DENAR TRACK II SYSTEM instruction manual

Transcription

1 DENAR TRACK II SYSTEM instruction manual

2 ACKNOWLEDGEMENTS The Track II System was developed in answer to the many requests from clinicians, dental educators and practicing professionals throughout the world. Some of their design criteria included the need for an arcon tracking (enclosed condylar guidance) articulator and one that could accurately reproduce centric relation. Schools, particularly, asked for an articulator capable of accepting casts mounted on another articulator, i.e., transferability of casts from one articulator to another which is accomplished by means of a calibration system. We set these needs as our objectives and proceeded to accomplish the task with the help of many professionals. We are most grateful for the direction and assistance they provided us. A special word of appreciation is expressed to Dr. Alvin Filastre and his wife Helga for their contribution in the early design phases as well as continual support throughout the development. Special recognition is directed to the teaching staff of the Pankey Institute, with acknowledgement going to Drs, L. D. Pankey, Loren Miller, Fred Cory, Jim Potts, Mel Steinberg, Ed Quinn and Mr. Jack Snyder, for their support in ensuring that the system can be used by practitioners wishing to render quality dentistry through the incorporation of the principles of occlusion. We wish to acknowledge Professor Muroaka in Japan for his contributions and Dr. Sheldon Winkler for the time he spent working with us. Additionally, without the advice and support from many of the current users of Denar instrumentation, this project would not have achieved the success criteria for which we strived. Throughout the development process many different ideas were expressed. But, through it all, the common objective was to provide dentistry with a high quality occlusal instrumentation system. We believe we have accomplished this task. 2

3 FEATURES AND BENEFITS DESIGN Excellent lingual visibility Arcon construction Enclosed condylar guidance Secured upper and lower bows Stable and balanced in open position with mounted casts efficient method for precise medio-lateral bow alignment when an immediate side shift is introduced Inspection Gage ADJUSTMENT CAPABILITIES Protrusive adjustment 0 to 90 degrees Progressive sideshift 3 to 30 degrees Immediate sideshift 0 to 2 mm CR CO adjustment increments of.5 mm (maximum 2 mm) Extra long range of motion (15mm) allows for maximum lateral movement. CONSTRUCTION Precision manufacturing Rigid and durable, yet lightweight Easy to clean FUNCTION Centric positioner offers unique and Positive centric lock on each condyle Excellent stability in the inverted position Alignment verified using Field ADAPTABILITY Optional pin and incisal table combinations are available for added versatility. The Denar standard incisal pins are curved to simulate the arc of closure for varying vertical dimensions. 3

4 TRACK II ARTICULATOR Progressive Sideshift Adjustment Upper Bow Protrusive Adjustment Incisal Pin CO/CR Adjustment Incisal Table Centric Positioner Immediate Sideshift Adjustment Lower Bow Centric Lock Sideshift Adjustment Key 4

5 Table of Contents I. The Track II Articulator Centric Lock Operation 6 Centric Positioner 6 Adjustments 6 Articulator Manipulation 8 II. The Slidematic Facebow Assembling on the Patient 10 Transferring to the Articulator 12 III. Mounting the Casts Maxillary Cast 13 Mandibular Cast 14 IV. Setting the Condylar Controls Protrusive 15 Progressive Sideshift 15 Immediate Sideshift 16 Appendices A. Field Inspection Gage 18 B. D31 AB Facebow/Earbow 19 C. Care and Maintenance 20 D. Accessories 20 5

6 6 I THE DENAR TRACK II ARTICULATOR Centric Lock Operation The articulator has a separate lock for each condyle. They can be engaged simultaneously or independently of one another. To lock the articulator into centric relation, rotate the centric lock screws and the centric occlusion adjustment screws (Fig. 1) counterclockwise so that the condylar balls can travel without interference along the fossae tracks. CO/CR Adjustment Centric Lock Screw FIG. 1 Centric Positioner The Centric Positioner (Fig. 2) will accurately confirm the centric position of work in progress. When immediate sideshift has been introduced the centric positioner offers a unique and efficient method for precise medio-lateral bow alignment. It can be momentarily engaged or locked into place. To engage the centric positioner, simply push the pin up into the centric positioner slot (Fig. 3). This confirms centric. To lock the centric positioner twist the knob one half turn. To release the centric positioner either twist the knob in the reverse direction or complete the turn all the way. FIG. 2 Protrusive Adjustment screw Centric Position FIG. 3 Adjustments Protrusive Adjustment The inclination of the protrusive condylar path can be adjusted by loosening the protrusive adjustment lock screw (Fig. 2). The protrusive condylar path inclination scale is lateral to the protrusive adjustment lock screws, and is calibrated in increments of 5 degrees. The scale indicates from 0-60 degrees, however, the condyles will adjust to a full 90 degrees.

7 Immediate Sideshift Adjustment Immediate sideshift is set by moving the condyle balls out laterally. This is accomplished by inserting the sideshift key into the slot of the condyle ball (Fig. 4) and turning counterclockwise. Each 360 degree turn represents 1.0 mm of immediate sideshift. Maximum adjustment is 2.0 mm per condyle. Zero degrees is obtained by turning the slot clockwise until it stops. FIG. 4 Progressive Sideshift Adjustment The angle of inclination of the medial fossa wall to the sagittal plane can be adjusted by loosening the progressive sideshift adjustment lock screws (Fig. 5) and moving the fossa track from 5 to 30 degrees (Fig. 6). The scale for the progressive sideshift adjustment is posterior to the adjustment lock screw and is calibrated in 5 degree increments. FIG. 5 FIG. 6 Centric Occlusion Centric Relation Zero Out (Neutral Position) 1. Set progressive sideshift adjustment to Set the protrusive inclination adjustment at Back out the Red CR/CO screw to a neutral position until the end of the metal housing (containing the 1 mm graduation marks) is visible. 4. Tighten the Red CR/CO screw in a clockwise position until the first graduation line on the metal housing is flush with the back wall of the fossae track. Turn the screw in either direction (choosing the shortest distance with the least amount of rotation) until the black dot on the face of the Red CR/CO screw is in the "12 o'clock" position. Adjustment 1. Forward movement of the condyle is obtained by turning the CR/CO adjustment screws clockwise. Make sure that you loosen the centric lock screw so the condyle balls can move freely. Each 360 degree turn is equivalent to 0.5 mm of forward travel. Use the black dot on the red 7

8 8 FIG. 7 FIG. 8 adjustment screws to measure each 360 degree turn (Fig. 7). Each line on the scale represents 1 mm of forward travel. 2. The condyle can be locked with the centric locks to a maximum 2 mm forward from centric relation (Fig. 8). A scale is located on the lateral walls of the fossa housing and reads from 0 to 10 mm. Articulator Manipulation The Track II has enclosed condylar guidance enabling the operator to easily guide the articulator through lateral excursive and protrusive movements. Note: A design feature of this instrument is the ability to add additional thumb pressure to the upperbow which more closely simulates the anatomical muscular movements. To use the Track II properly the operator must master the proper movement techniques. The first are lateral excursive movements. To effect both left and right excursive movements a right handed person should grasp the back of the articulator with the underhand grasp as illustrated (Fig. 9). Remember that the articulator and mounted casts are only a facsimile of bone, joints and teeth. There are no muscles. The operator must provide the muscle force. It is very important that the back of the articulator be guided with positive pressure of the left thumb to insure that the condyles function in accord with the instrument settings. The operator should maintain a slight down and FIG. 9 FIG. 10

9 forward pressure with the left thumb in lateral excursive movements. In addition, when the incisal pin is pushed to the left, the back of the articulator should also be pushed to the left (underhand push grasp) (Fig. 10). Conversely, when the incisal pin is pulled to the right, the back of the articulator should be pulled to the right (underhand pull grasp) to ensure that the articulator functions in accord with its condylar adjustment settings. To effect a straight protrus movement the upper bow is moved straight posteriorly guided by both hands (Fig. 11). Adjustment Limitations The Track II has an extremely long condylar track allowing the condyles 15 millimeters of protrusive and lateral movement. This movement is limited to 11 mm when progressive sideshift is set to 30. FIG. 11 9

10 10 MEASURING BOW 4 1. earplug 2. anterior reference pointer 3. intercondylar distance scale 4. finger lockscrew 5. Center lock wheel 6. Sight reference plane locater 3 TRANSFER JIG ASSEMBLY dentulous bitefork 2. bitefork index notch 3. vertical shaft 4. articulator index 1 reference plane marker II THE SLIDEMATIC FACEBOW Facebow Transfer The facebow transfer procedure establishes the relationship of the maxillary dentition to the horizontal reference plane so that the maxillary cast may be mounted on the articulator in the correct anatomical position. The Slidematic Facebow provides a fast, easy and extremely accurate means of transferring the proper anatomical relationship to the articulator. Any Denar facebow may be used for mounting the maxillary cast to the Track II. In this chapter only the procedures relating to the Slidematic facebow are described. However, the Denar D31AB Facebow/Earbow may also be used (see Appendix B). Assembling the Slidematic on the Patient Mark the anterior reference point on the patient s right side using the Reference Plane Locator and Marker. The point is 43 millimeters above the incisal edge of the right central or lateral incisors (see Figure 12). On an endentulous patient, measure up from the lower border of the

11 FIG. 12 FIG. 13 FIG. 14 upper lip when it is in repose. Cover the metal with two thicknesses of baseplate wax softened in warm water (approximately 135 F or 55 C). With the bitefork arm to the patient s right, place the fork in the mouth, aligning the patient s midline with the index notch, so that it is parallel with the patient s coronal and horizontal planes (see Figure 13). Be certain to obtain a light indexing of the patient s maxillary arch and then ask the patient to hold the bitefork in place. Attach the vertical shaft to the measuring bow with the clamp marked #2 on the patient s right and tighten the finger screw (see Figure 14). It is necessary to tighten this finger screw to secure the vertical shaft to the measuring bow and also to avoid movement. This same movement will occur after inserting the vertical shaft in the articulator index as shown in Figure 23. Be sure to tighten the finger screw. Loosen the finger screws on the clamps marked #1 and #2 on the vertical shaft. With your thumb, loosen the center wheel on the top of the measuring bow and slide the bow open to accommodate the width of the patient s face. Assemble the facebow on the patient by sliding the bitefork arm through the hole in clamp #2 as the measuring bow s earpieces are placed in the patient s auditory meatus (see Figure 15). Tighten the center wheel on the measuring bow and loosen the finger screw on the anterior reference FIG. 15 pointer. Raise or lower the bow so that the pointer or sight aligns precisely with the anterior reference point (see figure 16) and tighten clamp #1, then clamp #2 (see Figures 17 and 18). When tightening clamps #1 and #2, care must be taken not to displace the bow to either side by having the vertical shaft rest on 11

12 FIG. 16 FIG. 18 FIG FIG. 17 the fingers as shown in Figure 17. The patient s inter-condylar distance is the measurement indicated on the scale (see Figure 19). Record this measurement. Loosen the finger screw on the measuring bow, slide the bow open, and remove the entire facebow from the patient. FIG. 19 Detach the measuring bow from the transfer jig by loosening the finger screw (see Figure 20). Having completed the procedures involving the patient, the bitefork assembly (see Figure 21) may be labeled with the patient s name and set aside while the measuring bow portion can be used with an additional bitefork assembly for the next patient. FIG. 21 Note: The metal bitefork, vertical shaft and earpieces can be sterilized in an autoclave EXCEPT for the black finger screws on the #1 and #2 clamps. Remove the finger screws (and spacers) before autoclaving or use cold sterilization. Sterilize bitefork before each use.

13 III MOUNTING THE CASTS A benefit of using the Denar Slidematic Facebow is that multiple transfer jigs may be used with only one measuring bow. Although it is not always recommended, the mounting of the maxillary cast can be delegated to the laboratory, involving no loss of accuracy and no period of time without facebow transfer capability in the dental office. The laboratory can attain an articulator index for their own Denar articulator and mount the maxillary cast using only the bitefork assembly from the dental office. Each articulator index positions the bitefork assembly on any Denar articulator so that the relationship with the condyles recorded on the patient is accurately reproduced on the articulator. Mounting the Maxillary Cast Replace the incisal table on the articulator with the articulator index (see Fig. 22). With the numbers on clamps #1 and #2 in the upright position, secure the reference pin of the bitefork assembly in the hole of the articulator index. Tighten the lockscrew on the front edge of the index (see Fig. 23). Attach a mounting plate to the upper bow. Be sure that the incisal pin is at the zero position and that the upper bow is level and parallel to the table top. FIG. 22 The position that the incisal pin sits on the articulator index is determined by the type of incisal pin being used. The incisal pin (110092) with the long centric adjustment foot (used with the or incisal table) sits on the highest section of the movable insert. The round long incisal pin (300042, used with the incisal table) sits in the center of the index. The round, short incisal pin ( ), used with the incisal table) sits on the movable metal piece in FIG. 23 the center of the index (see Fig. 24). In situations where the Slidematic facebow is being used with the same articulator, secure the movable metal insert with a drop of wax once the insert s appropriate location has been determined. 13

14 Mounting the Mandibular Cast Attach a mounting plate to the lower bow. A centric relation checkbite record is used to mount the mandibular cast. With the maxillary cast attached to the articulator and the centric locks engaged, invert the articulator and place the centric relation checkbite record between the maxillary and mandibular FIG. 24 Place the maxillary cast in the wax index on the bitefork, close the articulator, and mount the cast with stone to the mounting plate (See Fig. 25). Normally, a maxillary cast support is not necessary, although one may be used, if desired. Once the stone has hardened, remove the transfer jig and replace the incisal table in the articulator. FIG. 25 FIG. 26 casts (See Fig. 26). Stabilize the position of the casts with either a rubber band or sticky wax. Adjust the incisal pin to accommodate the increased vertical distance caused by the thickness of the centric relation bite record. 14

15 Double check to be certain that the condyles are seated against the rear of the fossae, and using stone, proceed to mount the mandibular cast to the mounting plate on the articulator (See Fig. 27). FIG. 27 IV SETTING THE CONDYLAR CONTROLS The Track II articulator features three condylar path of movement adjustments: 1) protrusive condylar path; 2) progressive sideshift and 3) immediate sideshift. The operator may select any of the following alternate methods for making these adjustments dependent upon his or her specific requirements and preference. PROTRUSIVE 1. Arbitrary method. Set to 30 degrees. (This inclination is sufficiently low to eliminate almost all protrusive interference.) 2. Checkbite method. Loosen the protrusive and progressive sideshift adjustments on both sides of the articulator. Disengage the centric positioner. Set the protrusive checkbite record on either cast. Move the opposing cast in the protrusive position and seat it into the checkbite record. If the cast does not seat accurately, apply very light pressure to the bow of the articulator and rock the protrusive adjustments back and forth until the most accurate seating of the casts into the record is achieved (Fig. 28). (This procedure must be done very carefully so as not to modify the record.) Lock the protrusive and progressive sideshift adjustment lock screws. PROGRESSIVE SIDESHIFT a. Average Anatomic Setting: = 7 b. Arbitrary Setting: = 7+ c. Lateral Checkbite (procedure explained below without incorporating the immediate sideshift) 15

16 16 IMMEDIATE SIDESHIFT 1. Arbitrary adjustment. Setting this adjustment to zero provides for tight coupling of the centric holding cusps in the position of maximum intercuspation. Increasing the immediate sideshift adjustment in treatment provides for greater lateral freedom in the position of maximum intercuspation. For example: 0 mm = tight intercuspation 0.5 mm = slight lateral freedom 1.0 mm = moderate lateral freedom 1.5 mm = greater lateral freedom 2. Lateral checkbite method. Condylar path of movement studies* have shown that in almost all patients once the immediate sideshift has occurred the orbiting (balancing) condyle moves forward on a path inclined 7 medially to the saggital plane (progressive sideshift). *Luncleen, Harry C. and Wirth, Carl G. Condylar Movement Patterns Engrated in Plastic Blocks, Journal of Prosthetic Dentistry, December 1973, pages Therefore in this technique, due to inherent difficulties and potentials for error in obtaining accurate lateral checkbite records and setting the articulator to these records, more accurate results can be achieved by assuming the patient has a progressive sideshift of 7 and using the lateral records only to set the immediate sideshifts. When setting the immediate sideshift adjustment to lateral checkbite records: a. Set both sides of the articulator to the following adjustments: Progressive Sideshift: 7 locked Protrusive: 30 unlocked Immediate sideshift: 2 mm (screws turned counterclockwise two full revolutions). b. Seat the right lateral checkbite record between the casts with the articulator in a right lateral mandibular bow position. While maintaining a slight pressure on the bows, rock the left protrusive path adjustment back and forth until the most accurate seating of the cast into the record is achieved. (This procedure must be done very carefully so as not to modify the record.) On occasion you will note that the cast will not seat accurately on the rotating side. (In this instance, right side.) This is because the patient s rotating condyle may have also moved up or down and backward or forward as it moved out and this condylar position was reflected in the checkbite record. However, seat it as accurately as the articulator will allow. To set the immediate sideshift turn the right adjustment screw clockwise with the key provided until the screw head lightly touches the lateral aspect of the condylar element. Now remove the checkbite record and lower the incisal pin to disengage the posterior teeth and lock it in this position. With the key provided turn the immediate sideshift adjustment screw clockwise and count the revolutions required to achieve the most close position. The thread of the screw provides for 1 mm of immediate sideshift for each complete 360 revolution. A quarter turn (90 ) represents 0.25 mm of immediate sideshift. Now the measurement has been made and should be recorded on the patient s record. Resetting the

17 immediate sideshift to this measurement will allow the instrument to more faithfully simulate the immediate sideshift of the patient. The measurement of the left immediate sideshift is done in the same manner utilizing a left lateral checkbite record. DISCUSSION: A lateral checkbite record is a positional record in that it records only one position of the orbiting condyle. This condylar position reflects the patient s unique combination of any immediate and progressive sideshift movements. However, there are many combinations of immediate and progressive sideshift articulator adjustments which can achieve this same condylar position. In the past many articulators had only progressive sideshift adjustments without any provision for immediate sideshift movement. When lateral checkbite records were used to set such an instrument the total sideshift was reflected in the articulator only as progressive sideshift. One school of thought contends that in this usage the cusps tend to be more tightly coupled in the position of maximum intercuspation, generally requiring more occlusal correction on insertion of the restoration and the cuspal inclines of the posterior teeth tend to be more reduced because of the greater progressive sideshift adjustment. Restorations developed on an instrument that produces an immediate sideshift will typically feature a greater freedom (and possibly less occlusal correction on insertion) in the position of maximum intercuspation. In this usage, since the total sideshift is divided into immediate and progressive components, the progressive component decreases as the immediate component increases to arrive at the same condylar position recorded by a lateral checkbite record. The contention is that this will result in increasingly steeper cusps especially in the area of the balancing inclines of posterior teeth on the orbiting (balancing) side. As previously stated, when an articulator featuring both immediate and progressive sideshift adjustments is set to lateral checkbite records, one procedure is to set the progressive sideshift to the average anatomy dimension of 7, and use the lateral records to measure only the immediate sideshift components. The protrusive adjustment is set to the protrusive checkbite records. These articulator settings are used in diagnostic procedures and occlusal analysis. In treatment procedures the progressive sideshift adjustments may be increased to 7 + to insure non contact of the balancing inclines (buccal lingual) of cusps on the orbiting side. The greater the increase in the progressive sideshiftmovement the greater the clearance of these cuspal inclines (ie., a 15 setting will provide for greater clearance than a 10 setting). 17

18 18 APPENDIX A FIELD INSPECTION GAGE An added benefit of all Denar articulators is that they can be calibrated so that mounted casts can be transferred with precision from one articulator to another. The Denar Field Inspection Gage (D7) accomplishes this calibration by aligning the horizontal and vertical relationships by means of three dimensional adjustments of the articulator. Thus, a restoration can be in progress on the laboratory s articulator while the doctor s or student s articulator is free for other restorations. Note: When calibrating the Track II articulator the vertical adjustment is made by an elliptical action of the condylar shaft where it connects into the lower bow. To adjust vertical height, loosen the two condylar shaft lock screws (Fig. 29). Insert the sideshift key into the slot at the end of the condylar shaft (Fig. 30). Turn the condylar shaft slowly clockwise. (Do not turn counterclockwise for vertical adjustment.) The vertical movement can be observed by watching the dial indicator on the Field Inspection Gage. Continue to turn the FIG. 29 FIG. 30 FIG. 31 Condylar shaft Lock Screws Horizontal Adjustment Lock screws condylar shaft clockwise until a zero setting is obtained. This procedure will be the same for both sides. Note: When you change the height of one condyle it affects the readings on both dial indicators. When at zero settings check to see that the instrument dials stay within plus or minus 1-1/2 thousandths of an inch (±.0015). The horizontal adjustment is made by loosening the horizontal adjustment lock screws on both sides of the articulator the minimum amount necessary to allow horizontal movement of the horizontal crossbar (Fig. 31). Engage the centric positioner of the articulator. While maintaining slight downward pressure on the horizontal crossbar of the lower member of the articulator to keep the horizontal crossbar seated flush on the crossbar supports, slide the horizontal crossbar in the horizontal plane until the centric dots are on the junction of the crossbar targets as viewed through both scopes and stay within five thousands of an inch (±.005 inch). Then while carefully maintaining the crossbar position incrementally tighten in a criss-cross sequence the four horizontal adjustment lock screws.

19 For additional operation procedures on the Field Inspection Gage, please refer to the Instruction Manual enclosed with the gage. APPENDIX B D31AB FACEBOW/ EARBOW The Denar D31AB Facebow/Earbow is another accessory facebow that can be used to establish the relationship of the maxillary structures to the horizontal and vertical reference plane so the maxillary cast may be mounted on the articulator in the correct anatomical position. The Denar D31AB Facebow/Earbow provides an extremely accurate means of transferring the casts through either earbow or facebow registration. The use of the D31AB involves three simple procedures: a. Locating three reference points: one anterior and two posterior, either the ears or the hinge axis. b. Assembling the facebow/earbow on the patient. c. Transferring the facebow/earbow to the articulator. The Denar D31AB Facebow/Earbow consists of standard facebow/earbow sidearms, crossbar, dentulous bitefork, and all necessary accessories. Order part # When using as an earbow transfer to hole on side of fossa as pictured. 19

20 APPENDIX C CARE AND MAINTENANCE Your Whip Mix articulator is a precision instrument and requires care and maintenance. Periodic cleaning and lubricating as described below will assure prolonged life and dependable service from the instrument. Failure to follow these instructions will void your warranty. Cleaning Use a mild soap and water solution with the aid of a brush to dissolve accumulations of wax and to wash away carborundum grit. Then air dry and lubricate. DO NOT use strong detergents, alkalies, gasoline or naphtha as cleaning agents! Lubrication Lubricate the working and bearing components with a thin film of sewing machine or high speed handpiece type oil. Wipe off excess oil to prevent accumulations 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, alkalies, or corrosive medicaments. Wait a full day after mounting casts before storing the articulator in a carrying case. Moisture dissipation from the stone in an enclosed area causes alkalinity of the stone mixture which can damage the articulator surface. APPENDIX D ACCESSORIES Incisal Pins and Tables P2T2 Pin: Long Centric/ Adjustable Foot (110093) Table: Custom Platform, step (110241) P2T3 Pin: Long Centric/ Adjustable Foot (110093) Table: Adjustable (110109) 20

21 P4T4 Pin: Short Round with support (300270) Table: Custom Platform, flat (110240) P6T6 Pin: Tapered (110509) Table: Adjustable (110635) Maxillary Cast Support (101217) D31AB Facebow/Earbow (See Appendix B) Slidematic Facebow with three Denar transfer jigs; ( ) Disposable Mounting Plates, bag of 10 ( ) 21

22 Magnetic Mounting System Converter Plates ( ) Disposable Magnetic Mounting Plates, bag of 20 ( ) Articulator Carrying Case ( ) WARRANTY Whip Mix Corporation warrants the articulator system to be free from defects in material and/or workmanship for a period of one year. In the event of a defect, please notify the factory in writing of the defect prior to returning the instrument. Whip Mix Corporation will, at its option, either repair, replace or issue credit for such defects. Because Whip Mix Corporation is continually advancing the design of its products and manufacturing method, it reserves the right to improve, modify or discontinue products at any time, or to change specifications or prices without notice and without incurring obligations. 22

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24 Whip Mix Corporation - West 1730 East Prospect Rd., Suite 101 Fort Collins, CO Toll-Free: Fax: Whip Mix Corporation Denar and logo are registered trademarks of Whip Mix Corporation FN 8111-F AD R0608