Você está na página 1de 4

S E C T I O N EDITOR

S t u d y of the acceptability of lateral i n t e r o c c l u s a l r e c o r d s by


a m o d u l a r articulator
Mohammed Aleem Abdullah, BDS, MDS a
College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia

S e m i a d j u s t a b l e articulators are e x t e n s i v e l y u s e d for r o u t i n e restorative procedures.


The i n s t r u m e n t s m a y be adjusted b y lateral i n t e r o c c l u s a l records. H o w e v e r , it has
b e e n r e p o r t e d that s e m i a d j u s t a b l e articulators do not accept lateral interocclusal
records f r o m all patients. The H a n a u m o d u l a r s y s t e m 194 s e m i a d j u s t a b l e articulator
w a s i n t r o d u c e d to d e v e l o p o c c l u s i o n w i t h m i n i m a l error. The m a n u f a c t u r e r recom-
m e n d s that the i n s t r u m e n t s h o u l d be adjusted by m e a n s of lateral i n t e r o c c l u s a l
records. This s t u d y i n v e s t i g a t e d the acceptability of lateral i n t e r o c c l u s a l records. Sixty
lateral i n t e r o c c l u s a l records w e r e m a d e for 30 e d e n t u l o u s subjects, a n d t h e acceptabil-
ity of the records w a s e v a l u a t e d by use of the split-cast m o u n t i n g procedure. Out of 60
lateral i n t e r o c c l u s a l records, 52 (87%) records w e r e a c c e p t e d by the articulator. A Z
test w a s u s e d for t w o p r o p o r t i o n s a n d w a s statistically s i g n i f i c a n t (p < 0.05). (J
PROSTHET DENT 1995;74:408-11.)

~..Demiadjustable articulators are used for routine working condylar movement for better acceptability of lat-
restorative procedures. Before the occlusion is established, eral records. 4 The Hanau modular articulator system 194
the condylar mechanism of semiadjustable instruments is (Teledyne Hanau) was recently introduced with modifica-
adjusted with the use of the patient's lateral interocclusal tions of the condylar mechanism to simulate human work-
records. 1-4 The lateral interocclusal records are used to ing condyle movements (Fig. 1). The modular articulator
program the instrument for working condylar movement. incorporates the curved component of movement to the
Several investigators have reported that semiadjustable immediate side shift. This incorporation permits the work-
articulators do not accept lateral interocclusal records ing condylar element to follow a curved path as it shifts
made for all patients. 5 7 A clinical study by Bell and Mat- laterally (Fig. 2). The manufacturer claims that the curved
ich s evaluated the acceptability of lateral records used to path compares favorably to the movement of the working
set the condylar elements of the Whip-Mix articulator condyle that is found in patients and recommends that the
(Whip-Mix Corp., Louisville, Ky.) and reported that of 50 instrument may be set by the use of lateral interocclusal
lateral interocclusal records, 40 (80%) were accepted. Gas- records for the construction of complete dentures. 1~
ton et al. 9 reported that the Hanau Model H-2 articulator This clinical study was undertaken to determine the ac-
(Teledyne Hanau, Buffalo, N. Y.) accepted 39 (70%) of 56 ceptability of lateral interocclusal records made for eden-
lateral interocclusal records made for edentulous patients. tulous patients with the Hanau modular articulator sys-
Because semiadjustable instruments do not accept lat- tem 194.
eral records with fidelity, the use of such instruments in
fixed partial denture treatment may result in restorations MATERIAL AND METHODS
with occlusal errors in patients with immediate side shifts Thirty edentulous patients of both sexes ranging in age
and absence of an immediate anterior disclusion that re- from 35 to 55 years of age who were free of tempor0man-
quires posterior group function occlusion.47 For the same dibular joint dysfunction and local and systemic pathologic
reason semiadjustable instruments produce errors in bal- conditions were selected. Maxillary and mandibular final
ance occlusion when used for complete dentures. 5 The con- impressions were made with custom acrylic resin trays.
temporary semiadjustable instruments are provided with The custom trays were border-molded with low-fusing
modifications of condylar mechanism to simulate the compound, and impressions were made in permelastic
regular body rubber base material (Sybron/Kerr, Romulus,
Mich.). Final maxillary and mandibular edentulous casts
Supported by a grant from College of Dentistry Research Center were made in dental stone (Densite Stone, Vel-Mix, Sybron/
(CDRC) no. 1055. Kerr) for each patient. Permanent record bases were made
aAssistant Professor, Departmemt of Prosthetic Dental Sciences.
Copyright 9 1995 by The Editorial Council of THE JOURNALOF with heat-curing denture base acrylic resin. Before the pa-
PROSTHETIC DENTISTRY. tient's mouth was examined for proper extension, stability,
0022-3913/95/$5.00 + 0. 1011165832 and retention, each record base was finished and polished.

408 THE J O U R N A L OF PROSTHETIC DENTISTRY VOLUME 74 NUMBER 4


ABDULLAH THE JOURNAL OF PROSTHETIC DENTISTRY

The soft-tissue undercut surfaces of the permanent


maxillary and mandibular record bases were blocked out
with wax, and mounting casts were made. The mounting
casts were made with dental stone (Vel-Mix, Sybron/Kerr),
and wax occlusion rims were constructed.
Before the maxillary cast was mounted in the Hanau
modular system 194 articulator, the condylar mechanisms
were set according to Hanau manual instructions; that is,
the condylar horizontal inclination was set at 0 degrees,
immediate side shift at 3 mm, and medial wall guide at six
degrees. A face-bow registration was made with a Hanau
spring face-bow (Teledyne Hanau) for each patient. A Ha-
nau mount split-cast mounting plate (model 163-1, Tele-
dyne Hanau) was used to mount the maxillary cast (Fig. 3).
This mounting method produced a definite demarcation
line at the split-cast surface. The split-cast mounting per-
mitted accurate articulator adjustment to interocclusal
records by visual examination at the four notched cast in-
dexes.
A tentative centric relation record was made at the ver-
tical dimension of occlusion. The mandibular cast was at-
tached to the articulator with this record. An intraoral
tracing device (Teledyne Hanau) was attached to the Fig. 1: Hanau modular articulator system 194.
record bases with sticky wax. The central bearing point
was fixed to the maxillary record base, and the plate was
attached to the mandibular record base. The central bear-
ing point was set to maintain contact at the vertical instructed in the training session. The central bearing
dimension of occlusion. A mixture of rouge and isopropyl point maintained contact with the plate during the jaw
alcohol was used to coat the plate for recording the man- movement. At the same time the amount of lateral move-
dibular movements. ment of the mandible was controlled by observing the re-
With the record bases in the mouth, the patient was lationship of the maxillary and mandibular midlines of the
guided first into centric relation and then to the left and occlusion rims. After the training period was completed,
right lateral positions. At the end of the training period, the the arrowhead tracing was recorded. The record bases
metal plate was painted again with a mixture of rouge and were removed from the mouth, and the arrowhead tracing
isopropyl alcohol, and the tracing was reproduced. The lines were measured by a caliper from the apex. A
tracing was verified for reproducibility of a sharp arrow- minimum of 5 mm lateral movement of the tracing was ac-
head. The mandibular record base was removed from the cepted for evaluation. The record bases were returned to
patient's mouth. A transparent plastic shim with a hole in the mouth. Impression plaster was placed on the mandib-
its center was secured to the plate with sticky wax such ular metal plate, and the patient was guided first into cen-
that the apex of the tracing coincided with the hole. The tric relation and then into right lateral jaw position while
mandibular record base was again placed in the mouth, the central bearing point remained in contact with the
and the patient was instructed to close in the retrnded po- plate. The patient maintained this position until the
sition with the pin positioned in the hole of the shim. While impression plaster had set. After the plaster had set, the
the patient maintained this position, impression plaster assembly was removed from the mouth, and the plaster
(Harry J. Bosworth Co., Chicago, Ill.) was injected with a record was removed from the assembly without breaking
syringe on the buccal sides of the intraoral device. After the it. Following the same procedure, a left lateral interoc-
plaster had set, the assembly was removed from the clusal record was made, so right and left lateral interoc-
mouth. Three centric relation records were made in the clusal records were made for each of the 30 subjects.
usual manner and were used to verify the tentative centric The lateral records were placed on the articulator to de-
jaw relation record on the articulator. The verification termine their acceptability by the instrument. The maxil-
procedure was repeated until centric relation record was lary cast was separated from the mounting, and the record
proved correct. bases were seated on the maxillary and mandibular casts.
The recording assembly was removed from the casts and Right lateral plaster record was placed between the bases,
cleaned, and the plastic shim was removed. The recording and the casts were luted together with wooden sticks and
bases were placed in the patients' mouths, and the patients sticky wax; this assembly was then mounted on the artic-
were guided into the various positions as they were ulator. The upper arm of the articulator was closed, and the

OCTOBER 1 9 ~ 409
THE JOURNAL OF PROSTHETIC DENTISTRY ABDULLAH

:~i:!?:i!iJi!i~i!~:ili!

B D

F i g . 2. Condylar guide mechanism of 194 Articulator. A~ Condylar guidance of articula-


tor i s designed to incoporate curved p a t h for i m m e d i a t e side shift. B, Schematic represen-
tation of condylar guidance. A, B, A 3 m m i m m e d i a t e side shift; C, curve path, D, progres-
sive B e n n e t t agle, and E, curved posterior wall of condylar guidance.

condylar mechanisms were adjusted to obtain a union of


the m a x i l l a r y cast and the split-cast mounting plate a t the
four notches. The uniform contact a t the four notches was
visually noted a n d recorded as acceptable. A space between
the cast a n d the split-cast m o u n t i n g plate at the four
notches visually noted was recorded as unacceptable. A
similar procedure was followed to evaluate the left l a t e r a l
interocclusal record. In this m a n n e r a total of 60 l a t e r a l
interocclusal records were evaluated. The acceptable and
unacceptable d a t a of right a n d left sides were subjected to
a Z test of one sample proportion.

RESULTS
A total of 60 l a t e r a l interocclusal records were m a d e for
30 edentulous patients. The distribution of right and left
lateral interocclusal records either accepted or not ac-
F i g . 3. H a n a u - m o u n t , split-cast mounting plate.
cepted by the H a n a u m o d u l a r articulator are presented in
Table I. Out of the 60 l a t e r a l interocclusal records, 52 (87%)
records were accepted by the articulator. With the Z test
Table I. Distribution of right a n d left lateral used for one sample proportion, this value was found to be
interocclusal records of 30 edentulous subjects highly statistically significant (p < 0.00001).
It was also found t h a t 28 (93%) of 30 right lateral records
Accepted Not accepted
Side (%) (%) Total and 24 (80%) of 30 left l a t e r a l records were accepted by the
articulator. Application of a Z t e s t for two sample propor-
Right side 28 (93) 2 (7) 30 tions d e m o n s t r a t e d t h a t no difference existed between the
Left side 24 (80) 6 (20) 30
percentage values of acceptance of right and left l a t e r a l
Total 52 8 60
records (p 0.087).

410 VOLUME 74 NUMBER 4


ABDULI~I THE JOURNAL OF PROSTHETIC D E N T I S T R Y

DISCUSSION shortcomings of the instrument so that less clinical time is


spent to harmonize occlusion.
Lateral interocclusal records have been recommended to
program a semiadjustable articulator for restorative pro- SUMMARY AND CONCLUSIONS
cedures. 4-7To minimize occlusal error many contemporary
The acceptability of the right and left lateral interoc-
semiadjustable instruments are provided with a curved
clusal records by Hanau modular system 194 articulator
protrusive condylar path, but the side shift path remains
was investigated on 30 edentulous patients. Acceptability
straight. The recently introduced Hanau modular system
of right and left lateral interocclusal records was evaluated
194 semiadjustable articulator has a curved protrusive
with the use of the split-cast procedure. Conclusions from
and a curved side shift path. The curved side shift path has
the results of this study are the following.
a curvature of 3 mm radius, which permits the working
1. Of the 60 lateral interocclusal records, 52 (87%) were
condylar element to follow a radial curve path as it shifts
laterally. 10 accepted by the articulator and found to be statistically
significant (p < 0.05).
The acceptability of lateral records made by the Hanau
2. No significant difference (p 0.087) was seen between
H2 that had both straight protrusive and side shift paths
the number of right and left records accepted by the
was 70%, and that for the Whip Mix instrument with a
curved protrusive and a straight side shift path was 80%. instrument.
This study reported 87% acceptability of the lateral records
REFERENCES
for the Hanau Modular system 194. A Z test for two pro-
1. Boucher CO. Swenson's complete dentures. 6th ed. St Louis: CV Mosby
portions indicated that the value of acceptability of lateral Co, 1970:152-4.
record by the Hanau Modular system 194 when compared 2. Dawson PE. Evaluation, diagnosis and treatment ofocclusal problems.
with the values of Hanau H2 and Whip-Mix instruments 2nd ed. St Louis: CV Mosby Co, 1989:230.
3. Heartwell CM Jr, Rahn AO. Syllabus of complete dentures. 4th ed.
was significantly different (Z 1.98, p < 0.05). It is most Pbdladelphia: Lea and Febiger, 1986:92-3.
likely that the curved protrusive and curved side shift 4. Hobo S, Shillingburg HT Jr, Whitsett LD. Articulator selection for re-
paths permitted a greater percentage of acceptability of storative dentistry. J PROST~ETDENT 1976;36:35-43.
5. Weinberg LA. An evaluation of basic articulators and their concepts.
interocclusal lateral records. However, all the lateral Part II. Arbitrary, positional, semiadjustable articulators. J PROST~mT
records from 30 edentulous patients were not accepted DENT 1963;13:645-63.
with fidelity, because the working condyle path in any 6. Aull AE. Condylar determinants ofocclusal patterns. J PROSTHETDENT
1965;15:826-49.
given patient may be in one of nine lateral directions 7. Bellanti ND. The significance of articulator capabilities. Part I.
within the confines ofa 3 mm high and 60-degree cone. The Adjustable versus semiadjustable articulators. J PROSTHET DENT
study ofAull6 reported that out of 50 patients, 84% exhib- 1973;29: 269-75.
8. Bell LJ, Matich JA. A study ofthe acceptability oflateral records by the
ited laterotrusion of working condyle tracing with both Whip-Mix articulator. J PROSTm~TDENT 1977;38:22-5.
vertical and horizontal components. The Hanau modular 9. Gaston ML, Brady RE, Vermilyea SG, Moergeli JR Jr. A study of the
system 194 used in this study does not have adjustable top acceptability of lateral interocclusal records by the Hanau H-2 articu-
lator. J PROSTHETDENT 1985;53:252-6.
and back walls and therefore cannot accept all of the lat- 10. The Hanau modular articulator system 194 illustrated instruction
eral records. manual. Buffalo, NY: Hanau Engineering Co, 1989:5-7.

CLINICAL IMPLICATIONS Reprint requests to:


MO~MED ALEEMA~DULL~4,BDS, MDS
To minimize occlusal error in complete dentures that COLLEGEOF DENTISTRY
require balanced occlusion and in fixed partial dentures for KING SAUDUNIVERSITY
PO BOX 6169
patients who require group function occlusion, a semiad- RIYADH11545
justable instrument that has a high percentage of accept- SAUDIARABIA
ability of lateral records may be used while recognizing the

1-800-55-MOSBY
This number links you to the full text of literally every article ever published in Mosby
journals. Mosby Document Express | a rapid response information retrieval service,
provides quick turnaround, 24-hour availability, and speedy delivery methods. For inqui-
ries and pricing information, call our toll-free, 24-hour order line: 1-800-55-MOSBY; out-
side the U.S.: 415-259-5046; fax: 415-259-5019; E-mail: mosbyexp@class.org.

MOSBY Document Express | is offered in cooperation with Dynamic Information Corp.

OCTOBER 1995 411

Você também pode gostar