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Uses: oTemporarily provide an occlusal condition that allows the TMJ to assume the most orthopedically stable joint position. oIntroduce an optimum occlusal condition that reorganizes the neuromuscular reflex activity TYPES OF OCCLUSAL APPLIANCES:
1. Stabilization appliance primarily used to reduce muscle pain. muscle relaxation appliance 2. Anterior positioning appliance goal is to change the position of the mandible in relationship to the cranium. orthopedic repositioning appliance
4. Add self-cure acrylic to the anterior portion of the appliance as a stop for lower incisor. Area of this stop is 4-6mm.
5. Fit appliance to the maxillary teeth. It should be comfortable to the patient and no rocking should occur.
6. Self-curing acrylic is added to the occluding surface of the appliance. All occluding are as, except the contact on the anterior stop, have been covered. The setting acrylic is dried with an air syringe and rinsed in warm water before it is placed in the patient's mouth.
7. The appliance with the setting acrylic is placed in the mouth, and the mandible is closed into centric relation on the anterior stop. Adequate resin labial to the mandibular canines provides for the future canine guidance.
Note: The appliance must be removed well before the resin produces heat. It is then allowed to bench-cure until completely hard. Placing the setting acrylic in a cup of warm water can reduce the amount of bubbles that develop in an appliance.
8. Once the acrylic has set, the impressions of each mandibular buccal cusp tip and incisal edge are marked with a pencil. These represent the finished centric relation contacts that will be present on the finished appliance.
9. Excess acrylic surrounding the centric contacts is removed with a hard rubber wheel on a lathe. All areas, except labial to the mandibular canines, are flattened to the contact (pencil) marks. This area will create the eccentric guidance.
A, The acrylic prominence labial to the canine (lateral view) is demonstrated. B, During laterotrusive movement the mandibular canine disoccludes the remaining posterior teeth (canine guidance).
A, The laterotrusive and protrusive guidances are not continuous, smoothflowing contacts. These should be adjusted to produce smooth, continuous pathways as shown in B.
The mandibular canine provides the laterotrusive (LT) and protrusive (P) guidance. The posterior portion of the appliance should reveal only centric relation (CR) contacts. This appliance, however, also reveals undesirable laterotrusive (LT) and mediotrusive (MT) posterior contacts. These must be eliminated.
With the patient reclined, the occlusal appliance is adjusted. Then the patient is raised to the upright head position (alert feeding position), and the occlusion is evaluated. The anterior teeth should not contact more heavily than the posterior teeth. If they do, they are marked with articulating paper and adjusted to contact more lightly. Note: The patient can easily protrude the mandible and contact heavily on the anterior guidance. Careful instruction may be necessary to ensure that the patient does not protrude the mandible when asked to close on the appliance. The patient should be specifically asked to close and tap on the posterior teeth.
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