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Dental Tribune United Kingdom Edition

A ll dentists have articu- lating papers as part of their armamentarium to make occlusal adjustments. However, we often don’t ap- preciate the subtle differenc- es between the many papers and products that exist. The purpose of this article is to recommend a small number of well-designed products by one well-known manufacturer which will enable you to deliv- er a very high standard of den- tal care when assessing and adjusting occlusal contacts. Clinical tips Shimstock holds The BK38 Arti-Fol® 8mm wide metallic uncoated Shimstock- film (12µ) is a high-tech test film made of metallic poly- ester-film. It is antistatic and can be easily held on the end of the Miller type forceps. The film is extremely tear resist- ant and is used for resilience testing i.e. making a note of “shimstock holds” before any treatment is carried out. Always record a “shimstock hold” before a tooth (or teeth) is prepared. Then ensure this is re-established when the provisional restoration has been fitted. This also applies when assessing the labora- tory made restoration on the master model (against the op- posing model), and once the restoration has been cement- ed in the mouth. By making a simple note of the shimstock hold (on teeth that are not to be prepared) ensures time saving, accuracy and minimal adjustments to the occlusal surfaces of finished laboratory made restorations. Bite registration & Shim- stock holds An excellent tip is to hold Shimstock-film between the posterior teeth (where there was a hold) during bite regis- tration. As the bite registration material (eg Luxabite from DMG) is setting, resilience testing is carried out to verify with certainty the accuracy of the bite registration. This can then be recorded for the den- tal technician. Help from the dental assistant Let your dental nurse help by holding two articulation forceps bilaterally each time, as well as using gauze (to dry the occlusal surfaces), blow air from the “three in one” syringe and saliva as- piration to ensure a dry field and maximum efficiency when checking for markings. The dentist can then concen- trate more with the fine ad- justments using the fast hand piece bur and avoid stopping too many times. This will make the procedure more ef- ficient and also make it easier for the patient. The “two phase articulation system” I advise you make the first oc- clusal contact markings with BK51 paper (Progress 100 blue paper (100µ)). This paper is recommended to use initially mainly for fixed restorations. It is a smooth fibre reinforced paper with progressive colour transfer. It can even mark well on wet surfaces due to the transculase® bonding agent. The paper also marks difficult surfaces such as highly pol- ished crowns. It is better to use two ar- ticulation forceps placed bi- laterally. This paper is thicker and unilateral use may not be ideal due to imbalance caused in the occlusion system (in- cluding the TMJ). This is then followed by using the BK31 Arti-Fol® me- tallic red paper (12µ) which marks clearly the middle of the relevant blue marks. The red spots will then be the ex- act spots to remove in the oc- clusal adjustments. There- fore, one typically sees a blue larger zone, with a clear halo in between and a red spot in the middle. The BK 31 paper affords a unique combination of a high- tech metal foil (Shimstock foil 12µ) and a two-sided col- our coating with microfinely ground colour pigments which enable clear visible marking of all occlusal contact points. The paper also marks moist occlusal surfaces. Occlusal splint adjustments The BK28 Arti-Fol® metallic black/red paper (12µ) paper is ideal for occlusal splint ad- justment due to the ability to mark the centric and eccen- tric positions thanks to the two different colours. Interproximal tight contacts The BK35 Arti-Fol® 8mm wide metallic red (one sided) Shimstock-film (12µ) is use- ful for checking approximal contact points when fitting dental bridges, crowns or ve- neers. Since the back of the film is metallic, it is obvious which side is colour-coated and which is not. Articulation forceps There are two different articulation forceps that are useful for everyday practice: the BK132 Articulating Pa- per Forceps and the BK 145 Arti-Fol forceps. The for- mer is a high quality forceps with excellent fixation of the paper, as well as the ability to firmly hold the 8mm Shim- stock film on the end due to a strong grip. The latter will hold the BK35 8mm test film for approximal contact area assessment. I normally have two of the BK132 forceps ready with the Progress 100 paper and also two of the forceps with the BK31 red paper ready on each of the procedure trays. Al- though this results in a higher initial outlay for articulating forceps, I have found this to be time saving and therefore better in the long run. Articulating paper to check denture contacts One of the best papers for checking denture occlusion is the BK 81 Bausch micro- thin Articulating Paper (60µ) which is thin and tear resist- ant and is coated with liquid colours on both sides. The paper is also available in the horseshoe-shape. This paper is useful for marking den- tures; the two colours can be used for centric and excursion markings. The horseshoe-shaped ar- ticulating papers are also es- pecially useful for patients who tend to bite unilaterally during the occlusion test due to diminished resilience. The dentist can imme- diately detect the preferred side of the mouth. Symmetri- cal marking of all contacts is desirable especially when testing the occlusion of full dentures which are primar- ily adjusted according to the concept of bilateral balanced occlusion. Even marking of the full dental arch is essential when adjusting an occlusal device. In this respect, horseshoe- shaped papers provide a wel- come relief especially when testing occlusal contacts on moist artificial surfaces. Checking crown fits and denture clasps Articulation papers & occlusion tips Dr Ashish Parmar gives clinical tips for deal with occlusal contacts ‘The horseshoe-shaped articulating papers are also especially useful for patients who tend to bite unilaterally during the occlu- sion test due to diminished resilience’ Fig 1 Fig 2 Fig 2.5 Fig 3 Fig 4 Fig 4.5 April 15-21, 201314 Clinical United Kingdom Edition14