Fabrication of occlusal rims to record

the maxillomandibular relation for

complete dentures
Sivakumar Jayachandran, BDS, MDSa and
Nicholas Grey, BDS, MDSc, DRD, MRD, FDS, RCS, PhDb
School of Dentistry, University of Manchester, UK
This article describes an alternative method to establish the inclination of the occlusal plane by using the hamular notch,
incisive papilla plane. By using this plane, the fabrication of occlusal rims that conform to an ideal relationship may
make chairside trimming of the rims more straightforward. (J Prosthet Dent 2014;112:383-386)

Determination of the inclination of

the occlusal plane is an important step
in the fabrication of equilibrated complete dentures.1 Various anatomic
landmarks have been reported to locate
the occlusal plane.2-5 Many of these are
located on the soft tissues intraorally
and extraorally, and it requires clinical
experience to use the landmarks because
irregularities and asymmetry of the face
adversely affect their accuracy. Arbitrary
use of these landmarks to orient the
occlusal plane may compromise the
denitive prosthesis.6 The hamular
notch, incisive papillae plane (HIP),
which can be marked on the cast, is
reported to be parallel to the occlusal
plane.6 The hamular notch is the
palpable notch formed by the junction
of the maxilla and the pterygoid
hamulus of the sphenoid bone.7 The
incisive papilla is the elevation of soft
tissue that covers the foramen of the
incisive or nasopalatine canal.7
This plane has been studied since
1960 and proved to be parallel to the
occlusal plane.8,9 This article describes
a technique for making occlusion rims
by using the resting lip, HIP, corner of
the mouth, and the retromolar pad.
This method simplies the modication
of the occlusal rim during the jaw

relation procedure for complete dentures and may also reduce clinical time.

PROCEDURE
1. Fabricate a maxillary custom tray
from the preliminary cast with autopolymerizing acrylic resin (GC Ostron 100;
GC Europe). Design the lip-supported
tray handle, which corresponds with
the approximate width, height, and
inclination of the central incisors (Fig. 1).
2. Fabricate the mandibular custom tray from autopolymerizing resin
(GC Ostron 100; GC Europe). Design
the handle with the approximate shape

of the future occlusion rim, which extends from the canine to canine region
(Fig. 2).
3. Evaluate the custom trays intraorally for correct border extensions and
ensure that adequate lip support is
achieved with the tray handles. Trim the
handles as needed.
4. Border mold the maxillary tray
and make the impression (Aquasil ultra
tray material, Monophase; Dentsply
Caulk). If the lip support is insufcient
with the tray handle alone, this can be
improved by adding elastomeric putty
(Aquasil hand putty; Dentsply Caulk) to
the labial surface of the handle. Before

1 Maxillary custom tray with lip supported handle.

Presented at the Indian Dental Association Conference held at Tamilnadu, India, November 2004.
a

NHS and Private practice, Birmingham, UK.

Professor of Dental Education, Faculty Associate Dean for Teaching and Learning, National Teaching Fellow, School of Dentistry,
University of Manchester.

Jayachandran and Grey

384

Volume 112 Issue 2

2 Mandibular custom tray with handle, resembling

anterior teeth.

3 Tray handle modied with elastomeric putty for lip support and anterior occlusal plane marked.

4 Mandibular anterior occlusal plane marked on tray

handle by using clinical reference.

5 Upper anterior reference (UAR) marked on the cast at

3 cm distance from anterior occlusal plane.

removing the impression from the mouth,

mark the incisal level in relation to the
resting lip line with an indelible pencil
(Dr Thompsons Sanitary Color Transfer
Applicators; Great Plains Dental Products Co Inc) (Fig. 3).
5. Once the mandibular impression
is made, mark the anterior height by
using the esthetic guidelines and the
corner of the mouth (Fig. 4).2,5
6. Pour the casts after beading and
boxing (Hydrocal Denture Model
Stone, Type III; Kerr, UK). Before separating the casts from impressions,
measure a xed distance from the
incisal level markings (3 cm in the patient shown) and mark it with an
indelible pencil on the sides of the casts
(for easier understanding, the reference
on the maxillary cast is named UAR and

on the mandibular cast is named LAR)

(Figs. 5, 6).
7. Separate the casts from the impressions. On the maxillary cast, mark
the deepest point of the hamular
notches and the center of the incisive
papilla. On the mandibular cast, mark,
with an indelible marker, the junction of
the anterior two-thirds and the posterior
third of the retromolar pad.
8. Measure the distance from UAR
to the incisive papilla (2 cm in the patient shown). Measure and mark the
same distance from the hamular notches on
both the sides of the cast (for easier
understanding, this is named as upper
posterior reference [UPR]). Join the
UAR and UPR on both sides to form a
plane. Note that this plane is parallel
and 2 cm above the HIP and the

The Journal of Prosthetic Dentistry

occlusal plane, if made parallel to this

plane, therefore, would be parallel to
the HIP (Figs. 7, 8).
9. Fabricate the maxillary occlusion
rim (Dental wax products; Kemdent
Dental Products Ltd). Keep the height
of the rim at 3 cm from the UAR-UPR
plane. Use the other measurements
such as anterior rim at 8 to 10 mm
anterior to the center of the incisive
papilla and posterior rim on or slightly
buccal to the ridge (Fig. 9 ).10-15
10. Fabricate the mandibular occlusion rim with an anterior height of 3 cm
from LAR and in the posterior at the
level up to the anterior two-thirds of the
retromolar pad (Fig. 10).16
11. Verify the occlusion rims intraorally and record the maxillomandibular
relations (Fig. 11).

Jayachandran and Grey

August 2014

6 Lower anterior reference (LAR) marked on the cast at

3 cm distance from mandibular occlusal plane.

385

7 Distance from upper anterior reference (UAR) to incisive

papilla is measured.

8 Upper posterior reference (UPR) is marked from hamular 9 Maxillary occlusal plane fabricated with occlusal
notch by using measurement obtained from Figure 7, and
plane parallel and at 3-cm height to line marked in
references joined by line.
Figure 8.

10 Mandibular occlusal rim fabricated with anterior height 11 Occlusal rims in mouth with no or minimal adjustment,
of 3 cm from lower anterior reference (LAR), and posterior showing parallelism with ala-tragal line.
height in relation to retromolar pad.

Jayachandran and Grey

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Volume 112 Issue 2

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The Journal of Prosthetic Dentistry

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Corresponding author:
Dr Sivakumar Jayachandran
15 Quinton Road
Harborne, Birmingham B17 0PP
UNITED KINGDOM
E-mail: sivajsk1975@yahoo.com
Copyright 2014 by the Editorial Council for
The Journal of Prosthetic Dentistry.

Jayachandran and Grey