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References

Dawson PE Determining centric relation. Functional Occlusion from TMJ to Smile Design.St Louis, MO, USA: Mosby; 2007
Long JH Locating centric relation with a leaf gauge. J Prosthet Dent. 1973; 29:608-610 https://doi.org/10.1016/0022-3913(73)90267-9
Lucia VO A technique for recording centric relation. J Prosthet Dent. 1964; 14:492-505 https://doi.org/10.1016/S0022-3913(64)80017-2
Gaikwad AM, Tamore S Fabricating an inexpensive leaf gauge deprogrammer from panoramic radiographic film. J Prosthet Dent. 2019; 122:339-340 https://doi.org/10.1016/j.prosdent.2019.04.027
Carroll WJ, Woelfel JB, Huffman RW Simple application of anterior jig or leaf gauge in routine clinical practice. J Prosthet Dent. 1988; 59:611-617 https://doi.org/10.1016/0022-3913(88)90081-9
Goto Y, Shor A, Chigurupati K, Rubenstein JE A light-polymerized resin support tray as an aid for recording centric relation. J Prosthet Dent. 2002; 87:578-580 https://doi.org/10.1067/mpr.2002.124203
Land MF, Peregrina A Anterior deprogramming device fabrication using a thermoplastic material. J Prosthet Dent. 2003; 90:608-610 https://doi.org/10.1016/j.prosdent.2003.09.011
Hartrick NE, Acker SR Digital mandibular arch restoration at an increased occlusal vertical dimension in one visit. Compend Contin Educ Dent. 2017; 38:44-50
Nassif M, Haddad C, Habli L, Zoghby A Materials and manufacturing techniques for occlusal splints: a literature review. J Oral Rehabil. 2023; 50:1348-1354 https://doi.org/10.1111/joor.13550

Fabrication of an anterior deprogramming and mounting device using a vacuum thermo-moulded sheet

From Volume 52, Issue 3, March 2025 | Pages 219-220

Authors

Kevin George Varghese

BDS, MDS, Assistant Professor, Department of Prosthodontics and Crown and Bridge, Christian Dental College, Ludhiana, Punjab, India

Articles by Kevin George Varghese

Email Kevin George Varghese

Nirmal Kurian

BDS, MDS, Associate Professor, Department of Prosthodontics and Crown and Bridge, Christian Dental College, Ludhiana, Punjab, India

Articles by Nirmal Kurian

Nishanth A Sudharson

BDS, MDS, Assistant Professor, Department of Prosthodontics and Crown and Bridge, Christian Dental College, Ludhiana, Punjab, India

Articles by Nishanth A Sudharson

Samiksha Wadhwa

BDS, Consultant Prosthodontist, GTB Hospital, Ludhiana, Punjab, India

Articles by Samiksha Wadhwa

Abstract

Fabrication of an Anterior Deprogramming and Mounting Device using a Vacuum Thermo-moulded Sheet

Article

The significance of anterior bite stops in locating centric relation primarily lies in their efficiency as muscle deprogrammers.1 Deprogramming is attained by the separation of posterior teeth to hinder the influence of deflective posterior interferences on the musculature.2 This helps in the relaxation of lateral pterygoid muscles, resulting in complete seating of the condyles against the articular eminence in centric relation.2

Several methods have been described in the literature to achieve muscle deprogramming, such as using leaf gauges made from mylar strips as well as panoramic radiographic films, directly fabricated anterior deprogramming devices and lucia jigs.1,2,3,4,5,6,7

This article presents a straightforward technique that facilitates the clinician to fabricate an anterior deprogramming device using a vacuum thermo-moulded sheet. Additionally, the device can be used to mount models in an articulator to facilitate three-point contact during the articulation procedure.

Technique

  • Create an anterior bite plane in the palatal surface of maxillary anterior teeth using a pattern resin material (GC pattern resin, GC America, Alsip, USA) (Figure 1).
  • Adapt the vacuum thermo-moulded sheet (EasyVac Gasket, 3A Medes, Goyang, South Korea) of 1.5mm or other desired thickness over the maxillary cast and trim the vacuum thermo-moulded sheet (EasyVac Gasket, 3A Medes) at the premolar region to allow space for the interocclusal record in the molar region (Figure 2).
  • Instruct the patient to sit in an upright position; the device of sufficient thickness, along with the acrylic bite plane fabricated in the first step, is placed in the patient's mouth to achieve posterior disocclusion (Figure 3).
  • Guide the patient into closure by bilateral manipulation technique until incisal contact occurs on the device and the posterior teeth are separated.7
  • Verify the centric relation and inject bite registration paste (Jet Bite, Coltene, Altstätten, Switzerland) between the posterior teeth (Figure 4)
  • Check the interocclusal bite registration record on the model for accuracy; after this, it can be accepted for mounting.
  • Place the vacuum sheet device and the anterior bite plane on the master cast after facebow transfer. Use the vacuum sheet as a third point of contact to stabilize the mandibular model when bite registration records are placed bilaterally in the posterior section (Figure 5).
    • Figure 1. Anterior bite plane using pattern resin on palatal surface of maxillary anterior teeth.
    Figure 2. Vacuum thermo-moulded sheet adapted over the cast.
    Figure 3. Verification of centric relation using deprogrammer device.
    Figure 4. Bite registration using interocclusal registration paste.
    Figure 5. Vacuum thermos-moulded device and interocclusal bite registration for mounting maxillary and mandibular cast in centric relation.

    The anterior stop from the vacuum sheet will prevent any possible tilt of models during the mounting process.

    Discussion

    Deprogramming, particularly through the use of anterior deprogrammers for muscle memory retraining and establishing centric relation, is a crucial component in achieving aesthetic and functional prosthodontic rehabilitation of occlusion.8

    The success of a deprogramming therapy depends on selecting the right material, considering factors such as biocompatibility, ease of fabrication, adjustability, cost and patient preference.9

    Although traditional methods to achieve muscle deprogramming create an anterior stop that helps seat the condyles in a superior position within the fossae, the registration of this material can be easily achieved if the anterior stop is held in place.

    This can be done by the use of a thermoplastic sheet fabricated over the anterior bite plane. The thermoplastic sheet is trimmed at the premolar region to provide enough space for the bite registration material in the posterior region. The thickness of the thermoplastic sheet can be chosen according to the desired amount of disocclusion in the anterior region for restoration based on the phonetic and aesthetic evaluation.

    Although the thermoplastic sheet is of a soft material and may be more comfortable to some patients compared with the hard acrylic splint, there may be slight movement of the deprogramming device. This can be overcome by ensuring complete seating of the device before the bite registration material is injected. Another limitation of this technique is the additional step involved in the fabrication of the deprogrammer.

    Summary

    Although the additional step required in the fabrication of the device is a limitation of this technique, the deprogrammer made from a vacuum thermo-moulded sheet serves as an anterior bite stop during the mounting of the mandibular cast on an articulator as compared with the conventional technique using a leaf gauge.