Fabrication Craig K. Naylor,
of a custom anterior
guide table
D.D.S.
Vancouver, B.C., Canada
T
he anterior guide table serves as a device for transferring the unique features of a specific anterior guidance from an established relationship to the final restorations. It acts as a template for recording both lingual chrvatures of the maxillary anterior teeth (ClassI and II occlusions) and the incisal edge position. The fabrication of a custom anterior guide table is intimately related to an understanding of anterior guidance.’ Anterior guidance is described as the “dynamic relationship of the lower anterior teeth against the upper anterior teeth through all rangesof function.“* The contacts of the anterior teeth work in a protective manner in the excursive movements of the mandible by discluding the posterior teeth.3 Besidesprotecting posterior teeth by disclusidn, the anterior teeth (1) incise food, (2) aid in esthetics, and (3) aid in speech.* By its proximity to the posterior teeth, anterior guidance has a predominating influence on posterior tooth function.5 Scott6 has reported that the influence of anterior guidance on the cusp angulation of posterior teeth is far greater than- that of either condylar guidance or occlusal determinants. As a result, the dentist must have an understanding of the functional aspects of anterior guidance and also be cognizant of the relative importance of this entity to the other factors of occlusion. The guide table then becomes a valuable aid in the treatment of the prosthetic patient. The purpose of this article is to describe a technique for constructing a custom anterior guide table.
TECHNIQUE 1. Establish
Fig. 2. the anterior
guidance
in the mouth.
Utilize the esthetic and phonetic determinants described by Pound? and the methods of harmonizing the anterior occlusion illustrated by Dawson.* Presented to the Canadian Winnipeg, Manitoba.
466
OCTOBER
Fig. 1. A matrix correspondingto the envelopeof mofion scribed by the guide pin is formed in clay.
1979
Academy
VOLUME
of Restorative
42
NUMBER
Dentistry,
4
A custom sphere replaces the rectangular the guide pin.
foot of
Once the anterior guidance is established in the mouth and accepted by both dentist and patient, it can then be duplicated in the final restorations. 2. Set the condylar guidances of the articulator according to the prescribed technique. The gnatho-
0022-3913/79/100466
+ 04800.40/O
Q 1979 The C. V. Mosby
Co.
CUSTOM ANTERIOR GUIDE TABLE
Fig. 3. Proper hand positioning
on the articulator
ensures controlled
movement.
Fig. 4. Articulating ribbon is used to verify contact of the incisal pin with the guide table.
Fig. 5. Marked lingual surfaces of the maxillary tic cast confirm contact with the mandibular teeth.
logic approach uses pantographic tracings and a fully adjusted articulator. The functionally generated path technique sets the condylar guidance arbitrarily (protrusive path at 20 degrees; side shift at 30 degrees). 3. Establish the relationship of the harmonized anterior teeth on the articulator by mounting diagnostic casts utilizing face-bow and centric relation records. 4. Fabricate the custom anterior guide table. a. Place a matrix to act as support for the soft acrylic resin (Fig. 1). This matrix is adjusted to enclose the envelope of motion scribed by the guide pin. b. Lubricate the foot of the anterior guide pin
with Masque silicone lubricant.* A custom sphere replaces the rectangular foot supplied with the incisal pin. The spherical shape generates a more contoured guide table (Fig. 2). c. Mix Fastray? acrylic resin and flow it onto the guide table. d. Close the guide pin onto the guide table as the acrylic resin begins to set, confirming the centric contact of the pin to the base of the table. e. Move the casts through protrusive, Iateralprotrusive, and lateral excursions. Begin each motion from the centric position. Grasp the articulator in
THE IO~NAL
OF PROSTHETIC
DENTISTRY
*Peter-Austin tH.
J.
Bosworth,
Mfg.
Co., Chicago,
Toronto
and
Manitoba,
diagnosanterior
Canada.
111.
467
NAYLOR
Fig. 6. A horizontal line is marked on the guide table to correspond with the incisal edge position.
Fig. 7. The final prosthesis illustrates that the anterior guidance is in harmony with the guide table. such a manner that the movements are controlled to ensure simultaneous contact of the condylar elements, mandibular anterior teeth against maxillary anterior teeth, and guide pin against the acrylic resin of the guide table (Fig. 3). The guide pin thus shapes the acrylic resin according to the path described by the condyles and the upper anterior teeth as they slide over the lower anterior teeth. All excursions should be extended to include the anterior end-to-end position. This ensures a record of incisal edge position and, therefore, tooth length. Continue the excursions until the acrylic resin has set. f. Using articulating ribbon, verify that the guide pin maintains contact with the guide table (Fig. 4). The upper anterior teeth must maintain contact with the lower teeth (Fig. 5). Errors can be corrected by removing acrylic resin and redeveloping the
468
Fig. 8. The incisal edge position is identical to that previously established and accepted as correct. excursion in a fresh mix. Duralay,* an autopolymerizing acrylate, is used in the second mix because of its relative dimensional stability. g. Mark on the guide table the position that corresponds to the incisal edge to edge position of the teeth. This establishes the reference point for tooth length (Fig. 6). 5. Replace the diagnostic casts with the working casts. 6. Proceed with fabrication of the prosthesis. Instruct the dental laboratory technician to fabricate the anterior guidance and incisal edge position of the final restorations in harmony with the contours of the custom guide table (Figs. 7 and 8). ADVANTAGES The custom anterior guide table has the following advantages: 1. It provides a predictable result based on a relationship previously ‘accepted by dentist and patient as being correct. 2. It saves chair time, since the dental laboratory technician ‘is able to develop the required contours before the try-in appointment; the fabrication of the guide table can be delegated to a dental auxiliary. 3. It establishes a reference point for tooth length and incisal edge position. 4. It is created in harmony with the lingual curvatures of the maxillary anterior teeth (Class I and II occlusion), unlike the mechanical guide table, which merely establishes a straight line between incisal edge position and centric occlusion. 5. It can be applied to most fixed and removable *Reliance Dental
Mfg.
Co., Worth,
OCTOBER
1979
Ill.
VOLUME
42
NUMBER
4
CUSTOM
ANTERIOR
GUIDE
TABLE
partial dentures involving restorations third of the mouth.
of the anterior
6.
REFERENCES 1. 2.
3. 4.
5.
7.
Brodenon, S. P.: Anterior guidance in occlusal treatment. J PROSTHET DENT 39:398, 1978. Dawson, P. E.: Evaluation, Diagnosis, and Treatment of Occlusal Problems, ed 1. St. Louis, 1974, The C. V. Mosby Co., p 146. Stuart, C. E.: Why dental restorations should have cusps. J South Calif State Dent Assoc 21:198, 1959. Shore, N. A.: Temporomandibular Joint Dysfunction and Occlusal Equilibration. Philadelphia, 1969, J. B. Lippincott Co., p 180. Schuyler, C. H.: Factors of occlusion applicable to restorative dentistry. J PROSTHET DENT 3:772, 1953.
ARTICLES
Y. Nakamoto,
D.D.S.,
D.D.S.,
in postradiation
Harold
D.D.S.,
D.D.S.,
and
Ding
of the occlusal
T. Nagasawa,
of the incisive
R. Ortman,
xerostomia
inclination
T. Yamashina,
The relationship
ISSUES
MS.
The effect of anteroposterior force H. Okane, Ph.D.
Reprint requests to: DR. CRAIG K. NAYLOR 1527-927 W. GEORGIA ST. VANCOUVER, B.C., CANADA V6ClR5
TO APPEAR IN FUTURE
Use of a saliva substitute Roy
8.
papilla
M.
Parel,
The accuracy Neuton Araujo,
D.D.S.,
and
George
of soldering
Antonio Pazzini, C.D., L.D., and
Priest,
D.M.D.,
and
Prosthetic
restoration
Ari
D.M.D.,
Shifman,
Myofacial Joseph
Sickels,
C. Levin,
D.D.S.,
THF JOURNAL
A. Weinberg,
OF PROSTHETIC
DENTISTRY
D.D.S.,
for acquired
H. Tsuru,
central
D.D.S..
incisors
subglottic
stenosis in
M.D.
an existing
Goerig,
of orbital
The etiology, diagnosis, Part 1: Etiology Lawrence
A. Gates,
beneath
pain dysfunction:
fi. Van
and
D.D.S.
L.D., Lucia Irineta Pazzini, S. Lopes, CD., D.O.
Albert
Alan
Ph.D.,
plane on biting
investment
C.D., Eymar
Post and core fabrication George
D.D.S.,
to the maxillary
H. Tsao,
Prosthetic support of laryngotracheoplasty infants and children Stephen
Scott, W. R.: Application of “cusp writer” findings to practical and theoretical occlusal problems. ,J PROSTHET DENT 35:211, 1976. Pound, E.: Utilizing speech to simplify a personalized denture service. J PROSTI~ET DENT 24:586, 1970. Dawson, P. E.: Evaluation, Diagnosis and Treatment of Occlusal Problems, ed 1. St. Louis, 1974. Tbc C:. V. Mosby Co.. p 155.
MS.,
Paulo
Amarante
de
crown
D.D.S.
defects B.D.S.,
Magda
Levy,
A manifestation
and
CD.,
David
W.
and treatment
Ivey,
and
James
B. Lepley,
D.D.S.
of the short face syndrome D.M.D.
of TMJ
dysfunction-pain
syndrome.
M.S.
469
of a custom anterior
guide table
D.D.S.
Vancouver, B.C., Canada
T
he anterior guide table serves as a device for transferring the unique features of a specific anterior guidance from an established relationship to the final restorations. It acts as a template for recording both lingual chrvatures of the maxillary anterior teeth (ClassI and II occlusions) and the incisal edge position. The fabrication of a custom anterior guide table is intimately related to an understanding of anterior guidance.’ Anterior guidance is described as the “dynamic relationship of the lower anterior teeth against the upper anterior teeth through all rangesof function.“* The contacts of the anterior teeth work in a protective manner in the excursive movements of the mandible by discluding the posterior teeth.3 Besidesprotecting posterior teeth by disclusidn, the anterior teeth (1) incise food, (2) aid in esthetics, and (3) aid in speech.* By its proximity to the posterior teeth, anterior guidance has a predominating influence on posterior tooth function.5 Scott6 has reported that the influence of anterior guidance on the cusp angulation of posterior teeth is far greater than- that of either condylar guidance or occlusal determinants. As a result, the dentist must have an understanding of the functional aspects of anterior guidance and also be cognizant of the relative importance of this entity to the other factors of occlusion. The guide table then becomes a valuable aid in the treatment of the prosthetic patient. The purpose of this article is to describe a technique for constructing a custom anterior guide table.
TECHNIQUE 1. Establish
Fig. 2. the anterior
guidance
in the mouth.
Utilize the esthetic and phonetic determinants described by Pound? and the methods of harmonizing the anterior occlusion illustrated by Dawson.* Presented to the Canadian Winnipeg, Manitoba.
466
OCTOBER
Fig. 1. A matrix correspondingto the envelopeof mofion scribed by the guide pin is formed in clay.
1979
Academy
VOLUME
of Restorative
42
NUMBER
Dentistry,
4
A custom sphere replaces the rectangular the guide pin.
foot of
Once the anterior guidance is established in the mouth and accepted by both dentist and patient, it can then be duplicated in the final restorations. 2. Set the condylar guidances of the articulator according to the prescribed technique. The gnatho-
0022-3913/79/100466
+ 04800.40/O
Q 1979 The C. V. Mosby
Co.
CUSTOM ANTERIOR GUIDE TABLE
Fig. 3. Proper hand positioning
on the articulator
ensures controlled
movement.
Fig. 4. Articulating ribbon is used to verify contact of the incisal pin with the guide table.
Fig. 5. Marked lingual surfaces of the maxillary tic cast confirm contact with the mandibular teeth.
logic approach uses pantographic tracings and a fully adjusted articulator. The functionally generated path technique sets the condylar guidance arbitrarily (protrusive path at 20 degrees; side shift at 30 degrees). 3. Establish the relationship of the harmonized anterior teeth on the articulator by mounting diagnostic casts utilizing face-bow and centric relation records. 4. Fabricate the custom anterior guide table. a. Place a matrix to act as support for the soft acrylic resin (Fig. 1). This matrix is adjusted to enclose the envelope of motion scribed by the guide pin. b. Lubricate the foot of the anterior guide pin
with Masque silicone lubricant.* A custom sphere replaces the rectangular foot supplied with the incisal pin. The spherical shape generates a more contoured guide table (Fig. 2). c. Mix Fastray? acrylic resin and flow it onto the guide table. d. Close the guide pin onto the guide table as the acrylic resin begins to set, confirming the centric contact of the pin to the base of the table. e. Move the casts through protrusive, Iateralprotrusive, and lateral excursions. Begin each motion from the centric position. Grasp the articulator in
THE IO~NAL
OF PROSTHETIC
DENTISTRY
*Peter-Austin tH.
J.
Bosworth,
Mfg.
Co., Chicago,
Toronto
and
Manitoba,
diagnosanterior
Canada.
111.
467
NAYLOR
Fig. 6. A horizontal line is marked on the guide table to correspond with the incisal edge position.
Fig. 7. The final prosthesis illustrates that the anterior guidance is in harmony with the guide table. such a manner that the movements are controlled to ensure simultaneous contact of the condylar elements, mandibular anterior teeth against maxillary anterior teeth, and guide pin against the acrylic resin of the guide table (Fig. 3). The guide pin thus shapes the acrylic resin according to the path described by the condyles and the upper anterior teeth as they slide over the lower anterior teeth. All excursions should be extended to include the anterior end-to-end position. This ensures a record of incisal edge position and, therefore, tooth length. Continue the excursions until the acrylic resin has set. f. Using articulating ribbon, verify that the guide pin maintains contact with the guide table (Fig. 4). The upper anterior teeth must maintain contact with the lower teeth (Fig. 5). Errors can be corrected by removing acrylic resin and redeveloping the
468
Fig. 8. The incisal edge position is identical to that previously established and accepted as correct. excursion in a fresh mix. Duralay,* an autopolymerizing acrylate, is used in the second mix because of its relative dimensional stability. g. Mark on the guide table the position that corresponds to the incisal edge to edge position of the teeth. This establishes the reference point for tooth length (Fig. 6). 5. Replace the diagnostic casts with the working casts. 6. Proceed with fabrication of the prosthesis. Instruct the dental laboratory technician to fabricate the anterior guidance and incisal edge position of the final restorations in harmony with the contours of the custom guide table (Figs. 7 and 8). ADVANTAGES The custom anterior guide table has the following advantages: 1. It provides a predictable result based on a relationship previously ‘accepted by dentist and patient as being correct. 2. It saves chair time, since the dental laboratory technician ‘is able to develop the required contours before the try-in appointment; the fabrication of the guide table can be delegated to a dental auxiliary. 3. It establishes a reference point for tooth length and incisal edge position. 4. It is created in harmony with the lingual curvatures of the maxillary anterior teeth (Class I and II occlusion), unlike the mechanical guide table, which merely establishes a straight line between incisal edge position and centric occlusion. 5. It can be applied to most fixed and removable *Reliance Dental
Mfg.
Co., Worth,
OCTOBER
1979
Ill.
VOLUME
42
NUMBER
4
CUSTOM
ANTERIOR
GUIDE
TABLE
partial dentures involving restorations third of the mouth.
of the anterior
6.
REFERENCES 1. 2.
3. 4.
5.
7.
Brodenon, S. P.: Anterior guidance in occlusal treatment. J PROSTHET DENT 39:398, 1978. Dawson, P. E.: Evaluation, Diagnosis, and Treatment of Occlusal Problems, ed 1. St. Louis, 1974, The C. V. Mosby Co., p 146. Stuart, C. E.: Why dental restorations should have cusps. J South Calif State Dent Assoc 21:198, 1959. Shore, N. A.: Temporomandibular Joint Dysfunction and Occlusal Equilibration. Philadelphia, 1969, J. B. Lippincott Co., p 180. Schuyler, C. H.: Factors of occlusion applicable to restorative dentistry. J PROSTHET DENT 3:772, 1953.
ARTICLES
Y. Nakamoto,
D.D.S.,
D.D.S.,
in postradiation
Harold
D.D.S.,
D.D.S.,
and
Ding
of the occlusal
T. Nagasawa,
of the incisive
R. Ortman,
xerostomia
inclination
T. Yamashina,
The relationship
ISSUES
MS.
The effect of anteroposterior force H. Okane, Ph.D.
Reprint requests to: DR. CRAIG K. NAYLOR 1527-927 W. GEORGIA ST. VANCOUVER, B.C., CANADA V6ClR5
TO APPEAR IN FUTURE
Use of a saliva substitute Roy
8.
papilla
M.
Parel,
The accuracy Neuton Araujo,
D.D.S.,
and
George
of soldering
Antonio Pazzini, C.D., L.D., and
Priest,
D.M.D.,
and
Prosthetic
restoration
Ari
D.M.D.,
Shifman,
Myofacial Joseph
Sickels,
C. Levin,
D.D.S.,
THF JOURNAL
A. Weinberg,
OF PROSTHETIC
DENTISTRY
D.D.S.,
for acquired
H. Tsuru,
central
D.D.S..
incisors
subglottic
stenosis in
M.D.
an existing
Goerig,
of orbital
The etiology, diagnosis, Part 1: Etiology Lawrence
A. Gates,
beneath
pain dysfunction:
fi. Van
and
D.D.S.
L.D., Lucia Irineta Pazzini, S. Lopes, CD., D.O.
Albert
Alan
Ph.D.,
plane on biting
investment
C.D., Eymar
Post and core fabrication George
D.D.S.,
to the maxillary
H. Tsao,
Prosthetic support of laryngotracheoplasty infants and children Stephen
Scott, W. R.: Application of “cusp writer” findings to practical and theoretical occlusal problems. ,J PROSTHET DENT 35:211, 1976. Pound, E.: Utilizing speech to simplify a personalized denture service. J PROSTI~ET DENT 24:586, 1970. Dawson, P. E.: Evaluation, Diagnosis and Treatment of Occlusal Problems, ed 1. St. Louis, 1974. Tbc C:. V. Mosby Co.. p 155.
MS.,
Paulo
Amarante
de
crown
D.D.S.
defects B.D.S.,
Magda
Levy,
A manifestation
and
CD.,
David
W.
and treatment
Ivey,
and
James
B. Lepley,
D.D.S.
of the short face syndrome D.M.D.
of TMJ
dysfunction-pain
syndrome.
M.S.
469
