DENTAL TECHNIQUE

Printing and mounting digital casts in the centric relation

position for use on an analog articulator: A dental technique
Lauren L. Lustig, BS,a Weslie Williams, BS,b and David Gozalo-Diaz, DDS, MSc

Digital dentistry is becoming ABSTRACT

ubiquitous in private practice,
A technique for recording, printing, and mounting digital casts in centric relation is described.
opening up innovative ways to Combining elements of analog and digital workflows, centric relation records can be transferred
address dental care and giving by digital scanning and used to align casts for articulation. This method is useful to the clinician
patients and providers adapting to digital workflow or preferring a physical semiadjustable articulator in conjunction
increased options for treat- with digital scans. (J Prosthet Dent 2021;125:581-4)
ment.1 In particular, digitally
scanned impressions and 3D printed casts are popular on the path from centric occlusion to MI can be detected.
substitutions for irreversible hydrocolloid impressions Many clinicians consider CR to be essential for complete-
and stone casts. While scanning an impression is a mouth rehabilitations, the restoration of posterior teeth,
straightforward concept, transferring other patient in- and the management of patients with temporomandibular
formation, including the facebow and centric relation disorders.5 Being able to quickly and efficiently apply CR
(CR), may present challenges. records to a digital workflow is therefore advantageous.
The most common anatomic position used to align Multiple methods are available to articulate printed
digital scans is maximum intercuspation (MI). After scan- digital casts, with plastic nonadjustable single hinge artic-
ning both maxillary and mandibular arches, the occlusion is ulators being commonly used. Their use requires little
recorded by scanning the buccal surfaces while the patient effort on the part of the clinician but provides limited
assumes MI. Spatial and surface recognition then aligns the diagnostic information. The nonadjustable articulator is
arches to the MI scan. Research on using CR as the primary incapable of lateral excursions, protrusion, or analyzing
2
method to align digital scans is sparse, although it may be slides from centric occlusion to MI. To evaluate the full
the preferred anatomic position for various dental treat- envelope of motion, a semiadjustable or fully adjustable
6
ments. CR is defined by the Glossary of Prosthodontic articulator is recommended. In addition, a facebow
Terms as “the maxillomandibular relationship in which the transfer is essential when using an articulator; evaluating
mandibular condyles articulate in the most anterior-superior CR is contingent on the hinge-axis motion upon closure.7
position against the posterior slopes of the articular emi- By using physical articulators for dental laboratory pro-
nences; in this position, the mandible is restricted to a purely cedures is considered standard protocol, and many virtual
rotary movement. It is a clinically useful, repeatable, tooth- articulators still require a physical articulator to be scanned
8
independent reference for anatomical movement of the into the software program. The technique described in this
3
mandible.” The inferior lateral pterygoid muscles are article will provide the clinician with a printed cast which
relaxed, the muscles of mastication are most coordinated, can be immediately mounted in physical articulators.
and interference-free occlusion can be established in this Therefore, an intraoral 3D scanner can easily record a pa-
4
position. By using CR records to mount casts, interferences tient in CR, and the digital scan can be printed in CR.

a
DDS Candidate, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo.
b
Program Assistant, Department of Restorative Dentistry, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo.
c
Associate Professor and Director, Implant Prosthodontics, Department of Restorative Dentistry, School of Dental Medicine, University of Colorado Anschutz Medical
Campus, Aurora, Colo.

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Figure 1. Deprogramming patient to first contact using leaf gauge. Figure 2. Screenshot from 3Shape TRIOS after aligning arches to centric
relation scan.

Figure 4. Bases and pins placed on digital cast in 3Shape Dental System
Figure 3. Screenshot of 3Shape Dental System Model Builder,
Model Builder.
demonstrating how to highlight teeth in cast.

TECHNIQUE
8. Select “model module” and choose “unsectioned
1. Make digital scans of the mandible and maxilla option.”
with an intraoral scanning device (TRIOS 3, Soft- 9. Click “Ok” and import the maxillary scan,
ware (2015-1), v1.4.7.3; 3Shape A/S) mandibular scan, and occlusion scan as requested
2. Use a leaf gauge to deprogram the patient to the by the program.
first contact of teeth (Fig. 1).9 10. Once the files are uploaded, select “build model.”
3. Add 4 to 7 leaves to the gauge before scanning. 11. Trim the cast to have smooth gingival margins and
4. Scan the buccal relationship of the teeth at CR. set the occlusal plane.
Scanning 3 to 5 teeth should be sufficient. The 12. Open articular interface and select the base
program should automatically align the teeth or desired. Here, simple Full Arch v2.3 was used.
ask the user to confirm the alignment (Fig. 2). 13. Position the articulating pins and base as desired.
5. Download the standard tessellation language files For each articulator, the base dimensions may need
of the mandible, maxilla, and CR scan to a digital to be altered to be properly mounted. Generally, a
program capable of aligning the casts (3Shape tripod is created with 1 pin in the anterior of the
Dental System Model Builder 2018; 3Shape A/S). cast and 2 pins in the posterior (Fig. 4).
6. Open the Model Builder and start a new session. 14. Print the digital scans. Here, a FormLabs printer
7. Highlight and select the teeth which are present on was used (Form 2 printer by using PreForm 3.2.0
the scans (Fig. 3). software; FormLabs).

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April 2021 583

Figure 5. Printed maxillary cast mounted on facebow. Figure 6. Mounted casts before pin removal.

Figure 7. Mounted casts on semiadjustable articulator (Model 4641Q;

Whip Mix Corp). Figure 8. Mounted casts after pin removal.

15. Mount the maxillary cast on an analog articulator. DISCUSSION

A facebow is recommended for determining the Printing digital casts with articulating pins allows for
maxillary relationship to the temporomandibular convenient mounting on an analog articulator. When
joint (Fig. 5). Once the maxillary cast is mounted to comparing these digital casts with analog casts mounted
the articulator, connect the pins of the maxillary with polyvinyl siloxane CR records, the first contact was
cast to the corresponding pins on the mandibular identical. The advantages of this technique include being
cast. The mandibular pins act as female compo- able to accurately align digital casts in CR, being able to
nents. They have small depressions at the end of transfer that alignment to a printed cast, simplifying the
their columns, which allow the maxillary pins mounting of those casts on the articulator, and being able
(male components) to seat into the depressions to use the cast for further diagnostics or transfer to a
(Fig. 6). The male and female components can be virtual articulator. Possible modifications may need to be
held together by using modeling plastic impression made to the dimensions of the cast base depending on
compound (Impression Compound Type 1 Green; the articulator used.
Kerr Corp) during mounting of the mandibular cast.
16. After the mandibular cast is mounted on the
SUMMARY
articulator (Fig. 7), the articulating pins can be
removed (Fig. 8) by using an acrylic resin trimming Intraoral 3D scanning devices can process CR informa-
bur (1108.11 BrasselerUSA: All Purpose E-Cutter tion for digital casts that may be printed in CR by using
System; Brasseler). articulating pins in the 3Shape Dental System Model

Lustig et al THE JOURNAL OF PROSTHETIC DENTISTRY

584 Volume 125 Issue 4

Builder. This technique increases the utility and effec- 7. Weinberg LA. An evaluation of basic articulators and their concepts: part II.
Arbitrary, positional, semi adjustable articulators. J Prosthet Dent 1963;13:
tiveness of digital dentistry for the clinician interested in 645-63.
combining digital and analog methods. 8. Solaberrieta E, Minguez R, Barrenetxea L, Sierra E, Etxaniz O. Novel meth-
odology to transfer digitized casts onto a virtual dental articulator. CIRP J
Manuf Sci Technol 2013;6:149-55.
9. Carroll WJ, Woelfel JB, Huffman RW. Simple application of anterior jig or leaf
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School of Dental Medicine
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University of Colorado Anschutz Medical Campus
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Email: [email protected]
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Noteworthy Abstracts of the Current Literature

Polyetheretherketone in implant prosthodontics: A scoping review

Andrea Paratelli, Giammarco Perrone, Rocío Ortega, Miguel Gómez-Polo

Int J Prosthodont Nov/Dec 2020;33:671-9

Purpose. To undertake a scoping review of the available research on the application of polyetheretherketone (PEEK) in
implant prosthodontics, map the available literature in order to highlight possible gaps in knowledge and, if possible,
extract clinical guidelines.

Material and methods. The literature on PEEK in implant prosthodontics published through August 2018 was
identified with an online search of MEDLINE (via PubMed), Science Direct, Embase (via Ovid), and Google Scholar
databases. Qualitative and quantitative syntheses were carried out for original research studies.

Results. The amount of published original research studies was found to be limited. PEEK was found to be applied as a
material in the fabrication of implant-supported fixed dental prosthesis (IFDP) frameworks (43%), prosthetic implant
abutments (35%), implant abutment screws (15%), and retention clips on implant bars (7%). Only 38% of the studies
were clinical studies, while 15% were observational and 47% were in vitro. The studies identified did not permit the
estimation of long-term survival nor success rates for any of the prosthetic components. The results only allowed a
preliminary short-term assessment of PEEK IFDP frameworks, which presented satisfactory survival but alarming
success rates over the first year of service.

Conclusions. In light of the paucity of evidence on the viability of PEEK as an implant-prosthodontic material, its use
cannot yet be endorsed. Clinicians should heed the suggested protocols to improve mechanical performance and lower
the incidence of prosthetic complications. Further high-quality research is needed for an enhanced understanding of
the material’s viability.

Reprinted with permission of Quintessence Publishing.

THE JOURNAL OF PROSTHETIC DENTISTRY Lustig et al