Professional Documents
Culture Documents
RELATION
AND VERTICAL
DIMENSION
BY CEPHALOMETRIC
ROENTGENOGRAMS
JAMES
E.
PYOTT,
D.D.S.,
AND
AARON
Baltimore,
SCHAEFFER.
X.B.,
D.D.S., M.S.
Md.
HE PROSTHODONTIST
must establish the proper centric jaw relation
at the correct vertical dimension. This, of course, involves the determination
of the exact rest position. If this factor is not determined correctly in the beginning, the patient will suffer from too great a vertical dimension or overclosure.
that is, too little or too much free-way space. The symptoms are classic: irac-,
tured artificial teeth, midline fractures in the restorations, discomfort and poor
retention, loss of alveolar bone associated Lvith flabby- ridges, teml~oromnndihul;tr
ljain, sore ridges, and sore tongue.
\;lc have based the cephalometric technique on the work of t3roadbent.l and
the findings of Brodie and Thompson.~ These investigators have shown that the
position of the mandible remains in a constant relation to the skull during the life
(of an individual, and this position, the rest position, is determined by the muscles
which elevate and depress the lower jaw. This is: the position in which the mandible
is held most of the time when an individual
is not talking, swallowing, or
masticating.
The free-way- space varies in individuals, although it has been reported that
the average free-way space is 3 mm. From our experience, we have found that
most patients function well with that amount of free-way space between their artificial restorations.
(The patients exact free-way space can be determined 1,~.
making cephalometric roentgenograms of the jaws with natural teeth, prior to e:<.
traction. 1
CEPHALOMETRIC
TECHNIQCE
of Denture
Prosthetics,
Aug. 19, 1953.
35
Los
Angeles,
Calif..
April
II,
19.53
PYOTT
AND
J. Pros. Den.
January, 1954
SCHAEFFER
Fig. l.-The
cephalometer.
A, The x-ray
unit is fixed so that its central
ray travels
through
the ear rods, and is located
at a distance
of five feet from the midsagittal
plane of the head.
B, The stabilizer
for the patients
head.
The head of the patient
is stabilized
by means
of
plastic rods placed in the patients
ears.
Fig.
2.
Fig. Z.-The
patient
in the cephalometer
ear rods in position.
The cassette
holding
Fig.
3 .-The
patient
in the cephalometer
Fig.
is in rest position,
the film is moved
is in rest
position.
without
as close
The
3.
dentures,
as possible
cassette
is in position.
Volume 4
?;nmixr 1
CEPHALOMETRIC
Fig.
4.-A
.1 ;
roentgenogram
pogonion
Fig. S.-The
ROENTGENOGRASI
Gothic
of rest position.
The distance between
the nasion
(marked
A and R. respertively)
is 107L& mm.
arch
tracing
unit
with
the Gothic
arc%h tracing
and
inscribed
38
PYOTT
AND
SCHAEFFER
J, lro~. Den.
January, 1954
directly over the centric point. The hole in the acrylic must be directly over the
exact centric point. Thus by having the patient close his mouth, the Gothic arch
unit pin falls into the hole in the acrylic, locking the patients jaws in centric POsition. At this time another cephalometric roentgenogram is made.
b.
a.
A hole is punched
in the tracing
at
Fig. 6.--a, Tracing
of the frOntOnaSd1
area.
A hole is punched
in the tracing
at pogonion,
b, Tracing
of the mandibular
area.
tracings
are superimposed
upon each roentgenogram
of the patient.
All six original
grams are punched
and should show a constant
distance
between
the points
A and
position.
nasion, A.
B. These
roentgenoI3 for rest
Fig. %.
Fig. 7.
The Hanau
articulator
is
Fig. 7.-Cephalometric
roentgenogram
of the patient
at rest.
superimposed
upon the film to show the distance
between
the condyle
and the mandibular
incisor
area.
Fig. 8.- Roentgenogram
of the patient
with the central
bearing
point and intraoral
tracing unit maintaining
the vertical
dimension
at centric
relation.
The distance
between
points
A and B is rO4jh mm.
The plaster
checkbite
is again inserted,
and the lower cast is remounted
at the correct
vertical
dimension
and centric
relation
on the articulator.
Fig.
checkbite.
imposed
relation.
B.
9.--A,
The Gothic
arch unit is in the mouth
in centric
position.
with
R, Roentgenogram
with the Gothic
arch unit in position
in the mouth,
upon it is the Hanau
articulator
adjusted
to the correct
vertical
dimension
the ylastel.
and superand cywtri,
B.
If a change of vertical
dimension
is necessary,
the change
F ig. 10.-A,
B, The vertical
dimension
ipers from the upper ridge to the lower ridge.
to allow 3 mm. free-way
space.
duced from rest position
F ig.
OCCIUE
three
ll.-Cephalometric
:ion.
The vertical
months.
roentgenogram
dimension
is 104%
showing
mm.
The
the finished
patient
has
is measured
with calin this case was : re-
replacements
in ten ttric
worn
the restorations
for
CEPHAI.OMETRIC
ROENTCENOGHh.llS
41
This procedure should be repeated tultil the desired free-way space has iwr
established, and then the lower cast is remounted at this corrected vertical dinwnsion by means of a plaster checkhite on the tracer (Fig. 9). \2heu changes iu thy:
vertical dimension are necessary, they can be matlv 1)~ measuring betwrcn tht
ridges of the mounted casts in the area of the central incisor5 with calipers ( Fig.
10). 110 not depend on measuring the change in the length of the incisal guide
pin, for this procedure does not reflect the amount oi opening or closing accura~cl ti
in the area between the ridges.
After the proper free-way space has been established, l.he teeth are set 111)an:l
tried in, a protrusive
checkbite is made, and the condylar guidances are SCI 01)
the articulator.
The restorations
are fabricated, ground in on the articulator and
finished. After the patient has worn the restorations
several weeks cephalomrtr~,r
roentgenograms
are made with the restorations
in position at centric occlul;ic:n
and at rest. The results should be consistant with the previous cephalomrtric,
readings used in making the restorations
(Fig. 11 I.
Cephalometric roentgenograms
have a place in making artificial restorations,
They are used for patients needing full restorations,
partial restorations,
ant\
when making the so-called bite raising appliances.
The object of this procedure is to present a scientific and esact method of &atermining rest and centric positions at the correct vertical dimension.
Using this method, the measurements at vertical dimension made in makinrr;
the restorations
may be checked and rechecked, before, during, and after the COJIpletion of the restorations so that the vertical dimension may be changed or veritivtl.
REFERENCES
ARTS
1, MD.
BLDG.