12

Ministry of health of Ukraine

Higher state educational establishment of Ukraine

«Ukrainian medical stomatological academy«

«It is ratified«

on meeting of department

propedeutics of orthopaedic stomatology

Manager by a department

д.м.н., an associate professor is Korol D.М.

"_____"_____________ 20__

Methodical recommendations

FOR TEACHERS

Educational discipline	Propedeutics of orthopaedic stomatology
Module №1	Propedeutics of orthopaedic stomatology
Rich in content module №1
Theme of employment	Оклюдаторы. Articulators. Receipt of diagnostic models
Course	ІІI
Faculty	Stomatological

Poltava 2012

1. Concrete aims:

• To interpret a concept articulator;

• To interpret the concept of oklyudator;

• Classify articulators;

• To analyse the structure of oklyudator;

• To analyse the structure of average anatomical articulator;

• To analyse the structure of universal articulator;

• To analyse tactics of choice of articulator;

• To analyse the methods of record of motions of bottom jaw;

• To analyse the record of platformings of bottom jaw;

• To analyse the record of vertical motions of bottom jaw;

• To analyse the record of sagittal motions of bottom jaw.

2. Base level of preparation :

The name of previous is disciplines	Got skills
1. Anatomy	To own knowledge about the structure of dental-maxilla vehicle. To give description of dental rows and teeth, masseters, joints, to define muscles, providing the function of dental-maxilla vehicle
2. Physiology	To own knowledge at horizontal, vertical, sagittal motions of bottom jaw.

3. Organization of maintenance of educational material.

After determination of central occlusion of model with cereous bases and prikusnoi roller fix in devices, playback motions of bottom jaw. Vehicles vertical (joint) motions of bottom jaw are reproduced in which only are named oklyudatoramy. Vehicles, all playback motions of bottom jaw - anatomic articulator.

Oklyudator consists of two frames connected by inter se a hinge. A bottom frame is bent under the corner of 100-110 degrees, an overhead frame is located in a horizontal plane and has a vertical post for fixing of interalveolar heights. In articulator and oklyudator movable is an overhead frame, but it does not have a substantial value.

Oklyudator consists of two frames connected by inter se hinges. Bottom frame will bend under the corner of 100-110 degrees, overhead frame it is located in a horizontal plane and has a vertical post for fixing of interalveolar heights. In articulator and oklyudator movable is an overhead frame, but it does not have a substantial value the Exact orientation of models of bottom jaw in relation to the models of supramaxilla, allows by the best character to conduct renewal of teeth and obtain harmonious motions of bottom jaw and natural to the directing function of teeth.

TYPES OF ARTICULATORS

Doctors must know all existent types of articulators, their advantages and defects. It will allow correctly to choose an articulator for certain clinical procedure. There are 3 basic types of articulators : simplified (joint and planar.Doctors must know all existent types of articulators, their advantages and defects. It will allow correctly to choose an articulator for certain clinical procedure. There are 3 basic types of articulators : simplified (joint and плоскостные), semimanaged and universal.

Joint and planar articulators

It is devices with the fixed knots which can not be regulated.

Joint type. A joint articulator (oklyudator) can reproduce opening and closing motions and does not have adaptation for moving of bottom jaw forward or aside.

Planar articulator. Planar articulators have the simplified fixed «rectilineal» mechanism playback an arthral way. This mechanism provides the imitation of the limited motions of bottom jaw forward and sideways. Such articulators are widely used for ordinary restoration procedures due to their simple devices. A doctor must know about violation occlusions which can arise up at the use of such articulators, and in the process of work of them to remove.

The first articulator was constructed Bonneville. The so-called triangle of Bonneville is fixed in basis of his structure. Investigating skulls, Bonneville set that distance between the heads of bottom jaw and chisel point equal Combining 10 см. these points get a triangle. In basis of articulators with the middle setting of inclination of arthral ways anatomic data are fixed middling about the size of corners of arthral and chisel ways. For sagittal of arthral way this corner is equal to 33 °, for lateral are 17 degrees, for sagittal chisel are 120 degrees. To articulator of such type belong articulator of Sorokin aand Giza 'Simplex of Н'.

Semimanaged articulators

The Semimanaged articulators can be adjusted for reproducing of motions of bottom jaw at the decision of different clinical problems. They have the managed mechanisms allowing to recreate arthral and chisel to the way. Mechanisms playback an arthral way can be adjusted so that exactly enough to imitate a natural arthral way. Regulative mechanisms are set on by the interocclusal imprints of certain positions of bottom jaw.

Universal articulators

Universal articulators are difficult devices which with large exactness can reproduce all motions of bottom jaw. They are used at making of difficult types of prosthetic appliances, consisting of crowns and bridges.

Unlike middle anatomic articulators the universal allow to set corners a chisel and arthral skidding according to individual data which get at the inspection of patient.

The articulator of Giza-Trubayt, articulator of Hayta, articulator of Hanau, behave to such vehicles, which attribute to arthral, and articulator of Wustrow - no articular and other..

Universal articulators consist of overhead and bottom frame. An overhead frame is three footholds: two in joints and one on a chisel ground. Arthral articulators are built on principle of temporo mandibular joint. Before to set the certain size of corner, it is necessary to define this size by the special intraoral or pozarotovih records.

CHOICE OF ARTICULATOR

Basic theoretical ideas were higher given about possibility of recreation and registration of mutual relations of jaws and motions of bottom jaw. It is necessary to underline that for all methods of articulation a large value has a receipt of exact intraoral imprints and correct transference them on an articulator. Exactness is no less important at the removal of imprints, preparation of models and their setting. A run-time error any of these procedures is carried on an articulator and reproduced at final renewal of teeth.

Every method of articulation has the advantages and defects. The simple defects of teeth and dental row do not require the use of difficult articulators. And vice versa, a simple articulator can appear insufficient for the difficult types of renewal of teeth. Therefore a doctor must well know possibilities and lacks of all methods of articulation. He must know, what method most befits for implementation of these clinical procedures and how to get rid from errors peculiar to this method of articulation.

For example, one method can be rapid and simple, but does not allow to reproduce all motions of bottom jaw. This method can be used in case that a doctor knows, what violations of occlusion more credible arise up at renewal of certain teeth, how to educe these violations and remove them in an oral cavity non-destructive the recovered teeth.

Opposite partial models with a gasket

It is a simple method which is used for renewal of separate teeth by means of the cast elements. A removable gasket is used for indemnification of thickness of between the occlusal imprint. The recovered teeth usually do not contact in position of central occlusal. At the use of this method often arise up obstacle in position of central correlation, at workers and non-working motions of bottom jaw and at advancement of her forward. If this method of violation of occlusion is used, arising up must come to light and removed in to the mouth.

Opposite partial models, set on a joint articulator on the cereous imprints got in position of central occlusion

This method can be used for renewal of single teeth in the conditions of functional occlusion which teeth are at, providing adequate and stable central occlusion. During the careful setting of models on exact and thin to the cereous imprint got in position of central occlusion, it is possible to recover the correct contact of supporting hillocks in position of central occlusion. Easily arise up obstacle in position of central correlation, at workers and non-working motions and at advancement of bottom jaw forward, them it is necessary to remove in to the mouth. At the use of cereous mold of greater thickness premature contacts can appear in position of central occlusion.

Some partial articulators have a device for moving of models from a side aside. It provides the certain degree of control at reproducing of worker or visual motions of bottom jaw, but it not enough in an order to prevent the origin of gorbikovih obstacles.

Complete models can be much more precisely set in position of central occlusion, what private, due to stability which is provided by closing of teeth on either side of arc. Complete models can be set on many types of articulators of different complication. Complete models must be used, if a few teeth are restored, and at more considerable defects of dental rows.

Articulation of complete models of manually

This method is often used in those cases, when back teeth have a good between papulose contact in position of central occlusion. But in this case it is difficult to define the contact of supporting hillocks in position of central occlusion, therefore there is identical probability of origin at renewal of teeth of premature contact, correct contact or his absence.

Planarizings of teeth, ground during an imitation

motions of bottom jaw are not duplicated by the action of distal directing component at her motions. At the use of this method it is difficult to prevent the origin of hindrances in position of central correlation, at workers and non-working motions and advancement of her forward, if possibility of contact of supporting hillocks is not removed in position of central occlusion. Premature contacts and obstacles, arising up at such renewal of teeth, must be removed in to the mouth.

Complete models set on the simplified joint articulator, that does not have a device for reproducing of lateral motions of bottom jaw or advancement of her forward

A small articulator has a closing arc, that considerably differs from the arc of closing of patient. If models are set on a small joint articulator on an imprint in position of central occlusion, closing of device on the thickness of imprint is created by the contact of teeth of models, differs from the contact of teeth in to the mouth in position of central occlusion.

Teeth are recovered at next correlation have often

premature contact in position of central occlusion and will be felt to the patients as «high».

These devices are too small, to reproduce the terminal arc of closing in position of central correlation, and does not allow to the models to carry out sliding motions between positions of central correlation and central occlusion. It results in the origin of premature contacts in position of central correlation and «skidding on a center». As these devices do not reproduce motions of bottom jaw, on the recovered teeth often arise up : hindrances at a worker and non-working motions and at advancement of her forward. At the use of such devices there are violations of occlusion it is necessary to expose and remove during trying on of prosthetic appliances.

. At the use of such devices there are violations of occlusion it is necessary to expose and remove during trying on of prosthetic appliances

Planar articulators, sizes of which less than jaws of patient, can not reproduce the arc, described by the bottom jaw of patient at her closure motion. During setting of models on planar articulator after the between the occlusal imprints got in position of central occlusion, there is the same possibility of origin of premature contacts in position of central occlusion, as well as at the use of the simplified joint articulators described higher.

This defect can be compensated by the use of between the occlusal imprints of minimum thickness without violation of stability of their form. At positive і mizhhorbykovomu stable ratio of teeth in central occlusion position opposing the fullmodel can be set in position maximal mizhhorbykovoho closing teeth withoutmizhoklyuziynyh prints, which eliminates errors. If there is a doubt in stability between papulose correlation of teeth of models, it is necessary to use between the occlusal the cereous prints got in stable positions of central occlusion.

Small planar articulators can not reproduce the terminal arc of closing motion of bottom jaw and does not have adaptation for the transfer of testimonies of facial arc. On them it is unsimple to recreate sliding motions of bottom jaw between position of initial contact of teeth at central correlation and position of central occlusion..

Consequently, there can easily be premature contacts in

position of central correlation and baffle skidding in position of central occlusion. Planar articulators can only very approximately reproduce the lateral forward movements of bottom jaw or advancement of her. The distal directing component of articulator creates the only vague resemblance of arthral way of patient. The directing function of teeth at the working forward movement of bottom jaw and advancement of her provides a front directing component.

He is a dominant factor in breaking of back teeth and often helps to avoid an origin on the recreated teeth of serious obstacles at a worker and non-working motions of bottom jaw and at advancement of her forward. However some violations of occlusion in form hindrances at a worker and non-working motions of bottom jaw and at advancement of her forward can arise up from inaccuracies of mechanisms playback an arthral way. Possibility of approximate imitation on the articulator of lateral motions of bottom jaw and advancement of her forward allows to the dental technician to plan the relative thickness of metallic component of the combined crown or ceramet prosthetic appliance. Thus, if even the final will be required adjustments of prosthetic appliances in to the mouth, she will not cause the perforation of gold, plastic or porcelain.

These devices befit for making of single teeth and small prosthetic bridges in the conditions of functional occlusion with stable position of central occlusion and front directing component, providing breaking of back teeth. Violation of occlusion, arising up at making prosthetic appliances by means of such devices, it is necessary to expose and remove in to the mouth. To them premature contacts behave in position of central occlusion and central correlation, and also tubercles of obstacle at a worker and non-working motions of bottom jaw and at advancement of her forward. It is necessary correctly to estimate the lacks of these devices. If it is necessary to reproduce position of central correlation or change one of basic elements of occlusion, models need to be set at least on the semimanaged articulator.

Complete models set in semimanaged articulator

Complete models can be set, using between the occlusal cereous prints on any type of the semimanaged articulators in position of central occlusion.

The models of supramaxilla can be set by the transfer of testimonies of facial arc, using arbitrary or real joint axis. It allows correctly to orientate an overhead model in regard to an arthral axis, gives an opportunity to get more exact arc of rotation in position of central correlation and correctly orients occlusal planes.

Raising of models in central correlation allows to set character of present violations in position of central correlation and central occlusion. When prosthetic appliance is fixed at a before existent stable central occlusion, it is possible to obtain a correct contact

Reference heights, not creating new premature contacts at central correlation. Models can be also set in position of central correlation in default of stable central occlusion; in this case it is necessary to form new between bugorokovoe correlation in proceeded in teeth. At such position between bugorokovoe correlation can be formed or in position of central correlation, or in a more antelocation depending on the choice of dental technician. If necessary to change the height of occlusion setting of models by means of facial arc and between the occlusal of the cereous imprints got in position of central correlation, diminishes possibility of error. These imprints allow to duplicate the arc of closing and center of rotation of bottom jaw of patient on such articulator. It means that at an increase or diminishing of height of occlusion on an articulator new between bugorokovoe correlation of teeth will be in position of central correlation.

All These articulators Have the managed mechanisms of reproduction of corner of arthral way, corner of Bennett and inclination chisel to the way. Some of them Have a device for adjusting of distance between elements, imitating articular head. All these devices allow exactly enough to reproduce motions of bottom jaw, but they are duplicated not fully. That is why they are named «semimanaged». Corner of arthral way (inclination of arthral way) of can be installed on any of these articulators by the use of mizhoklyuziynoho cereousimpression received at the nomination of the mandible forward (control to the bite at the extended position). Corner of Bennett of can be set on the left and right mizhoklyuziynymprints. In some the articulator of this type the mechanism of setting of corner of Bennett is not very much sensible - it is here possible to set a corner, that averages 15°.

There is a corner of arthral way on the articulator of «Whip-Mix», and also the corner of Bennett is set on lateral control imprints. All these devices have the managed mechanical supports playback a chisel way, which can be adjusted for an imitation by a chisel to the way at advancement of bottom jaw forward and in parties along equal planes.

In addition, if necessary, matrix chisel it is possible to the way

to make from samootverdevayuschy acrylic mass on any of these supports. Devices, imitating arthral and chisel to the way in these the articulator, conforming to the requirements at making of most types of dentures, not creating hindrances at advancement of bottom jaw forward and at a worker and non-working her motions. Good enough manoeuvrability of jaws of articulator allows to recover the harmonious directing functions of teeth at the working forward movement of bottom jaw and advancement of her.

Devices, having devices for adjusting between arthral of distance and exact mechanisms for setting of corner of Bennett, allow more exactly to reproduce the trajectory of motion of bottom jaw in a horizontal plane. Some of THESE articulators arc, other. In arc devices inclination of occlusal plane of supramaxilla in relation to directing track of motion of arthral spheres or overhead wall of mechanical fossula remains permanent at opening and closing motions of overhead part of articulator. In bezdugovy articulator inclination of occlusal plane of supramaxilla in relation to directing track of motion of arthral spheres at opening and closing motions of device changes. It is necessary to underline that the use of the managed articulator on itself does not give a reliable guarantee that the recovered teeth will function in complete harmony with joints, neuromuscular vehicle and fabrics of paradontium. Possibility of the exact enough reproducing on the articulator of positions and motions of bottom jaw allows to make prosthetic appliances, harmoniously included in the complex of motions of bottom jaw, that also depends on knowledge, experience and trade of dental technician. The typeselection of the semimanaged articulator depends on that, what model will be chosen by a doctor. Some consider that a strong bezdugovy articulator with directing track for motion of arthral spheres befits for most manipulations. Other prefer to arc articulator with managed by distance between arthral spheres.

Universal articulators

Universal articulators exactly reproduce motions of bottom jaw and set on pantografichnoyu or by stereography registration of these motions. Other methods, in which dynamic methods are used registrations of motions of bottom jaw, including the technique of the «functional reproducing of trajectory of motion» and adaptation for the correct location of jaws. These methods can be used for separate cases in clinical practice.

Universal articulators require determination and transfer on them terminal joint axis of patient by means of facial arc, and also making of intraoral clamps for the receipt of pantografichnoyu and stereography images with work with such the articulator preparation, receipt stored motions and establishments of models require considerable time and attention. It hampers their use for ordinary restoration procedures. They are recommended at making of fixed crowns and bridges, where it is necessary to bring down to the minimum the possible loading on the neuromuscular system and containing woven.

Record of motions of bottom jaw

Zovnyshnorotovyy record of arthral way. Such record is done by means of facial arc. intraoral part of facial arc unites with a prikusnoi roller. Outwardly mouth part of arc ends with metallic bars, giving pencils, joints set in area of athwart to the skin.. On the cheek of sick in area of joint lay on hard paper so that his bottom edge arcuated at right angles was parallel to the facial arc which presents occlusions well planePatient is asked to put forward the lower jaw. There is a moving and face of the arc ofpencils at this o'clock, which outline the moving heads of the mandible. Corner appearing the drawn line and bottom edge of paper sheet. And will be the corner of sagittal of arthral way. In order that to write down the lateral change of heads of bottom jaw. Pencils put at козелка, and their writing edges direct downward. Paper lay horizontally at the level of trestle under pencils

Record of sagittal of chisel way. A pencil is put in area of central chisels by means of bar. Which attached to occlusal roller of supramaxilla. A roller is placed horizontally at right angles to ​​the bar. The tag of pencil is placed opposite a chisel point, and paper dispose in a sagittal plane. At opening of mouth and advancement of bottom jaw, a pencil will outline the way of chisel point. A corner appearing between the drawn line and closing line will be a corner chisel skidding.

External oral record of by a chisel by-way. By means of bite rollers determine between alveolar height and central occlusion. To bite roller of bottom jaw fasten a bar the end of which goes out outside. Here on him place a metallic ground covered by the skim of black beeswax. The similar bar connected with an overhead bite roller ends with a post which at lateral motions dints on a beeswax. The corner formed is named gothic, or by the corner of by a chisel by-way.

Inwardly mouth the record of motions of bottom jaw is first offered in 1914 of Eyhentopfom. On occlusal to the surface of overhead roller of укриплюють4 small brad, salient from a beeswax on a 1-2 mm: two in area of central chisels, two in area of molars on the right and on the left. On lower illusory roller in the areas of location these a brad is done by deepening which fill plastic mass or amalgam, did not harden. Then rollers enter in the cavity of mouth and patient must close a mouth in position of central occlusion. After it offer to the patient to move a bottom jaw forward and in parties, here a brad is drawn by furrows on a bottom roller. After it give to the amalgam to harden and carry models in an individual no articular articulator.