Biomedical subjects
Publications and source records attributed to N J Capp.
Control of occlusal contacts is important to the success of restorative dentistry. Tooth surface loss can contribute to a loss of stability in the occlusion. An occlusal splint is often part of pre-restorative management and can also have a valuable role in protecting both teeth and restorations from excessive loads and further wear.
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This paper describes the clinical and laboratory stages necessary to ensure the occlusal precision of fixed restorations. The important diagnostic stages, including elimination of mandibular dysfunction, the occlusal analysis and waxing of diagnostic casts, and the diagnostic use of provisional restorations, are outlined. The importance of having the clinician control all stages of laboratory work, including die trimming, mounting working casts on an articulator, the determination of both anterior and posterior tooth form, and the final occlusal adjustment of the restorations, is emphasized.
Intra-oral fracture of metal-ceramic restorations sometimes occurs when clinical and laboratory techniques have been inadequate. Removal and refabrication of the prosthesis is the ideal solution, but may not always be practical. Recently, several products have been marketed for expediting the repair of fractured restorations in the mouth. This study compared the effectiveness of three of these repair systems (Super-C, Command Ultrafine and 3M Porcelain Repair Kits) with a control group of porcelain-fused-to-metal specimens. Measurement of failure load of each material being tested was carried out in compression using a universal testing apparatus and a specially designed jig. Each experimental and control group contained ten specimens. Each material was tested individually for repairs against metal and against porcelain. A comparison of the failure load values indicated that the control samples gave the highest mean value of 881.6 +/- 192.9 N, while that of Super-C against metal was the lowest at 385.4 +/- 102.4 N. The Command Ultrafine Repair Kit was the strongest of the repair systems studied.
This article presents a clinical case requiring reconstruction with a combination of fixed and removable prostheses. It describes the use of a stable base partial denture to restore a distal extension saddle and outlines the advantages of the technique when compared to the conventional use of precision attachment or clasp retained partial dentures.
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The purpose of this study was to determine the effect of TMJ dysfunction on the recording of centric relation. Centric relation was recorded using an anterior occlusal stop and by bimanual manipulation. Changes in occlusal contacts were recorded before and after occlusal splint therapy in six subjects with TMJ dysfunction. The pantographic reproducibility index and clinical signs and symptoms were used to determine the presence or absence of dysfunction. Use of the anterior occlusal stop resulted in a more posterior, superior initial tooth contact position when compared with bimanual manipulation. Occlusal contact positions were less consistent in TMJ dysfunction subjects than in control subjects. Initial occlusal contacts changed toward centric relation as the dysfunction disappeared. Final occlusal contact was found on the side where clinical signs and symptoms occurred. The condyle on the affected side appeared to be repositioned posteriorly and superiorly in most instances. Occlusal splint therapy was more effective when the splint was adjusted weekly. This study indicates the need to eliminate TMJ dysfunction before recording centric relation or adjusting the occlusion. Occlusal interferences found with TMJ dysfunction are not the same as occlusal interferences found when TMJ dysfunction is absent. Abnormal features on pantographic tracings may aid in indicating the presence of occlusal interferences. Occlusal adjustment in the presence of TMJ dysfunction would result in erroneous occlusal reduction.
An indirect method to locate the first tooth contacts in centric relation was described in this study. Mounted casts with an associated table and styli were used to locate the position of contact points in three planes. The method was tested using the anterior occlusal stop with chin point guidance and bimanual manipulation for recording centric relation. Ten records from one subject were analyzed statistically for each method. At the p less than .05 level of significance, the anterior occlusal stop produced a centric relation position more posterior than that found with bimanual manipulation. There was no statistically significant difference in the vertical and mediolateral planes. The anterior occlusal stop method produced more consistent tooth contacts in all three planes. The centric relation points found on the recording plates correlated well with the initial tooth contacts marked on the cast. This indirect method is an accurate means of recording and reevaluating changes in tooth contact positions in three planes.
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The restoration of anterior teeth for patients with excessive vertical overlap is often complicated by a lack of space for restorative materials. This situation often occurs in patients with worn anterior teeth. Two methods of creating adequate space to permit satisfactory restoration are presented.