Interocclusal Records in Fixed Prosthodontics.

An accurate interocclusal record is essential for the successful delivery of fixed prosthodontic restorations. There are various materials and techniques used to obtain an interocclusal record in order to facilitate mounting of the dental casts on an articulator. The interocclusal record describes the vertical and horizontal relationship of the maxillary and mandibular teeth. In circumstances where the vertical relationship is not supported through a tripod of widely spaced opposing contacts, the interocclusal record will be needed to restore this vertical support to prevent inaccurate mounting. The clinician should understand when an interocclusal record is required and have an awareness of the different materials and techniques available to record an interocclusal registration.

The accuracy of virtual interocclusal registration during intraoral scanning.

STATEMENT OF PROBLEM: Evidence on the accuracy and reproducibility of the virtual interocclusal registration procedure and recommendations as to how to make a virtual interocclusal record are lacking. PURPOSE: The purpose of this in vitro study was to assess whether virtual interocclusal registration records made at different locations around the arch affect the alignment of virtual casts, and to assess whether quadrant and complete arch scans have different effects on cast alignment when they are articulated with virtual interocclusal records. MATERIAL AND METHODS: Three sites of close proximity (SCPs) and 3 sites of clearance (SCs) were identified in each sextant of mounted zirconia master models. The SCPs and SCs were confirmed by using shimstock foil and the transillumination of an interocclusal impression. Complete-arch and quadrant scans of the master models were made with an intraoral scanner and registered with different virtual interocclusal registration records. The SCPs and SCs indicated by the scanner's software and by independent software were compared according to the sensitivity, specificity, and predictive values of each method. RESULTS: Changed locations of SCPs were found depending on the location of the virtual interocclusal registration record. The intraoral scanner's software contacts had a higher sensitivity of 92.86% and a negative predictive value of 84.21% than the contacts revealed by the independent software that exhibited a sensitivity of 69.05% and a negative predictive value of 70.45%. However, the intraoral scanner software had a lower specificity of 41.03% and a positive predictive value of 62.90% compared with the independent software, which exhibited a specificity of 79.49% and a positive predictive value of 78.38%. The quadrant scans had a higher sensitivity than did the complete-arch scans. CONCLUSIONS: Different occlusal contacts are obtained from interocclusal registration scans in different segments of the dental arch. The difference is more obvious in complete-arch scans, where a tilting effect toward the site of the interocclusal registration scan was observed. Occlusal contacts obtained from interocclusal registration scans for quadrant scans had a higher sensitivity than did those for complete-arch scans.

Determining the interchangeability of KaVo PROTAR semi-adjustable articulators.

OBJECTIVE: Interchangeable articulators are crucial for a precise clinical outcome. Lack of interchangeability will affect the accuracy of the occlusion of prosthetic restorations. The objective of this study was to evaluate the interchangeability of KaVo PROTARevo articulators. METHOD AND MATERIALS: KaVo PROTARevo semi-adjustable articulators in routine use were employed. Identical casts were transferred among the articulators and the distance between casts was measured using digital photos of sagittal and frontal aspects of each articulator by two independent examiners. Interchangeability was assessed and analyzed by designated software. RESULTS: Inter-examiner reliability was found to be high. Of 231 possible pairs of articulators only 27 pairs were found to be interchangeable (less than 166 µm in all measured dimensions), and of the other 204 pairs of articulators at least one of the dimensions measured was larger than 166 µm. CONCLUSION: The majority of articulators tested did not pass the 166-µm criterion to establish them as interchangeable. Therefore, in order to maintain accuracy while producing restorations, it is advisable to use the same articulator throughout the entire process, both at the clinic and in the dental laboratory.

[JUSTIFICATION OF CHOICE OF THE POSITION OF THE REINFORCEMENT ELEMENT OF A GLASS-FIBER ADHESIVE TIRE BASED ON THE STUDY OF DIAGNOSTIC MODELS IN THE ARTICULATOR AND THE FOLLOWING PARALLELMETRIC RESEARCH].

The aim of the study was to develop the most optimal variant for placing the reinforcing element of a fiberglass splint with the mobility of the anterior teeth on the basis of a parallelometric study of the diagnostic models of the jaws depending on the type of occlusion and the degree of bone resorption. For the most optimal variant of the placement of the reinforcing element of the adhesive splint with orthognathic bite and deep incisal overlap, the front slope of the model was selected with the transfer of the reinforcing element of the adhesive splint onto the lingual surface. With direct, prognathic and progenic bite and bone resorption up to » height (according to retrography data), the back slope of the model was selected with the placement of the reinforcing element of the adhesive splint on the vestibular surface of the lower jaw. The disadvantage of locating the reinforcing element on the lingual surface when the incisors were crowded was that after the application of the splint and inter-proximal adaptation, the change in the position of the teeth was not corrected. On the contrary, when applying an adhesive splint on the vestibular surface with the help of restoration, it was possible to completely restore the original position of the teeth and fix it for a long time.

Fully automated searching for the optimal VMAT jaw settings based on Eclipse Scripting Application Programming Interface (ESAPI) and RapidPlan knowledge-based planning.

PURPOSE: Eclipse treatment planning system has not been able to optimize the jaw positions for Volumetric Modulated Arc Therapy (VMAT). The arbitrary and planner-dependent jaw placements define the maximum field size within which multi-leaf-collimator (MLC) sequences can be optimized to modulate the beam. Considering the mechanical constraints of MLC transitional speed and range, suboptimal X jaw settings may impede the optimization or undermine the deliverability. This work searches optimal VMAT jaw settings automatically based on Eclipse Scripting Application Programming Interface (ESAPI) and RapidPlan knowledge-based planning. METHODS AND MATERIALS: Using an ESAPI script, the X jaws of rectal VMAT plans were initially set to conform the planning-target-volume (PTV), and were gradually extended toward the isocenter (PTV center) in 5-7 mm increments. Using these jaw pairs, 592 plans were automatically created for 10 patients and quantitatively evaluated using a comprehensive scoring function. A published RapidPlan model was evoked by ESAPI to generate patient-specific optimization objectives without manual intervention. All candidate plans were first stored as text files to save storage space, and only the best, worst, and conformal plans were consequently recreated for comparison. RESULTS: Although RapidPlan estimates dose-volume histogram (DVH) based on individual anatomy, the geometry-based expected dose (GED) algorithm does not recognize different jaw settings but uses PTV-conformal jaws as default; hence, identical DVHs were observed regardless of planner-defined jaws. Therefore, ESAPI finalized dose-volume calculation and eliminated the plans with unacceptable hotspots before comparison. The plan quality varied dramatically with different jaw settings. Trade-offs among different organs-at-risk (OARs) were collectively considered by the proposed scoring method, which identified the best and worst plans correctly. The plans using conformal jaws were neither the best nor the worst of all candidates. CONCLUSIONS: VMAT plans using optimal jaw locations can be created automatically using ESAPI and RapidPlan. Conformal jaws are not the optimal choice.

Head position affects the direction of occlusal force during tapping movement.

Despite numerous reports describing the relationship between head position and mandibular movement in human subjects, the direction and magnitude of force at the occlusal contacts have not been investigated in relation to head position. The objective was to investigate the effect of head position on the direction of occlusal force while subjects performed a tapping movement. Twenty-three healthy adult subjects were asked to sit on a chair with their back upright and to perform 15 tapping movements in five different head positions: natural head position (control); forward; backward; and right and left rolled. The direction and magnitude of force were measured using a small triaxial force sensor. The Wilcoxon signed-rank test and Bonferroni test were used to compare head positions in each angle of the anteroposterior axis direction and the lateral axis direction with respect to the superior axis. The force element in the anteroposterior axis shifted to the forward direction in the head position pitched backward, compared with control, pitched forward and rolled left positions (P = .02, <.01 and <.01, respectively). The force direction in the lateral axis with the head position rolled to the right or left shifted to the left and right directions, respectively, compared with those in the other positions (P < .05). Results of this study suggest that the head should be maintained in a position in which a stable tapping movement can be performed in a relaxed position without anteroposterior and lateral loading.

Three-Dimensional Static Articulation Accuracy of Virtual Models - Part I: System Trueness and Precision.

PURPOSE: To evaluate the 3D static articulation accuracy of 3 model scanner-CAD systems (Ceramill Map400 [AG], inEos X5 [SIR], Scanner S600 Arti [ZKN]) using a coordinate measuring machine (CMM). Trueness and precision for each system will be reported in Part I. MATERIALS AND METHODS: The master model simulated a single crown opposing a 3-unit fixed dental prosthesis. Five mounted stone cast sets were prepared, and one set was randomly selected. Reference values were obtained by measuring interarch and interocclusal reference features with the CMM. The stone cast set was scanned 5 times consecutively and articulated virtually with each system (3 test groups, n = 5). STL files of the virtual models were measured with CMM software. dRR , dRC , and dRL , represented interarch global distortions at right, central, and left sides, respectively, while dRM , dXM , dYM , and dZM represented interocclusal global and linear distortions between preparations. RESULTS: For trueness values, mean interarch global distortions ranged from 13.1 to 40.3 µm for dRR , -199.0 to -48.1 µm for dRC , and -114.1 to -47.7 µm for dRL . Mean percentage error of interarch distortion did not exceed 0.6%. Mean interocclusal distortions ranged from 16.0 to 117.0 µm for dRM , -33.1 to 101.3 µm for dXM , 32.9 to 49.9 µm for dYM and -32.0 to 133.1 µm for dZM. ANOVA of trueness found statistically significant differences for dRC , dRL , dRM , dXM , and dZM . For precision values, absolute mean difference between the 10 superimposition combinations ranged from 25.3 to 91.0 µm for dRR , 21.5 to 85.5 µm for dRC , 24.8 to 70.0 µm for dRL . Absolute mean difference ranged from 49.9 to 66.1 µm for dRM , 20.7 to 92.1 µm for dXM , 86.8 to 96.0 µm for dYM , and 36.5 to 100.0 µm for dZM . ANOVA of precision of all test groups found statistically significant differences for dRR , dRC , dRL , dXM and dZM , and the SIR group was the least precise. CONCLUSION: The overall interarch global distortion of all three model scanner-CAD systems was low and did not exceed 0.6%. Variations in scanner technology, virtual articulation algorithm, and use of physical articulators contributed to the differences in distortion observed among all three groups.

A hemispherical contact model for simplifying 3D occlusal surfaces.

STATEMENT OF PROBLEM: Currently, dental articulators can recreate mandibular movements and occlusal contacts. However, whether virtual articulators can also provide information about occluding dental surfaces, functional movements, and the mandibular condyles is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the occluding surfaces on dental casts obtained from a patient and approximate them to a hemispherical contact model. Both models were tested by digitizing the Dentatus ARL dental articulator. MATERIAL AND METHODS: A combination of photogrammetry and structure from motion methods were used to scan a Dentatus ARL articulator and representative dental casts. Using computer-aided engineering and finite element analysis, contact points and action vectors to the forces on occluding surfaces and condyles were obtained for cast and hemispherical models. This experiment was performed using centric occlusion and 3 different condylar inclinations. The Kruskal-Wallis 1-way analysis of variance on ranks test was used to allow all pairwise comparisons between condylar inclination and mechanical action vector values in each location (α=.05). RESULTS: Action vectors from the cast model and each location of the hemispherical model were calculated to show the mechanical consequences and the similarity among models. Overall, no significant differences were observed for action vectors (A20 versus A40 versus A60) at each location (dental cast/hemisphere, right condylar, and left condylar) in the analysis of dental casts and the hemisphere model (.382≤P≤.999). CONCLUSIONS: This study provided graphical information that may assist the dental professional in determining which occlusal contacts should be modified to attain condylar and balanced centric occlusion.

Three-Dimensional Static Articulation Accuracy of Virtual Models-Part II: Effect of Model Scanner-CAD Systems and Articulation Method.

PURPOSE: Accurate maxillomandibular relationship transfer is important for CAD/CAM prostheses. This study compared the 3D-accuracy of virtual model static articulation in three laboratory scanner-CAD systems (Ceramill Map400 [AG], inEos X5 [SIR], Scanner S600 Arti [ZKN]) using two virtual articulation methods: mounted models (MO), interocclusal record (IR). MATERIALS AND METHODS: The master model simulated a single crown opposing a 3-unit fixed partial denture. Reference values were obtained by measuring interarch and interocclusal reference features with a coordinate measuring machine (CMM). MO group stone casts were articulator-mounted with acrylic resin bite registrations while IR group casts were hand-articulated with poly(vinyl siloxane) bite registrations. Five test model sets were scanned and articulated virtually with each system (6 test groups, 15 data sets). STL files of the virtual models were measured with CMM software. dRR , dRC , and dRL , represented interarch global distortions at right, central, and left sides, respectively, while dRM , dXM , dYM , and dZM represented interocclusal global and linear distortions between preparations. RESULTS: Mean interarch 3D distortion ranged from -348.7 to 192.2 µm for dRR , -86.3 to 44.1 µm for dRC , and -168.1 to 4.4 µm for dRL . Mean interocclusal distortion ranged from -257.2 to -85.2 µm for dRM , -285.7 to 183.9 µm for dXM , -100.5 to 114.8 µm for dYM , and -269.1 to -50.6 µm for dZM . ANOVA showed that articulation method had significant effect on dRR and dXM , while system had a significant effect on dRR , dRC , dRL , dRM , and dZM . There were significant differences between 6 test groups for dRR, dRL dXM , and dZM . dRR and dXM were significantly greater in AG-IR, and this was significantly different from SIR-IR, ZKN-IR, and all MO groups. CONCLUSIONS: Interarch and interocclusal distances increased in MO groups, while they decreased in IR groups. AG-IR had the greatest interarch distortion as well as interocclusal superior-inferior distortion. The other groups performed similarly to each other, and the overall interarch distortion did not exceed 0.7%. In these systems and articulation methods, interocclusal distortions may result in hyper- or infra-occluded prostheses.

Comparison of excursive occlusal force parameters in post-orthodontic and non-orthodontic subjects using T-Scan® III.

OBJECTIVE: Published studies indicate that orthodontically treated patients demonstrate increased posterior occlusal friction contributing to temporomandibular disorder (TMD) symptoms. This study investigated measured excursive movement occlusal contact parameters and their association with TMD symptoms between non- and post-orthodontic subjects. METHODS: Twenty-five post-orthodontic and 25 non-orthodontic subjects underwent T-Scan® computerized occlusal analysis to determine their disclusion time (DT), the excursive frictional contacts, and occlusal scheme. Each subject answered a TMD questionnaire to determine the presence or absence of TMD symptoms. Statistical analysis compared the within group and between group differences (p < 0.05). RESULTS: Statistically significant differences were observed in the disclusion time: DT = 2.69 s in the post-orthodontic and 1.36 s in the non-orthodontic group. In the non-orthodontic group, 72.7% working and 27.3% non-working side contacts were seen, while in the post-orthodontic group, (near equal) 54.7% working and 45.3% non-working side contacts were seen. Presence of canine guidance was seen in 60% of the non-orthodontic group and 24% in the post-orthodontic group. Seventy-two percent of the post orthodontics subjects presented with one or more TMD symptoms. CONCLUSION: Significantly longer disclusion time, higher posterior frictional contacts, and more TMD symptoms were observed in the post-orthodontic group, suggesting that orthodontic treatment increases posterior tooth friction. Computerized occlusal analysis is an objective diagnostic tool determining the quality of excursive movements following orthodontic treatment.

Influence of Class II Elastics on Centric Relation and Centric Occlusion Discrepancy after Orthodontic Treatment / Influencia de los Elásticos de Clase II sobre la Discrepancia de Relación Céntrica para la Oclusión Céntrica Después del Tratamiento Ortodóncico

ABSTRACT: The objective of this study was to verify the influence of the use of Class II intermaxillary elastics on centric relation (CR) to centric occlusion (CO) occlusal discrepancy. A total of 30 patients had been at the contention stage for at least three months were divided in two groups: G1 - 15 had been submitted to intramaxillary orthodontic mechanics only, and G2 - 15 had used Class II intermaxillary elastics. Distances of horizontal and vertical overlap and the distance or coincidence of the mandibular dental midline in relation to the maxillary midline were measured in CR and CO positions. Intergroup comparisons were performed using the Mann-Whitney test. No statistically significant differences (P>0.05) were found between G1 and G2. Both in the horizontal and vertical directions, these discrepancies were smaller than or equal to 1mm in 96.66 % of the patients. In the transverse plane, there was no discrepancy in 63.33 % of the patients, and in 33.33 % these discrepancies were equal to 0.5 mm. The use of Class II elastic didn't be capable of increasing the occlusal discrepancies between CR and CO.

RESUMEN: El objetivo de este estudio fue verificar la influencia del uso de los elásticos intermaxilares Clase II en la discrepancia oclusal entre la relación céntrica (RC) y la oclusión céntrica (OC). Un total de 30 pacientes que permanecieron en la fase de contención durante al menos tres meses se dividieron en dos grupos: G1 - 15 fueron sometidos solamente a la mecánica ortodóncica intramaxilar, y G2 - 15 habían utilizado elásticos de clase II intermaxilar. Se midieron las distancias de traslapo horizontal y vertical y la distancia o coincidencia de la línea mediana dentaria mandibular con respecto a la línea mediana maxilar en las posiciones RC y OC. Las comparaciones entre grupos se realizaron mediante la prueba de Mann-Whitney. No se encontraron diferencias estadísticamente significativas (P> 0.05) entre G1 y G2. Tanto en las direcciones horizontal como vertical, estas discrepancias fueron menores o iguales a 1 mm en el 96,66 % de los pacientes. En el plano transversal, no hubo discrepancia en el 63,33 % de los pacientes, y en un 33,33 % estas discrepancias fueron iguales a 0,5 mm. El uso de la clase II elástica no logró aumentar las discrepancias entre RC y OC.

Interocclusal registration for diagnosis and treatment planning for implant restorations.

This paper describes a new technique to record the interocclusal relationship of an implant case where multiple posterior teeth are missing and need to be replaced by implant restorations. In the case presented, an appliance was designed to be supported only by hard immovable tissues; teeth that provide a precise fit of records. The well-fitting appliance can be used to accurately mount implant cases with inadequate posterior support for diagnosis and treatment planning. This technique of interocclusal registration has the advantages of accurate mounting, preservation of materials and financial expenses, and reduction of chair-side time. This appliance may also be used in all cases of multiple missing posterior teeth requiring prosthodontic treatment.

Evaluation of the Elastic Properties of Thirteen Silicone Interocclusal Recording Materials.

Background. Addition silicones are popular as dental impression materials and are used in bite registration procedures. Objective. This study aimed to compare the postsetting elasticities and other mechanical properties of thirteen addition silicone interocclusal recording materials. Materials and Methods. The following materials were investigated: Colorbite D, Futar D, Genie Bite, Jet Blue Bite fast, Memoreg 2, O-Bite, Occlufast Rock, Omni-Bite Plus, Regidur i, Registrado X-tra, Regofix transparent, StoneBite, and Variotime Bite. Thirty specimens of each material were tested. The elasticities and strengths of the materials were measured with a universal testing machine, and computer software was used to determine the E-moduli, ultimate tensile strengths, and ultimate elongations of the specimens. Results. The results were subjected to statistical analysis using the Kruskal-Wallis test (p ≤ 0.05). The statistics revealed that the mean E-modulus values varied significantly across the materials (p = 0.000) and were highest for the StoneBite and Registrado X-tra and lowest for the Regofix transparent. The ultimate tensile strengths were highest for the Regofix transparent and Registrado X-tra (p = 0.000) and lowest for the Jet Blue Bite fast and Memoreg 2 (p = 0.000). The elongation percentages at the point of breaking varied significantly across the materials (p = 0.000); the lowest value was observed for the StoneBite, whereas the Regofix transparent nearly doubled original length. Conclusions. The authors concluded that materials with the high E-moduli and great ultimate tensile strengths may be most useful clinically. Registrado X-tra and StoneBite best met these criteria.

A comparative study of identical VMAT plans with and without jaw tracking technique.

The unwanted radiation transmission through the multileaf collimators could be reduced by the jaw tracking technique which is commercially available on Varian TrueBeam accelerators. On the basis of identical plans, this study aims to investigate the dosimetric impact of jaw tracking on the volumetric-modulated arc therapy (VMAT) plans. Using Eclipse treatment planning system (TPS), 40 jaw-tracking VMAT plans with various tumor volumes and shapes were optimized. Fixed jaw plans were created by editing the jaw coordinates of the jaw-tracking plans while other parameters were identical. The deliverability of this artificial modification was verified using COMPASS system via three-dimentional gamma analysis between the measurement-based reconstruction and the TPS-calculated dose distribution. Dosimetric parameters of dose-volume histogram (DVH) were compared to assess the improvement of dose sparing for organs at risk (OARs) in jaw-tracking plans. COMPASS measurements demonstrated that over 96.9% of structure volumes achieved gamma values less than 1.00 at criteria of 3 mm/3%. The reduction magnitudes of maximum and mean dose to various OARs ranged between 0.06% ~ 6.76% (0.04 ~ 7.29 Gy) and 0.09% ~ 7.81% (0.02 ~ 2.78 Gy), respectively, using jaw tracking, agreeing with the disparities of radiological characteristics between MLC and jaws. Jaw tracking does not change the delivery efficiency and total monitor units. The dosimetric comparison of VMAT plans with and without jaw tracking confirms the physics hypotheses that reduced transmission through tracking jaws will reduce doses to OARs without sacrificing the target dose coverage because it is meant to be covered by radiation beams going through the opening.

The face scan as a means for the visualization of complex prosthetic reconstructions.

The face scan can serve as a means for the visualization of planes relevant for extensive prosthetic reconstructions. The key prerequisite is the availability of data in stl format for further processing in different software programs. The method is described in this article by a patient case.

The Effect of a Radiation Positioning Stent (RPS) in the Reduction of Radiation Dosage to the Opposing Jaw and Maintenance of Mouth opening after Radiation Therapy.

The effect of a radiation positioning stent (RPS) in radiation dosage reduction to the opposing jaw and maintenance of mouth opening was audited. 55 Head and Neck cancer patients who received radiotherapy were reviewed. Radiation dosages at similar points in the primary/opposing jaws were measured along with the mouth opening. Results showed a significant reduction in the radiation dosage to the opposing jaw in patients given the RPS. Mouth opening was generally maintained in patients given the RPS (77.7% improvement in mouth opening) compared to patients without RPS. Patients undergoing radiotherapy who had an RPS showed a significant reduction in radiation dosage to the opposing jaw and maintained their mouth opening in the short-term.

Comparison of Skeletal and Dental Reference Planes with the Hamulus-Incisive-Papilla Plane: A Pilot Study on 3D Reconstructed Tomographies of the Skull.

PURPOSE: The aim of this study was to investigate the hamulus-incisive-papilla (HIP) plane as an alternative for transferring the three-dimensional position of a patient's maxilla to an articulator. MATERIALS AND METHODS: Camper, Frankfurt horizontal, occlusal, and HIP planes were evaluated in 21 patients' computed tomography scans and compared to one another. RESULTS: Analysis of variance showed significant differences between all planes, with the HIP plane being closest to the occlusal plane (HIP-OP: 0.6 ± 4.0 degrees). Frankfurt and Camper planes, being more peripheral, showed higher geometric asymmetries. CONCLUSION: The HIP plane, when used for articulator mounting, results in a closer and more technically reliable patient relationship in a clinical and laboratory context.