Clinical
fundamentals Restoration
Despite the new materials available, tried-and-tested techniques are the fundamentals of full mouth reconstruction. Dr Paul Tipton begins a series of articles with a discussion of occlusion and occlusal concepts
M
ost advanced restora tive dentistry tech- niques have
changed little over the past 20 to 30 years, including that of the full mouth reconstruc- tion. However, the impact of new dental materials, such as titanium and zirconia, has had a major influence on aesthetic dentistry and implantology during this time. As a result, the profession
may have an over-reliance on new materials rather than tried-and-tested techniques. Some fundamental techniques are just as relevant today as they were when I started my master’s degree in conserva- tive dentistry at the Eastman Dental Hospital in London in ı987. In this article, some of the
old restorative techniques will be revisited in light of today’s aesthetic and restorative requirements and some newer concepts will be discussed in greater detail while dealing with the overall topic of full mouth reconstruction. This article discusses the topic of occlusion and occlusal concepts.
Fig 1 Pre-op view
Gnathology Stallard coined the term gnathology in ı924, defining it as the science that relates to the anatomy, histology, physiology and pathology of the masti- catory system. McCollum formed the Gnathological Society in ı926 and is credited with the discovery of the first positive method of locating the transverse horizontal axis and transferring the recording to an articulator using a facebow. Stuart became associated
with the Gnathological Society early and published the classic ‘Research Report’ with
McCollum in ı955. Their obser- vations led to the development of the principles of mandibular movements, transverse hori- zontal axis, maxillomandibular relationships, and an arcon- style articulator that was designed to accept the transfer of these occlusal records. The goal was to truly
capture maxillomandibular relationships that accurately reproduced border jaw move- ments and which would then allow the technician to produce the most stable, functional and aesthetic occlusal form for indirect cast restorations. The
registration of the horizontal and sagittal movements of patients was believed to allow the maximum cusp height- fossae depth with proper placement of ridges and grooves to enhance stability, function and aesthetics.
Fundamentals of gnathology The fundamentals of gnathology include the concepts of retruded axis position (centric relation), anterior guidance, occlusal vertical dimension, the intercuspal design and the relationship of the deter- minants of mandibular movements recorded using complex instrumentation to the occlusion in fixed prostho- dontics. This has evolved into the five principles of occlu- sion I embrace today:
ı. RCP = ICP around RAP 2. Mutually protected occlusion
3. Anterior guidance 4. No non-working side contacts
5. Posterior stability. Continued »
Fig 2 ICP
Fig 3 Facebow recording
Fig 4 Diagnostic waxing front view
Fig 5 Lower wax-up Scottish Dental magazine 53
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