There are a variety of ways I capture bite records for diagnostic models that will be mounted in a seated condylar position. One way to capture these records is with bite registration silicone and either a leaf gauge or a lucia jig. These techniques are fantastic for patients where we need to release muscles or who tighten their muscles as a response to our procedures. One challenge they pose is trimming the records and mounting them to get an accurate representation. Another is that some patients will posture forward during the record. Having multiple techniques in your arsenal will allow you to use the one that is most appropriate and will yield the most accurate results for each individual patient.
Another way I capture these records is with a wax platform, a technique I learned as a student at the Pankey Institute. It works easily for patients who present with relaxed musculature or have been wearing an occlusal appliance that was adjusted to a seated condylar position. It is an accurate record for capturing seated condylar position and easy to mount with high accuracy.
In the case of patients with an appliance I ask that they wear the appliance to sleep in, the morning of the appointment take it out to brush and eat breakfast and wear it into the office. I take the appliance out to take the bite record. We make wax platforms from Schuyler wax, which comes in sheets like baseplate, but is stickier. Heat the sheet at the midpoint and cut in half. Next heat each half at the midline and fold to double thickness. Next cut the sides to create a trapezoid.
- Heat one surface of the wax on the sides only and then seat over the maxillary teeth with the front of the platform at the contact between the laterals and canines.
- Cut the platform around the canines and through the central groove of the posterior teeth.
- Warm sides again.
- Seat over maxillary teeth and have patient close until lower cusps are embedded in the wax.
- Cool wax with teeth still in occlusion with air spray.
- Place two drops of blue Delar wax over the impression of the lower canines in the platform.
- Seat platform over teeth and guide patient until lower canines are touching Delar Wax ( other teeth should be out of occlusion).
- Cool Delar Wax
- Place Delar wax dots over cusp tips of second molars.
- Seat Platform and guide patient into now set anterior stops.
- Cool posterior Delar wax.
- Store record in cool water until ready to mount the lower model.
I love this record. What has become your preferred way of holding the lower cast to the upper cast when mounting? When I question my records I wonder if I was consistent in my technique in the mounting. This technique takes away a lot of the trimming one needs with the PVS records. I’ve been using big paper clips with super glue which I accelerate the set-up with Zip Kicker.
Carl,
I use the same mounting stabilization system or the accumount. Some error will be introduced becasue of the shrinkage of the mounting stone, and the larger the amount the bigger the discrepancy. Also the facebow is an assumption and introduces error, as do the casts, etc. How are you evaluating the accuracy of the mounting?
Lee
Lee,
Thanks for the response.
At some point I examine (usually numerous times) what the patient is able to show me for first point of contact while seating the condyles (the best we think) with either bimanual guidance or leaf gauge (using the leaf gauge more and more). I note it (need to be more consistent taking photos). Then I take “cr” records with the intent to record what I have noted. Comparing the mounting to what I noted is I guess the short answer to your question.
Honestly, this is an area (records and mounting casts) that I feel like I need to get better so I can feel like what I have is something I can really use to do a case work up.
Thanks as always for your time!! You’re the best, Lee!
CARL
What is the name of the wax you use and do you use wax for full mouth restorative cases
Thanks
This is called Master Wax, and the blue dots are a delar wax pencil. I use this technique for CR records for diagnostic records. I use silicone for bite registration on prepped teeth during restorative, and the silicone should only be over the preps, as crown and bridge bite records need to be taken at the VDO of the final occlusion.