hello and welcome to my presentation on the science and research of the pan and articulator system my name is Thomas Lee I’m the son of dr. Robert Lee who did studies on job movements and gravy and saw plastic for articulated controls which led to the development of the patented articulator he also coined the word biosynthetic s– and defined it as the study or theory of the beauty of living things in their natural forms and functions so there’s not only beauty in a mountain lion in its form but there’s also a beauty in the way it functions well in mechanical engineering form follows function in other words if you have a preconceived function of mind that you want to fly high undetected and be able to drop bombs you develop a form to accomplish that function that would look something like this now in biology it’s a complete opposite function follows form that’s because form is a given factor its genetic matter of fact if we deviate this form ever-so-slightly by just cutting a couple of feathers here will deviate the function of this bird and he’ll no longer be able to fly well I gave it a better definition for dentistry as oral facial dalmatic bio statics and define that as the study or theory of the beauty of the mouth the face the teeth the jaws and the neuromuscular system as they enter relate to each other in normal genetic forms and functions the bio site forms would be the form of the individual T the form of included dentition the form of the joints the periodontal forms as well as the form of the smile and the form of the face what he did is study two healthy dentition that had little or no wear no periodontal disease and no tmd problems and found similarities or what he called observations of long lasting trouble-free natural bent Asians and that showed that MIP or Co equals CR within a half a millimeter that all these patients had a stable color position there’s also a proper Larry Max a teeth overlap that the incisor overlap averaged vertically three to five millimeters in horizontally two to three millimeters the canine overlap averaged vertically four to five millimeters with the horizontal being half a millimeter to one millimeter there’s also genetic like shark crown forms in a biosynthetic smile what he observed was that the centrioles are relatively large and long the laterals was short and rounded and the canines were long and pointed and so were all the rest of the posterior teeth which creates a more efficient cutting surface compared to someone’s preconceived notion of what T should look like and if they deviate the forms of these teeth we also believe they deviated the function compared to a natural set of dentition that God or Mother Nature or whoever you believed in designed so he developed his bio psych study models which is a biological model of health which leads to a very bio static smile well he often said regarding Dylan ethic functions form is everything you can get more information on bio psychic dentistry by contacting candidate or by aesthetics so what is an articulator well the average person might ask if that’s someone that speaks well dentists like to call mandibular movements simulators but I’d like to simply call them that they’re chewing simulator what we’re trying to do is duplicate the way someone choose which is a very dynamic three-dimensional movement that includes an opening lateral and closing movement so as we look at the introduction to human showing by dr.
Gibson Lundin we can see the differences in these different movements let’s look at the video at this time the computer plots reveals some interesting differences between the right and left cognate or movement patterns upon opening the working side translates along a course that is often superior to its closing movement distraction or separation of the working side condyle from its temporal articulating component is a common occurrence the separation begins during the closing stroke before the teeth have contacted the resistance created by food between them from 0.7 the working condyle moves upward and forward through 0.82 its intercostal position at point one guided by tooth contact the non-working side shows little evidence of separation between its opening and closing tracings some authors feel that the non-working side is under a heavier load and the thinner setter part of the disk is interposed between the condyle and articular eminence throughout the opening and closing movement again action of the non-working side condyle is shown in the split screen simultaneous views the subject is now chewing on the right side the black dot is located on the non-working condyle many articulate errs thought to try to simulate these job movements and some have kind of joked around by using a barn door hinge or even using what they call arista later or what I call the living articulator but there’s been many patents issued on different articulator design trying to duplicate these job movements or based on different philosophies of occlusion what is occlusion or function it’s the state of being closed or the act of closure a most dentists agree that they should have equal simultaneous bilateral contacts of the teeth but they may or may not look at what’s going on here at the joint the act of closure is a much more dynamic movement where you have a friend stimuli from the paradol membrane mucosa slips tongue cheeks and muscles and TMJ it’s and signals to the central nervous system the then sends efferent stimuli to the muscles of mastication it deals with condylar guidance and as we look at dr.
Tanaka’s work on dissected sections of the temporomandibular joint we can see the anatomy of the condyle the biconcave shape of the disk the fossa and the eminence it knows how all these surfaces are curvilinear in nature well articulator are the anatomical or they mathematical when I superimpose a mandible onto a lower frame of an articulator I’m trying to imagine how the steel ball-bearing is supposed to anatomically represent this condyle that looks like a football well if you take a sphere and reduce it infinitely small it becomes a point you go any distance from that point you take another sphere reduce it immediately small it becomes a second point two points in space define a straight line that’s what we’re doing with these two steel ball bearings is simulating a straight line or the hinge axis of the mandible so articulator simulate hinge axis movements not condyle movements per se and as you move your jaw laterally some authors say you will rotate around a vertical axis as well as a sagittal axis but to record Kannada movements we need only to track two points of fixed distance apart on the hinge axis since any movement of the mandible around a vertical or saddle axis will always move the hinge axis it’s also the one axis it’s constant with both condyles well how far apart do the condyles need to be well they say there is an effective intercondylar distance and here’s an author that’s showing a small medium and large inner Conner distance and showing that there’s a change in the groove directions of your teeth here’s another author that’s also going to show it and he’s going to show the lines even further here so they can really show the separation the lines between a small medium and large inter colored distance but this picture is out of perspective you can’t really expect me to believe that this large and econo distance is gonna come down here turn it the ramus under the arch form around the art form and then Bend back out to condyle number three it’s just out of perspective it seems that if you had a larger intercondylar distance you might also have a wider arch but here’s another author that’s gonna even prove the point even more and we may or may not be able to move our jaws that far laterally but he’s showing the lines that far to prove the point well my father never did believe research so he looked at the functional range and when he moved your jaw laterally to canine to canine it’s approximately three millimeters it’s also approximately three millimeters from the central fossa the cut step through your molar so he took a set of miles and ground down the teeth to make a writing service and mounted into an articulator had a small name and large inner on their distance then he took the compass and start the senator tooth at the small intercondylar distance and drew the first line he then index the compass at the medium intercondylar distance readjusting the compass to the same starting point drawing the second line then he put it the wide intercondylar distance readjusting the compass again to the same starting point to draw the third line we can now see the three lines and as we looked on the working side as we move towards the back of the mouth we can see a separation in the lines but again he ground down these teeth which made it much wider so if we draw it back in where the top of the tooth is I can’t see how you can wax the difference between small Mema and large within the functional range at the top of the tooth just the show we didn’t go less than the three millimeter functional range here we’re showing three and a half millimeters well it all starts with a hinge axis that McCallum in their group discovered in 1926 and there’s been many people coming up with different terms that basically describe the same thing that there’s an axis of rotation within the joint or the condyle when the mandible opens or closes well the value of the hinge axes and articulator is it makes access movements valid at various vertical dimensions you can also change if a closed overall dimension of occlusion on the articular and maintain the Caston centric relation it’s also a repeatable reference location we can locate this axis by using an ACCI path recorder where we put a clutch over the lower T so we can add this crossbar and put on some recording arms that we can move over a graph paper on a head frame that’s over the joint level we can then move this thousand different locations on the graph paper have the patient open and closed and see the arcs that the stylus makes on the graph paper moving the stylus until that Stiles just rotates at a Center Point locating the hinge axis of the patient we can then mark the skin where that hinge axes point is so then we come back with a face bow we can add a crossbar and clamp here so we can add back the recording arms to come back to that spot we marked on the skin so we can transfer that true hinge axis of the patient over to the two hinge axis of the articulator so when we mount the cast to the true hinge axis you can also use an arbitrary relationship to the axis by using a face bow which uses an arbitrary relationship using the ears so when we mount the cast in the articulator we have a arbitrary relation to the axis of rotation but most dentistry has done on these small disposable articulator is where the axis of rotation is down here behind the third molar it’s actually in line with occlusal plane here at Point C which creates a pure vertical movement out of the fossa in other words is impossible to have interferences on these small disposable articulator is where the axis of rotation is at Point C in line with a closed applying the problem arises when you place those restorations in the mouth the axis of rotation moves up by point a which creates this downward and backward rotation and this axis of rotation discrepancy will lead to you adjusting the Meisel inclines of the upper teeth and the dis link lines of the lower teeth every single time so we know we need an articulator that more anatomically represents the axis of the patient so we mount the casting the articulator will be duplicating the movements more accurately and I realized that my mounting plates are constant to the axis here regardless of where the models are mounted using a near bow or true hinge axis so we developed a secondary receiving port in the back of the mounting plate to plug in this pal articulator this palate articulator has the same axis of rotation as the full-sized articulator as a built-in support stand for patient consultations it can be open past 90 degrees to separate the frames it also has vertical and horizontal aesthetic alignment guides built into the front you can then push a button in the plate to release the model so you can go back to the full-size Panda to do any quality control or final adjustments using the curvilinear analogues of motion as your guide the plane of occlusion well we have steep planes of occlusion flat planes of occlusion and reverse planes of occlusion situations and see planes of occlusions are hard to work out functionally and reverse planes look bad aesthetically so we want to get the relationship with a plane of occlusion to a plane of reference and we do this by using a face bow we first take a bite fork registration of the patient’s maxillary teeth which is picking up the plane of occlusion and we add the face bow where the upper surface of this face bows related to the plane of reference again we’re referencing to an arbitrary relationship of the access use in the years they were referencing 22 millimeters ballonets young where the average canthus of the is setting up the axis orbital plane of reference connecting the clamp to the bite fork can the two planes together so when we go to the articulator we’ll get the plane of occlusion as it relates to a plane of reference on the articulator now this may or may not be aesthetically correct but it will be functionally correct so we do have to look at the functional plane versus the aesthetic point most things are taught to make the teeth parallel to the eyes but the eyes are uneven then there’ll be a can’t to the occlusal plane as well my father advocated making the teeth parallel to the horizon when the patient’s mid satchels erect a regardless of soft-tissue landmarks in other words teeth are part of the heart tissue system and should be read perpendicular to the vertical call while face bows and true hinge axis bows are not related to the eyes or the horizon that relate either to the true hinge axis to the ears which may be also uneven and of course even though these teeth may be functionally correct they look aesthetically bad when they go to the mouth based on a lack of aesthetic information an anthropological society meeting in Frankfurt Germany they said from the top of the ear hold poori on to the lower border of the eye or batali was basically horizontal and modern man now in the 20s Macomb and their group found the hinge axis and realized that was more clinically significant than the ear hole so they moved the to posterior points down for to the axis but let the Third Point reference the same at or batali trained the axis orbital plane of reference so when we have a patient stood erect and looked straight ahead the face Bowlby often counted upward here in the front the vertical post is also candid but every time we go to the articulator to mouth the vertical post is always related vertically so this would accentuate the plane of occlusion as we go to the articulator so we developed a little adjustable nazy on Relater in a level Gage and we can turn the screw here in the center of the housing so we can separate these housings leveling the front of the face bowed down to what I call an arbitrary axis horizontal plane of reference although the face bill is level from a profile view once we look in the frontal plane we can see this patient has one ear that’s slightly higher than the other so we can have the patient move the face bowing the soft tissue of the ears leveling the face well as they look at the level gage this will now free up our hands to go ahead and attach the clamps to the bike 4 and then we can take that bike for to the articulator to mount the maxillary calves so if we can look through the patient’s cheek here and see the steepness of her plane of occlusion we get the same result on the articulator and looking at the frontal plane we can see a cat to the occlusal plane rain downhill from left to right we’d get that same look on the articulator when we mount the cast so now we can do an evaluation of whether we want to do some general recontouring on this side for symmetry and balance whether we want to prep more on this side or add back to this side to level the plate of occlusion for both function and aesthetics they also developed the Kois del facial analyzer system which is a simplified face though it looks a lot like a fox plane where we’ve had a little vertical rod it has an index tray and an adjustable platform again we’re looking at the occlusal plane to someone’s eyes but when I talk about the dental midline and ask whether you want a straighter cannon everyone agrees that they wanted straight straight to what the eyes are the horizon well actually the facial midline C facial midline will actually dictate your dental midline then your dental midline will dictate your occlusal plane it’ll be perpendicular to that it’s just what laboratory technicians do well we looked at the research of ear bows and it showed that 75% are within 5 millimeters of the axis which is an acceptable range for mounting chaos they show if it’s off 5 millimeters from the axis creates a minimum mirror at the tooth level so dr.
Khoi said do we really have to relate the axis to the ear hole or can we relate the axis directly to the teeth so he did a study measuring the distance of the hinge access to the central incisor and found it averaged approximately 100 point to 1 millimeters and if we go 5 millimeters below the 5 millimeters above it encompasses about 75 to 80% of the patient base so statistically is about the same as an ear bow so we’re gonna standardize the system to an axis in size with distance of 100 millimeters knowing this all we got to do is pick up one of these two points in a face bow I’ll engineer it that the second point is $100 for the first point when we get to the articulator other related research would be bond welds equilateral triangle Monson spherical theory of four inches happens to be approximately 100 millimeters and of course Weinberg studies well bond was equilateral triangle states that from con Dada condyle is 110 millimeters and from condyle to incisal edge is 110 millimeters which would create an equilateral triangle but from the centre of the axis Ford is about ninety eight millimeters was within five millimeters of dr.
Courses 100 millimeter or average iron Bert was going for the centre of the axes out 100 millimeters and then down 32 but the axis incisal distance was again within five millimeters of dr. Khoi 600 millimeter average so we have a vertical rod that we slide into the slot and we slide in the slot because some people have shorter noses and some people have longer noses and the closer we are to what we’re trying to reference to will make this system less subjective you can also see that we have little holes in the play here will accept the pins on the bottom of the Kois index tray so we see the Kois index tray all the way down onto the dental facial analyzer we can then add our bite tabs that write a pressure compound on a self adhesive strip head to back in the molar area and I also like to add two more over the bicuspid area we can then temper that compound in hot tap water once it’s softened we can then mold that compound into a cone shape to build more height than the compound especially if we have a steep play of occlusion situation if we had a reverse play of occlusion situation I may squeeze the compound the front up a little bit higher while step one is to set the wall that’s on the Kois index tray to the central incisor clicking at one point of that axis incisal distance for function step two is get the vertical rod a facial midline well what is facial midline I like to split the eyes and use the philtrum of the lip but you have to decide what facial midline is you can also see the lateral wings going down the side of the face or approximately level and then we come straight up to whatever tooth is lowest in the arch hits the tray and stop we can do this in the supine position so we can really focus on the vertical rod which is the critical aspect of this system if you get a half a degree can’t in the vertical rod you more unlikely get at half a degree can’t in your dental midline and your final prosthesis so now we capture the cats and tilt of the occlusal plane in the bite registration material on a horizontally lined index tray we can now come to the articulator where we inset the incisal pin to zero we have a decimal platform that will adjust to the zero line for mounting and then we index the adjustable platform to the lower magnetic mounting plate we can then add the index tray to the holes onto the platform which will now align the wall on the index tray a hundred millimeters from the center of the axis of the articulator notice how the platform also creates a built-in by fork support system it will support the pass during the mounting procedures so there’s no longer need for mounting wedges jack screws or even plaster under your bite for for mounting so now we can add a mounting plate and plaster and make a connection of the upper cast to the upper frame I believe the upper caste should be more of an aesthetic relationship it does have to be related to an axis of rotation because we use that upper caste to mount the lower cast with the centric relation record which is your functional mounting it’ll dictate how the lower teeth approach the upper teeth is larger within statistical average of the axis of rotation dr.
Quest also uses his down facial analyzer for dentures what he’ll do is set the incisal edge where he wants it vertically in the face as well as anterior-posterior lee for lip support then he’ll take the back of his mouth mirror and make a couple orientation dimples in the occlusal surface of the bite room then he’ll take the PVS material and put it on the Kois index tray and take a face bill registration of the bike rim here we can see the little orientation dimples in the bite registration materials so that the by trim will reorient eight correctly onto the Kois index tray when we come to the platform to mount the cast then we can use the platform as a guide for setting our occlusal plane and making sure that the esthetic relationship with a close a plane is correct as well as tooth widths but we also have a bra trick and clothes a plain analyzer that we can use to evaluate the occlusal plane or the curve of speed it’s based on Watson spherical theory of four inches so we’ll set the compass at four inches and we come to a k9 point on the lower caste and scribe an arc here on the flag above the articulator well then come to a molar point and scribe another line on the flag if you don’t have one of those two points you can also come back to an access point here and scribe a third line notice how all three lines intersect basically at the same point we can now readjust the compass to that point and then sweep the compass across the clues or surfaces of the teeth to evaluate the plane of occlusion or the curve of Spee centric relation I’m not sure if I really like this term I like the term stable condor position it just makes orthopedic sense to seat the condyle in the fossa and we do this by some type of enter deprogrammer here’s shown as the penitent byte tray with a compound jig is this anterior deprogrammer here that creates a fulcrum point allowing the mandible to rotate around that fulcrum point upward and forward into the fossa without interferences of the posterior teeth we do this by taking a centric relation record by adding a bite registration material to the upper side of our bite try to get an index of the upper teeth of the patient then we’ll add a lower compound jig although you can cut the anterior section of the trail right here and use it with a leaf cage or with a Lucia jig here we’re showing a compound jig then we go to the mouth and actually push on the lower jaw back to get the most retreated of the position of the mandible what we’re trying to do is push the job back from a co or mi P’s position back to CR or the apex of basalts rhombus we then check to make sure we have no posterior contacts of the oppose to your teeth and then we can add it by treta stration material to the lower posterior half of the bite ray then we can see that the teeth fit very accurately in the bite registration material then we can test our study cast to see if they fit the record as well if the models don’t fit then maybe the models are inaccurate we then take the centric relation record and index it to the upper caste and then index the lower caste into the centric relation record and we now have the articulator upside down in our mandibular mounting stamp and with the mandibular mounting stand we can actually adjust the front of the articulator down so we can level a caste here so the plaster will stay in place we can now add plaster to the model and the mounting plate swinging the lower frame around making a connection of the lower caste to the lower mounting plate centric relation versus stable caller position we developed also the API or CPI system to help track caller stabilization during splint therapy we can also use it to determine slide versus fulcrum and also to verify here occlusal records the CPI system is a dedicate articulate with built-in graph supports where the API system or graph supports that can be put in place of the motion and logs on their articulator and then we add a paper graph on here that has a grid and now we have these models that are mounted to the original CR position and so I would expect the mark on here be right at or near the crosshair of this graph paper so we’ll mark that with a piece of marking ribbon then we’ll put the patient on splint therapy for a period of a couple days to a week and have them back and take a new centric raishin record and we’ll stick this second relation record into the originally mounted casts so we want to see is where is the con doubt going during splint therapy so we’ll mark that with a different color and we can see on the patient’s right side that the condyle is moved up about one millimeter and forward about a half a millimeter on the patient’s left side it’s gone up a little over a millimeter and gone forward about 3/4 of a millimeter and we can do this weekly until we achieve the points at the same position verifying as stable cobler position well is it a slide or is it a fulcrum when you take a centralization record many times you’ll have a posterior interference and you’ll end up with an anterior open bite if you have the patient’s squeeze the teeth together it’ll appear that the lower jaw slides forward into occlusion well we can actually superimpose the patient’s pathway right on the side of the graph paper and then we can take our models that we now remount it to the stable condylar position so we have that record of the stable color position in here and when we mark the graph again expect it to be back at the crosshair or centric relation of the articulator then we’ll put in an MIP or Co record so we can see where does the condyle go when the patient bites their teeth together so here on the patient’s left side we can see the condyle is being focal dawei from the Amanat about a millimeter on the patient’s right side we can see actually the condyle is down the eminence and that’s a pure slide and here’s a case that’s actually part slide part fulcrum the part vertically forward from the vertical line four is the amount of slide the distance from the pathway straight down to the dot is the amount of fulcrum well produce a pathway deals with opening or incising movement the condyle not only has the ability to rotate within the fossa but it has the ability to translate and it’s this downward for moon and the condyle is a disclosing factor and they show that if you have a flatter evidential angle versus a steeper evidential angle will affect the approach to the posing teeth and that’s true but they left something out of the equation in other words we want to know what the disclosing factor of the condyle is because you can’t change that but you need to override any negative effect this condor movement has on your posterior teeth with the other disputant factor you can change the anterior teeth so when we look at a steep plane of occlusion situation an opening movement would be a lot like a vertex where the axis is in line with the occlusal plane I’d expect to see excellent disclosure in opening movement promise with the petrusha pathway the plane of occlusion is very close to that so you see little or no separation of the teeth in a protrusion movement if we take the extreme opposite of that of a reverse plane of occlusion I expect to see excellent exclusion a producer movement but yeah I expect to see very poor disclosure during an opening movement so what we’d like to do is actually create a fairly level plane of occlusion or a slight plane of occlusion for aesthetic so we get disclosure nary an opening movement which sets up the Meisel inclines of the upper teeth as well as disillusion in a producer movement which sets up the distal inclines of the upper teeth produce a pathway by using our AXI path recorder which traces the purchase of pathways the patient’s slides forward and slides back we can then superimpose the protractor on to the patient’s pathway here and then read the axis over the reference line out to the patient’s condylar inclination on the right side we can do the same thing on the patient’s left side superimposing this pathway on to the patient’s pathway reading the reference line out getting that inclination of the patient’s left side condylar inclination we can also get this information by using a patru civ record where we use the byte tray again and the procedures are the same as the centric record for the upper side getting an index of the upper teeth then we add a lower compound jig go to the patient’s mouth and we actually have them re– Trude and make em centric index first then we have them open come forward come forward until their head to edge and bite up into an edge-to-edge position we can then see that we’ve gone for between five to seven millimeters and measuring that purchase of pathway and we also know that the record that has two indexes in it is our producer record while the one that only has one index is our centric record we can then add the byte registration material to the lower posterior half of the byte tray go back in the patient’s mouth guiding them back to that edge to edge but rusev movement and then holding the tray in place while the material sets we can then take that tray to the articular let’s move the lower frame and the cast downward four to that edge to edge position and we can now loosen the screw allowing the guide system of the articulator fall down to where that access element is move downward forward in the fossa setting the patient’s patrisa pathway then a pathway deals with lateral or chewing movement described a lateral shift of the working sign condyle and as we look straight down on top of someone’s head and look at opening movement the mandible translates forward then we’ll move laterally to a chewing side in the working side condyle moves upward our and backward as the non-working side shifts in now we’re coming from a lateral position back into full occlusion as the working side shifts in this is what better described but the non-working side is moving upward our and backward in a curvilinear pathway so I like to call this Bennett movement if you have a little bit of Bennett movement or and we’re moving of the condyle versus a lot of been a movement will affect the approach to the opposing teeth it almost looks like you have to grind these teeth down no matter what better movement you have that’s because they left something out of the equation the canine guidance in other words that this was your restoration back here and this is a big interference I’m sure you don’t like that and you may want to adjust that but I’m saying let’s look at this canine which has a lot of wear on it and if we add it back a millimeter so – this canine we not clear that interference that’s why I diagnosing and mounting cast and articulator is so important and we can actually measure this bennet movement with our active path recorder where we have the patient move laterally three millimeters and then we push at the angle of the mandible to simulate a hard shoe and as we push it the angle of the mandible the condyles moved inward now and forward and as the condyles moved inward the recording arm is attached to the mandible so it also moves inward they’ll push the Stiles out giving the measurement or amount of bennet movement taking place at the joint we can also get this information using our analog selectors with lateral check bytes to measure the Banat movement history recording devices is the pantograph the definition of a pantograph is two rigid bodies that move relative to each other and the Stuart pantograph was an ingenious system but it had telescoping stylized so it actually wasn’t two rigid bodies that moved relative to each other but did have clutches over the teeth with a central bearing screw and they’d paint the vertical and horizontal graphs here with a chalk like material as the patient moved around in border movements these thousands of describing those movements on the vertical and horizontal plate then they’d mount the whole recorder along with the models into the articulator so they could try to move the articulator similarly in the same movement scribed on the vertical horizontal plates until something bound up in the guide system then they’d mark that with marking ribbon and basically custom grind and analog emotion specific for that patient well Dana came out with a mini recorder where they move the stellas forward from the hinge axis and when you do that you lose fidelity in other words was it more easier to grind in this complex curvilinear movement here or was it much easier just to set a quote-unquote bennett angle so you lose fidelity by moving away from the source you’re trying to record from other misinterpretations would be the Fisher angle the backlash the Gothic arch and immediate side chef so the backlash is actually an artifact from recording outside the center rotation of the condyle condyle isn’t actually going back and up into the brain the Fisher angle here might be actually due to the shape of the condyle or maybe an inaccuracy in locating the hinge axis the Gothic arch was again the stylus trying to keep up with this plate that’s moving away from it and it creaked this sweeping motion or so-called gothic arch the stereo graph is actually two rigid bodies that move relative to each other so it is a true pantograph it had a central bearing screw in the center here and it had these steel studs here with its put soft material in here and how the patient moved their jaws around and border movement and mold in basically basalts envelope emotion and again it you can see that we didn’t see the so-called gothic arch it looks more like a Greek arch then they take these plates and mount it into the articulator and then put some acrylic up in the guide system here moving this around molding a custom analogue emotion specific for that patient well it all deals with two plane versus three plane pantograph II in two plane pant Agra fee the condyle moves inward downward forward and a curvilinear movement and the vertical and horizontal stylus record that movement onto the plates the problem arises when you go to the articulator that this point could stay at Point a while this stylus shifted straight across from A to B inducing what they called immediate side shift in the articulator and then this stylus would race down to Point C to catch up with this stylus tracing in the patient’s patru civ pathway well is an immediate side shift factor artifact well as you move your jaw laterally the condyle is actually moving down which is moving the plate down away from the stylus and you can see from the edge of the plate to the stylus here to the edge of the plate here to the sides is a longer distance so as this plate moves down the stylus stays in the same orientation and it creates this sweeping motion across the plate or inducing in an artifact of immediate side chip on the recording play well it all deals with six degrees of freedom that there’s translations as well as rotations in all three planes of space as the con down moves inward downward and forward in a curvilinear movement the vertical stylus and horizontal sauce are recording the same movement on the vertical and horizontal plates but now we have a frontal plane here so when we go to the articulator this point can’t stay at point a while this one shifts across otherwise we see it’s shifting straight across here so the frontal plane really gives the timing between the vertical and horizontal bites so when we go to the articulatory reproduce that curvilinear movement that we got from the patient the axial Penta graphic research data showed that high percent of the 220 patients right and left border movements 440 movements showed a downward four position of the contralateral condyle from CR in other words we did not see immediate side chef he published his results in the Journal of prosthetic dentistry in 1969 part 1 being the recording apparatus where he did not know what the intercondylar distance was but he standardized the drills at 220 millimeters apart and these were actually air driven drills that went into solid plastic blocks so as the patient moved their jaw laterally the drill it’d be grinding in the patients movements into these solid resin blocks so let’s take a look at the research film at this time the left lateral recording is verified by repeating the border movement to the left and then to the right these repeat movements are done to make sure that the mandible was tracing a true border movement the pro true civ recording is verified by repeating the movement the mandible is again placed in centric relation in preparation for recording the movements of the hinge axis with the mandible in centric relation the two axis drills are made to penetrate their associated recording blocks a predetermined depth as indicated by calibrations on the turbine carriage the turbine carriages are locked when the drill tips are precisely at the standardized distance of 220 millimeters apart the left lateral movement is shown being recorded on the right side of the patient while the right side drill is recording the left lateral movement as shown here the left side drill which cannot be seen is recording the same movement in a reverse direction the mandible is returned to centric relation with the drills inactive the right lateral movement is now recorded and appears on the working side as a backlash the mandible is returned to centric relation with the drills enacted the axis record blocks are switched from right to left so that the blank sides may be used for recording the pro true Civ movement you the mandible is retreated to centric relation and the axis recording drills are made to penetrate the new sides of the record blocks they are locked at the same depth as they were for the recording of the lateral jaw movements the same two points 220 millimeters apart on the hinge axis which were previously traced in the lateral jaw movements are traced in the pro true Civ movement the mandible is returned to centric relation with the recording drills inactivated the anterior reference pointer is adjusted and secured to the orbital spot on the right side of the nose note that the orbital spot has been marked temporarily with dark ink for photographic clarity the recording equipment is removed from a patient by loosening the attachment clamps here in these resin blocks are recorded in three dimensions the right and left lateral and pro true civ mminton tubule part two of this motion picture will show how the information stored in these three blocks is reconverted by a secondary pantograph two locations near the condyles this procedure produces a pair of motion analogues which will serve to guide and control the movements of an articulator or assimilating this patient’s characteristic jaw movement now he could view these solid resin blocks and three planes of space here’s the vertical plane where we can see the patient’s produce a pathway then we can look in a horizontal plane here and see from the point century the Bennett movement coming in rear and forward and then of course in the frontal plane where we see the benefit coming inward and downward now we can see the variances in the producer pathway as some had very flat producer pathways and some had much steeper producer pathways there’s also a difference in the amount of Bennett movement as the Conda moved in a little bit on some patients where it moved in quite a bit on other patients so part two of the research was the transfer apparatus where he standardized the inner collar distance at 110 millimetres half the distance of the recording drills he’d have these resin blocks on the upper frame here and he had pens ‘some laying the drills from the recorder so now these pins would guide this upper frame his two vertical mils would basically mill out a custom analog emotion specific for that patient so let’s take a look at the secondary paragraph research clip at this time the pointer is indicating that the patient’s recording blocks have now been reversed to expose the lateral border recordings to the guide pins the analogs are repositioned over the vertical mills in centric relation and the guide pins are inserted into the lateral border recordings the mills are activated and the border movements are pantograph here we see the right recording with an analogue being generated on the left note the backlash effect in the recording was caused by the pivotal action of the working condyle observed that the Bennet and orbiting paths are magnifications of the movements at the condyle level a closer view of the recording shows the backlash affect the lateral and medial Bennett shift and the Bennett and orbiting paths starting in centric we see the lateral and medial Bennett shift of the working condyle followed by the curvilinear Bennett and orbiting movements a closer view of the guide pin shows the lateral Bennett’s ship and backlash the medial venit shift and the Bennett and orbiting paths this view shows the anterior recording of the lateral border movements note the twisting motion of the frame as it rotates and translates in the three planes of space after the border movements have been generated in the analogues the guide pins are retracted and the analogs examined that close range in the right analog we see outlined the border movements including the Bennett orbiting and pro true civ paths here we see the same movements on the left this view shows that the content elements of the articulator and centric indicating key are spaced exactly like their counterparts on the wreck inverter the analogs are removed and attached directly to the maxillary frame of the articulator for replay observe the right condylar element as it moves from centric to protrusion and back to centric in word Bennett ship in word on the Bennett and orbiting paths in the right working path the balancing Bennett and orbiting paths and back to centric the centric pian is depressed to position the condylar elements in centric relation so now he could put these custom analogs of motion onto the articulator to duplicate the patient’s actual jaw movements the Gibbs replicator was developed by dr.
Charles Gibbs and dr. Harry London and it actually had para occlusal clutches so patients could actually chew different consistencies of food and the bows had six transducers on it which actually are the six elements of freedom those six transducers would send signals to the six channel tape recorder that would then send those signals to a digital reconvert that would break them up in two milliseconds and then send those signals up to six servo motors that have the ability to reverse direction in an instant so as the patient was chewing different consistencies of food here their models were actually chewing at the same time over here they were looking at how people chewed but then they also looked at the condylar movements of these chewing patterns as well my father went down with dr.
Gibbs and dr. lund Dean and what he did is measured a patient with his recorder and developed a custom analog emotion and mouth the cast and an articulator then they married the two systems together by a mounting the articulator into the Gibbs replicator so the Gibbs replicate would then move the lower caste around so they could see if everything tracked the guide system the same is what my father recorded which it did so here we have two different researchers with two different instruments supporting each other’s research it also met scientific method where it was standardized the primary investigator was able to repeat his results other investigators were able to repeat the primary results and the data was in a form that could be analyzed what they did is took all these movements and put them into a computer to come up with statistical averages of actual patients job movements which led to the development of five different sized motion analogues of motion ranging from 0.5 to 2.
5 in half millimeter increments in a distribution chart shows that 15% of the patients had a half a millimeter Bennett 52% one millimeter Bennett twenty one percent of 1.5 eight percent of two and two percent of 2.5 we recommend a 1.5 motion analog of motion if you’re gonna use it statistical average because that will cover approximately 85 to 90 percent of the patient base so use a statistical average use a larger Bennett movement the major differences of Kannada movements in the functional range was the steepness of the patrisa pathway and the curvature of the balancing side Bennett pathway so if we look at a schematic of the motion analogues here we have the sagittal plane or profile view and we see the patients produce a pathway which averaged a 3/4 inch radius and we can rotate the analogues to set different patients but rusev pathway angulations the Bennett pathway again was varied a little bit by half a millimeter crane these five different analogs of motion of the Bennett movement within the functional range of three millimeters so here we see the balancing side Bennet pathway which is a curved path way like this dotted line which is led to three main types of articulated guide systems pathway a is a straight line under compensated Bennet guide path where it goes from point centric out to point Bennet the patient can actually chew beyond the limitations of the articulator which means from the solid line to the died line is a potential posterior interference so they came out with the immediate side shift articulator went from point centric out the side chef and then out to point Bennet and eliminate all possibilities of interferences as now the patient choose within the limitations of the articulator but if you have two millimeters of side shift it’s only three millimeters from the central fossa to the cusps which means two-thirds of your tooth would be as flat as this floor so this little triangular area in here would be anatomy so we want to copy the patient’s pathway as closely as possible like pathways see so we can reduce or eliminate the possibility of interferences while still maximize anatomy for joint efficiency stability and longevity so here we’re showing the wit mix under compensated straight-line articulator going from point centric up to point Bennett and the patient choo a little beyond that in a curved pathway and then here’s the immediate side shift articulator ignore for point centric shift straight over to point Bennett side shift and then go out to point Bend and then back very robotic system very difficult to work with versus the curvilinear analog system of the panna des has moved the jaw laterally the working side shifts out and the non-working side moves and we’re downward forward on a curve linear movement more duplicate life lecturing motions so now we can manipulate the articulator by just grabbing the side of the frame and we just glued like the patient does by simply opening the mouth then we’ll push the articulator into a patrisa position so we can evaluate if there’s any interferences in different lateral movements so some basic fundamental functional analysis records would be a face book restoration so we can get a relationship to the axis of rotation as well as the plane of occlusion near occlusal records will give us a centric relation position as well as the purchase of pathway disk looting factor and then mounting casts on a curved path guide articulated for more accurate jaws simulation well introduction the golden proportion there’s a fire ratio of 1 to 1.618 and we do have what’s called a golden ruler that maintains this 1/2 1.
618 relationship and we can use this to evaluate the face or do a facial analysis using golden proportion and there’s many proportions within the face but you may remember the true bite mask that actually measures eye grammatic width and facial length to help you choose the width and length of denture teeth for a patient the same concept applies here where there’s lateral portions to the face where we’re showing here the lateral canthus of the eyes is approximately 6% wire in the width of the mouth the width of the mouth is then 60% wiring the width of the nose then the width of the nose would be 60% wiring the width of 2 central incisors and they show the width at 2 is B then 60% water than the height the one which would end up being about an 80% single central width the height ratio they also show that a width of the central is 60% wire than the apparent width of the lateral not the actual width the apparent width because the lateral slightly rotate then they also say that the width of the lateral is 60% wire and the width of the canine but when they show the picture it kind of shows a funky looking canine well we did develop golden proportion wax and guys that can be added to the Kois platform to help evaluate tooth widths the width of the central to the parent with the lateral to the cusp of the canine but if you don’t like golden proportion I recommend visiting dental GPS where dr.
Lane methodical to computer software program where you can import the patient’s face and actually set up different proportions of the teeth and evaluate that to come up with a patient specific proportion tooth guide you can then print these out on paper and then set the model on the paper or tape this to the course platform to evaluate tooth widths there’s also a vertical portions to the face there’s facial thirds is the upper third there’s the middle third and the lower third as the middle third and the lower third overlap each other they create proportions so we do have a vertical rod from the Kois bellow that has little slidable ol rings so we can annotate these different facial landmarks and we can use the golden ruler to evaluate from the inner canthus of the eye to the olive the nose to evaluate in size ledge position and here we’re showing the incisal edge is short about two or three millimeters and if we want to add back that length through both functional concerns we may also want to add it back for aesthetic concerns being in golden proportion so we can actually adjust the Kois platform down two or three millimeters and then the teeth are suspended by the incisal pin giving a guide for the technician to wax in toothless and then of course with the waxing guides you can evaluate tooth whit’s at the same time you can also evaluate from under the nose and size ledge to evaluate the chin for vertical dimensions you may want to change that to where you may take a shorter face or a longer face and try to make it more ideal we also have conned out positioners which are used for making repositioning splints or simulating model surgery they go in place in the motion analogues and they have little screws on the top and in the back here and one full rotation of the screw is one millimeter there’s actually a little line on the screw and the housing here so you can measure the rotation of the screw as we screw the top screw down and be like impacting the maxilla screwing the back screw forward would be like an advance with a mandible a combination that T would be like an auto rotation of the mandible we also put lines here on the shaft so we can do lateral shifts of the mandible for simulating model surgery as well we also have an articulator test palm which has a split cast form on the middle of the call and we can pour this up in a good dice tone so that we can check the articulate from time to time to see if it’s still accurate with the laboratory and also I’ll have an adjustable in size of guide table where you can set up a different incisal angle as well as k9 angles or a guide system so that we can reproduce these different incisal or canine guidance in our restorations so now we can evaluate the inclusion of this patient the state of being closed do we have equal simultaneous contacts when the joints and the fossa we can also check the act of closure going from a patru supposition back into full occlusion or left lateral movement back in the full occlusion or right lateral movement back into full occlusion with no interferences of the teeth my father also talked about graduate buccal cusp guidance what he said was during age 612 during the most formative years of our children’s lives they don’t even have canines so was guiding our children from age 6 to 12 the 6-year molar and many times that distal buccal cusp falls down out of occlusion a little bit which may be a surrogate canine so when he had his doctors wax the case he wax it without the canines in and haven’t watched from the six-year molar for so here we can see how the restoration fits on the articulator then we can see that it fits accurately in the mouth then we can see how that six your molar functions on the articulator with no canine guidance getting disclosure of the non-working side we can see how that works also in the mouth then when we get to canine guidance we get excellent disclosures of all the teeth and no interferences back into the occlusion in other words that this patient was the wearer break this canine the first bicuspid will start picking up guidance with no interferences of the teeth if that was everywhere a break the second bicuspid picks up and if that was ever to where a break than the first molar would pick up in other words this patient will probably never have interferences the rest of their life it’s a great little exercise I recommend you try and then we can see how this also works in the patient’s mouth and you can see how accurately the articulator simulates the same movements of the patient well the Stevenson tilted it closed the plan related to an average axis of rotation along with smile teeth and gingival symmetry and balance along with HIDA lip comma shears tooth and facial proportions can all be diagnosed comprehensively to achieve a superior treatment plan for optimum aesthetics so if you have candidate occlusal plains dental mid lines that are off and unsymmetrical gingival tissues you can hopefully get that all straightened out the first time now the panted articular area with the curved path analogs of motion can be programmed either averaged values with check bites or active path recordings to reproduce the patient’s three-dimensional mandator your border movements for optimum function so here we see a lot of pathology and a little have a dentistry but there’s no teeth that look like teeth you can restore those teeth back to the form so we can restore the function here again pathology pathology disease restoration the form of the taste so we can restore the function is it reconstruction or rehabilitation many times I think we do reconstruct pathology in the teeth maybe to a lesser degree rehabilitation is not a good word either because nobody wants to go through rehab I think rejuvenation is one of the most powerful words you can use because it’s not only a renewal of body it’s also renewal of spirit so now we can take them out that has a lot of pathology and disease and here’s a couple teeth that look halfway decent and restore the individual forms of the teeth with the form of the cluded intuition in harmony with the form of the joint to restore physiology again pathology and disease restoration back into health there’s no straight lines in nature just big biological and beautiful so what is beauty well Webster describes it as the quality or aggregated qualities in a person or thing that gives pleasure to the senses or pleasure Li exalts the mind or spirit and here we can see that we have a restoration of vertical dimension release eccentric relation and look at the renewal of body and renewal as spirit as the eyes brighten up and there’s a new roof figuration within this patient qualities of beauty is the visual perception of any object including the face is a function of four qualities color texture size and shape and of course they put form down here a shape now tell you that shape more than shade will make your teeth believable so if you have an older patient do we want to age their teeth no because if we change the form we change the function you can maybe age it with color check lines but you don’t want to change it Anatomy because you’ll change the physiology here we see we’re just starting and we can actually mount this case up and maybe diagnose why this wire is starting and equilibrate the mouth so that the joints are in harmony with the teeth and then add back this tooth structure for optimum aesthetics as well as for function so some treatment goals for both function aesthetics would be to eliminate interferences to maximize anatomy for two inefficiencies to building longevity to create a beautiful smile and to enhance facial aesthetics so the rationale for articulate errs would be to diagnose whether we have interferences when the joints in the socket development treatment plan that’s in harmony with the biologic system to communicate with the laboratory for both function and aesthetics you also need one for teaching or for didactics and I think most importantly for baseline records knowing how the patient came to you what you did to them and how they are now we’re compatible at all especially in disciplines including orthodontics or the ethic surgery prosthodontics implantology periodontics restorative dentistry and I think we develop some tools and techniques to accomplish aesthetic or cosmetic goals at the same time our benefits is that were user-friendly we have simplicity and design we create time same procedures so you can communicate with the laboratory for both function and aesthetics we give great education support and being more predictable and your treatment is trained and cost effectiveness our mission is we’re dedicated providing quality innovative products and exceptional customer service to the dental profession since 1974 if you’d like more information please contact Patty at the following address now I want to thank you for your attention and have a great day you