Establishing the bite and preparing models for laboratory construction of Mandibular Stabilizing Splints using Denar-Witzig Articulator

The following steps are suggested for construction of mandibular stabilizing splints on a Denar -Witzig articulator.  Dr. Witzig has used these methods in his practice and found them to create the most success for placing the condyles in a healthy position.

1. Take the full arch, upper and lower alginate impression. The full reproduction of the teeth, hamular notch and retromolar pad should be present with no voids or bubbles.  Pour the impressions in lab stone or ortho stone, not plaster.

2. "Zero" all settings, as per instructions in the manual, for Denar-Witzig Articulator.

3. Do a face bow mounting of the upper model on the Denar-Witzig articulator.

4. Mount the lower model in interocclusal contact.  No occlusal bite record should be used.  If there are missing molars with no posterior contact a bite rim should be used for taking x-rays as well as mounting the lower model.

5. Take Transcranial x-rays in three positions, clenched interocclusal contact, rest position, and fully open. NOTE: When taking transcrainials it is important that the top of the cassette is parallel to the floor and the patient's optic plane or Frankfort horizontal is parallel to the floor so there is a horizontal reference plane when tracing your transcranials.

6. Using the interocclusal contact x-ray view, do a vector analysis to locate the new position in which to place each condyle.  A Gelb 4/7 position is a reliable reference point.

7. The silver button lock on top of the articulator must be unlocked before adjusting articulator.

8. Open the anterior by adjusting the anterior pin 5mm before starting to adjust the articulator.  This will keep the anterior teeth from fracturing as you make the necessary adjustments.

9.  Adjust the articulator as per the numbers learned from the Denar-Witzig articulator manuals or the tables .

10. Adjust the anterior pin settings to desired vertical.

11. Make the Tak Hydroplastic or Myo-print occlusal record on the articulated models on the newly adjusted Witzig-Denar articulator.  It is advisable to make three records:  Use one in the mouth during transcranials x-ray. (see step #12).  This one also may be used as a temporary splint for the patient.  The second to send to the laboratory as a construction bite.  The third to be kept with the patient's records for future reference.

12. With the teeth firmly seated in the Tak Hydroplastic or Myo-print bite, take a new set of transcranials x-rays to verify that the condyle is in the desired position.  If there is a discrepancy, redo the vector Analysis, reset the Denar-Witzig articulator, take a new bite, and retake the transcranials.

13. When the condyle is in the proper position and the vertical is correct, record the following measurements from the Denar-Witzig Articulator: Left condylar angle and length of movement, right condylar angle and length of movement, also anterior pin setting.

Send the following item to the laboratory:

1. The mounted models on the mounting plates. Do not send the articulator.

2. The Tak Hydroplastic or Myo-print bite record.  Pack in a retainer box to protect it.

3. Index card with doctor's name, patient's name, articulator settings, and anterior pin vertical setting indicated.

4. Copy of the transcranials tracing.

5. Prescription detailing splint construction.  Indicate if you would like the mandibular stabilizing splint made different than the standard construction as follows:

• Splint is made of clear acrylic

• Ball clasps

• Occlusal pattern is almost a negative of upper posterior

• Anterior slightly out of contact

The function of a splint is like a cast on a broken leg. it must be worn full time, including while eating, to let the joint heal.  After all, you wouldn't take a cast off to walk and expect the leg to heal!

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