Facebow Tips for the Restorative Dentist

Facebow Tips for the Restorative Dentist

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I’m Gary DeWood from Spear Education, and
I’m here with some of my best friends. This is some of my articulators. I’ve been collecting
articulators for a number of years. I’d like to spend a few minutes and give you a
couple of tips about using this with an articulator. This is an earbow. But first let me talk a
little bit about articulators. Semi adjustable articulators that made it possible for us
to make simple some things that were tough in dentistry. We can mimic patients using
them. Now that they’re magnetically mountable, which all of these are, means that they are
cross mountable. So I can do multiple mountings and have one articulator or a couple articulators.
If my technician has the same articulator they can see exactly what I see. Which brings
us to transferring information. Any semi adjustable articulator works great. The one that I’m
going to talk about is the SAM, although I will tell you I have used every one of these
articulators working with patients and they all produce great results. We teach with the
SAM so let’s talk about the SAM articulator. The SAM articulator is sitting right here
one of the things that we’re going to try to accomplish by using a facebow, is to place
the upper cast in that articulator in a way that’s related to that hinge access so that
when I open and close, I’m actually mimicking what the patient can do. To do that we’re
going to use a device called a facebow, okay, and this is the facebow. This is the jig for
the facebow and I’ll just slide that on just so I can show you the relationship. Once
that’s on, well it would help if I put it the right way, wouldn’t it? Let’s pop
it on there. The blue tips are going to go in the ear, because this is an earbow facebow.
There are also kinematic facebows in which I would have to figure out where that hinge
access was, and a hinge access facebow which actually lets me measure with a device where
it is. Hinge accesses are complex, their tough to use because you have to make clutches,
they take a lot of time. Arbitrary facebows, like kinematic and earbows actually give you
99.999 percent of the information you need and with a healthy joint, I would tell you
there is no decision you would make that would be clinically different if I had a hinge access
facebow. With unhealthy joints, that could be a discussion for another time, we might
want to use a hinge access. For this one, I would argue that for almost every case in
almost every patient I see, I’m going to use one like this, an earbow. And it’s what
we teach. Now to position this on the face, I have some references. All of the systems
that you see here come with the device that allows me to reference, it’s called a third
reference point. In this case it’s this one for the SAM, it’s a nasion piece it
goes on the nose. So you can imagine that if the nasion piece is set to my nose, my
nose will now determine where this goes relative to my face like this. Now, great idea because
it positions the model right in the middle of the articulator but, I’ve lost a reference.
So the tip I’d like to talk about is kind of giving up that third reference point for
my system and, with any system you can do this, for instance with a Denar earbow it
means you would not use the little device that slides in and out from the side to point
to infraorbital. I’m going to give that up. What I am going to do is have my patient
get in position, looking at horizon, then I’m going to look at their face and I’m
going to make sure they don’t tip because as soon as you put a facebow on somebody’s
face, they’re going to do that, because they put weight out there. So you want to
look how they’re faced, I’m looking at horizon. That’s the same relationship that
I want when I’m done with my facebow. I might have to coach my patient to get that.
I would now go in and this can be placed on the patient. You can see what’s going to
happen. This is going to go in the ears. The teeth are going to set right here in the bite
fork and a bite registration that I would have. This one will be really loose, I can
now move this around and line it up. When I line it up, I want it to be level with horizon
in this plane and in this plane. And if I can accomplish that, what I’ve done is I’ve
grabbed a reference. And the reference is, all of these teeth relative to the floor or
the bench top, which lets my technician now use that information to say, “Here is where
that plane should be.” It also lets them give me a midline that won’t be canted because
it will be perpendicular to that. Okay, here’s how the tip happens. Every system out there,
once I record this and tighten this up, will always take this jig, and I’m going to pull
the jig off and show you the jig. Every system will take this jig. And when you mount it,
that jig automatically, makes this, no matter where you recorded it, parallel with that
upper member, every one of them. So if I have recorded this on a face where this is tipped
up it will tip the model down forward, changing the occlusal plane. We’re going to recommend
that is a reference that you might want to have. Because it can be really helpful if
you’re working with occlusal planes or incisal edges and in many mounted cases, those are
two things that are really important because I am changing a lot of the things that are
happening there. The concept of doing that is not a new one. It does create some problems
occasionally in spacing although they’re rare because as long as we aren’t going
to put a die metals on we can do analysis with that. There are work arounds for those
things. If you would like some other information about this, I actually just am finishing an
article that we should get up on Spear Digest soon, that is going to talk the comparison
of the digital workflow to the analog workflow which is what these are. I believe I am going
to live long enough to be able to do this digitally, I really do. But right now, I got
to tell ya, that there’s nothing better about that world. I think that might happen
because, can you imagine the ability to tie together a CBCT? A movement scan? A T-scan?
A rendering of how teeth touch? If you can tie all of that data together, you could look
at things as they really occurred. When that’s possible, I would argue analysis is really
going to be something we probably would take to a digital realm and planning. But at some
point what do we have to do? It’s got to become three dimensional because it has to
go to teeth. And I would argue that articulators are always going to have a place in what we
do. Because they’re the thing that will allow us to take it from the two dimensional
world to the three dimensional world. There are a number of Spear Online videos about
using articulator systems. In fact I’ve gone facebow to mounting to customization
with a large number of the systems that you see sitting here. So if you want to know more
about facebows, Spear Online is a great place. More about articulators, also. And watch for
that Digest article because that should be coming out real soon. Thanks for watching.

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