Tif denture max-setup

© Merz Dental GmbH, Germany 1

Part 3 - Maxillary Setup

Total prosthetics in Function - TiF®

According to Karl-Heinz Körholz, MDT

Merz Dental Prosthetic Training


Lateral incisors

Canines

First premolars

First molars

Overview

Central incisors

Static lines

Setup order

Second premolars

Second molars

Maxillary setup steps according to TiF®

Concept, graphics and texts: Martin J. Hauck based on the TiF method by Karl-Heinz Körholz

Checklist posterior setup

Tooth setup – Maxilla


Ideal line

Based on the individual atrophy status

Maxilla: Marks the ideal position of the palatal (working) cusps, except for the first premolars.

Mandible: Marks the ideal position of the centric fossae, except for the first premolars.

Static lines – Definitive setup line


Balancing:

Offers a broad contact zone

Marks the vestibular contact limit of the maxillary and mandibular buccal cusps

If exceeded in the maxilla, the cusps must be placed out of contact to prevent rocking or tilting

Static lines – Outer correction


Marks the vestibular contact limit of the maxillary and mandibular buccal cusps

If exceeded in the maxilla, the cusps must be placed out of contact to prevent rocking or tilting

Lingualized setup according to Gerber

Static lines – Outer correction


Delimits the positions of the maxillary palatal cusps

Delimits the lingualmost positions of the mandibular central fossae to allow freedom of movement of the tongue, alternatively, the mylohyoid line may be used

Static lines – Inner correction


Setting up the maxillary first molars


The setup for the maxillary posterior segment starts with the statically most important tooth, the first molar

It is placed at the first molar position transferred from the mandible, ideally with the mesiopalatal cusp.



Buccal contacts are only allowed if the study cast analysis shows they are possible

Distopalatal cusp on the distal marginal region of the mandibular first molar

Tripod contacts are best

Mesial palatal cusp in the center fossa of the mandibular first molar



Buccal contacts only where possible according to the study cast analysis (definitive other correction)


First create and check centric Contacts, then protrusion, laterotrusion and mediotrusion.

The other posterior teeth are set up after the first molars

Located at the first molar position transferred from the mandible

Statically most important tooth, first posterior tooth to be set up

Summary – Maxillary first molar


Setting up the maxillary second molars


22.5°

Whether a second molars setup will depend on the stop line (cf. study cast analysis)

22.5° angle between the crystalline in the occlusal plane, delimits the setup on the dorsal aspect Stop line Stop line helps prevent the

restoration from sliding forward



If the tooth is positioned behind the stop line, it will be placed on a steeper incline relative to the horizontal condylar path inclination.

When assuming the maximum multi-contact intercuspidation position, the mandible would invariably be shifted forward and down. Gerber called this phenomenon “anterior sliding.”



One premolar each can be setup on both sides to provide anterior sliding.

This is not an aesthetic disadvantage and certainly functional.



Subordinate to the first molars on extrusive movements, i.e. it supports but does not dominate the guidance.

Mesiopalatal cusp always in contact with the centric fossa of the second molar, tripod contact is ideal (not for crossbites)

Setup as for first molars

Same checks of centric stops and extrusion movements



Setting up the maxillary first premolars


Located at the so-called first premolar position

Almost at a right angle to the occlusal plane

Buccal facet clearly covers the mandibular first premolar, so that the integral® also facilitates premolar guidance

Tooth-to-tooth occlusion giving the visual appearance of a tooth-to-two-teeth occlusion

Setting up the maxillary first premolars


Contact between lower buccal cusp and mesial fossa of the maxillary first premolar

Tooth-to-tooth occlusion

Centric contactsof the maxillary first premolars


Place at the premolar position (cf. study cast analysis)

Almost at a right angle to the occlusal plane

Buccal facet clearly covers the mandibular first premolar Palatal cusp is out of contact

Protrusion via the mesiobuccal incline of the mandibular second premolar

Cusp-to-fossa contact only in tooth-to-tooth occlusion

Laterotrusion via the buccal facet

To achieve balancing, adjust to achieve molar guidance, then cut back

Summary – Maxillary first premolars


Setting up the maxillary second premolars


Also almost at a right angle to the occlusal plane

No pronounced buccal facet, hence no premolar guidance as on the first premolar

Tooth-to-tooth occlusion giving the appearance of a tooth-to-two-teeth occlusion

Setting up the maxillary second premolars


Centric contactsof the maxillary second premolars


The ideal situation is a tripod contact in the mesiocentral fossa of the mandibular second premolar

Palatal cusp of the maxillary second premolar may contact the distal fossa of the mandibular second premolar

Centric contactsof the maxillary second premolars


Roughly right angle to the occlusal plane (like the first premolar) No premolar guidance (no pronounced

buccal facet)

Protrusion via the mesial marginal ridge of the mandibular first molar Laterotrusion via the buccal facet of

the maxillary and mandibular second premolars (approx. 1-5–2 mm); additio-nal support by mesial lingual marginal ridge of the mandibular second premolar

Cusp-to-fossa contact only, main contact: mandibular buccal cusp to mesial central fossa of the maxillary second premolar

distal

Mediotrusion possible by the palatal cost supported by the distobuccal incline of the mandibular second premolar (approx. 1.5–2 mm).

Summary – Maxillary second premolar


Are the centric flossae of the mandibular first molars and the mesial palatal cusps of the maxillary first molars within the tolerance range of the markings for the largest masticatory unit? Is anterior sliding prevented

by respecting the stop line ?

Checklist posterior setup


Are the centric stops positioned correctly?

Maxilla Mandible

Checklist - Posterior setup


Has the relatively narrow ”corridor” supporting lateral movement (definitive outer correction) Been taken into account? Definitive inner

correction as in balancing?

Gerber-style setup

Are the molars in centric contact with the upper palatal cusps only?

Does the definitive inner correction delimit the maxillary palatal costs and mandibular central fissures?

Is the definitive outer correction (modification) the vestibular most limits of the buccal balancing contact?

Balanced complete dentures

Checklist - Posterior setup


Maxillary caninesThe following graphic representation relates to average-valueaspects without regard to aesthetic and phonetic data


1–1.5 mm

Viewed from buccally, the maxillary canine is almost at a right angle to the occlusal plane, following the first premolar

Uniform overjet relative to the mandibular canine: approx. 1–1.5 mm For balancing, the incisal edge of the

maxillary canine is reduced from palatally, that the the mandibular canine from labially; maximum laterotrusion: 1,5–2 mm

First large pair of palatine rugae points approximately in the direction of the canine position

Facial view: “Edge in – cervix out”

Maxillary canines


integral® and artegral® both permit, as an alternative to balancing, canine/premolar guidance if the extrusion paths of the first premolar and of the canine are not adjusted until they are balanced.

Canine/premolar guidance


Maxillary central incisorsThe following graphic representation relates to average-valueaspects without regard to aesthetic and phonetic data.


1–1.5 mm

1–1.5 mm

Fixed average setup7–8 mm

Labial surfaces approximately 7–8 mm anterior to the incisive papilla

Uniform overjet of approx. 1–1.5 mm

Maximum protrusion 2–3 mm, concurrently with the molars

If laterotrusion is supported, it will be concurrent with that the the molars

Maxillary central incisors


The following graphic representation relates to average-valueaspects without regard to aesthetic and phonetic data.

Maxillary lateral incisors


1–1.5 mm

1–1.5 mm

Contact may be present in laterotrusion

Harmonious placement between the canines and central incisors

Lateral incisors should contribute to protrusion: slight rotation may provide (additional) support for balancing during extrusive movements

Uniform overjet of approx. 1–1.5 mm, as for the canines and central incisors

Fixed average setup:

Maxillary lateral incisors


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