during the past several years,
the technology and techniques surrounding fixed prostate
tonics have improved considerably.
Many of these improvements have been enhanced to the use of
the highly accurate,
fully adjustable articulator with
such an instrument.
For example,
the Hannah 1 30 21 1 can
study and diagnose a variety of dental problems,
secure in the knowledge that the instrument when properly
used is extremely accurate.
Once the casts have been fabricated in the articulator
set,
the design or implementation of the treatment plan can
be carried out with precision and confidence.
This will be a demonstration of the procedures involved in the
use of the Hannah 130 21 fully
adjustable articulator.
The hand now 1 30 21 we will be
demonstrating is a fully adjustable
articulator that is set using static positional
records.
Techniques generally employed with this instrument
include location of hinge axis,
facebook transfer the making of centric
relation records and registration of the border
positions.
Some of the desirable features of this articulator are an
adjustable intercon dealer,
distance,
a Bennett guide adjustment and horizontal and
vertical axis adjustments for each con dial
an articulator,
which is set using panda graphic tracings might also
incorporate these adjustments.
However,
when using the panda graphic system,
it is necessary to show the entire movement of the mandible
within the border points.
The Hannah one 30 20 one can be
used successfully for most major oral
rehabilitation procedures.
If the system is properly understood and the
articulator is used carefully.
The instrument is sturdy,
easy to adjust during the required laboratory
procedures and provides an excellent centric
lock.
Also,
since this system makes use of split casts,
the accuracy of the records and the articulator
settings can be easily verified.
The first step in the location of hinge axis is the
segmentation of a segmented clutch trey into the
patient's mouth.
The clutch trey can be cemented either with impression plaster
or with commercially available gel.
Um The tray is filled with the cementing medium and
placed into the patient's mouth.
It should be held in position until the final set has been
achieved.
The face bow is now attached to the clutch trey
stem.
Notice that the stylists leaves are in the approximate
location of hinge axis.
Once the facebook has been properly positioned,
it can be secured by tightening the clamp on the stem
tray.
The style I are now inserted into their respective
sleeves and secured at their maximum depth.
The lock nut for the condor sleeve is loosened,
allowing the style I to reach a position close to the
skin.
The condor locknut is then secured.
The style I can be adjusted in two ways.
First by means of a horizontal thumb screw
and second by using the vertical thumb screw.
These two thumb screws allow for adjustment of the style I in
an anterior posterior direction,
as well as a superior inferior direction
to locate the hinge axis point recruited,
the patients mandible and noticed the ark of the stylists
around the point of hinge axis.
This diagram shows the relationship of the retreated
mandible to hinge axis.
You can see that the hinge axis point corresponds to the
center of rotation of the mandibular con dial.
It is this point we want to tattoo for later reference.
In this case you can see that there is both vertical and
horizontal movement of the stylists around the point of hinge
axis.
Think of the hinge axis point as the center of a clock.
In its present position,
the stylist is in the 4 to 5 o'clock position,
so we must use the vertical thumb screw to bring the stylus
up.
As we raise the stylist,
we can see that it is rotating slightly in the three o'clock
position,
so we moved the stylist posterior lee using the
horizontal thumb screw,
There is still a very small arc remaining in the 6:00
position,
so we raised the stylist slightly.
Now that the final adjustments have been made,
there is no movement of the stylus.
Once the stylist becomes stationary,
it is directly over the point of hinge axis.
This procedure should be repeated on the other side.
Once the hinge axis has been located,
this point can be tattooed,
it should be noted that the location of hinge axis can be
determined with the patient in either a supine or an
upright position.
However,
to avoid any error caused by a shift of the facial
tissues.
During the facebook transfer procedures,
the patient should be upright for tattooing.
First,
remove the stylists from the sleeve and clean the
area with an alcohol sponge.
Then replace the stylus
and reconfirm hinge axis by retreating the
patient's mandible once again,
partially retract the stylists
and after mixing the red tattooing die with
alcohol,
Place a small amount of this pigment on the tip of the
stylus.
Retread the patient's mandible and make a small
dot on the patient's skin.
The stylist can now be removed.
The tattooing will be done with the sterile 27
gauge needle.
The tattooing dyes picked up on the tip of the needle
the skin is tensed and then pierced,
repeat the procedure to be sure the dye is well under the
skin,
rotating the needle will help to deposit the die,
clean any excess dye with an alcohol
sponge.
As you can see,
we have a permanent mark at the point of hinge
axis.
After tattooing the hinge axis on the other side,
remove the face both from the stem of the clutch trey,
the labial and lingual portions of the tray can
be separated by removing the two screws at the side
of the tray.
The hardened plaster can now be removed in segments,
remove the clutch trey and clean any remaining
material from the patient's teeth.
We will now show the component parts of the hand.
Now 1 30 21 articulator
into candler distance,
candler guidance
centric lock
retention.
Lock.
Bennett guides
in size sculpin
inter Kanzler distance
vertical axis,
support
horizontal axis,
support
candler ball
candler shaft
extendable shaft
in size L.
Table.
The first step in making a split cast is to make
accurate hydroxyl Lloyd impressions of both the maxillary and
mandibular arches.
These impressions should be made using vacuum improved di
stone to avoid any irregularities caused by
air bubbles trapped in the stone.
The finished cast should be trimmed and V shaped
notches should be made in the peripheral border of the maxillary
cast.
Carefully smooth the bottom of the cast and the edges of the
notches with 400 silicon carbide paper
lightly lubricate the bottom of the cast and pour an
index using a stone of a different color.
This color difference will make the accurate seating of the two bases
easy to inspect.
You can see that we have an accurate seating of the cast.
The following items are needed for the transfer of the maxillary
cast to the articulator.
The hand now 1 35 automatic transfer
bow bite fork,
orbital pointer tightening
wrench modeling compound,
zinc oxide and Youth Journal bite registration
paste.
Once the modeling compound has been molded around the bite
fork used the cusp tips of the maxillary
cast to make preliminary impressions in the
compound final indexing will be done in the
patient's mouth.
Place the bite fork in position against the patient's
maxillary teeth and asked him to close down lightly
on the compound.
The bite fork and modeling compound will serve as support for the
facebook.
The hardened compound is trimmed so that only
the impressions of the cusp tips will remain as an
index for the final seating of the cast,
zinc oxide and Youth Journal bite registration
paste are mixed and a small amount is
used to cover the indentations of the cusp tips.
This is held in position in the patient's mouth until
final set has taken place.
When the registration paste has set,
remove the bite fork and trim away any excess
paste to be sure there is no interference between the
maxillary cast and the bite fork.
The facebook was secured to the bite fork and the style
I are placed in their respective sleeves and secured.
Make any adjustments needed to bring the style I into
position over the hinge axis points
position the orbital pointer so that it
corresponds to the inter orbital notch.
This creates the axis orbital plane
which in the patient corresponds to the
Frankfurt plane.
Finally check to be sure the facebook is
secure and properly positioned over the hinge axis
points.
The following items are needed to mount the maxillary
cast on the articulator using the Kinnah Matic face
bow,
the mounting block,
the mounting pin,
the axle,
a liners and axial crib
and finally the orbital indicator.
The following adjustments should be made to prepare the
articulator for the facebook transfer
The inter conjurer distances of the maxillary and
mandibular members are set to 55
cm.
The vertical and horizontal axes are set
to 0°
And the inside cell table is set to
10°.
Also the pro true sieve of the candler
guide is set at 30 degrees
And the Bennett Guides are set at 40°.
The mounting block and the axial cribs
are attached to the lower member of the articulator.
The condor ball is removed and the
axial crib inserted.
Repeat this procedure for the left side of the lower
member.
To prepare the upper member of the articulator,
attach the mounting pin and the orbital indicator in
their respective positions.
The axial align ear's are then attached
to the candler pointers of the facebook.
The inter Kanzler distance of the lower member has
increased to accommodate the inter facial
dimensions of the patient In this
case to 63 cm.
Also the extendable axes are expanded
so as to leave one millimeter on each side.
This distance will be accounted for later.
When the facebook was removed from the articulator,
the cast support of the mounting block is raised to
touch the bite fork,
the upper member of the articulator is placed into
position.
The infra orbital pointer will now touch the orbital
indicator.
The mounting pin is dropped to touch the bite fork
stem.
These two points have given us the stopping point on the
arc of closure,
secure the centric lock pins to ensure
stability
with the mounting pin in place,
the orbital indicator may be removed.
To facilitate mounting
the split portions of the maxillary cast have been
joined together with sticky wax
to avoid the possibility of tension between the dry
and the wet stone during mounting,
wet the base of the cast,
the mounting of the maxillary cast to the upper member of the
articulator will be done using two
applications of gray rock quick stepping
stone.
After the first application has set refined
the mount with a second mix of stone to ensure
increased stability and neatness.
The centric relation record is made from two sheets of
base plate wax melted together.
First heat the ends of the separate pieces
and attach the two sheets,
then soften the remaining ends and
fold them into the middle.
Make an outline of the maxillary cast in the softened
wax and trim around the edges of the record,
melt the edges of the record to be sure there is no
separation of the sheets
retread the patient's mandible so there is an
uninterrupted arc of closure,
lightly placed the record over the maxillary teeth,
Only slight indentations of the cusp tips are needed.
Apply firm distal pressure to the mandible
as you lightly bring the mandibular teeth into
contact with the soft wax.
Repeat this procedure until the cusp tips are
clearly outlined,
chill the wax in water and return it to the
patient's mouth to be sure the record is accurate
after trimming the record to be sure only the cusp
tips are registered.
Make a final refinement of the record using bite
registration paste.
A second centric relation record should be made in order
to confirm the accuracy of the first
to mount the lower member of the articulator.
First remove the axle cribs and replace them
with the condor balls.
Then place the mandibular cast on the
maxillary cast and measure the distance from the
base of the cast to the ring,
inspect the centric relation record to be sure
none of the bite registration paste will interfere with
an accurate seating and then place the record on the
maxillary cast.
The mandibular cast is then placed onto the
record.
The inside isil pin is opened to accommodate the
thickness of the wax.
The mandibular cast can now be mounted the same way as the
maxillary cast,
wet the cast to avoid tension and cover the
top of the cast with gray rock stone closed
the articulator and allow the stone to harden.
A second mix of stone should be used to refine the
mounting.
Both the mandibular and maxillary casts are
now neatly mounted on the articulator.
One of the advantages of the split caste system
is the ease with which existing records can be
verified.
For example,
with the second centric relation record between the mandibular
and maxillary casts.
You can see that as we open and close the upper member of
the articulator.
The split will seat perfectly into the base of the
cast.
This verifies the accuracy of the centric relation
record
to ensure that the lateral records made from the patient are
purely lateral with no protruding component.
It is best to preregister these records on the
articulator.
The right lateral record,
for example,
can be preregistered by first loosening the
candler element on the left side of the articulator
and then moving the upper member of the articulator
so as to bring the casts into a cusp
tip to cusp tip position on the left side,
raise the wing of the inside cell table until it
touches the inside cell pin and mark the point of
contact with a pencil.
Place the softened wax record on the mandibular
cast and using the pencil mark as a
reference,
moved the maxillary cast into a lateral
position.
Close the articulator until the cusp tips of the
cast make a slight indentation in the wax
to preregister the left lateral record,
tighten the condor.
Guide on the left side of the articulator and
loosen the one on the right,
move the upper member of the articulator into a right
lateral cusp tip to cusp tip
position and mark this position on the inside cell
table.
Again place the wax record on the mandibular
cast and using the mark already made as a
reference point,
register the right lateral position on the record
to obtain a preregistered pro truce of record,
loosen both centric locks and move the upper member
of the articulator posterior lee until the
incisor teeth are cusp tip to
tip,
raise the inside cell table and again mark the
point of contact.
Use this point as a reference to register the protrusion of
record
Here you see the three preregistered records
the right lateral,
the left lateral and the pro truces
to refine each record in the patient's mouth,
mixed bite registration paste and spread a
thin layer over the record.
Place the record in the patient's mouth and have him
close into the preregistered indentations.
After the paste dries,
carefully inspect the records to be sure there are
no irregularities that might interfere with an
accurate seating.
The record is then placed between the maxillary and
mandibular casts,
which are then joined together to ensure stability.
While the articulator is being set.
The articulator will be set using the techniques
described by Napkins Ebert,
in the April 1969 issue of the Journal of
Prosthetic Dentistry
in preparation for setting to the left lateral record,
the left centric lock is tightened and the left
Bennett guide is rotated out of possible contact
on the right side.
The centric lock,
the Kandahar guide and the horizontal and vertical
axis supports are all loosened
as the split cast is lowered into position,
adjust the horizontal condolence inclination
and the vertical and horizontal axis supports
until the split seats accurately.
When the cast seats properly rotate the
left.
Bennett guide into light Contact
record the horizontal Kanzler inclination and
the vertical and horizontal axis support readings
and tighten these adjustments.
The same procedure is used to set the articulator
for the right lateral,
record
separate truces adjustments must be made and
recorded on the back of the data card.
Once the articulator has been set in all three
positions,
record the settings and placed them in the patient's
chart
to demonstrate the patient's seclusion in the right lateral
exclusive movement.
We will loosen the left centric lock
and with the thumb on the right Bennett guide
plate,
move the upper member of the articulator to the
right.
This procedure is reversed for the left lateral
movement
for petru sieve loosen both centric
locks and perform the desired movement
By analyzing the patient's seclusion throughout the full
range of movement,
it is possible to plan a treatment for the patient
that will be completely functional in all positions.