc is at most superior ant position on condyle that posterior ligaments allow; loading on steepest part of eminence; inferior LP pulls condyle forward while superior LP relaxes so elastic fibers can pull disc to top of condyle as it moves

    forward; at max opening, condyle is below eminence w/disc in btw

    Closing: inferior LP relaxes so that condyle may move posteriorly; superior LP contracts to pull disc forward on condyle so it may slide up steepest portion of eminence;

    AV shunt (vascular knee): blood rushes into vascular retrodiscal tissue as condyle moves forward to expand tissue to fill empty space; if disc is displaced anteriorly, condyle will load on tissue causing pain;

    Locked Jaw: possible for condyle to slide too far forward, beyond articular eminence which locks jaw open

Muscles of Mastication: lateral pterygoid, masseter, medial pterygoid, temporalis, & digastric

LP muscle: when it spasms, a deviation will occur on contralateral side during opening (normal deviation is on same side for ALL

    other muscles); protraction, depression, contralateral abduction, joint stabilization; inferior head- origin is outer surface of LP plate &

    insertion is neck of condyle; jaw opening & protrusion; translation of condyle down, anteriorly, & contralaterally during opening;

    superior head- originates on greater sphenoid wing & inserts onto TMJ capsule & anterior aspect of articular disc; final closure; stabilizes condyle head & disc against articular eminence during closing;

     ndMasseter muscle: origin zygomatic arch; broad insertion from posterior lateral ramus to 2 molars; layers separated at posterior upper

    portion; forceful closing; assists in protrusion;

    Medial pterygoid muscle: origin on medial surface of LP plate & palatine bone; inserts on medial surface of angle of mandible & ramus up to mandibular foramen; protrusion, elevation & lateral positioning of mandible;

    Temporalis: origin is temporal fossa; inserts on ant border & medial surface of coronoid process & ant border of ramus; 3 component parts; positions mandible during elevation; post part retrudes mandible; ant part for clenching & final closure;

    Digastric muscle: ant digastric attachment at or near lower border of mandible & near midline; tendon btw ant & post portion attached to hyoid bone by loop-like tendon; ant part covered by platysma & beneath it lies mylohyoid & geniohyoid (all active in jaw opening);

Normal tooth wear: enamel wears ~30 µm /year (0.3 mm in 10 years); can be ~10x worse w/ abuse;

Major Closing Muscles: Masseter, medial pterygoid, anterior temporalis, & posterior temporalis

Gordon Christensen’s 6 pathologic conditions of occlusion: Bruxism- cow-clusion; excursive grinding; most prevalent (1/3 pop) &

    most destructive (teeth fucked by 40); 2 types, odontogenic or psychological (bruxism continues even after adjustments made): Tx via

    O splint & possible O equilibration (OE); Clenching- gater-clusion; centric grinding; k9 rise & incisal guidance become steeper; Tx w/ O splint or possible OE; Abfractions- caused by FL movement of teeth during occlusion; Tx w/ O splint or possible E; restore teeth if oosensitive; 1 O Trauma- abnormal loads on healthy teeth; Tx via OE; 2 O Trauma- perio disease w/ normal load; Tx via perio therapy

    & OE; TMD- often multifaceted w/psychological overlay; most (80%) short term TMD is muscular in nature & Tx via general dentist; limited opening, muscle pain, worried pt; Tx via O splint & possible E (if simple case);

Truths: everyone bruxes at night to some extent; not everyone w/ a CR/CO discrepancy needs Tx;

    Forces: post teeth accept & transmit ? vertical forces to periodontium (b/c ? root SA); ant teeth accept & transmit horizontal forces to


    Anterior Coupling: in light centric contact, thin O paper (shimstock) should drag btw ants but hold on posts

     stMolar Disocclusion: measured from MB cusp tips of Man 1 molars; working 0.5mm; nonworking 1.0mm; protrusive 1.1mm;

    deviations (b/c articular disc) avg 0.3mm in working & 0.8mm in nonworking & protrusive

Restoring Bruxers: create long centric (1mm forward slide from CR) & wide centric occlusion (lateral shift) w/out much incisal