Post on 07-May-2015
transcript
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Part 3 - Maxillary Setup
Total prosthetics in Function - TiF®
According to Karl-Heinz Körholz, MDT
Merz Dental Prosthetic Training
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Lateral incisors
Canines
First premolars
First molars
Overview
Central incisors
Static lines
Setup order
Second premolars
Second molars
Maxillary setup steps according to TiF®
Concept, graphics and texts: Martin J. Hauck based on the TiF method by Karl-Heinz Körholz
Checklist posterior setup
Tooth setup – Maxilla
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Ideal line
Based on the individual atrophy status
Maxilla: Marks the ideal position of the palatal (working) cusps, except for the first premolars.
Mandible: Marks the ideal position of the centric fossae, except for the first premolars.
Static lines – Definitive setup line
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Balancing:
Offers a broad contact zone
Marks the vestibular contact limit of the maxillary and mandibular buccal cusps
If exceeded in the maxilla, the cusps must be placed out of contact to prevent rocking or tilting
Static lines – Outer correction
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Marks the vestibular contact limit of the maxillary and mandibular buccal cusps
If exceeded in the maxilla, the cusps must be placed out of contact to prevent rocking or tilting
Lingualized setup according to Gerber
Static lines – Outer correction
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Delimits the positions of the maxillary palatal cusps
Delimits the lingualmost positions of the mandibular central fossae to allow freedom of movement of the tongue, alternatively, the mylohyoid line may be used
Static lines – Inner correction
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Setting up the maxillary first molars
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The setup for the maxillary posterior segment starts with the statically most important tooth, the first molar
It is placed at the first molar position transferred from the mandible, ideally with the mesiopalatal cusp.
Setting up the maxillary first molars
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Buccal contacts are only allowed if the study cast analysis shows they are possible
Distopalatal cusp on the distal marginal region of the mandibular first molar
Tripod contacts are best
Mesial palatal cusp in the center fossa of the mandibular first molar
Setting up the maxillary first molars
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Buccal contacts only where possible according to the study cast analysis (definitive other correction)
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First create and check centric Contacts, then protrusion, laterotrusion and mediotrusion.
The other posterior teeth are set up after the first molars
Located at the first molar position transferred from the mandible
Statically most important tooth, first posterior tooth to be set up
Summary – Maxillary first molar
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Setting up the maxillary second molars
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22.5°
Whether a second molars setup will depend on the stop line (cf. study cast analysis)
22.5° angle between the crystalline in the occlusal plane, delimits the setup on the dorsal aspect Stop line Stop line helps prevent the
restoration from sliding forward
Setting up the maxillary second molars
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If the tooth is positioned behind the stop line, it will be placed on a steeper incline relative to the horizontal condylar path inclination.
When assuming the maximum multi-contact intercuspidation position, the mandible would invariably be shifted forward and down. Gerber called this phenomenon “anterior sliding.”
Setting up the maxillary second molars
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One premolar each can be setup on both sides to provide anterior sliding.
This is not an aesthetic disadvantage and certainly functional.
Setting up the maxillary second molars
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Subordinate to the first molars on extrusive movements, i.e. it supports but does not dominate the guidance.
Mesiopalatal cusp always in contact with the centric fossa of the second molar, tripod contact is ideal (not for crossbites)
Setup as for first molars
Same checks of centric stops and extrusion movements
Setting up the maxillary second molars
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Setting up the maxillary first premolars
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Located at the so-called first premolar position
Almost at a right angle to the occlusal plane
Buccal facet clearly covers the mandibular first premolar, so that the integral® also facilitates premolar guidance
Tooth-to-tooth occlusion giving the visual appearance of a tooth-to-two-teeth occlusion
Setting up the maxillary first premolars
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Contact between lower buccal cusp and mesial fossa of the maxillary first premolar
Tooth-to-tooth occlusion
Centric contactsof the maxillary first premolars
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Place at the premolar position (cf. study cast analysis)
Almost at a right angle to the occlusal plane
Buccal facet clearly covers the mandibular first premolar Palatal cusp is out of contact
Protrusion via the mesiobuccal incline of the mandibular second premolar
Cusp-to-fossa contact only in tooth-to-tooth occlusion
Laterotrusion via the buccal facet
To achieve balancing, adjust to achieve molar guidance, then cut back
Summary – Maxillary first premolars
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Setting up the maxillary second premolars
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Also almost at a right angle to the occlusal plane
No pronounced buccal facet, hence no premolar guidance as on the first premolar
Tooth-to-tooth occlusion giving the appearance of a tooth-to-two-teeth occlusion
Setting up the maxillary second premolars
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Centric contactsof the maxillary second premolars
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The ideal situation is a tripod contact in the mesiocentral fossa of the mandibular second premolar
Palatal cusp of the maxillary second premolar may contact the distal fossa of the mandibular second premolar
Centric contactsof the maxillary second premolars
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Roughly right angle to the occlusal plane (like the first premolar) No premolar guidance (no pronounced
buccal facet)
Protrusion via the mesial marginal ridge of the mandibular first molar Laterotrusion via the buccal facet of
the maxillary and mandibular second premolars (approx. 1-5–2 mm); additio-nal support by mesial lingual marginal ridge of the mandibular second premolar
Cusp-to-fossa contact only, main contact: mandibular buccal cusp to mesial central fossa of the maxillary second premolar
distal
Mediotrusion possible by the palatal cost supported by the distobuccal incline of the mandibular second premolar (approx. 1.5–2 mm).
Summary – Maxillary second premolar
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Are the centric flossae of the mandibular first molars and the mesial palatal cusps of the maxillary first molars within the tolerance range of the markings for the largest masticatory unit? Is anterior sliding prevented
by respecting the stop line ?
Checklist posterior setup
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Are the centric stops positioned correctly?
Maxilla Mandible
Checklist - Posterior setup
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Has the relatively narrow ”corridor” supporting lateral movement (definitive outer correction) Been taken into account? Definitive inner
correction as in balancing?
Gerber-style setup
Are the molars in centric contact with the upper palatal cusps only?
Does the definitive inner correction delimit the maxillary palatal costs and mandibular central fissures?
Is the definitive outer correction (modification) the vestibular most limits of the buccal balancing contact?
Balanced complete dentures
Checklist - Posterior setup
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Maxillary caninesThe following graphic representation relates to average-valueaspects without regard to aesthetic and phonetic data
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1–1.5 mm
Viewed from buccally, the maxillary canine is almost at a right angle to the occlusal plane, following the first premolar
Uniform overjet relative to the mandibular canine: approx. 1–1.5 mm For balancing, the incisal edge of the
maxillary canine is reduced from palatally, that the the mandibular canine from labially; maximum laterotrusion: 1,5–2 mm
First large pair of palatine rugae points approximately in the direction of the canine position
Facial view: “Edge in – cervix out”
Maxillary canines
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integral® and artegral® both permit, as an alternative to balancing, canine/premolar guidance if the extrusion paths of the first premolar and of the canine are not adjusted until they are balanced.
Canine/premolar guidance
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Maxillary central incisorsThe following graphic representation relates to average-valueaspects without regard to aesthetic and phonetic data.
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1–1.5 mm
1–1.5 mm
Fixed average setup7–8 mm
Labial surfaces approximately 7–8 mm anterior to the incisive papilla
Uniform overjet of approx. 1–1.5 mm
Maximum protrusion 2–3 mm, concurrently with the molars
If laterotrusion is supported, it will be concurrent with that the the molars
Maxillary central incisors
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The following graphic representation relates to average-valueaspects without regard to aesthetic and phonetic data.
Maxillary lateral incisors
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1–1.5 mm
1–1.5 mm
Contact may be present in laterotrusion
Harmonious placement between the canines and central incisors
Lateral incisors should contribute to protrusion: slight rotation may provide (additional) support for balancing during extrusive movements
Uniform overjet of approx. 1–1.5 mm, as for the canines and central incisors
Fixed average setup:
Maxillary lateral incisors
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