Figures & tables
From the following article
Occlusion:
Good occlusal practice in advanced restorative dentistry
S J Davies, R M J Gray & S A Whitehead
British Dental Journal 191, 421 - 434 (2001) Published online: 27 October 2001
doi:10.1038/sj.bdj.4801200
Figure 1a
Pre-operative view before proposed crown preparation of LL4,5,6,7 (34,35,36,37)
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Figure 1b
LL4 (34), LL6 (36) are prepared and Duralay 'bites' taken on these teeth using occlusal contacts on LL5 (35) and LL7 (37) to ensure the 'conformative approach'
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Figure 1c
All teeth are now prepared, but bites against LL4 and 6 ensure models are mounted to pre-operative registration (conformative approach)
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Figure 2
The flag is attached to the articulator and the incisal pin is set before the upper model is removed
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Figure 3
An arc is drawn on the flag at a set radius using the tip of the lower canine as its centre (Canine Arc)
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Figure 4
The canine arc is bisected by an arc using the articulator hinge as its centre. This intersection is the centre of a possible occlusal plane (sphere)
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Figure 5a
Proposed occlusal plane obviously still touches the tip of the lower canine
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Figure 5b
Relationship of proposed occlusal plane to the mesial abutment and to pontic of the planned bridge
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Figure 5c
Relationship of proposed occlusal plane to the distal abutment of the planned bridge
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Figure 6a
This occlusal plane would be impossible against the opposing molar
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Figure 6b
This occlusal plane would be too traumatic to the distal abutment of the proposed bridge
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Figure 8
Morphology is carved into the wax, to represent the final abutments and pontic of the proposed bridge to a planned occlusion
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Figure 9
Minor occlusal adjustment is necessary to the teeth opposing the abutment teeth, whereas the crown on the overupted tooth opposing the gap (in this case) will need to be replaced
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Figure 11a
Pre-operative lower model, illustrating lingual and mesial tilting of distal abutment of proposed bridge
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Figure 11b
Lower model after wax up illustrating improved occlusal planes
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Figure 12a
Patient's profile, suggesting loss of vertical dimension
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Figure 12b
Patient's dentition exhibiting significant tooth surface loss
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Figure 12c
Upper stabilisation splint with labial veneers to fit over unprepared upper anteriors
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Figure 12e
Anterior view of upper stabilisation splint. Note the provision of median diastema
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Figure 12f
Provisional restoration vertical dimesion and labial support by the upper stabilisation splint. Compare with Fig. 12a
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Figure 12g
Definitive lower restoration by partial denture and crown preparations of upper anterior teeth, at the prescibed vertical dimension
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Figure 12h
Mirror view of upper definitive restoration by partial denture and anterior crowns as developed in the 'provisional' phase
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Figure 13a
The models, including provisional crowns on upper anterior teeth, are used to carve a custom incisal guidance table in a slow setting autopolymerising acrylic
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Figure 13b
Custom incisal guidance table. The incisal pin of the articulator is resting in a postion that is related to the centric occlusion of the models
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Figure 13c
Custom incisal guidance table is used to guide the upper working model into the same left lateral excursion as was present in the provisional restorations (This would be a right lateral excursion in the patient)
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Figure 13d
Close up of custom incisal guidance table, guiding upper model into a left lateral excursion
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Figure 13e
Using this technique it is easy to see exactly what the crown lengh and palatal contour should be to provide the same canine guidance as was present in the provisionals
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Figure 13f
Custom incisal guidance table determining the lengh of right canine definitive crown
Full size figure and legend (24 KB)Slides may be downloaded for educational use, according to the terms described in Nature Publishing Group's licensing policy.
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