17 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001

Prost het i c Dent i st ry

The Biofunctional Prosthetic System (BPS)
A new approach in
removable denture prosthetics
Dr. O. He
1
- Dr. P. Mariani
2
1- Olivier He. Vice-Dean and Lecturer, Dental Clinic Htel-Dieu, University
Paris VII Denis Diderot, rue Lincoln, F-75008 Paris
2- Paul Mariani. University Professor, Dental Faculty Marseilles, Department
for Dental Research and Education, Centre Gaston Berger, 19, boule-
vard Mireille-Lauze, F-13010 Marseilles
I N T R O D U C T I O N
The treatment of edentulous patients fre-
quently goes hand in hand with a number
of clinical and technical problems.
According to the authors Olivier He and
Paul Mariani, the BPS system, developed
by Ivoclar under the supervision of
Professor U. Stttgen (University Dssel-
dorf), represents an efficient approach to
the prosthetic treatment of edentulous
and partially edentulous patients. As this
publication will show, the Stratos 200
articulator is a decisive component of the
BPS system. Given the fact that the
design of the articulator is based on
anatomic and geometric concepts, which
will be described in detail by our authors,
the Stratos 200 permits the fabrication of
dentures by means of the template tech-
nique. After the comprehensive descrip-
tion of the mode of function of the articu-
lator, the working steps involved in setting
up denture teeth will be explained in
detail.
INDICES: removable denture prosthetics, BPS complete denture prosthetics
external auditory
meatus
Campers plane
occlusal plane
Fig. 1: Orientation of the occlusal plane in relation to the different Camper's
planes (depending on the selection of the posterior reference point) 1: upper
position; 2: central position; 3: lower position).
18 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001
Prost het i c Dent i st ry
The Stratos 200 articulator
T h e g e o me t r i c c o n c e p t
The Biofunctional Prosthetic System
(BPS) is based on a logical concept for
the treatment of edentulous and partial-
ly edentulous patients. The correspond-
ing therapy concept combines impor-
tant treatment steps and provides both
clinicians and dental technicians with an
exact and logical method.
Today, the use of clinical protocols and
simple, reliable treatment methods that
can be easily adjusted to the needs of
the majority of the patients is gaining in
importance. The golden standard
developed overseas complies with the
above finding.
In the field of complete denture pros-
thetics, the BPS System and the Stratos
200 articulator, combined with a specif-
ic technique to setup denture teeth,
strive to meet these requirements as
well.
This Arcon type articulator has been
developed by Ivoclar in cooperation of
Professor Stttgen (University
Dsseldorf). It is a multifuctional articu-
lator, which means that it is suitable for
the two main concepts of analysis and
reproduction of the jaw movements, i.e.
the geometric concept and the anatom-
ic concept.
The Stratos 200 is based on four main
geometric conditions, which will be
described below in the sequence of
their appearance.
1. Camper's plane
Camper defined this reference plane
during excavations conducted in the
southwest of Spain in 1780. When the
skulls found in the course of the exca-
vation were placed in a straight line on a
table, all of them resting on the occlusal
surfaces of the maxillary teeth, Camper
identified a plane with the external audi-
tory meatus and the sides of the nose as
reference points, which ran parallel to
the table surface and thus parallel to the
occlusal plane. In the clinical practice,
this plane, which runs through the ante-
rior nasal concha and the tragus, was
and still is used as a reference plane in
prosthetics.
The determination of the anterior refer-
ence point is relatively easy and reliable.
However, this is not valid for the tragus.
There are three possibilities: should the
upper edge, the centre, or the lower
part of the tragus be used as the refer-
ence point? The selection of this angle
is important as far as the final alignment
of the occlusal plane is concerned
(Fig. 1, Table 1).
According to the investigations of
Karkaris et al., it seems to be preferable
to take the lower part of the tragus as
the reference point.
Occlusal Average Standard Range
plane value deviation
Camper 1 5.25 3.35 -2.0 to 11.50
Camper 2 2.75 3.64 -5.0 to 9.0
Camper 3 0.50 3.55 -8.0 to 6.5
Table 1: Average angles between the
different Camper's planes and the
occlusal plane [2].
Fig. 2: The Balkwill angle is formed by
the occlusal plane and the straight
line that connects the incisal point
with the articular processes.
Fig. 3: The posterior vertical dimension
of occlusion equals L sin (L = dis-
tance between the hinge axis and the
incisal point; = Balkwill angle accord-
ing to Orthlieb).
hinge axis
occlusal plane
reference
plane
Balkwill
angle
Fig. 4: Bonwill triangle. An equilateral
triangle between the incisal point (A)
and the upper edges of the articular
processes (B-C). The angle LAD corre-
sponds with the Balkwill angle.
reference plane
Fig. 5 Geometric relationship between
the Bonwill triangle and the
Christensen angle.
2. Balkwill angle
The Balkwill angle was first described on
the occasion of a congress in London in
1866. It corresponds with the angle pro-
duced by the mandibular occlusal plane
of dentulous patients and a second
plane, which runs through the incisal
point and the two upper edges of the
articular processes (Fig. 2). According to
the author, the corresponding value
ranges from 22 to 30.
This angle corresponds with the values
suggested by Khler (21 to 22), Hart
(20) and Bergstrm (18) as the aver-
age, with the extreme values ranging
from 12 to 24. For the Stratos 200
articulator, the Balkwill angle was
defined at 15, which is rather low com-
pared with the above values.
In this context, it has to be pointed out
that the Balkwill angle is directly related
to the distance between the occlusal
plane and the condylar axis of rotation.
The importance of this distance has
19 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001
Prost het i c Dent i st ry
T h e a n a t o mi c c o n c e p t
been proven by Orthlieb [7] (Fig. 3).
According to this author, the bending
radius of the compensation curve would
depend on the Balkwill angle.
3. Bonwill triangle
After approximately 6000 measure-
ments of mandibles and 4000 measure-
ments conducted on living individuals,
Bonwill found out that the triangle
formed between the incisal point and
the upper edges of the two articular
processes [8] is an equilateral triangle
with a side length of 104 mm (Fig. 4).
Other authors, however, have chal-
lenged these results, particularly the
measurements of skulls showing devia-
tions of up to 10 mm. Bonwill's measure
(104 mm), however, is still a universally
accepted value. In the articulator in
question, this value was defined at
108 mm.
4. Monson template [9]
The template theory attributed to
Monson is based on the theory of the
Bonwill triangle. According to this theo-
ry, the mandibular cusps are arranged
on a part of a circle that measures
10.4 cm. Its centre is located on the
crista gali apophysis. However, the
above circle must not be confused with
the curve of Spee [10].
s 110 mm 100 mm 90 mm
() = 110 x sin 60 = 100 x sin 60 = 90 x sin 60
15 0.79 3.64 0.79
30 2.26 2.50 2.78
45 2.26 2.50 2.78
50 3.20 3.53 3.94
/ 30 26 22 18 14 10
5 0.32 0.30 0.30 0.29 0.29 0.28
10 0.61 0.60 0.59 0.58 0.57 0.57
15 0.88 0.87 0.86 0.86 0.86 0.86
20 1.15 1.14 1.13 1.13 1.14 1.15
25 1.40 1.40 1.40 1.41 1.43 1.45
30 1.65 1.66 1.68 1.70 1.73 1.76
Table 2a: Incidence of the measures of the Bonwill triangle (s) and the condylar
path () on the Christensen angle [13].
Table 2b: Christensen angle in dependence of the changes of the Balkwill angle
() and the condylar path () [14].
Critical analysis
The Balkwill angle, the measures of the
Bonwill triangle, and the condylar path
are directly related to the phenomenon
described by C. Christensen [11], as was
confirmed by the examinations of F.T.
Christensen [12, 13, 14]. The individual
factors can be expressed with the fol-
lowing formula (Fig. 5):
sin {(/)/} =
sin (/) + p/ sin
= Condylar path
= Christensen angle
= Balkwill angle
= Measures of the Bonwill triangle
p = Protrusion length
The combined deviations of the condy-
lar path and the measures of the Bonwill
triangle result in a change of 3.15 in the
angles of Christensen's phenomenon
(Tables 2a and 2b). Likewise, the devia-
tions of the Balkwill angle combined
with the deviations of the condylar path
result in a change of 1.44 of the
Christensen angle. In view of these
results, it has to be pointed out that the
inclination of the condylar path, the
Balkwill angle, and the measures of the
Bonwill triangle demonstrate only limit-
ed incidence as far as the Christensen
angle (i.e. the cusp height) is concerned,
which is necessary to achieve a bilater-
ally balanced occlusion. Consequently,
the average values that were selected
for the Stratos 200 articulator are excel-
lently suitable for the fabrication of com-
plete dentures.
The Stratos 200 is a semi-adjustable
articulator that follows the concept of
simulating the displacement of the
mandible.
The maxillary model is aligned with the
joint axis by means of the facebow. The
axial infra-orbital plane, which is very
close to the Frankfort horizontal, is used
as the reference plane for the facebow.
It is important to note that the present
articulator demonstrates an angle differ-
ence of 15 between Camper's plane
and the axial infra-orbital plane. This fact
is important for the subsequent selec-
tion of the correct joint inserts.
These inserts are different from conven-
tional ones. The concept behind these
inserts rather tends to correspond with
the Condylator articulator according to
Gerber. The upper part of the joint insert
holder does not really simulate the
canine fossa. Rather, the inserts are guid-
ing joint inserts, which slide over a hori-
zontal, metallic protuberance and actual-
ly represent the condyles. The exchange-
able joint inserts are available with vari-
ous angles, ranging from 15 to 60.
If the articulator is used with Camper's
plane as the reference plane, the 30
inserts are required. If the Frankfort hori-
zontal is used as the reference plane,
the 45 inserts are needed.
Furthermore, it is also possible to use
joint inserts that are specifically fabricat-
ed according to the recordings of the
optical pantograph system according to
Klett. However, this technique is not
usually applied in clinical practice and is
restricted to certain complex cases
(Figs. 6a and 6b).
The horizontal displacement of the bal-
ancing condyle is achieved by means of
exchangeable Bennet inserts (Figs. 7a
and 7b), while that of the vertical
20 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001
Prost het i c Dent i st ry
displacement is adjusted by the inner
eminence of the TMJ protuberance. In
this way, the working condyle is lowered
(Fig. 8).
Critical analysis
The analysis of this articulator refers to
its multifunctionality and the selection of
the reference plane.
How is this multifunctionality achieved?
It is the result of two objectives, which
strongly contrast in the analysis and
reproduction of the mandibular move-
ments. This contrast was already proven
by Monson, who noted that the princi-
ples of mandibular movements are
dominated by two important concepts.
Fig. 6a: The joint insert holder with the
securing mechanism for the jaw rela-
tion.
Fig. 6b: Exchangeable joint inserts
ranging from 15 to 60.
The first one assumes that the occlusion
of the teeth is determined by the shape
and the movements of the condyles.
The second one suggests that the
occlusion of the teeth is the determining
factor, which controls the shape of the
condyles as well as their movements in
the canine fossa. [15]
The first assumption is advocated by all
the supporters of gnathology. The sec-
ond concept is backed by the works of
Monson, which have since been redis-
covered by Pankey, Mann and Schuyler.
The BPS concept is based on the sec-
ond assumption and uses canines that
have been designed according to the
occlusal morphology defined by Strack.
Fig. 7a: Bennet insert attached to the
joint mechanism of the articulator.
Fig. 7b: Exchangeable Bennett
inserts: red = 15; black = 30
Selecting the reference plane
In complete denture prosthetics, there is
no generally applicable scientific
method for the definition of the occlusal
plane. Rather, the various methods may
be divided into two groups:
Occlusal plane and maxillary arch:
Although, from a historical point of view,
Camper's plane proved to be the refer-
ence plane most frequently used, a vast
number of studies have shown that this
Downward movement of
the working condyle
Fig. 8: The 'condyle' of the articulator.
In a lateral movement, the inner ridge
results in a downward movement of
the working condyle. The guiding joint
insert of the upper holder (a) slides
along the 'condyle' of the lower artic-
ulator frame (b).
plane does not seem to run parallel to
the occlusal plane [16, 17, 18, 19].
This objection caused a number of
authors to prefer the Frankfort horizon-
tal as the reference plane. The use of
anatomically-correct articulators further
backs their decision [20]. In this context,
however, it is important to point out that
this approach is based on a major mis-
conception. The Frankfort horizontal
must never be confused with the axial
infra-orbital plane, since the angle differ-
ence between these two planes is 6.5.
This fact also explains why the differ-
ence between the axial infra-orbital
plane and the Camper's plane of the
Stratos articulator is 15 and not 10 as
it is the case in other articulators, which
are erroneously based on an angle of
9.8 as suggested by Downs [21].
Occlusal plane and mandibular arch:
In contrast to the above controversy, the
mandibular reference points seem to be
preferred by the majority of the authors.
They are most often intra-oral reference
points, such as the tongue equator
plane, maximum buccinator curvature,
or the retromolar triangles [22]. All of
these references are subsequently
passed on to the dental laboratory with
the mandibular occlusion pattern. The
Stratos articulator offers the indisputable
advantage that it has been designed for
model transfer and orientation accord-
continued on page 25
25 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001
Prost het i c Dent i st ry
C l i n i c a l a p p l i c a t i o n s
ing to the various reference planes
selected by the individual practitioners.
In clinical practice, there are two meth-
ods to mount the models for complete
dentures in the articulator, depending
on whether the practitioner has selected
a maxillary reference point or a
mandibular reference point.
Fig. 9: The maxillary model is mounted
by means of the bite fork attached to
the lower articulator frame.
Fig. 10: The principle of determining
the occlusal plane. It runs in the cen-
tre of the distance between the low-
est points of the folds towards the
upper thirds of the retromolar trian-
gle.
Method No. 1: First, the maxillary
model is positioned in the articulator by
means of a facebow or a setting-up tem-
plate. The facebow allows the spatial
position of the maxilla to be transferred
by selecting Camper's plane or the axial
infra-orbital plane as the reference
plane (Fig. 9). Subsequently, the maxil-
lary model is mounted in the articulator
using conventional, clinical techniques.
In a second step, the mandibular model
is aligned in the correct relation to the
maxillary model by means of the bite
registrations.
In this case, the measures of the Bonwill
triangle are taken into account, with the
exception of the intercondylar distance,
which remains unchanged. The (anteri-
or/posterior) position of the incisal point
and the Balkwill angles, however, are
more individualized.
In the dental office, the practitioner
adjusts the ridge of the maxillary model
according to the usual criteria: paral-
lelism with the pupil line and Camper's
plane, lip support, identification of the
median plane.
In the laboratory, the model is posi-
tioned on the setting-up template by
means of the base record and subse-
quently secured to the upper frame of
the articulator. In this case, the Bonwill
triangle of the articulator is exactly main-
tained. However, the Balkwill angle is
not individualized.
Method No. 2: If this method is applied,
the mandibular model is positioned first.
For this step, either the usual anatomic
reference points or the base record are
used.
In the dental office, the vertical dimen-
sion of occlusion is determined and the
jaw relations recorded. All these data
are passed on to the laboratory by
means of the base record.
Basically, the occlusal plane meets the
following criteria: In the anterior region,
the occlusal plane runs at an equal dis-
tance between the bottom of the
mandibular and the maxillary folds,
while it runs through the upper third of
the retromolar triangle in the posterior
region (Fig. 10). These reference points
seem to match exactly the ideal course
of the occlusal plane, which has also
been confirmed by the works of Cbelic
[22].
In the laboratory, the models are mount-
ed according to the following method:
What is known as the horizontal guide
(Fig. 11) is used to position the mandibu-
lar model in the articulator. This compo-
nent is attached to the upper frame of
the articulator and is equipped with a
small ruler that can be vertically adjust-
ed. Furthermore, it features a horizontal
insert that can be adjusted towards the
front and the rear.
In a first step, the reference point of the
maxillary centre (between the central
incisors) is transferred to the mandibular
model. After that, the distance between
the lowest points of the mandibular and
maxillary folds is measured (Fig. 12).
In the second step, the small ruler is
adjusted to a value that corresponds to
half the distance between the two folds
with the two ends of the ruler resting at
the bottom of the folds. In the posterior
region, the wings of the horizontal guide
touch the upper third of the retromolar
triangles (Fig. 13). The mandibular model
is mounted on the horizontal guide with
sticky wax or silicone. Subsequently, the
entire unit is attached to the upper
frame of the articulator (Fig. 14). In this
way, the mandibular model is exactly
oriented according to the Bonwill trian-
gle. However, the Balkwill angle is not
individualized. Finally, the maxillary
model is positioned in the articulator
with the help of the base record.
If the occlusal plane of the wall of the
mandibular base record is aligned with
the mandibular reference points, the
horizontal guide is attached to the ridge.
In this process, the median plane and
the centre line between the central
incisors have to be taken into consider-
ation. Subsequently, the mandibular
model is positioned in the articulator. If
the models are positioned by means of
the base plate or the horizontal guide,
Fig. 11: Horizontal guide.
26 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001
Prost het i c Dent i st ry
the 2D setting-up template may be used
to set up the posterior teeth.
If a facebow is used, however, the mod-
els are not oriented according to the
geometric reference points. In these
Fig. 12: Measuring the distance
between the lowest point of the
mandibular fold and the maxillary fold.
Fig. 13: In the distal area, the horizon-
tal guide rests in the upper third of
the retromolar triangles. In the front,
the end of the small ruler rests in the
median plane.
Fig. 14: The mandibular model attached
to the horizontal guide is positioned in
the articulator and secured by means
of a fast-setting plaster.
cases, a setting-up template is required
that permits three-dimensional orienta-
tion of the teeth (Figs. 15a and 15b).
These two setting-up templates demon-
strate a curve radius of 125 mm, which
is 20 mm more than the value suggest-
ed by Monson. However, the incidence
of occlusion between these two radii
does not exceed 0.1 mm.
Setting up the denture teeth
The setup is carried out according to the
template technique, in other words, an
occlusal pattern, in which all occlusal
forces are directed according to the
Robin support cone. This method pro-
motes the stability of the dentures (of
the mandibular dentures in particular).
The suggested setup technique offers
the following two sets of features: In the
laboratory, this method is both easy to
carry out, as well as exact and codified.
The suggested working steps enable
technicians to set up the teeth in opti-
mum symmetry. At the same time, the
correct relationships between the two
dental arches can be checked at all
times. Moreover, the sagittal and frontal
compensation curves may be estab-
lished in harmony with the morphologi-
cal properties of the occlusal surfaces.
In the dental office, the use of a setting-
up template permits quick and reliable
checking of the position and the corre-
sponding orientation of each group or
unit of teeth.
However, the following seven working
steps must be meticulously observed in
order to benefit from the above advan-
tages:
1
st
working step: Recording the vari-
ous reference points
Analysis of the models: In addition to
the classical reference points, such as
the median plane or the perpendicular
canine plane in the anterior region
(which runs through the central palatal
fold), the axes of the posterior sectors
are defined for the maxillary model. In
this process, it has to be made sure that
these axes run through the outer quar-
ter of the tubera (Fig. 16).
Fig. 15a: Underside of the 2D setting-
up template.
Fig. 15b: The 3D setting-up template
permits three-dimensional orientation
of the template.
As far as the mandibular model is con-
cerned, the reference points recorded
are comparable, i.e. axis of symmetry or
median plane, anterior ridge axis in the
frontal plane, axis of the posterior sec-
tors, which points towards the position
of the canine in the inner quarter of the
pear-shaped elevation or retromolar tri-
angle (Fig. 17).
Analysis of the interocclusal relation
of the dental arches: The general axes
are extended in the distal parts of the
model. This enables the practitioner to
assess the transverse relations and to
determine the bucco-lingual position of
the intercuspal fissure (Figs. 18a and
18b). In this context, the fact that the
frontal inclination of the occlusal plane
in the Stratos 200 articulator depends
on the transverse size of the arch and
not on the inclination of the axis
between the two ridges must be taken
into account. This approach is different
27 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001
Prost het i c Dent i st ry
from Gysi's, who assumed that the incli-
nation between the ridges influences
the frontal inclination of the occlusal
plane (Fig. 19) [23].
2
nd
working step:
Setting up the maxillary anterior teeth
Once the size and the shade of the teeth
have been selected, the maxillary ante-
riors are set up according to one of the
following two methods:
Observing the ridge determined by the
practitioner: The teeth are set up
according to the usual criteria, such as
central lip support, symmetry, etc.
Observing the anatomic criteria: With
the BPS System, anatomic reference
Fig. 16: Reference lines of the maxil-
lary arch: (a) median plane, (b) the axis
of the posterior sectors runs through
the outer quarter of the tubera, (c)
canine plane, (d) tubera.
Fig. 17: Reference lines of the
mandibular arch: (a) median plane, (b)
the axis of the posterior sectors runs
through the inner quarter of the retro-
molar triangle, (c) canine plane that
runs through the vertex of the frontal
ridge, (d) retromolar triangle.
points, i.e. the palatal folds, are taken
into consideration when positioning
the anterior teeth.
The bucco-lingual dimensions of the
central incisors are always identical in
the cervical area (7 mm), which indirect-
ly facilitates their setup. The central
incisors are set up on either side of the
central palatal fold (seen from the medi-
an plane) (Fig. 20). The incisal edges are
located two millimetres in front of the
halfway point between the two ridges. In
this way, a slight anterior overbite is
ensured. The actual degree of the over-
bite is adjusted to the corresponding
setup method used for the posterior
teeth (0.5-1 mm with a lateral overbite;
2-3.5 mm with a pronounced lateral
overbite).
Positioning the setting-up template on
the lower part of the articulator allows
these parameters and the correspon-
ding symmetry to be checked.
After that, the maxillary canines are set
up, for which the palatal folds are used
as the reference points. There is a cor-
relation between the position of the
canines and the first two palatal folds
[24]. The tips of the canines are located
on an imaginary straight line that runs
through the large axis of the palatal
folds. The cervical areas of the canines
are positioned two millimetres away
from the end of the folds. In this way, the
vestibular side of the teeth are nine mil-
limetres away from these ends (Figs. 21
and 22). Finally, the lateral incisors are
set up, taking the morpho-physiological
characteristics of the patient into
account.
Fig. 18a: In the Stratos system, the
frontal orientation of the occlusal
plane is independent of the inclination
of the axis between the ridges.
curvature of
the setting-up
template
3
rd
working step:
Setting up the mandibular canines
During the setup of the mandibular
canines, it has to be made sure that the
distal sides are located perpendicular to
the tips of the maxillary canines. This
setup prevents the mandibular canines
from producing a pronounced over-
turning moment during excursive move-
ments (Figs. 23a and 23b). At the same
time, an overbite of approximately one
millimetre is achieved.
4
th
working step:
Setting up the mandibular posterior
teeth
The morphology and the mould of the
posterior teeth are selected according
to the jaw relation type (angle class)
(Table 3).
When positioning the setting-up tem-
plate, the front part has to be positioned
at the height of the distal angle of the
mandibular canines. The canine tips
must protrude over the front edge of the
setting-up template by 1 mm.
The posterior teeth are set up according
to the defined axis that runs from the
anterior region to the posterior region.
All the vestibular cusps of the mandibu-
lar teeth come in contact with the set-
ting-up template (Fig. 24). However, only
the lingual cusps of the second premo-
lars and the mesial cusps of the second
molars touch the template. The graduat-
ed reference points allow continuous
checks of the symmetry and the lineari-
ty of the setup.
Fig. 18b: According to Gysi, the frontal
orientation of the occlusal plane
depends on the inclination of the axis
between the ridges.
28 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001
Prost het i c Dent i st ry
5
th
working step: Setting up the maxil-
lary posterior teeth
The maxillary posterior teeth are set up
in such a way that optimum occlusion
with the mandibular teeth is achieved.
For that reason, the contact cusps must
touch the corresponding contact sur-
faces in the antagonist dental arch
(cusp/interdental area in the premolar
region and cusp/fossa in the molar
region (Fig. 25)).
6
th
working step: Setting up the
mandibular incisors
The mandibular incisors are the last
ones to be set up. In this process, the
sagittal overbite proportional to the
angle class and the height of the
occlusal plane must be observed. With
this method, the ideal occlusal relations
between the incisors, the premolars,
and the molars, which have been estab-
lished with the previous working steps,
can be maintained.
7
th
working step: Checking the occlu-
sion
At this point, the harmony of the setup
during lateral movements is checked:
In protrusion, the mesial inclines of the
premolars, the mandibular molars, as
Fig. 19: Reference lines of the axes
between the ridges. The axes of the
maxillary sectors (a) and the mandibu-
lar sectors (b) are extended in the
posterior part of the model. The gen-
eral setup axis (c) is located in the
centre of the distance between the
maxillary reference points (a') and the
reference points of the mandibular
axes (b).
well as the free edges of the mandibu-
lar anteriors touch the inclines of the
antagonist maxillary teeth.
During lateral movements, the incisors
and the mandibular premolars on the
working side touch the inner inclines
of the maxillary premolars. In contrast,
the lingual cusps of the premolars and
all the molar cusps are not in occlusion
(Fig. 26).
width of tooth neck
Fig. 20: Position of the incisors in rela-
tion to the central palatal fold.
Fig. 21: The cervical ridge of the
canines is located at a 2-mm distance
from the ends of the main palatal fold.
Therefore, the design of the working
side corresponds with the principle of
group guidance. This concept, however,
is entirely contrary to the principle of the
dynamic rest cone according to Robin
Fisher [18]. This approach might result
in an overturning moment, partic-ularly
if severe atrophy is present in the area of
the maxillary cusps. Together with the
balancing side, the two rearmost molars
are in contact.
Subsequently, the dentures are complet-
ed, polymerized, polished and incorpo-
rated into the oral cavity of the patient.
With the BPS System, selective grinding
is not required. The concept of occlu-
sion should permit optimum balance
during the various lateral movements of
the mandible.
Fig. 22: The reference points on the
setting-up template attached to the
lower frame of the articulator permit
the checking of the symmetry.
Fig. 23a: Position of the canine in
occlusion.
Fig. 23b: In lateral movement, the dis-
tal incline of the mandibular canine
slides along the mesial incline of the
maxillary canine.
Jaw relations Type of tooth
Class I N
Class II T
Class III K
Table 3 Properties and indications of
the posterior teeth according to the
angle class.
29 A NEW APPROACH IN REMOVABLE DENTURE PROSTHETICS DENTAL NEWS, Volume VIII, Number I, 2001
Prost het i c Dent i st ry
Fig. 24: Setup in the mandible in con-
tact with the setting-up template.
C o n c l u s i o n s
A c k n o wl e d g e me n t
A streamlined setup procedure as a
part of a comprehensive denture fab-
rication system undoubtedly repre-
sents an advantage for patients, prac-
titioners, and dental technicians alike.
In this respect, the BPS System meets
these requirements. However, the fol-
lowing three points must be taken
into consideration:
1. Golden standards: Although the
concept has been developed in the
United States, the trend is such that
the system is particularly popular in
Germany and the Scandinavian coun-
tries. Moreover, certain selection cri-
teria and technical possibilities of the
concept can be explained if one
knows the country of origin.
2. Selection of Camper's plane: The
entire German teachings according to
Gysi and Gerber are based on
Camper's plane. Do we have to
renounce this approach in favour of
the Frankfort horizontal or the axial
infra-orbital plane? Undoubtedly, it is
more a habit than a real therapeutic
'plus', even if certain investigations
[Literature available from the authors]
We would like to thank Ivoclar for the
technical support.
Ivoclar Aktiengesellschaft
Bendererstrasse 2
FL-9494 Schaan / Liechtenstein
Fax ++423 / 235 33 60
Fig. 25: Intercuspation.
Fig. 26: Setup during lateral movement.
have attempted to demonstrate the
therapeutic superiority of orienting
the occlusal plane according to the
Frankfort horizontal instead of the
Camper's plane.
3. Selection of the articulator and the
setup method: The BPS System cer-
tainly offers a number of decisive
advantages when it comes to setting
up denture teeth. Even if the template
principle of starting the setup with the
posterior sectors in the mandible has
been known for quite a while, the
revival of this method satisfies a gen-
uine technical necessity. It permits
optimum control of the lingual space
and improved distribution of the
occlusal stress on the underlying rest
areas.
Le professeur Pierre RISCALLAH me fait un
grand honneur en me demandant dcrire
une prface ce nouveau livre.
Je nai pas prsenter le professeur
RISCALLAH au public professionnel libanais,
spcialis ou non. Tous connaissent cet mi-
nent Matre
Cet ouvrage reprsente lnorme travail
dun auteur qui sait prendre ses respons-
abilits.
Il pense offrir au spcialiste dOrthopdie
Dento-Faciale une possibilit effective de
mieux cerner les problmes thoriques et
pratiques qui sont la base de la Spcialit
et restent non rsolus. Il espre ainsi
ramener LO.D.F., qui vient de traverser,
selon lui, une priode de dsorientation, sur
une voie quil juge la fois nouvelle et
exacte.
Le professeur RISCALLAH sait combien jap-
prcie son attachement ses ides.
Loriginalit de ses conceptions mrite une
approbation sans rserve, du moins un sen-
timent admiratif pour la qualit et la nature
de son savoir.
Il tente dans cet ouvrage de nous faire
partager sa philosophie fruit de quarante
ans dexprience.
Je souhaite quil y parvienne
Zouhair SKAFF
Directeur, Socit Libanaise dOrthodontie
PRECIS DORTHODONTIE
PRECIS DORTHODONTIE