M.

muslim abdullah
31101200265
1. Tahap-tahap penentuan MMR
{Source:THE JOURNAL OF PROSTHETIC DENTISTRY;Physiologic jaw relations
and occlusion of complete dentures }
PART I
The procedure
The physiologic concepts of jaw relations and
occlusion are based upon studies of dental and oral
physiology. The procedures involved are divided into
three parts: (1) jaw relations, (2) centric occlusion, and
(3) the removal of premature contacts from the paths
leading to centric occlusion.
The constant function of swallowing saliva is the basis
for establishing the mandibular positions and occlusion.
In swallowing saliva, the mandible rises to its habitual
closing terminal, then, as the saliva is forced backward
into the pharynx by the tongue, the mandible is retruded
to its physiologic centric relation (Fig. 1). These are the
mandibular movements that are used in determining the
vertical dimension and the centric relation for complete
dentures.
In practice, the vertical dimension is established by
first determining the length of the upper teeth on the
occlusion rim and then making a tentative vertical
dimension determination by using the free-way space
technique, or any of the usual methods, and mounting
the casts on an articulator.
To establish the physiologic vertical dimension, the
lower occlusion rim is reduced 3 mm, and a cone of very
soft wax is placed on top of the shortened occlusion rim
at the median line. The upper and lower occlusion rims
are placed in the mouth, and the patient is requested to
swallow several times. As the patient swallows, the soft
wax is reduced to the natural and physiologic vertical
dimension (Fig. 2).
PHYSIOLOGIC CENTRIC RELATION
To establish the physiologic centric relation, blocks
of soft wax are placed on the same lower occlusion rim in
the bicuspid and first molar regions. Both occlusion rims
are inserted in the mouth, and the patient is requested
again to swallow several times.
As the mandible rises to its vertical dimension
terminal, the occlusion rims are evenly balanced by the
musculature, and the mandible is retruded by the
tongue to a natural centric relation. This is the centric
relation that is transferred to the articulator for

establishing centric occlusion (Fig. 3).

The lower teeth are set up to a flat occlusal plane on
the lingual aspect and to a gentle anteroposterior curve
on the buccal aspect to form a reverse occlusal curve for
the average patient (Fig. 4).
After the try-in, the dentures are processed and
returned to the articulator to check the centric
occlusion. The dentures are now ready to be taken from
the inanimate articulator to the living tissues of the
mouth. Here the premature contacts will be removed
from the occlusal paths leading to centric occlusion.
REMOVAL OF PREMATURE CONTACTS
The technique for testing centric occlusion and for
locating premature contacts in the mouth during the
functional closures is as follows: Thirty gauge casting
wax is placed on the lower denture over the occlusal
surfaces of the teeth and over the denture base covering
the retromolar pads. The upper and then the lower
denture are placed in the mouth, and the patient is asked
to close and swallow several times. If, upon examination,
any of the buccal cusps or the incisal edges have
perforated the wax, the perforations indicate the
presence of premature contacts (Fig. 5). To remove
these contacts, the exposed areas of the lower buccal cusps
or the incisal edges are marked with a pencil, and these
spots are ground with a fine stone.
If any lingual cusp of the lower denture appears
through the wax, it indicates the presence of a premature
contact on the lingual cusp of the upper denture.
To locate an upper prematurity, the wax is removed
from the lower denture, and the upper occluding
surfaces and the base material covering the tuberosities
are covered with 30 gauge casting wax. Both dentures
are inserted, and the patient is asked to swallow several
times. The area of the upper lingual cusp that appears
through the wax is marked and reduced with a fine
stone. (Fig. 6).
To test for premature contacts during the nonfunctional
lateral and protrusive movements of bruxism,
the occlusal surfaces of the lower denture are covered
with 30 gauge wax in the same manner as for the
functional movements. The dentures are then inserted
in the mouth, and the patient is requested to grind his
teeth from side-to-side and forward and backward
without undue pressure or exaggeration of movement.
If any of the lower buccal cusps or incisal edges appear
through the wax, they are marked and reduced with fine
stones.
Premature contacts on the lingual cusps of the upper
denture are indicated when the wax covering the lower

lingual cusps is perforated. To locate these upper

premature contacts, the wax is removed from the lower
, and the upper occlusal surfaces are covered
with 30 gauge wax; both dentures are inserted, and the
patient is asked to glide his teeth forward and backward
and from side-to-side without exaggeration. The area of
the upper lingual cusp that appears through the wax is
marked and reduced with a fine stone (Fig. 6).
Remember, the physiologic way to remove premature
contacts from the paths leading to centric
occlusion in the mouth is to reduce the buccal cusps of
the lower teeth and the lingual cusps of the upper teeth
for normal cases.