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2$ a g e


,>. . . ,.
}aw ielationship iecoiu
: Notes
The Bi. staiteu the lectuie by ievising a few steps in making complete
uentuie which we talkeu about it many times !
The ui. announceu that hell ask us in the exam about auvantages anu
uisauvantages of mateiials useu foi making piimaiy anu seconuaiy
impiessions in the lab, I summaiizeu them in the last page.
This lectuie anu the coming one, well covei chapteis &
in the book .
the Bi. iepeateu some points many many times so I mentioneu them
in a simple way.
Now well begin oui lectuie ..
}aw ielationship iecoiu has a lot of steps, its not a simply taking an
impiession oi boiuei moluing oi wax impiession, it essentially
. measurement of patients face establishing the
Now we know fiom stuuies that usually theie aie ceitain things
piesent in patients mouth befoie anu aftei extiacting teeth.
: we know that aftei we extiacteu teeth, the iesiuual iiuge Example
iesoib , anu when we want to set teeth back to theii noimal position,
how can I uo that if I have lost teeth anu I uont have a iecoiu foi the
patients oiiginal ones .! .. theie aie a numbei of guiuelines that will
help us along away.
***we bove quiJelines tbot Jont cbonqe tbeir position before onJ ofter
extroction so tbey belp us to finJ tbe iJeol position of tbe teetb
: ncisive papilla
3$ a g e

I tolu you that theie aie some lanumaiks in the mouth iemain in theie
place such as the incisive papilla, we saiu that the location of the
incisive papilla is 8- mm behinu the incisal euge of the cential
incisois.
e know that the teeth in the uppei aich aie angulateu labial (facially)
to the iiuge, so when the iiuge iesoibs I have to set the aitificial teeth
labially to compensate.
manuibulai ielationship : - Naxillo
In jaw ielationship iecoiu, theie aie thiee basic steps :
- Aujusting the maxillaiy anu manuibulai iims to establish the piopei
. vertical relationsbip
o firstly, l finJ tbe Jistonce between two orcbes; its importont onJ Jifferent
between potients
- Binge axis location , I neeu to finu the ielationship(the iight
uistance) between the uppei jaw anu patient's heau(specifically uppei
jaw anu tempoiomanuibulai joint), The ielationship between the
uppei jaw anu the axis of iotation of the lowei jaw, then I tiansfei this
ielationship to an instiument calleu Bental Aiticulatoi which is
useu to simulate the patients jaws anu the ielationship between them.
- Boiizontal ielationship between uppei anu lowei jaws.
To finu the ielationship between two objects; I have to finu the x,y
anu z axis.
: is the ielationship between uppei Ucclusal Vertical Dimension
anu lowei jaws when the teeth aie in occlusion.
the centiic ielation. : also calleu orizontal relationsbip
It is the iefeience position of the manuible that can be ioutinely
assumeu by euentulous patients unuei the uiiection of the uentist | fiom
the bookj.
4$ a g e

entiic ielation is :the maxillo-manuibulai ielation ship in which
the conuyles aiticulate with the thinnest avasculai poition of theii
iespective uisks with the uisk of tempoiomanuibulai joint anu the
conuyles in an anteiioi supeiioi position against aiticulai eminences .
impoitant points about centiic ielation :
- It's bone to bone ielation ship inuepenuent of teeth position
- It's iepiouucible even if we uon't have teeth
- All the muscle fibeis aie ielaxeu in this position

of vertical dimension In this lectuie well concentiate on the
occlusion ..
hen the patient comes without teeth, how can I finu the ielationship
between the uppei anu lowei jaw. emember always we use a
guiueline that piesents befoie anu aftei extiaction because the
patients comes to me aftei extiaction so I uont know what he like
befoie. In some iaie cases patients come with some teeth so I can uo
some measuiements. B0T usually the patient comes without teeth so
the noimal ielationship is almost lost.

You know fiom physiology that muscles always anu foi ceitain
uegiees aie contiacteu, the manuible is hangeu; attacheu to the uppei
jaw not only thiough the TN} but with muscles.
e have the massetei outsiue, meuial pteiygoiu insiue.. we have
muscles of mastication anu muscles in flooi of the mouth attacheu to
the hyoiu bone.
hen Im not iequiieu to chew, speak oi swallow then the manuible
is ielaxeu (hanging), If the patient is setting upiight, muscles that
sLudenL asked do we have an average LhaL we can rely on lL Lo all paLlenLs ?
unforLunaLely no ! lL doesnL work so Lhe besL Lhlng ls Lo use a guldellne whlch
ls presenL before and afLer exLracLlon
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holu the manuible up by tension with the help of giavity will keep the
manuible a specific uistance away fiom the uppei jaw.

Because weie uealing with euentulous patients so I neeu a
measuiement that is piesent befoie anu aftei extiaction. 0ui aim
when making complete uentuie is to use the complete uentuie with
the teeth piesent on it to keep the piopei anu iight uistance between
uppei anu lowei jaws that was piesent befoie teeth weie extiacteu .
If I uiaw a point on the tip of the nose anu the tip of the chin then I get
a iulei anu measuie the uistance between them; I call it the veitical
uimension of occlusion (vB0)
reprexenteJ by A ln the plcture below.

This is impoitant because Ill set the teeth accoiuing to it.
Aftei the teeth aie lost, vB0 is lost but we still have the veitical
uimension of iest (vBR) so its the same befoie anu aftei extiaction.
vBR(veitical uimention of iest ):is the uistance between uppei anu
lowei jaws when the manuible is at iest "mouth not open anu not
closeu "
So now, I know vBR but the vB0 is unknown .. heie we use the
aveiage , they took many noimal people anu measuieu vB0 anu vBR
foi them anu founu that the uiffeience between these two
is about ( - mm ) in 9 % of population.
hy this is significant .
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This uistance is calleu the inteiocclusal uistance (I0B) oi commonly
. reeway space known as
So foi my euentulous patient; I know I0B (constant) anu vBR but I
uont know vB0 .. look at this simple equation :
VD VDU + UD {
VDU VD - UD {
Assume that vBR = 8 cm ( 8 mm) then I can finu my objective which
is vB0 :
VDU 8mm - mm
mm
e maue a iecoiu block in the lab which has a wax iim on it; wax iims
maue accoiuing to the aveiage measuiements, when I put the wax iim
in the patient mouth anu measuie fiom tip to tip (its not vB0 noi vBR
its veitical uimension of wax iims) , assume that we founu it 8 mm
then we have to iemove wax to ieach mm ( accoiuing to the
example ) , if we founu it mm then we have to auu mm of wax in
oiuei to ieach mm which is the vB0.

Teeth weie uesigneu to chew anu even uuiing chewing theyll not
come in touch because if they uo well enu up with whats calleu
clenching anu biuxism. So its a natuial piotection in oiuei not to huit
the muscles anu joints so they become in touch only - minutes
uaily !
The teeth only touch in chewing anu swallowing, the aveiage of
swallowing is about uaily but they actually become in touch foi
less than a seconu so its a count foi almost nothing.
If we give the patient a longei teeth, lets say 8 mm .. then when they
become in contact moie than they shoulu because theie is no enough
hy we have FS .
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space between them so theie will be tension on TN}, muscles anu
inflameu mucosa.
So the ieasons foi having FS aie :
- phonetics.
-ielaxing jaw.


tip of hile measuiing, tiy to use tissues that uont move a lot like the
, oi the base of the nose anu the base ose tip of tbe n anu the tbe cbin
of the chin. (( the Bi. showeu a pictuie foi instiuments useu foi
measuiing vB0 )) but in the clinic we usually use a iulei.




e have whats calleu Fiankfuit Boiizontal plane .
It's the plane passing thiough "oibitale" (which is appoint on the
miuule of infeiioi oibital iim )to the exteinal auuitoiy meatus like
shown in the pictuie bellow

noL ln lylng upr|ght vuC and vu8 when Lhe paLlenL ln We measure
poslLlon because Lhe Lenslon on muscles wlll be dlfferenL and Lhe
equaLlon also wlll be
Now, how can I know the coiiect plane of the suiface of the
wax iim in the patient mouth .
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But its not oui iefeience because the teeth aient at the same level;
they follow a cuive "the cuive of spee " anteiioi teeth aie longei than
posteiioi teeth..
soooooooooo
In the clinic we use whats calleu ampeis plane ; campei is the
name of a uentist.

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tragus line - Ala
fiom the lowei boiuei of the ala of the nose to the tiagus of the eai (
vaiiable between patients) . The angle between the Ala- tiagus line
anu Fiankfuit plane is
S
-
S
.
anteiioily we neeu a iefeience line , the anteiioi one pass fiom pupil
to pupil ; this is the anteiioi iefeience to the wax.
so the wax iim posteiioily shoulu be paiallel with the ala-tiagus
line anu anteiioily shoulu be paiallel with the intei-pupilaiy line

The patient shoulu show - mm of the incisal euges ( the wax iim in
euentulous ).
So now we know the length anu axis of the wax iim, we iemove wax
until it becomes paiallel to
the Ala-tiagus line anu at the same time
shows - mm of the wax iim inteiioily. Aftei we knew the length of
the wax iim , we neeu to suppoit the lip so
Bow long the wax iim shoulu be .
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the angle between the columella of the nose anu the philtium of the lip
is 9
S
.
So I aujust the uppei wax iim to be paiallel to the Ala-tiagus line ,
intei-pupilaiy line showing - mm below the ciest of the uppei lip.
Now aftei finishing with the uppei, we put the lowei one anu stait
aujusting it by auuing oi iemoving wax as in the uppei.

0sually we aujusting the uppei iim foi esthetics, phonetics anu
occlusal plane then we put the lowei iim anu stait auuing oi iemoving
wax accoiuing to oui vB0.

The next two pages contain classification of impiession mateiials
anu tables foi mateiials useu in both piimaiy anu seconuaiy
impiessions ..









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2$ a g e

Nateiials foi taking piimaiy impiessions
ulsadvanLages Auvantages Nateiial
poor dlmenslonal
sLablllLy
2syneresls (loss of waLer)
and lmblblLlon(sorpLlon of
waLer)


elasLlc
2 cheap
3 good for deep undercuLs
4 used for denLaLe and edenLulous
paLlenLs
3 accuraLe


lglnaLe

oor dlmenslonal sLablllLy
2 Lasy Lo dlsLorL when
wlLhdrawn from Lhe
MouLh
reusable
2 nonlrrlLanL and nonLoxlc
lmpresslon
compound
hydrophoblc
2 expenslve
accuraLe
2 dlmenslonal sLablllLy
3 non lrrlLanL or Loxlc

8ubber



Nateiials foi taking seconuaiy impiessions
ulsadvanLages Auvantages Nateiial
CannoL be used ln deep
undercuLs
2 Lugenol allergy ln some
paLlenLs

Low vlscoslLy no compresslon of
sofL Llssues
2 ulmenslonal sLablllLy (shrlnkage less
Lhan 0 )
3 Cood surface deLall reproducLlon
4 cheap

Zlnk oxlde
eugenol
(ZCL)

hydrophoblc
2 expenslve
accuraLe
2 dlmenslonal sLablllLy
3 non lrrlLanL or Loxlc

8ubber

3$ a g e