Laboratory

by Clayton A. Chan, DDS, MICCMO

One of the main things that I have communicated with each and dental technician that has done my full mouth restorative cases over the years is that I want and need a gnathological and anatomical occlusal wax up. Why?

Over  the years while practicing restorative/TMJ dentistry I have found that the central nervous system of the human body demands specific senses in the bite that allows one to feel comfortable and stable.  Without these proprioceptive occlusal feelings of stability, balance and a solid even bite, the human being may experience difficulty in finding ultimate quality of physiologic rest.  Some individuals are more particular about what they feel than others.  Some individuals central nervous (CNS) system demands a higher level of precision to function comfortably than others.  This is what the dental profession does not fully understand in general.

Once the dentist has stabilized and proven the bite relationship between the upper teeth and the lower arch of teeth a bite registration can be recorded without torques and skews.  I recommend to all dentist who are interested in physiologic precision to record the bite in a sitting up right position rather than a laying down (supine) position.  It is this registration that the laboratory technician depends on to continue the precise bite management process to meet the proprioceptive demands of the patient/client.

The dental technician uses specialized wax to shape, mold and carve the upper and lower arch form, shape and surfaces of each tooth that should simulate comfortable function and resting modes to the central nervous system.  A re-architecting of the complete occlusal table, smile line, positioning of each tooth, and their relationship to one another is often required in the severely debilitated worn dentition.  Optimal ccclusal waxing often requires more than creating a crown/tooth shape to cover the prepared tooth form, but often requires the occlusal/biting surfaces to fit the opposing dentition as well as support a proper positioned mandible and temporomandibular (TMJ) joint and disc relationship.

Anatomical occlusal morphology matters.  Establishing contact points in wax prior to final pressing and or casting matters.  It is not just to look good, but even more, contact points established on incline planes when synchronized together as a unit allows the mandible to know where is home base.  If there are premature  contacts in the bite during the final stages of occlusal adjustments, the central nervous system will proprioceptively find them and will cause grinding and clenching.

This means that I don’t want the following:

1. I don’t want over contoured crowns
2. I don’t want flat looking occlusal anatomy
3. I don’t want rounded bulbous looking gingival necks
4. I don’t want chicken scratch occlusal anatomy
5. I don’t want wide occlusal molar anatomy
6. I don’t want the lingual cusp tips to be higher than the buccal cusp tips
7. I don’t want the mesial lingual axial contours of the first bi’s to be bulk
8. I don’t want bicuspid drop offs in my occlusal tables
9. I don’t want the lower anteriors to be higher than the posterior occlusal tables of the bi’s and molars (re: deep curve of Spee)

In other words this is what I want: My Prescription

1. Natural occlusal cusp fossa form
2. I want the gingival necks of each tooth to have a normalized emergence profile (the tooth needs to look real not fake).
3. I like steep looking cusp fossa form – reason being is that after adjustments things can start looking flat.
4. The occlusal anatomy should look really anatomical, not some man made occlusal anatomy…it should look like a real bi or a real natural molar….Not a crown!
5. I want the cusp tips to line up and have a natural symmetry to them yet they are asymmetric and individualized – natural in appearance…not stock standard form.
6. I am not interested in trying to match the opposing anatomy.  If the opposing is flat I don’t match flat.  I always want anatomical form.
7. I want my embrasure form to be opened up so it looks natural and esthetically pleasing…Too many lab crowns close up the embrassure spaces causing the group of restorations to look fake, blocked in and unnatural.
8. I want natural lingual anatomy even on the non functional surfaces…including the lingual surfaces of my anteriors – uppers and lowers….flat surfaces on the lingual of the anteriors is not acceptable to me.
9. I want a normalized occlusal tables…I believe those of you who have come to OC courses have seen my occlusal tables of many of my cases during my lectures.  The case has to have anatomical form that functions well and looks great.

Proper forum will result in proper function.  Abnormal form leads to abnormal function.

** Waxing Up and Porcelain work by Las Vegas Esthetics – Ray Foster Team – Master waxer – Dragos Cobori

© 2009 Clayton A. Chan, DDS. All Rights Reserved.

The Leader in Neuromuscular Dentistry

Filed under: Bite Management, Comprehensive dentistry, Dental Laboratory Technology, Esthetic Waxing, full mouth rehabilitation, Lab Technician, Las Vegas Esthetics, Neuromuscular Dentistry, Neuromuscular Occlusion, Occlusal Plane, Occlusal Waxing, Optimized Chan Orthotic, Orthotic, Uncategorized by Clayton A. Chan, D.D.S.
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Prevalence of degenerative join disease according to scientific studies have estimated the incidence of degenerative temporomandibular joint disease to be 70-84% (1). The human jaws and the accompanying atlas and axis of the vertebral column are linked into one basic system by the various fascia surrounding them, so stress in one area is carried throughout the system. When the muscles become strained so do the teeth (occlusion) resulting in worn dentition and enamal and dentin breakage.

Re-establishing natural functional form by skilled technician’s is what is required to begin the esthetic rejuvenation process both functional and cosmetically pleasing to the eye.

Courtesy of Ray Foster and Team (Master Waxer - Dragos Cobori, Las Vegas Esthetics Laboratory with Clayton A. Chan, D.D.S.

Reference:
(1) Haskin CL, Milam SB and Cameron IL: Pathogenesis of Degenerative Joint Disease in the Human Temporomandibular Joint. Critical Rev Bio Med, 1995.

Filed under: Dental Laboratory Technology, Esthetic Waxing, Lab Technician, Occlusal Waxing, Uncategorized by Clayton A. Chan, D.D.S.
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The following are guidelines and requirements for the dentist to follow if they want an OPTIMIZED CHAN ORTHOTIC properly fabricated by a trained and approved denal laboratory.

Impression Requirements:

1. Accurate undistorted PV impressions – Check the gingival margin details in the anterior and posterior regions.
2. Check the gingival margins for accuracy and details.
3. The lab prefers quality detailed PV impressions mailed to the lab in order that they themselves can pour up the model with their own stone.  They use special stone that has the proper stone expansion ratio required to make a properly fitting orthotic.

Requirements for Model Casts:

1. To fabricate the orthotic the lab will need to pour 2 sets of models free of bubbles and any irrigularities in the anterior and posterior regions. 
2. 2 sets of detailed and accurate undistorted models will be poured by the lab.
3. The Lab will need to pour these impressions at least 2 times.
4. Don’t send in only a single poured model – The lab will need to duplicate another set of models if you only send in one set of model casts and you will be charged for the time required to duplicate and manage the second set.  (It is better to send in accurate impressions that the lab can pour themselves).

Required Bite Registration Materials:

PV Bite Registration

1. The Bite Registration must be rigid enough – PV Aquasil Rigid is required for the lab to mount your case accurately to properly fabricate the Chan Orthotic.

Sapphire Bite Registration

1. The Sapphire Bite registration (Bosworth) should not be excessively thinned or trimmed, because it will become distorted and will not allow an accurate mounting.
2. Keep sufficient peripheral  thickness (bulk) around the edges of the Sapphire bite as a frame and matrix to prevent bite registration from warping.

Requirements Bite Registration:

1. Make sure you open the bite no less than 2 mm in the thinnest area between the upper and lower casts during bite registration.  If the bite is too thin the lab will contact you and will ask you to retake the bite so they can make the orthotic properly so there is no thinnest or holes in the orthotic.

Marking Vertical Lines on Models to Check Your Bite Relationship:

1. On one set of poured and trimmed models hand held in CO (centric occlusion);  Draw vertical pencil marks from the gingival margin of the upper mesial buccal cusps down to the lower molar vertically on both left and right side. 
2. Draw a vertical line between the maxillary central incisors down to the labial of the lower central incisors.  This will allow you to check your NM bite relationship. 
3. If the lower marked lines in the molar region are distal to the upper line, retake your bite over. 
4. If the lower molar line is at or anterior to the upper line, you are on the right track.  
5. Also check the frontal or lateral relationship using the anterior midline as your guide and reference.  (In general, the midlines should line up in most cases).  If the bite is skewed off to one side, reconsider if you have optimized the condyles and discs properly.

Filed under: Dental Laboratory Technology, Neuromuscular Orthotic, Optimized Chan Orthotic by Clayton A. Chan, D.D.S.
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Bite transfer management is the key to the precise multi-dimensional occlusal management of any comprehensive reconstruction. Without it the case can fail.

There are specific systems and steps that must take place for records, models, photographs, bite registrations and matrixes to be meaningful to the technician. Details protocols must be in place in order to transition from a phase I stabilization stage to a phase II finishing restorative stage.

Break this cycle and learn the proven bite transferring protocols and techniques of Dr. Chan that will increase productivity and the precision in your dentistry.

“Bite Management and Transfer” - You can’t practice complete dentistry without it!

Filed under: Bite Management, Dental Laboratory Technology, Neuromuscular Occlusion by Clayton A. Chan, D.D.S.
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DOCTORS,
ARE YOU HAPPY WITH YOUR ORTHOTICS?
 
1. Are you having difficulty fitting your patient’s properly at the orthotic delivery appointment?
2. Are you having to grind and adjust your orthotic more than you think you should be on delivery day?
3. Are your patient’s complaining that their orthotic doesn’t fit well?
4. Are your orthotics thin, flimsy and breaking?

Call Dr. Chan and let him know and he can direct you to a quality ORTHOTIC LAB that has been APPROVED by Dr. Chan and knows his orthotic design and prescription.

1. Are you having difficulty fitting your patient’s properly at the orthotic delivery appointment?
2. Are you having to grind and adjust your orthotic more than you think you should be on delivery day?
3. Are your patient’s complaining that their orthotic doesn’t fit well?
4. Are your orthotics thin, flimsy and breaking?

Dr. Chan desires that all doctors are getting the best orthotic service and support for their patients!

Filed under: Appliance Therapy, Bite Management, Dental Laboratory Technology, Neuromuscular Dentistry, Neuromuscular Occlusion, Neuromuscular Orthotic, Optimized Chan Orthotic, Orthotic, TMJ TMD CMD Myofacial Pain, Uncategorized by Clayton A. Chan, D.D.S.
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THE ANATOMICAL REMOVABLE ORTHOSIS

Clayton A. Chan, DDS, MICCMO
Master International College of Craniomandibular Orthopedics

The lower anatomical orthosis I advocate is a specialized dental appliance that is orthopedically designed to match the physiologic function of the patient’s jaw and head posture. (Read more….). It is scientifically determined using computerized jaw tracking technology, low frequency TENS and EMG technology to determine and confirm the bite registration which is key to establishing a an “Optimal” jaw relationship. Patient who experience, jaw pain, headaches, neck aches, facial pain and or has an over-closed bite can benefit from this therapy.

This anatomical appliances main objective is to orthopedically relign the mandible to the cranium to bring support, balance and allow true physiologic rest to the musculature.

PHYSIOLOGIC SCIENCE AND OBJECTIVE MEASURING INSTRUMENTATION
This specialized appliance is constructed from a bite registration that is scientifically established by neuromuscularly trained dentists who use the J5 Myomonitor TENS (low frequency neural stimulation) to relax spastic muscles in six dimensions. Advanced dentists implement both low frequency TENS combined with their diagnostic skills to better identify the patient’s jaw position with the more sophisticated K7 kineseograph to track and visually identify a more optimal position on the computer monitor. Muscle calmness can be observed and more importantly a correct jaw position can be physiologically located.

Electromyography (EMG) can be used in complex cases to measure muscle activity before the bite registration is recorded.

Computerized Mandibular Scanning (CMS) is used to locate the jaw position in a sitting upright position without the dentist manipulating the jaw position or guessing. Objectively monitoring the jaw in real time allows the clinician to make accurate decisions as to where best to record the jaw position.

Advanced dentist recognize that a quality and accurate bite registration is the beginning point to effectively relate the upper and lower teeth together.

The NM orthosis is best fabricated by a qualified lab who understands these principles and a dentist who is trained in these advanced principles and techniques.

Filed under: Neuromuscular Dentistry, Neuromuscular Occlusion, Neuromuscular Orthotic, TMJ TMD CMD Myofacial Pain by Clayton A. Chan, D.D.S.
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