Occlusion

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Gypsum:Fixation casts to articulators
w/p=63cc/100g

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Quick Set Plaster

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Gypsum: Diagnosis/Planning
w/p=45 to 55 cc/100g

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Plaster Study Models

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Gypsum: Fabricate Appliances
w/p=30cc/100g

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Stone Casts

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Gypsum: Crown Fabrication
w/p=22cc/100g

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Improved Stone Dies

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If more water is used than recommended. Mixes have _______ setting time, are _________, poor _________ (too fluid), and ________ hard, so it ________more easily

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LONGER
WEAKER
STACKING
LESS
ABRADES

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Accelerators

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2% KSO4
Slurry Water
Longer Mix/Vibration

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Retarders

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Blood
Salivia
Alginate
Less mixing/vibration

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6 to 8 minutes

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initial set/loss of gloss

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15 to 30minute

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final set

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30 to 60minutes

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separate from impression

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Mixing Principles

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-Sift powder into water bowl with vibrator on high
-Mix without fluffling until homogeneous on Vibrator
-Flex bowl vigourously and repeatedly while pressing bowl hard on vibrator on high setting

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sources of macroscopic porosity

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-air trapped in btw powder particles
-air mixed in while homogenizing
-air trapped while pouring the mix in the mold

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Back 13

Gypsum Powder

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Gypsum Cast

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Gypsum Rxn

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Front 16

Forming Gypsum powder into Gypsum Cast is what type of chemical reaction?

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Exothermic-releases heat

Front 17

3 things that cause Alginate's poor dimensional stability

Back 17

-water evaporation
-imbibition
-syneresis

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explain Water evaporation in relating to poor dimensional stability

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evaporation from gel causes 25+% shrinkage

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explain imbibition in relating to poor dimensional stability

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water absorption with water soaking

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explain syneresis in relating to poor dimensional stability

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shrinkage with continued reaction in humidor. AT 100% HUMIDITY

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When do you pour your cast after taking the Alginate impression?

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ASAP-as soon as possible

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sets alginate too fast

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hot water

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slow set and flows too much

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cold water-also problem for sensitive teeth.

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a type whose physical condition is changed by a chemical action that is not reversible. It is an impression material that is elastic when set.

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irreversible hydrocolloid

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a type whose physical condition is changed by temperature. The material is made fluid by heat and becomes an elastic solid on cooling. Can change from a gel to solid set with the addition or removal of heat

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reversible hydrocolloid

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particles less than 0.5um

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colloid

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Steps in making successful alginate impressions

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1. fluff powder and scoop parallel to container
2. level scoop, NO packing
3. 1 scoop/water ring
4. use room temperature water
5. wet powder slowly
6. spread in thin layers with flat spatula, to eliminate air bubbles by "strooping" back and forth til cmppth and creamy
7. load tray back to front, must be full
8. seat pt upright, wipe alginate on tray with wet glove finger
9. rotate corner of tray into mouth, center tray on midline of arch
10. pull lips over the tray before seating. seat posterior first. (3-5mm material tray btw teeth and soft tissue)
11. wit 2 minutes
12. break air lock
13. rinse in water for 30s
14. check impression for voids
15.spray with disinfectant and wrap in damp towl and placed in plastic bag
16. clean metal tray/ pour casts

Front 28

the condylar housing is on the upper member of the articulator and the condylar ball is on the lower articulator

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arcon articulator

Front 29

Same relationship found in the human skull

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arcon articulator

Front 30

the condylar housing is on the lower member of the articulator and the condylar ball is on the upper member of the articulator

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non arcon articulator

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opposite of what is found in the human skull

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non arcon articulator

Front 32

caliper-like instrument which is used to relate the maxillary cast to the condyle elements of the articulator just like the maxilla is related to the condyles and fossa of your patient

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facebow

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facebow utilizes an estimate of the location of the transverse horizontal or hinge axis

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arbitary/ average value

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facebow has adjustible caliper ends which are used to locate the transverse horizontal axis of the mandible

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kinematic

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precise enough for most diagnosis and treatment

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arbitrary facebow and fixed conylar width articulator

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mechanical instrument that represents the tempromandibular joints and jaws, to which maxillary and mandibular casts are attached to stimulate some or all mandibular movements

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articulator

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Masseter

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Superficial head
O: Anterior 2/3 of lower border
of the zygomatic arch
I: On the angle and ramus of the
mandible

Deep head
O: Medial surface ( posterior) of
the zygomatic arch
I : On ramus and part of the coroniod
process

Action: elevation (as in closing of the mouth) and protraction of mandible

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temporalis

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O: Lateral surface of the skull;
temporal fossa and temporal fascia

I: Coronoid process of mandible and
border of ramus

A:Elevation and retraction of mandible

Front 39

Occipitalis

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Origin: Superior nuchal line of the occipital bone and mastoid process of the temporal bone

Insertion: Galea aponeurosis

Actions: Moves the scalp back

Front 40

frontalis and occipitalis joined at _______ by fascial connective tissue sheath and aponeurosis (tendon) sheath

Back 40

vertex

Front 41

Sternocleidomastoid

Back 41

Origin: Manubrium sterni and medial portion of the clavicle

Insertion:Mastoid process of the temporal bone, superior nuchal line

Actions: Acting alone, tilts head to its own side and rotates it so the face is turned towards the opposite side.
Acting together, flexes the neck, raises the sternum and assists in forced inspiration.

Front 42

digastric

Back 42

Origin:
anterior belly - digastric fossa (mandible);
posterior belly - mastoid process of temporal bone

Insertion: Intermediate tendon (hyoid bone)

Actions: Opens the jaw when the masseter and the temporalis are relaxed.

Front 43

Medial Pterygoid

Back 43

Origin:
deep head: medial side of lateral pterygoid plate behind the upper teeth
superficial head: pyramidal process of palatine bone and maxillary tuberosity

Insertion: medial angle of the mandible

Actions: elevates mandible, closes jaw, helps lateral pterygoids in moving the jaw from side to side

Front 44

Lateral Pterygoid Muscle

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Origin: Great wing of sphenoid and pterygoid plate

Insertion: Condyloid process of the mandible

Actions: depresses mandible, protrude mandible, side to side movement of mandible

Front 45

Occurs when there is contact
between the maxillary and
mandibular posterior teeth
on the same side of the arches
as the direction in which the
mandible has moved

Back 45

working interference

Front 46

An occlusal contact between
maxillary and mandibular teeth
on the side of the arches opposite
the direction in which the mandible
has moved in a lateral excursion

Back 46

nonworking interference

Front 47

The proximity of the teeth to the
muscles and the oblique vector
of the forces make contacts
between opposing posterior
teeth during protrusion

Back 47

protrusive interference

Front 48

Pattern of Disclusion

A pattern of mutually-protected
articulation in which the
vertical and horizontal overlap of the
canine teeth disengage the posterior
teeth in excursive movements of
the mandible

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anterior/canine guidance

Front 49

Pattern of dis-occulsion

Multiple mandibular teeth
contact the maxillary teeth
during lateral movement
on the working side

Occlusal forces distributed
over a group of teeth

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group function

Front 50

It is characteristic where the
incisal edges of the maxillary
incisors extend below the
incisal edges of the
mandibular incisors when
the posterior teeth are
fully interdigitated.

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overbite

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vertical dimension

Back 51

overbite

Front 52

It is the characteristic where the incisal edges of the maxillary teeth
extend labially to the incisal edges of the mandibular incisors when
the posterior teeth are inter digitated

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overjet

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horizontal dimension

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overjet

Front 54

When the upper canine
occludes in the
embrasure between the
lower canine and the
lower first premolar

Back 54

Class 1

Front 55

The maxillary first
molar mesiobuccal
cusp tip occludes in
the lower first molar
buccal developmental
groove

Back 55

Class 1

Front 56

When the upper canine occludes
anterior to the embrasure between the lower canine
and the lower first premolar

Back 56

Class 2

Front 57

When the maxillary first molar
mesiobuccal cusp tip occludes
anterior to the buccal
developmental groove
on the mandibular first molar

Back 57

Class 2

Front 58

When the upper canine
occludes posterior to
the embrasure between lower canine and the first
premolar

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Class 3

Front 59

When the upper first molar mesial cusp
tip occludes distal to
the buccal develop-mental groove
of the lower first
molar

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Class 3

Front 60

diagnostic dilemma

Back 60

PATIENTS WITH PRIMARY MYOFASCIAL PAIN PROBLEMS CAN DEVELOP SECONDARY TEMPOROMANDIBULAR JOINT PATHOLOGY

PATIENTS WITH PRIMARY TMJ PATHOLOGY CAN DEVELOP SECONDARY MYOFASCIAL PAIN PROBLEMS

Front 61

joint pain is

Back 61

constant and localized

Front 62

muscle pain is

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intermittent and poorly localized

Front 63

muscle pain increases when biting on the

Back 63

painful side

Front 64

joint pain increases when biting on the

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opposite side

Front 65

congenital anomalies of the TMJ are characterized by

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agenesis of the condyle

Front 66

IS A CHRONIC LIMITATION OF MOVEMENT DUE TO JOINT CONSOLIDATION

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ankylosis

Front 67

IS LIMITATION OF MOVEMENT DUE TO MUSCLE INFLAMMATION OR SPASM

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trismus

Front 68

Patients with disc displacement have a history of

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prior clicking

Front 69

Patients with disc adhesion have a sudden onset of

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locking without a prior history of any TMJ problems

Front 70

TREATMENT OF THE MPD PATIENT Phase I (2-4 Wks)

Back 70

INITIAL EXPLANATION OF THE PROBLEM
HOME THERAPY
MEDICATIONS FOR PAIN AND ANXIETY
MEDICATION FOR SLEEP
POSSIBLE USE OF A BITE APPLIANCE

Front 71

TREATMENT OF THE MPD PATIENT Phase II (4Wks)

Back 71

RECONSIDER THE DIAGNOSIS
CHECK FOR COMPLIANCE
CONTINUE HOME THERAPY AND MEDICATIONS
CONSIDER USING A BITE APPLIANCE

Front 72

TREATMENT OF THE MPD PATIENT Phase III (4-6 Wks)

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CONTINUE HOME THERAPY AND MEDICATIONS
RE-EVALUATE THE BITE APPLIANCE
INITIATE PHYSICAL THERAPY

Front 73

TREATMENT OF THE MPD PATIENT Phase IV

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RE-EVALUATE DIAGNOSIS AND COMPLIANCE
DETERMINE THE NEED FOR CONSULTATION
PSYCHOLOGICAL COUNSELING
REFERRAL TO A PAIN CENTER

Front 74

oral devices that have been fitted over the occlusal surfaces of teeth for the treatment of different masticatory disorders

Back 74

oral orthotic
occlusal/bite splint
occlusal/bite guard
night guard
deprogrammer

Front 75

modes of action

Back 75

use of appliances will induce muscle relaxation, and usually makes it possible to record centric relation clinically by jaw manipulation to produce stable records

some beneficial effects of the occlusal splint may be psychologic and based on congnitive awareness,

allows for optimal positioning of the condyles and discourages bruxism through elimination of the habitual dysfunctional patterns of the teeth

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How do they work?

Back 76

Front 77

Stabilizing Occlusal Splints Indications

Back 77

1. patients with tmj or muscle disorders such as bruxism
2. Diagnosis and treatment of trauma from occlusion 1
3. Establishment of the optimal condylar position in centric relation prior to definitive occlusal therapy
4. Stabilization of mobile teeth by mainting them in stable position
5. Holding maxillary teeth in the desired position following orthodontic therapy or loss of opposing teeth
6. temporary disocclision of teeth for orthodontic or other purpose
7. differential diagnosis in patients with signs and symptoms imitating TMJ or muscle
8. treatment of headaches caused by neurousclar tension

Front 78

Full Coverage: Advantages

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1. worn continuously w/o tooth movement
2. good for bruxism, even if uncontrolled
3. can be worn on maxillary of mandibular teeth

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Full Coverage: Disadvantages

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1. longer adjustment period
2. patients with jaw pain and manipulation during adjustment difficult
3. commercial lab fee

Front 80

occlusal scheme full coverage appliance

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stabilizing splint with stops for all opposing teeth and controlled cuspid rise

Front 81

Partial Coverage: Advantages

Back 81

Good diagnostic device
Easy adjustment and more acceptable to patients with jaw pain
Lack of bulk makes it easier to wear

Front 82

Partial Coverage: Disadvantages

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Should not be worn for extended periods of time
Less acceptable by patient because palatal coverage is necessary

Front 83

Functional Activities: Force of contact

Back 83

17,200 lb-sec/day

Front 84

Functional Activities: Direction of Force to teeth

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Vertical-tolerated

Front 85

Functional Activities: Mandibular position

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C.O.-stable

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Functional Activities: Protective relfexes influence

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present

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Functional Activities: Pathology

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unlikely

Front 88

Para-Functional Activities: Force of Contact

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57,600 lb-sec/day

Front 89

Para-Functional Activities: Direction of force to teeth

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horizontal-not tolerated

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Para-Functional Activities: Mandibular position

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Eccentric-unstable

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Para-Functional Activities: Protective reflexes influence

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absent

Front 92

Para-Functional Activities: Pathology

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highly likely

Front 93

involuntary activity of the jaw musclature characterised by parafunctional activities such as jae clencing, tooth gnashing, and grinding

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bruxism

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Awake Bruxism

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Unrelated to sleep bruxism
•Ususally occurs subconsciouly without cognitive awareness, however, it is under voluntary control
•Protective reflexes intact
•Often occurs during periods of concentration , exertion, stress, anxiety of grinding
•May accompany other types of parafunctional oral habits such as cheek biting, tongue posturing, nail biting, lip biting, jaw bracing or posturing
•20% are aware of at least occasional daytime clenching

Front 95

Sleep Bruxism

Back 95

•(International Classifacation of Sleep Disorders)
ICSD -2 (2005) : Sleep bruxism was re-classified as a sleep-related movement disorder (relatively simple, usually stereotyped movements that disturb sleep and are less complex that other parasomnias)

•An oral activity characterized by grinding or clenching of the teeth during sleep
•Usually associated with microarousals
• Often seen in lighter stages of sleep
• Change in sympathetic-parasympathetic activity
• Tonic muscle contractions = clenching
• Phasic, repetitive muscle contractions = grinding
•Not under voluntary control
•Protective reflexes decreased

Front 96

Sleep Bruxism Etiology

Back 96

The most accepted theory of SB is that it is a movement disorder involving a cascade of physiological events characterized by autonomic-cardiac activities as related to sleep arousal.

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NREM Bruxism

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Stage 1: Transitional lighter sleep
•Stage 2: Deeper sleep
•Stage 3: Slow wave activity
•Stage 4: Slow wave activity
•Stages 3 and 4 are referred to as slow-wave sleep or delta sleep
•Parasympathetic nervous system predominates. Hormonal changes to promote anabolism. Protein synthesis and tissue repair. Restorative period

Front 98

REM Bruxism

Back 98

•“Dream” stage
•Sympathetic nervous system predominates
•– Increased oxygen consumption
•– Increased BP, pulse, respirations, CO
•Increased chance of plaque rupture due to surges in pressure and changes in coronary artery tone

Front 99

Bruxism: Diagnosis Based on History

Back 99

Self Awareness
•Report of witnessed sounds of tooth grinding or tapping
•Jaw discomfort, fatigue or stiffness in the morning
•Morning headache
•Generalized sensitivity of the teeth to cold

Front 100

Bruxism: Diagnosis Based on Clinical Findings

Back 100

•Tooth wear (100% of bruxers; 40% of nonbruxers)
•Masseter muscle hypertrophy
•Mandibular angle hypertrophy on panoramic radiograph
•Masticatory muscle tenderness to palpation
•TMJ tenderness to palpation
•Maxillary exostosis and mandibular tori
•Other evidence of parafunctional jaw activity (tongue scalloping/buccal mucosal lesions)

Front 101

2 types of Sleep Bruxism

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1.Idiopathic: without clear cause
2.Secondary Bruxism: Associated with an identifiable cause; may also occur while awake

Front 102

2 types of Secondary Bruxism

Back 102

a)Drug induced (alcohol, caffeine, cigarettes, SSRI, cocaine, ecstacy)
b)Medical disorders (cerebral palsy, Parkinson’s disease, mental retardation, autism)

Front 103

Evidence of Bruxism

Back 103

1. excessive tooth wear
2. fractured tooth structure or restoration
3. tooth sensitivity
4. tooth mobility
5. pulp necrosis
6. abfractions
7. alveolar exostosis and tori
8. periodontal bone loss
9. masticatory muscle hypertrophy
10. muscle pain and headache
11. traumatic ulcer
12. linea alba and tongue indentation

Front 104

Management of Bruxism

Back 104

Identify the cause and work toward reducing factors

behavioral modifications
occlusal appliances
pharmacology

Front 105

Behavioral Modifications

Back 105

1.Avoidance of known triggers (smoking, caffeine, SSRIs)
2.Stress management (hypnosis, biofeedback)
3.Sleep Hygiene education
4.Change sleep position

Front 106

Occlusal Splints-management

Back 106

Comprehensive reviews by Dao et al and Kato et al conclude that splints are useful adjuncts in the management of sleep bruxism, but are NOT DEFINITIVE treatment

Front 107

PHARMACOTHERAPY

Back 107

The short term use of pharmacotherapy aimed at reducing sleep onset, increasing sleep continuity and total sleep time has been helpful in managing sleep disturbances, including bruxism.

1) muscle relaxants ( Methocarbamol; Robaxin)
2)Benzodiazepines ( Valium)
3)low dose of tricyclic antidepressants