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Removable Prosthodontics,
Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
Introduction
Occlusion includes the integrated relationships of the
teeth, jaw muscles and temporomandibular joints. To
produce good functional occlusion in prosthodontic
treatment, the correct registration of intermaxillary
relation is essential. When the intercuspal position (IP)
is lost, dentists must determine the proper IP for the
patient from the data of condylar position and masticatory muscle function. There are some different
methods for the registration of IP. Recording of tapping
movement remains popular because some studies
suggested that the convergent point of the tapping
movement seems to coincide the IP and is called
muscular position (15). However, the path of the
tapping movement is influenced by the head position
(6, 7), frequency of tapping movement (8, 9) and also
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Analyzing method
The data were analyzed in the location of the incisal
point and the right condylar point of the subject in the
sagittal plane.
In this study, intra-oral tracing devices were used and
the vertical dimension was increased to record the
tapping movements without contact of dentition.
Therefore, the true IP of the dentition was lost on the
tracing plate. Then, the geometrically equivalent point
of the IP was obtained as follows. The position can be
calculated as an intersection of the Gothic arch plate
and the rotational trajectory of incisal point around the
kinematic axis (13, 14) in the condyle. This point was
denoted as calculated IP.
Ten tapping movements were selected from the
middle of each of the three tapping trials. The location
of the convergent points and the standard deviation
(s.d.) of 30 tapping movements were obtained to assess
the degree of the convergence of tapping points. The
reference position at the incisal point was the calculated
IP. At the condylar point the reference was the condyle
position in the IP without appliance.
Data were statistically analyzed using repeated measure one-way ANOVA, followed by the Scheffes F-test.
Experimental procedure
Each subject was comfortably seated upright with back
support on a dental chair. The head was free and
positioned with the Camper plane horizontal.
The intra-oral tracing devices were inserted in the
dental arches and the tapping movements terminated
with tracing pin and tracing plate of intra-oral device in
Results
Convergence of tapping points
Figs 4 and 5 demonstrate the influence of the inclination of tracing plate on the convergence of tapping points and the positions of the condyle on
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Fig. 8. The distance between the Gothic arch apex and the mean
position of tapping points (n 30) with three appliances.
Fig. 9. The distance between the Gothic arch apex and the
condylar position corresponding to the mean position of tapping
points (n 30) with three appliances.
Discussion
Design of the device and measuring method
The intra-oral tracing device that is widely used in
restasative clinics (Gothic arch tracing device) corresponds to the horizontal appliance in this experiment.
As the tracing plate is parallel to the occlusal plane, the
jaw-closing path is not perpendicular to the tracing
plate (16). This might produce unstable tapping movement points on tracing plate. There will be the anterior
component of the force when the stylus contacts on the
plate. To avoid this, the authors decided to modify the
appliance by changing the inclination of the tracing
plate so that the jaw-closing path would be perpendicular to the tracing plate. In this regard a new
appliance was fabricated. The authors considered the
hinge rotation of the condyle and determined the
inclination of tracing plate to set on a line drawn from
the condylar point to the tip of the stylus at occlusal
plane, which was named inclined appliance. For five
subjects the inclination of the tracing plates was
278 18 (mean s.d.) to the occlusal plane.
In this experiment as the tapping movement was
performed at an interincisal distance of 30 mm, the
mandible translated and rotated simultaneously around
the condyle. Therefore, here the jaw-closing path was
more anteriorly located from the jaw-closing path
observed from a simple hinge rotation of the condyle.
With the inclined appliance there is possibility that the
jaw-closing path was not perpendicular rather steeper
to the tracing plate on tapping movement. When the
stylus contacts on the plate, the posterior component of
the force may be provoked. To compensate this problem
Convergence
Tapping points should be within a small convergent
area to record the jaw position during occlusal registration. Changing the inclination of the appliance, the
areas of the tapping points in sagittal view were 030,
016, and 012 mm in average of the s.d.; the steeper the
inclination the smaller the tapping area in incisal point.
(Fig. 6). In the case of the condyle position, the result
was same as incisal point, 021, 013 and 013 mm,
respectively (Fig. 6). It may be that the design of
horizontal appliance could not produce a convergent
tapping movement of the mandible; thereby the stylus
could not strike almost same point. While the mandible
has followed a muscular path, the point of its arrival is
imprecise and the recordings display scatter. On the
other hand, the inclined tracing plates of the inclined
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appliances were able to enhance the convergent
tapping movements of the mandible and guided the
mandible to strike repeatedly in and around a point
precisely. As a result, the inclined appliances were able
to record the tapping points in a convergent area
compared with the horizontal appliance.
Position
To record the optimum intercuspal position the convergent tapping points should be located near the IP of the
subjects. In this study, as the inclination is increased, the
mean location of the incisal tapping points from the IP
moved posterior in mean values: 055, 004 and
)006 mm (anterior from IP) (Fig. 7). In the case of
condyle position, the change was also in the same
direction: 038, 001 and )009 mm anterior from the IP
corresponding condylar position in mean value (Fig. 7).
There are some studies that reported that the muscular reproducibility decreases when protrusive tooth
contacts are eliminated (22) and in this situation the
mandible is potentially elevated anteriorly when the
major jaw closing muscles become active (23). This
result may be applicable in case of the horizontal
appliance because the subjects produced tapping movements guided by condyle and the jaw closing muscles
only. The horizontal appliance could not provide
anterior guidance on tapping movements. Therefore,
it might record the tapping points anterior to the
calculated IP in scattered fashion. On the other hand,
the inclination of the tracing plate of inclined and halfinclined appliances, has the advantage of acting as an
anterior guidance and was able to inhibit the excessive
anterior movement of the jaw and allow the subject to
reproduce jaw tapping movements near the IP. This
might help overcome the limitations of horizontal
appliance during registration of tapping movements.
These results of the condylar position are coincident
with the concept of the stable position of the condyle
within the fossa (24). He described that the stable
position of the condyle has the width within 023 mm
by measuring human temporomandibular joint complexes separated from the body.
Inclination
From our result, we found that the inclination of the
plate makes the tapping area smaller and nearer to the
IP without devices. But, there was only little difference
Conclusions
From the distribution of the scattered tapping points,
the inclined appliances should be used to record the
convergent tapping area nearer to the intercuspal
position.
Half-inclined appliance (about 14 degrees to the
occlusal plane) is recommended and reliable as it allows
the recording of tapping points in a convergent area
with the condyle in optimum position in the fossa.
References
1. Brill N, Lammie GA, Osborn J. Mandibular positions and
mandibular movements. Br Dent J. 1959;106:391.
2. Moller E. The chewing apparatus. An electromyographic
study of the action of the muscles of mastication and its
correlation to facial morphology. Acta Physiol Scand Suppl.
1966;280:1.
3. Posselt U. Physiology of occlusion and rehabilitation, 2nd edn.
Oxford: Blackwell Science; 1968:25.
4. Fujii H, Mitani H. Reflex response of the masseter and
temporal muscles in man. J Dent Res. 1973;52:1046.
5. Brill N, Tryde G. Physiology of mandibular positions. Frontiers
of oral physiology. 1974;1:199.
6. Goldstein DF, Kraus SL, Williams WB, Glasheen-Wary M.
Influence of cervical posture on mandibular movement.
J Prosthet Dent. 1984;52:421.
7. Rahman M, Kohno S, Sawada K, Arai Y. Head position affects
the antero-posterior location of tapping points. J Japanese Soc
Stomatognathic Funct. 2001;8:1.
Correspondence: Dr Shoji Kohno, Removable Prosthodontics, Graduate School of Medical and Dental Sciences, Niigata University, 5274,
Gakkocho-dori-2, Niigata City, Japan 951-8514.
E-mail: kohno@dent.niigata-u.ac.jp
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