In prosthetic dentistry used the term "occlusion". It is understood interdigitation. There are 4 main occlusion and many intermediate. The former include the Central, anterior and 2 lateral. Central occlusion is characterized by the maximum contact of the surfaces close to the opposite teeth. It is considered to be the initial and final stage of articulation, since the first stage begins with the release of the lower jaw from Central occlusion state, and the last ends with bringing it to its original state.
The Articulation in dentistry called the whole complex of movements (chewing and nievely) committed by the lower jaw, the possible occlusion.
One of the types of articulation is the Central occlusion. When her muscle fiber, raising the lower jaw, maximum and evenly tense on both sides.
They are used with Definition of the Central occlusion (or Central relationship of the jaws). A correct occlusion in dentistry is called orthognathic. It is defined by the following features:
It is Worth saying that such signs can be detected only in intact rats (intact, non-pathological) occlusion.
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As practice shows, the majority of people in the first place lose first molars, the disposition of which determines the contents of the fourth.
If we talk about the third criteria, it typically is not applied when Define the Central relationship of the jaws.
The Most reliable in clinical terms as the first two signs. The essence of Central occlusion is to maximize the contact surfaces of the teeth opposite each other, regardless of their number. Accordingly, when an intact dentition or number of teeth, which would be sufficient to Determine the Central correlation of the jaws, you can use the characteristic of ethnic or even pathological to their position. The fact that the latter also differs, although distorted, but the typical relative positions of the jaws.
If as a result of secondary (acquired) premature loss (partial/complete loss of teeth) the number of signs reduced, defining the Central relationship of the jaws can be implemented with a careful study of the facets (flat surfaces) of the last pairs of oppositely located (antagonismus) teeth. In full their absence the state of Central occlusion is determined by circumstantial evidence.
The presence of the opposite teeth of the Central ratio to determine simply. Difficulties arise when the patient they do not exist.
In the second case, the specialist to establish the most advantageous in terms of functional Central correlation of the jaws. Definition Position is effected in three planes, mutually perpendicular to each other: horizontal, frontal and sagittal (longitudinal). Thus the physician does not have the required benchmarks.
Of Course, with the complexity of the problem increases, the probability Medical errors in the determination of the Central relationship of the jaws.
Mezhalveolyarnyh height (distance between jaws) is determined in the frontal plane. A proper understanding of this process will eliminate aboutVery much in the determination of the Central relationship of the jaws. Every wrong move provokes certain morphological and functional disorders with characteristic symptoms.
For example, if you increase the vertical size (height megavideoporno) there is a knocking teeth during a meal, and in some cases when talking. In addition, patients talk about fatigue of the masticatory musculature.
Reduction of vertical dimension causes even more negative effects.
So, if you decrease the distance between the parts, fixed dentures, decreases the vertical dimension of the lower third of the face. The upper lip becomes shorter, nasolabial folds – the deeper, the corners of the mouth down. As a result, the face of the person is acquiring senile features. It is often possible to observe the maceration of skin in the corners of the mouth (abnormal swelling that occurs when prolonged contact with water).
It Should also be said that the decrease in vertical size leads to a decrease inthe functionality of the prosthesis. This fact was proven chewing samples.
Together with the reduction in the distance between the jaws decreases and the mouth. This, in turn, results in tightness in the movements of the tongue, speech disorders. Accordingly, in this case, patients can talk about the fatigue of the masticatory musculature.
Error while determining the Central relationship of the jaws lead to a position change of the mandibular head in the glenoid fossa. The head moves deeper, and a thick back layer of the articular disc exerts pressure on the neurovascular bundle. In this phase, patients often begin to experience pain.
Incorrect determination of vertical dimension affects the design of prostheses. In the case of its overestimation, the product become a massive. In underestimation of the height of the prostheses obtained low with short teeth.
Includes:
Consider some of the stages separately.
During this stage:
The specified boundaries is to eliminate interference to the fixing roller on the prosthetic bed. It allows to prevent deformation of the upper lip. The technician checks all the borders of the template, freeing him from the frenulum of the tongue, lips, cheeks, cryochemistry and lateral folds of mucous.
The formation of the thickness of the bite block of the upper roller and the vestibular surface is affected by a number of circumstances.
Atrophy after tooth loss is manifested in different areas in different ways. In the lower jaw, for example, a bone decreases, first from the lingual surface and the top of the ridge. In the upper jaw, on the contrary, the bone begins to disappear from the top and vestibular surfaces.
At the same time the alveolar arc narrows the conditions for setting the teeth deteriorate significantly. In the anterior marked retraction of the upper lip, whereby the person is acquiring senile features.
The height of the upper roller is determined based on the following factors. The cutting edges of the upper Central incisors with closed jaws coincides with the line of contact of the lips. In conversation they are approximately 1-2 mm protruding from under the lips. The man looks several years older if the edges of the cutters when the smile is not visible. The Template is introduced into the mouth, and the patient is asked to close his lips. The roller is applied to the line where set the height. If the edge of the cushion is below the tangent line, it shorten, if the above – increasing strip wax. Then the height of the cushion check half-open mouth. Its edge should be 1-2 mm to protrude from under the upper lip.
Having determined the height of the cushion, the expert gives the occlusal surface in accordance with the line of pupils. To do this, use two lines. One is installed on the pupillary line, the other – on the occlusal plane of the cushion. If they are parallel, then all actions were done correctly.
The result of the measurement of a large number of skulls revealed that the occlusal surface of lateral teeth parallel kasperovskoy horizontally. This is the line of contact of the lower edge of the auditory (outer) passage and nasal spine.
On the face of the horizontal passes through nosochnoy line, which connects the base of the wing to the middle of the trestle.
To check the parallelism is also used two lines.
When the fit is important to achieve complete closure of the elements in the anteroposterior and transversale (transverse) directions and location of buccal areas in the same plane. Adjustments that may be required, are carried out only on the lower platen. Have well-matched surface elements firmly in contact for its entire length. At the closing of the jaws as they lie in the lateral and anterior.
First, you need to check the contact in the anteroposterior direction. With non-simultaneous closing is possible to note the displacement of the roller. All identified deficiencies are eliminated through increasing or removing the wax to the relevant sections of the cushion.
The determination of the Central correlation of the jaws in the absence of the patient's teeth. to detect violations of the occlusal contact areas of the rollers in the transverse direction is quite difficult.
As you close your mouth they first lie down to the right, and then left. In some cases, this violation is visually imperceptible. This is due to the fact that under dense cushions clearance between them is missing. This situation, in turn, is caused by the fact that the templates droop on one side. Accordingly, between the mucosa of the alveolar process and the rollers is formed a gap,which is not visible to the specialist.
For locating between the elements is inserted into a cold spatula. If the rollers fit tight, and they lie on the same ridge, to enter a tool without effort will not succeed.
It is finding the distance between the ridges of jaws, the most comfortable for the muscles and joints, providing better fixation and operation of the prosthesis. If The determination of the Central relationship of the jaws with complete loss of teeth in terms of vertical dimension restored the contours of the face. Thus, solved the aesthetic part of the question prosthetics. The Presence of vertical dimension, in fact, is the stage of determining the vertical component of the Central relationship of the jaws. Definition The distance is currently being implemented in two ways: anatomical and functional and anthropometric. Take a closer look.
In its application benchmarks are used:
Anthropometric method of determining the Central ratio jaws is based on the information about the proportionality of certain areas of the face.
The German philosopher and poet of the 19th century, Adolf Zeising, in his works developed the law of proportionality of the division. He found a few points through which the human body is divided on the principle of "Golden section". Their presence is associated with quite complex mathematical constructions and computations. Facilitates the solution of tasks the use of a compass of Geringer. This tool automatically determines the required point of section.
Methods in determining Central occlusion and relationship of the jaws is as follows. The patient should be asked to open your mouth wide. On the tip of the nose overlaps with extreme compasses of Geringer, and the genial tubercle – the second. The distance between them will split the middle leg in the middle and extreme positions. Greater value corresponds to the distance between points in adjacent cylinders or teeth.
There is another method of determining the Central relationship of the jaws – Wordsworth-white. It is based on the equality of the distances from the center of the pupils to the line of junction of the lips and from the base of the nasal septum to the bottom of his chin.
It Should be noted that the above methods for the determination of the Central relationship of the jaws can be used with the classic profile of the person. As practice shows, they do not give accurate results, so apply with some restrictions. Optimal anatomical and functional method of determining and fixation of the Central relationship of the jaws.
The Patient engage in a short conversation, which with prosthetics is not connected. At its completion the mandible is at rest; her lips are usually free. In this position, the technician measures the distance between the marks on the chin and base of the nasal septum. In the mouth are introduced templates with rollers. The patient is asked to close them. Mezhalveolyarnyh height is defined at the Central position of the lower jaw. During the processing rollers mouth repeatedly opens and closes. Typically, the patient sets a lower jaw in the Central position.
After the introduction of the rollers, the technician again measures the distance – occlusal height – between the above points. It should be less than height alone, 2-3 mm.
If the height of the lower third of the face at the closing of the platens and at rest was equal, mezhalveolyarnyh distance is increased. If the occlusal height is below the height of the rest more than 3 mm, the height of the bottom cushion should be increased.
After the measurement, the expert drew attention to the tissues around the mouth slit. If mezhalveolyarnyh height is correct, the normal line lower third of the face are restored. At the lowered figure the corners of the mouth down, the nasolabial folds become more pronounced, and the upper lip becomes shorter. With such signs it is necessary to make measurements.
In case of increase of vertical dimension the closing of the lips accompanied by a certain tension, nasolabial folds are smoothed, and the upper lip becomes longer. In such a situation is very illustrative is the following test. When touched with a fingertip the lines of closing of lips instantly revealed, which is unusual for a situation when they lie down freely.
It is the second addition to anatomical methods.
After identification of vertical dimension specialist asks the patient to pronounce certain syllables or letters (f, p, o, m, e, etc.). While the doctor monitors the level of separation of the rollers. If mezhalveolyarnyh height is normal, it is about 5-6 mm. If the distance exceeds 6 mm, it may be necessary to reduce the height. If it is less than 5 mm, respectively, you can increase the height.
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Alin Trodden - author of the article, editor
"Hi, I'm Alin Trodden. I write texts, read books, and look for impressions. And I'm not bad at telling you about it. I am always happy to participate in interesting projects."
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