Adjustment of complete denture occlusion Dr. Monia M.N.Kandil

Fabrication of Remount Jig (Occlusal index for clinical remounting) At the end of the try in stage where the dentist and patient are both satisfied. This is a time save procedure for you because you do not have to make a new facebow record at the time of delivery.

1. PRE‑INSERTION PREPARATION A . Adjustment of Processing Error . 1 . Deflasking . 2 . laboratory remounting . 3 . Selective grinding . B . Finishing and Polishing of Denture . Visual Examination Impression Surface . Polished surface . C . Fabrication of Remount casts (Clinical Remounting) 1 . Fabricate plaster remount casts for the processed denture . 2 . Remount the maxillary cast and denture utilizing the remount matrix.

2. INSERTION VISIT 1 . Re‑examine dentures and foundation tissues. 2 . Insert each denture independently . a . Test for retention and stability . b . Evaluate placement of artificial teeth . 3 .Occlusal equilibration to be accomplished at this time. a . Clinical remount of the upper cast . b . Interocclusal records ‑ waxes, impression or plaster . 4 . Remounting lower denture .

Causes of faulty occlusion 1-Errors in the recording jaw R. 2-Errors in mounting the casts on the articulators. 3-Errors in the processing. 4-Denture settling.

Postponing this important step may lead to: 1-Deformation of the underlying soft tissues. 2-Destruction of the supporting bone. 3-Discomfort to the patient. 4-The occlusal errors cannot easily located and corrected at a later date.

Clinical errors in registration jaw relationship may be the result of: 1-Ill fitting bases. 2-Shifting of the bases over displaceable tissues. 3-Excessive pressure exerted by the pt during jaw relation record. 4-Unequal distribution of stress during registration.

5-Record bases placed on deformed tissues by a previous ill fitting denture. 6-Pts not registering centric relation due to: a-Lack of control by the operator. b-Muscle spasm. c-Abnormalities of the T.M.J.

Errors in mounting casts on the articulator: 1-Record bases not properly seated to casts during mounting procedures. 2-Occlusion rims not locked or keyed definitely. 3-Interference of casts in the posterior region.

4-Articulator not in centric position during mounting lower cast. 5-Change in the plaster used to mount the casts. 6-Failure to use the face bow and changing VDO.

Faulty laboratory procedures: 1-Vertical changes made on the articulator by laboratory technicians. 2-Movement of teeth in wax before and during flasking. 3-Excess wax left on teeth. 4-Improper packing procedures.

5-Improper closure or careless opening of the flasks. 6-Improper curing. 7-Dimensional changes of the denture base material. 8-Over heating of dentures in polishing.

Methods of adjustment

Remounting methods 1-Laboratory remount: done after deflasking the dentures. 2-Clinical remount: done on a new recording and mounting of the articulator, after the dentures are processed and before they are delivered to the patient.

Laboratory remount techniques Laboratory remounting remove occlusal disharmonies caused by processing errors

Dentures being re-mounted on the original articulator and adjustments carried out to provide correct articulation.

Laboratory Remounting The cast with the processed denture should be remounted on the articulator using the V-shaped notches. using the split-cast method

The incisal guide pin not contact the incisal guide table Place red articulating paper between the teeth and gently tap the teeth together in centric occlusion.

The adjustment in eccentric occlusal positions

The adjustment in eccentric occlusal positions should be stopped when widespread Contacts are produced and the incisal guide pin usually stays in contact with the incisal guide table.

Clinical remounting It is needed: 1- Mount the upper cast according to face bow record. 2- Mount the lower cast according to a new centric relation record.

CLINICAL REMOUNT AND OCCLUSAL REFINEMENTS with new centric relation Remounting the Maxillary Denture

Correcting occlusal errors 1- Articulating paper in the mouth. 2- Central bearing device (correlator, balancer). 3- Wax (Adhesive wax or carding wax). 4- Abrasive paste (Milled method)

Occlusal Refinement Monoplane Occlusion. 1 . Adjust mandibular teeth to a perfectly flat occlusal plane . 2 . Adjust maxillary posterior teeth in centric occlusion . 3 . Achieve a multiplicity of bilateral point contacts of equal intensity . 4 . Replacement of one or more artificial teeth in large discrepancies Anatomic Occlusion utilizing bilateral balance. 1 . Adjust the condylar inclinations . 2 . Re‑establish centric occlusion . 3 . Correct working ‑ side contacts . 4 . Correct Balancing side contacts . 5 . Correct Protrusive contacts

Selective grinding for cusp teeth (anatomic teeth) Occlusal vertical dimension is maintained by occlusion of palatal upper cusp and the buccal lower cusp in normal occlusion.

Refine occlusion in eccentric positions A- Lateral movement: 1- On the working side: Follow BULL rule of reducing buccal upper and lingual lower inner cusp inclines. 2- On the balancing side: BULL rule does not work

Laterotrusive and Mediotrusive action Path Movement during Laterotrusive and Mediotrusive action LEFT MANDIBULAR EXCURSION An illustration of laterotrusive and mediotrusive sides in a lateral excursion. The lower jaw moves towards the right, which is the working or laterotrusive side. The left side is the balancing side, or non-working side, or mediotrusive side- these are all synonomous Non-working / balancing side (Mediotrusive) Working Side (Laterotrusive)

II. Milling A small amount of abrasive paste is placed over the lower teeth and the articulator is closed in centric position. Several movements are made from centric into each eccentric position to eliminate any slight interference

Remounting has the following advantages 1- Reduce patient's participation. 2- Allow for better visualization. 3- Provides a stable working foundation. 4- More accurate markings with the articulating paper in absence of saliva.

B- Protrusive movement Reduce distal inclines of maxillary cusps and mesial inclines of mandibular cusps

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