PROGRAMMING OF HANAU WIDE VUE & GOTHIC ARCH TRACING.pptx

Programming a Hanau articulator and performing Gothic arch tracing are essential steps in prosthodontics to ensure precise jaw movement replication and occlusal accuracy. The Hanau articulator, a semi-adjustable dental instrument, simulates mandibular movements by allowing customization based on the patient's unique jaw dynamics. This involves setting the condylar inclination, Bennett angle, and incisal guidance. Gothic arch tracing, on the other hand, is a technique used to record the centric relation of the mandible. It involves using a stylus and recording plate to trace mandibular movements, creating a characteristic arrow-point tracing that aids in accurately locating the centric relation. Both procedures are crucial for fabricating well-fitted dental prostheses, ensuring patient comfort, and maintaining optimal oral function.

1. PROGRAMMING OF HANAU WIDE VUE & GOTHIC ARCH TRACING DR. SATVIKA PRASAD MDS DEPARTMENT OF PROSTHODONTICS

2. CONTENTS Introduction Hanau Wide Vue Evolution of Hanau Vue articulators Parts of Hanau Wide Vue Classification Condylar guidance Bennet angle Dual end incisal pin Adjustable incisal guide Orbital indicator Accessories Facebow transfer Articulator preparation Spring bow earpiece facebow How to record facebow? Transferring facebow to articulator Gothic arch and tracing Extra-oral & intra-oral tracing Classification of arrow points Why gothic arch tracings? Limitations of graphic method Hanau H2 Care & maintenance Conclusion References

3. INTRODUCTION An accurate determination, recording and transfer of jaw relation records from patients to the articulator is essential for the restoration of function, facial appearance and maintenance of patients oral health.

4. DEFINITIONS A rticulator – a mechanical device which represents the temporomandibular joints and the jaw members to which maxillary and mandibular casts may be attached to simulate jaw movements - GPT 8 A rticulation – the static and dynamic contact relationship between the occlusal surafces of the teeth during function -GPT 8

5. EVOLUTION OF HANAU ARTICULATORS Hanau model C (1921) - Research articulator. Hanau model M Kinoscope (1923). Hanau model H (semi-adjustable) (1923). Hanau H115, H110 (1923), Hanau H110 modified (1927). Hanau crown and bridge articulator 29-0(1934). Hanau-mate model 165. Hanau 96H2 (1958) - designed by Hanau. Hanau H2 series (1977) - designed by Hanau. Hanau Arcon H2, H2-O, H2-X, HZ-PR (protrusive-retrusive), H2-XPR. Hanau XP-51 (Teledyne articulator). Hanau Radial Shift articulator (1981). Hanau wide Vue and Hanau wide Vue II (1983).

6. HANAU WIDE VUE ( MODEL 183 & 184 ) Hanau- brand articulators were first introduced to the dental profession in 1921 by RUDOLF HANAU These are the newest Hanau articulators These are arcon in nature The only difference is that the upper and the lower members can be separated in model 184 due to open condylar track The Horizontal condylar guidance is adjustable from -20 º to + 60 º The bennett side shift is adjustable from 0º to 30º

7. Allows adjustment to replicate avg. mandibular movements = Class 3 Simulates condylar pathways by using avg. values for all or part of the motion Permit eccentric + only part of condylar motion , hence semi adjustable Condyles attached to lower member Condylar guides to upper member Same as natural jaw

8. PARTS OF HANAU WIDE VUE ARTICULATOR

9. CONDYLAR GUIDANCE The condylar guidance are the control centers of the articulator and they adjustably assimilate the multiple function of the glenoid fossa The condylar track may be adjustably inclined on the horizontal transverse axis from a “zero” to a “ +60 ” degrees to a “ – 20 ” degrees. These inclinations are termed the protrusive inclination and simulate the patient’s superior wall of fossa It may also be adjusted on the vertical axis from a “zero” sagittal to “ 30 º ” This is termed as the progressive Bennett angle and corresponds to the medial wall of patient’s fossa

10. Bennett angle The angle formed by the sagittal plane and the path of advancing condyle during lateral mandibular movements This corresponds to the medial wall of the patient’s fossa Avg. value = 7.5 º – 12.8 º Bennett angle (L) = H/8 + 12 LATERAL CONDYLAR GUIDANCE

11. DUAL - END INCISAL PIN The incisal pin serves as the forward control of the articulator. It maintains a vertical stop and provides a stylus contact for the excursive movements of the articulator against the various inclined guiding surfaces of the incisal guide. 5 additional lines calibrated in millimeters extend on either side thereof These lines are used for recording or altering the vertical dimension

12. Two annular grooves, appear on the Incisal Pin at 37 and 54 mm below the Frankfort Horizontal Plane. These grooves form arbitrary vertical landmarks for alignment of the incisal edge of the maxillary centrals when making a Facebow transfer.* The 37 mm line is based in part on the Bonwill Triangle and results in a generally horizontal appearing plane of occlusion. The 54 mm line forms an average landmark for alignment of the incisal edge of the upper centrals, when making a Facebow transfer. *This reference line is based on the research study by Frank R.Lauciello , D.D.S., and Marc Appelbaum, D.D.S., "Anatomic Comparison to Arbitrary Reference Notch on Hanau™ Articulators," Journal of Prosthetic Dentistry, December 1978, Volume 40, Number 6, Pages 676-681 3 rd point of stability

13. ADJUSTABLE INCISAL GUIDE Provides adjustment to anterior guidance. The Incisal Guide rotates antero-posteriorly from a horizontal " zero" degree to a 60 degree positive inclination of protrusion which is then secured by the small Locknut. The central guiding table is 5.56 mm wide and forms the inclined surface for the protrusive guidance of the Incisal Pin. Separately adjustable Lateral Wings elevate by a Thumbscrew from a " zero" horizontal to a 45 degree incline and are fixed by a Thumbnut. An anterior slot, in the Lower Member, allows repositioning of the Incisal Guide. Adjust and lock the Guide at a "zero" horizontal and slightly loosen the Platform Lock screw. Slide the Platform antero-posteriorly to align the chisel end of the Incisal Pin with the "zero" indicating line on the Lateral Wings.

14. ORBITAL INDICATOR Some articulators are equipped with an Orbitale Indicator. This "crescent" represents the patient's infra- orbitale notch and is the anterior reference landmark of the Frankfort Horizontal Plane. When used with an Orbitale Pointer on a Facebow it provides an anatomical vertical orientation for the upper arch, obviating the use of any average reference lines on the Incisal Pin Gonzalez JB, Kingery RH. Evaluation of planes of reference for orienting maxillary casts on articulators. The Journal of the American Dental Association. 1968 Feb 1;76(2):329-36.

15. MOUNTING PLATES To attach upper and lower casts to upper and lower members of articulator Has elongated luting slots – for a secure adherence of gypsum mounting Center domed brass insert which is internally threaded for attachment of upper and lower members.

16. ACCESSORIES

17. FACEBOW TRANSFER ON WIDE VUE HANAU ARTICULATOR

18. # #

19. ARTICULATOR PREPARATION (ZEROING OF ARTICULATOR) Adjust the protrusive inclination of both condylar guidance to 30°. Adjust the Bennett angles of both condylar guidance at 30°. Adjust the Incisal Pin to align the mid-line calibration to the top edge of the upper member. Adjust the Incisal Guide to a 0°. Tighten the Centric Locks, to restrict the articulator to opening and closing movements only Slide the Platform to align the Incisal Pin contact over the “zero” indicating line on Guidance and tighten Platform Lock screw. Articulators with Protrusive-Retrusive feature ONLY must be adjusted to a “zero” centric Apply a thin coating of petroleum jelly to all surfaces of the Articulator that will be exposed to the stone mounting media. Firmly attach a Mounting Plate to the Upper Member.

20. Whip Mix Hanau Spring-Bow Earpiece Facebow The HANAU™ Spring-Bow is an earpiece-type facebow, used to capture and record the patient’s maxillary arch and its relationship to the external auditory meatus. It is capable of preserving this clinically accepted relationship and transferring it to a HANAU™ or other brand articulator. For indirect or direct mounting to all HANAU and DENAR Articulators (except HANAU Model 145)

21. BENEFITS: – Automatically centers for outstanding accuracy and patient comfort. – Unit may be sterilized by steam autoclave for cross-contamination control. – Transfer clamp attaches directly to the articulator which allows for multiple measurements with only one facebow required. – Allows for transfer clamp assembly to be used with DENAR®, SAM, Whip-Mix articulators. – Facilitates in aligning the measuring bow with the horizontal reference plane.

22. How to record facebow ?

23. FOR DENTULOUS FOR EDENTULOUS BITE FORKS

24. Modelling compound is heated Modelling compound is attached to bite fork It is positioned over the maxillary teeth It is removed from the mouth and cooled Trim the excess 1 2 3 4 5 DENTULOUS

25. With bite fork in position facebow is guided onto the stem of the bite fork Place the earpiece in the external auditory openings Orbital pointer is positioned (infra-orbital notch) Thumbscrews tightened to maintain the spatial relationship between facebow and bite fork 10. Facebow assembly along with bite fork is removed from the mouth and positioned over articulator 6 7 9 8

26. EDENTULOUS Do tentative jaw relation Heat the bite fork Insert it coinciding the line with the midline marked on maxillary rim Secure it in position with sticky wax and should be parallel to occlusal plane Insert the bite fork in patient’s mouth Insert mandibular rim Place the facebow, with bite fork stem into thumb screws 1 3 2 4 6 5

27. Raise the U frame till it coincides with infra-orbital notch and check the parallelism of the facebow to interpupillary line Place indirect transfer jig Place the entire facebow assembly to the indirect transfer jig Tighten the lock screw Support the bite fork and maxillary rim with cast support and remove the U shaped facebow Orbital bars should coincide

28. PURPOSE OF ALL 3 THUMB SCREWS TS 1 – Vertical TS 2 – Lateral TS 3 – Anterior - Posterior

29. TRANSFERING TO ARTICULATOR Direct face-bow transfer After making the face-bow record, the ear pieces of the spring-bow were used for suspending the bow over the condylar shaft ends of the Hanau™ Wide-Vue articulator. The anterior elevator was adjusted so as to position the top of orbitale pointer on the spring-bow to the underside of the orbitale indicator on the articulator and then was secured by the thumbscrew. The bitefork index was checked to be adequately supported by cast support before placement of the maxillary cast and plaster mounting to the articulator [Figure 2]. Indirect face-bow transfer After the direct transfer had been completed, the spring-bow was unscrewed from the transfer assembly. The mounting platform was secured on the lower member by the cast support. The transfer assembly was secured onto the mounting platform, and the cast support was raised to support the bitefork index following which the maxillary cast was mounted [Figure 3].

30. GOTHIC ARCH “Gothic” name originates from ancient Gothic peoples’ houses Important feature of gothic architecture is the pointed arches

31. GOTHIC ARCH TRACING Graphic methods are either intra-oral or extra-oral, depending upon the placement of the recording devices Extra oral tracing are also referred to by 2 other names :- gothic arch tracings and arrow point tracings The Hight Tracer, 1986 – it is a four component assembly which consists of an upper bearing plate, lower bearing plate with central screw, a scriber point to be attached to the upper rim and a tracing platform which extends in forward and is attached to the lower rims

32. EXTRA ORAL TRACING TECHNIQUE After taking facebow records, it is transferred to the articulator and mounting of the maxillary cast is done. Then, with tentative CR records, mandibular cast is mounted The upper bearing plate is heated and waxed to the maxillary rim, making it flush with the occlusal plane The lower rim is reduced by 3 mm and the lower plate is fixed to the mandibular rim

33. The scriber is attached to the maxillary rim and lower tracing platform is waxed to the mandibular rim. The upper and lower tracers are made parallel Seat the patient with head upright in a comfortable position Intraorally seat the record bases with the attached devices Retract the and conduct training exercises by instructing the patient to move the jaw forward, backward and to left and right side

34. When the patient is proficient in executing the movements, prepare the tracing plate. The tracing plate is covered with a thin layer of precipitated chalk and denatured alcohol or soot . The subject is made to perform protrusive and lateral movements till a gothic arch tracing with sharp apex is obtained A protrusive tracing point is marked, 6mm away from apex . A plastic sheet with a hole corresponding to the apex and the protrusive tracing points is mounted over the platform of the tracer.

35. Prior to making records, small nicks are made in the maxillary and mandibular rims which assist in repositioning the records in their correct positions later. For making the centric and protrusive records, the patient is asked to hold the pin in the drilled holes to stabilize the position while injecting quick setting plaster between the rims. Eccentric records are made at 6 mm because- The normal functions are performed within 6 mm The articulator will be optimally sensitive to be programmed for a horizontal angle and bennett angle only at 6mm distance or above Condyles will be positioned too anteriorly, beyond 6mm, resulting in a reduction of horizontal angle while programming the articulator.

36. Centric interocclusal records – It has to be perforated, there should be no gap between the split cast and the centric should be properly placed with pin in designated slot on tracing platform. Protrusive interocclusal records- Elevate the incisal pin and loosen the thumbscrews of condylar guidance. Seat the protrusive record and note the reading on the horizontal condylar guidance. Then calculate the, L=H/8+12 Purpose of the protrusive jaw relation record is to adjust the condylar elements of the articulator so that they will present inclinations which are, as nearly possible, similar or equivalent to those in the temporomandibular articulation It allows the clinician to extrapolate all mandibular movements : maximum intercuspation (MIP), protrusive end to end, lateral excursive and the pathways to them

37. INTRA ORAL TRACING

38. Intra – oral Extra – oral The intra oral tracings cannot be observed during the tracing Extra oral tracings are visible and can be observed during the tracing Since the intraoral tracings are small, it is difficult to find true apex Tracings are larger and so the patient can be directed and guided during the movements The stylus cannot be observed in the apex of the tracing. If the patient moves the mandible before the occlusion rims are secured, the accuracy of the record is destroyed The stylus can be observed in the apex of the tracing during process of injecting plaster between the occlusion rims

39. Classifications of arrow point tracings TYPICAL Well defined apex with a symmetrical left and right lateral tracings The mean gothic arch angle is about 120 º Reflects a healthy TMJ without interferences in condylar path and balanced muscle guidance Symmetrical form indicates an uniform movement of the condyle in fossa and distal slope of eminence with symmetrical balanced muscle guidance FLAT FORM The gothic arch angle is >120 º It has more obtuse left and right lateral tracings It signifies a marked lateral movement of condyle in the fossa ASSYMETRICAL FORM The left and right lateral tracings meet in an arrow point; however their inclination to the protrusive path is not symmetrical One of the lateral tracing is shorter Indicates an inhibition of the forward movement because of restricted movement of one joint; either in left or right joint

40. APEX ABSENT / ROUND FORM Incomplete retrusive movement Movement of record bases MINIATURE ARROW POINT The extension of tracing is very limited This can be due to restricted mandibular movements improper seating of record bases, and painfully fitting record bases during registration Also an indication of a long period of edentulousness with an inhibition in condylar movements DOUBLE ARROW POINT It is a record of habitual; and retruded centric relation It is also seen when vertical dimension is altered during registration Allow patient training and repeat till a single gothic arch is obtained

41. DORSALLY EXTENDED ARROW POINT The protrusive path extends beyond the apex of the gothic arch Signifies a forced strained retrusive movement of the lower jaw Sometimes caused by the forward displacement of upper occlusal rims or backward dislodgement of lower occlusal rim while removing them from the mouth It can also occur when head of the patient is tilted too far posteriorly. INTERRUPTED GOTHIC ARCH Break or loss of continuity of lateral incisal path of gothic arch. This happens due to posterior interference at the heels of occlusal rims during lateral movements Check for posterior clearance before recording ATYPICAL FORM Protrusive component does not meet at apex but on one of the lateral path This may happen if faulty muscular pattern is present due to parafunctional habits Also seen in very old edentulous patients, who are using complete denture with incorrect centric relation.

42. WHY GOTHIC ARCH TRACINGS? Verifies centric relation position most accurately Store the records for future To set the horizontal condylar guidance

43. LIMITATIONS OF GRAPHIC METHOD It is preferred in good edentulous ridges with normal inter-arch relation Arrow point tracing is difficult in excessively resorbed and flabby ridges as it causes instability of the recording bases and this restricts its use. It is not indicated when there is inadequate inter arch distance, as it is difficult to accommodate the tracing device without increasing the vertical dimension A sharp arrow point cannot be traced in persons with TMJ arthropathy. In these instances conventional wax closure method is the alternative choice

44. HANAU H2 Horizontal Condylar Guidance

45. CARE AND MAINTENANCE CLEANING- Use a mild soap and water solution with the aid od a brush to dissolve accumulations of wax and to wash away carborundum grit. Then air dry and lubricate. DO NOT use strong detergents, alkalis, gasoline or naphtha as cleaning agents. LUBRICATION- Lubricate the working and bearing components with a thin film of sewing machine or high speed hand piece oil. Wipe off excess oil to prevent accumulation of dust or grit A thin coating of petroleum jelly must be applied to all articulator surfaces that will be contacted by the gypsum mounting material. STORAGE- Store the articulator in a clean, dry atmosphere free of plaster and carborundum dust; away from acids, alkalis or corrosive medicaments. Wait a full day after mounting casts before storing the articulator in a carrying case or corrugated carton. Moisture dissipation from the stone in an enclosed area causes alkalinity of the stone mixture which can damage the articulator surface

46. CONCLUSION The accurate articulation of the maxilla to an articulator is essential for achieving optimal outcomes in prosthodontic treatment. The use of precise mounting techniques, such as facebow transfer and interocclusal records, ensures that the articulator mimics the patient's maxillomandibular relationship, enabling the fabrication of prostheses that function harmoniously with the patient's natural occlusion. Despite the availability of digital technologies, the facebow transfer technique remains a cornerstone in prosthodontics, highlighting its continued relevance and importance in modern dental practice. gothic arch tracing remains a valuable tool in prosthodontics, offering a non-invasive and cost-effective, simple, reliable, and easy accessibility make it a valuable technique for prosthodontists seeking comprehensive assessments of mandibular movements and occlusal stability, ultimately contributing to improved patient outcomes in prosthodontic treatment.

47. REFERENCES Zarb GA, Hobkirk J, Eckert S, Jacob R. Prosthodontic treatment for edentulous patients: complete dentures and implant-supported prostheses. Elsevier Health Sciences; 2012 Mar 15. Winkler S. Essentials of complete denture prosthodontics. (No Title). 1979. Levin B, Richardson GD. Complete denture prosthodontics. A manual for clinical procedures. 2002:54-. Christiansen RL. Rationale of the face-bow in maxillary cast mounting. Journal of Prosthetic Dentistry. 1959 May 1;9(3):388-98. Brandrup- Wognsen T. The face-bow, its significance and application. The Journal of Prosthetic Dentistry. 1953 Sep 1;3(5):618-30. Quran FA, Hazza’a A, Nahass NA. The position of the occlusal plane in natural and artificial dentitions as related to other craniofacial planes. Journal of Prosthodontics: Implant, Esthetic and Reconstructive Dentistry. 2010 Dec;19(8):601-5. N air CK. Programming the semiadjustable articulator. Trends in Prosthodontics and Dental Implantology. 2011 Jul 21;2(1):12-4. Rubel B, Hill EE. Intraoral gothic arch tracing. New York State Dental Journal. 2011 Aug 1;77(5):40.

48. Wilkie ND. The anterior point of reference. The Journal of prosthetic dentistry. 1979 May 1;41(5):488-96. MANUAL II. HANAU™ WIDE-VUE ARCON ARTICULATORS AND WIDE-VUE II ARTICULATORS. Myers M, Dziejma R, Goldberg J, Ross R, Sharry J. Relation of Gothic arch apex to dentist-assisted centric relation. The Journal of prosthetic dentistry. 1980 Jul 1;44(1):78-81. Langer A, Michman J. Intraoral technique for recording vertical and horizontal maxillomandibular relations in complete dentures. The Journal of Prosthetic Dentistry. 1969 Jun 1;21(6):599-606. T Ashish., et al. “An Understanding of Gothic Arch Tracing- A Clinical and Academic Rapid Review". Acta Scientific Dental Sciences 6.9 (2022): 40-48 Rubel B, Hill EE. Intraoral gothic arch tracing. New York State Dental Journal. 2011 Aug 1;77(5):40. Mishra A, Palaskar J. Effect of direct and indirect face-bow transfer on the horizontal condylar guidance values: A pilot study. J Dent Allied Sci. 2014 Jan 1;3:8-12. Gajavalli SM, Kranthikiran G, Burugupalli P, Raju AR, Sajjan MS, Nair KC. An insight into Gothic arch tracing. Trends Prosthodont Dent Implantol . 2019;10:5-10. Frank R.Lauciello , D.D.S., and Marc Appelbaum, D.D.S., "Anatomic Comparison to Arbitrary Reference Notch on Hanau™ Articulators," Journal of Prosthetic Dentistry, December 1978, Volume 40, Number 6, Pages 676-681 Gonzalez JB, Kingery RH. Evaluation of planes of reference for orienting maxillary casts on articulators. The Journal of the American Dental Association. 1968 Feb 1;76(2):329-36.