Freeway space - definition

The space that exists between the upper and lower articul atory memb ers at rest

T heory of Freeway Spac e Ja w Re gistration

The difference between the vertical dimension o f occlusion an d the vertical dimension o f rest Inter-occlusal rest space

Speech
Say (out loud) the days of the week Do teeth contact during speech? What is the role of teeth during speech?
Labio-dental sounds (Friday) Linguo-dental (Thursday) Alveolar (Saturday )

Vertical dimensions natural dentition

In the natural dentition, a space exists between the teeth at rest i.e. teeth are not clen ched at rest Two vertical dimensions may be m easu red Resting Vertical Dimension (RVD) Occlus al Vertical Dim ension (OVD)

TEETH DO NOT CONTACT DURING SPEECH IN THE NATURAL DENTITION

Freeway space in the natural dentition

Freeway space in edentulous patients wearing dentures

Blank canvas Position of the upper and lower occlusal planes are prescribed by dentist as part of the jaw registration process Usually try to provide a similar FWS to that which would exist in the natural dentition i.e. 2-4 mm The concept of a negative FWS can exist in the edentulous patient i.e. if OVD > RVD

FWS typically 2-4mm in natural dentition

Excessive vertical dimens ion problems

FWS too small, absent or negative Functional difficulties, particularly eating Teeth contact during speech clicking during speech, difficulty forming some sound s Difficulty approximating lips Poor aesthetics MO M constantly under stres s Pain and/or TMJ P DS s ymptoms ?Accelerated bone resorption

Deficient vertical dimension problems

FWS too large Functional difficulties, particularly eating Poor aesthetics Over closure Pain and/or TMJ P D S symptoms Reduced masticatory efficiency Cheek biting due to bunching of tissues Dribbling at angles of mouth/angular chielitis because of inappropriate support at angles of mouth/bunching

Assessing FWS
Facial measurements FWS = RVD - OVD Speech (look for clos est speaking distan ce, listen) Appearance Others: Electromyog raphy, biting forces, pre-extraction metho ds

Sequence for measuring FWS

Wi ll is bi te gau ge & two sta bl e ref ere nce po ints Two Dots technique (nose/chin) Naso-labial angle /underside of chin RV D Take one denture out Patient relaxed, head in neutral position Encourage patient to swallow, rest with lips just together Take measurement OVD Both dentures in Ask patient to close together (RCP) Take measurement, ensuring same head position and same reference points

Factors affecting RVD

Short term Head position Stress Mouth contents (teeth/dentures) Pain Respiration (minor variations with inspiration and expiration) Long term Age and health Bruxism/parafunctional habits

FWS = RVD - OVD

Important to get head position relaxed not too far forward or back!

Jaw Registration

Jaw Registration - Objectives

Creation of the form of the upper and lower dentures Prescription of upper rim to include; lip support incis level al centre lines canine lines occlusal planes buccal corridors

Sequence for C/C jaw registration

As sess rims on casts prior to patient coming in Are they fit to go in the patients mouth? modify if necessary Disinfect Upper extension, retention, stability (modify) Lower extension, retention, stability (modify) Prescribe upper rim Prescribe lower rim, in conjunction with upper, and establish the vertical dimension in RCP Relate lower rim to upper, in RCP Tooth selection Prescription & disinfection

Relationship of upper rim to lower rim in three dimensions Tooth selection

(Rela tio n sh ip o f u p p er ca st to co n d yles if a fa ceb o w tra n sfer is u sed )

Form of upper rim

Aim is to position teeth and the periphery of the denture in a functionally stable and aesthetic position Must be in harmony with the proposed position of the lowers There may have to be a compromise between function vs aesthetics The position of teeth prior to extraction is, at best, only a guide and may not be reliable

Methods of determining previous tooth position

Photographs Radiographs Study casts, when patient had teeth Anatomical and fun ctional guidelin es

BUT Prosthetic replacements are not necessarily placed in the same positions as that natural predecessors! THINK

Guidelines to tooth position

Verti cal naso -labi al angle Horizo ntal naso-l abial angl e Incisal point Incisal plan e Canine points Posterior occlusal plan e

lip support incisal level centre lines canine lines occlusal planes buccal corridors

Reproducible registration V notches in upper Build up wax in lower Seal together in RCP Chill Separate Check

Mould of denture teeth Rounded Tapered Square