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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 10  |  Issue : 4  |  Page : 187-193

Comparison between Broadrick flag Vs Yurkstas metal occlusal template in the assessment of mandibular Over-erupted teeth


1 General Dentist, King Abdulaziz University, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
2 Department of Oral and Maxillofacial Prosthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia

Date of Submission02-Nov-2018
Date of Acceptance27-May-2019
Date of Web Publication22-Jan-2020

Correspondence Address:
Prof. Mahmoud Elsamahi
Associate Professor, Oral and Maxillofacial Prosthodontics Department, Faculty of Dentistry, King Abdulaziz University, Jeddah
Saudi Arabia
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DOI: 10.4103/srmjrds.srmjrds_54_18

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  Abstract 

Introduction: An occlusal plane analyzer has long been used to assist an operator in the development of an initial mandibular occlusal plane in diagnostic contour casts and later as an integral part of both the contours of the definitive restorations as guide for the actual tooth preparation. Broadrick and Yurkstas metal occlusal template were devices frequently used to determine the proper occlusal plane. Aim: The aim of this study was to determine which of the two methods. Broadrick flag occlusal plane analyzer or Yurkstas metal occlusal template is more conservative during occlusal plane adjustment. Materials and Methods: Eight diagnostic casts mounted on Hanau semi-adjustable articulator were selected from the casts of patients of undergraduate 6th-year dental students, King Abdulaziz University. Diagnostic maxillary cast was mounted according to arbitrary ear-bow and the mandibular casts were mounted according to centric relation records. First, Broadrick occlusal plane analyzer was secured to the upper member of the articulator. The anterior and posterior survey points were drawn. From the intersection point, the anteroposterior curve was drawn on the buccal surfaces of the canine, premolar, and molar. The distance from these lines to the cusp tip was measured through mesiobuccal, midbuccal, and distobuccal areas. Yurkstas metallic occlusal plane was used in the second method. The articulating paper horseshoe was placed between the occlusal table of the stone teeth and the metallic template, and the articulator was closed and taped several times, a die marking indicating the first over-erupted teeth. Then the highlighted area was reduced to 1 mm. The procedure was repeated until a uniform touch of the template over the mandibular teeth was maintained. Finally, the amount of reduction was collected. Conclusion: Producing curve of Spee is more conservative while using Yurkstas metallic occlusal plane.

Keywords: Broadrick, curve of Spee, Yurkstas


How to cite this article:
Alsaileek Z, Alqurayqiri N, Elsamahi M. Comparison between Broadrick flag Vs Yurkstas metal occlusal template in the assessment of mandibular Over-erupted teeth. SRM J Res Dent Sci 2019;10:187-93

How to cite this URL:
Alsaileek Z, Alqurayqiri N, Elsamahi M. Comparison between Broadrick flag Vs Yurkstas metal occlusal template in the assessment of mandibular Over-erupted teeth. SRM J Res Dent Sci [serial online] 2019 [cited 2020 May 25];10:187-93. Available from: http://www.srmjrds.in/text.asp?2019/10/4/187/276371


  Introduction Top


One of the most important decisions that restorative dentistry has to make is the determination of a functional and esthetic occlusal plane.

The plane of occlusion is an imaginary surface that is related anatomically to the cranium and that theoretically touches the incisal edges of the incisors and the tips of the occluding surfaces of the posterior teeth.[1]

The natural arrangement of the posterior occlusal scheme may be disturbed by rotation, tipping, and overeruption of posterior teeth, most commonly following posterior tooth loss.[2]

When restoring posterior dentitions to design an occlusal scheme in harmony with the patient's incisal and condylar guidance and permitting total posterior dislocation on the mandibular protrusion is the challenge to the restorative dentistry.[2],[3]

Such interferences have been shown to cause abnormality in mandibular elevators, especially the masseter and temporalis muscles.[4]

Excessive extrusion teeth may require therapeutic endodontic therapy, and crown lengthening surgery to achieve proper resistance and retention form for full-coverage restorations, or extraction if the discrepancy is severe and the treatment outcome is uncertain.

An occlusal plane analyzer has long been used to assist an operator in the development of an initial mandibular occlusal plane in diagnostic contour casts and later as an integral part of both the contours of the definitive restorations as a guide for the actual tooth preparation.[5],[6]

In 1963, Dr. Lawson Broadrick developed an instrument, which can be used in conjunction with various types of articulators, to provide a guide to the most suitable position and orientation of the posterior occlusal scheme where the natural Curve of Spee has been arranged.[2]

This instrument includes a laminated piece of plastic pad snapped onto one side and attached to the superior aspect of the upper member of a semi-adjustable articulator [Figures 1] [Figures 2]. Its purpose is to permit construction of the Curve of Spee in harmony with the anterior and condylar guidance.[3]
Figure 1: Tools of Broadrick Flag Occlusal Plane Analyzer

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Figure 2: Laminated plastic pad snapped onto the side and attached to the superior aspect of the upper member of a semi-adjustable articulator

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It requires that articulator casts be mounted with articulator following maxillary face bow, as the curve of Spee is an arc of circle that passes through the cusp tip of the mandibular teeth and condyle. It is possible to locate the center of the curve on the Broadrick flag using a compass.[7],[8],[9] The mandibular canine was selected as the “anterior survey point” (ASP) from which an arc of 4 inch was drawn using the compass on the Broadrick flag [Figure 3]. The distal incline of the distobuccal cusp of the second molar was selected as the “posterior survey point” (PSP) from which a corresponding arc of 4 inch was drawn onto the plastic card [Figure 4]. The point of the compass should be placed at the intersection of arcs on the flag. A curve can then be drawn through the lower teeth to demonstrate the ideal position of the mandibular cusp tips [Figure 5].
Figure 3: Determination of the anterior survey point

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Figure 4: Determination of the posterior survey point and point of intersection

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Figure 5: Occlusal plane line scribed on the mandibular teeth

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Teeth (or portion of the teeth) that are over-erupted infra-occluded, rotated, or tipped can be identified and modified when restoring the posterior dentition.

Banasr (2016) concluded that there was no statistical difference utilizing two different PSP.[10]

Yurkstas metal occlusal template was a device frequently used to determine proper occlusal plane[11]. It is used commonly for the analyses and correction of the plane of occlusion.

The aim of this study was to determine which of the two methods Broadrick flag occlusal plane analyzer or Yurkstas metal occlusal template is more conservative during occlusal plane adjustment.


  Materials and Methods Top


A total of eight diagnostic casts mounted on a semi-adjustable articulator were selected from the casts of patients of 6th-year undergraduate dental students, King Abdulaziz University. The diagnostic maxillary cast was mounted according to arbitrary ear-bow and the mandibular casts were mounted according to centric relation records.

The following casts were selected according to the following criteria:

  1. Maxillary dentulous arch and mandibular Class III Kennedy's classification either bilateral or unilateral bounded spaces
  2. The missing teeth were second bicuspids and first molars
  3. The maxillary arch was dentulous.


  1. Over-erupted teeth were delineated using Broadrick occlusal plane analyzer (BOPA) (Whipmix Corporation, PN3390-6, 2012, USA)


    1. After mounting the casts, the maxillary cast was removed and set aside


    2. BOPA was secured to the upper member of the Hanau semi-adjustable articulator [Figure 1] shows the Tools of Broadrick Flag Occlusal Plane Analyzer.


    3. The ASP and PSP were drawn [Figure 2], [Figure 3], [Figure 4]


    4. From the intersection point, the anteroposterior curve was drawn on the buccal surfaces of the canine, premolar, and molar [Figure 5]


    5. The distance from these lines to the cusp tip was measured through three locations: mesiobuccal, midbuccal, and distobuccal areas [Figure 6].
    Figure 6: The distance from these lines to the cusp tip measured through three locations: mesiobuccal, midbuccal, distobuccal areas

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  2. The occlusal plane was established using Yurkstas metallic occlusal template (20°) [Figure 7]
  3. Figure 7: The occlusal plane established by using Yurkstas Metallic Occlusal Template (20°)

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  4. Metallic template was applied on the occlusal table of the mandibular casts


  5. Articulating paper horse-shoe was placed between the occlusal table of the stone teeth and the metallic template


  6. The articulator was closed and taped several times, a red or blue die marking indicating the first over-erupted teeth [Figure 8]
  7. Figure 8: The articulator was closed and taped several times, a red or blue die marking indicating the first over-erupted teeth

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  8. The over-erupted color was reduced by using a carver equivalent to 1 mm and closed the articulator again [Figure 9]
  9. Figure 9: The over-erupted color reduced by using a carver equivalent to 1 mm and closed the articulator again. The procedure was repeated until a uniform touch of the template over the mandibular teeth was maintained

    Click here to view


  10. The procedure was repeated until a uniform touch of the template over the mandibular teeth was maintained [Figure 9]


  11. The amount of reduction was collected.


The Mann–Whitney test was used to assess the statistical significance between two methods usingIBM SPSS Statistics for Macintosh, Version 22.0 (IBM Corp., Armonk, NY: USA).

The power of this study because it was the 1st study that assesses Mandibular Over-erupted Teeth and compares between Broadrick Flag Occlusal Plane Analyzer or Yurkstas Metal Occlusal Template.


  Results Top


Tables describe mean and median measurements by Yurkstas Metal Occlusal Template and BOPA at the canine, first premolar, second premolar, and second molar at three mesial, middle, and distal surfaces:

The mean values measured by Yurkstas Metal Occlusal Template of mesial, middle, and distal surfaces of the canine were 0.75 (2.12), 2.62 (2.77), and constant, respectively. With the same sequence, the mean values measured by the Broadrick Flag Occlusal Plane Analyzer were 2.06 (0.78), 2.31 (0.46), and 2.37 (0.69), respectively. The mean was statistically significant* in the mesial surface of the canine measured by Yurkstas Metal Occlusal Template (*P < 0.05)[Figure 10].
Figure 10: The mean was statistically significant* in the mesial surface of the canine measured by Yurkstas Metal Occlusal Template (*P < 0.05)

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When using Yurkstas Metal Occlusal Template, the mean values of mesial, middle, and distal surfaces of the first premolar were constant, 2 (1.92), and constant, respectively. While the mean values measured by the Broadrick Flag Occlusal Plane Analyzer were 2.21 (0.69), 2.86 (0.89), and 2.35 (0.94), respectively [Figure 11].
Figure 11: Mean values measured by Yurkstas Metal Occlusal Template and BOPA at first premolar.

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The mean values of the same surfaces were 0.13 (0.35), 1.75 (2.66), and 0.13 (0.35), respectively, by using Yurkstas Metal Occlusal Template. However, the mean values measured by the Broadrick Flag Occlusal Plane Analyzer were 1.80 (0.57), 2.80 (0.27), and 2.30 (0.67), respectively. The mean was statistically significant* in the mesial and distal surfaces measured by Yurkstas Metal Occlusal Template (*P < 0.05)[Figure 12].
Figure 12: The mean was statistically significant* in the mesial and distal surfaces of the second premolar measured by Yurkstas Metal Occlusal Template (*P < 0.05)

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The mean values measured by Yurkstas Metal Occlusal Template of mesial, middle, and distal surfaces were constant, constant, and 4.25 (2.25), respectively. With the same sequence, the mean values measured by the Broadrick Flag Occlusal Plane Analyzer were 1.50 (0.53), 2 (0.46), and 2.75 (0.53), respectively [Figure 13].
Figure 13: Mean values measured by Yurkstas Metal Occlusal Template and BOPA at second molar

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  Discussion Top


The Broadrick Flag Occlusal Plane Analyzer was designed as an instrument to provide a guide to the location of the center of the Curve of Spee, from which a curve could be created to facilitate the restoration of a posterior quadrant. Craddock and Youngson found that the occlusal curve produced by the Broadrick Flag method closely approximated the natural occlusal curve, caused by overeruption, or tipping of teeth adjacent to the site of tooth loss, include the restoration of occlusal and dental form, function and the maintenance and restoration of aesthetics.[12],[13] The existence of a scientifically evaluated tool, which restores the occlusal form for individual, allows the restorative team to make an evidence base decision when designing and restoring occlusal schemes.[9] The amount of occlusal plane reduction in irregular occlusal plane affects the treatment plan procedure during the construction of removable partial denture through enameloplasty, dentinoplasty and crown or endodontic treatment and crown fixation if the extruded tooth is more that certain level.[14] The relevance of recording and maintaining the curve of spee is to minimize posterior protrusive interference, which in turn prevents the abnormal activity of mandibular elevators like temporalis and masseter.[7] Excursive interferences may result in wear, fracture of restorations, and temporo-mandibular joint dysfunction.[8] Monson proposed that the mandibular teeth should be arranged to close around a sphere of 4-inch radius, with the mandibular incisal edges and cusp tips touching the sphere, thus permitting protrusive and lateral excursion free from posterior interferences.[8]

Manvi et al.[4],[8] described that 3.75-inch radius would be more appropriate when a class II skeletal relationship exists, and five-inch radius would be more suitable in Class III skeletal relationship, the main criteria in this study included the selection of a skeletal class I with a 4 inch at the ASP. Few studies were reported about the accuracy of the Broadrick flag.

Yurkstas Metal Occlusal Plane is used commonly for the analysis and correction of the plane of occlusion. Once the analysis is accomplished on the diagnostic casts, the same equilibration can be initiated for the patient.

The main advantage of this study was the assessment was done on the same casts for the two methods. The 1st one is Broadrick Flag Occlusal Plane Analyzer because it is just analytical device while the Yurkstas Metal Occlusal Plane is analytical and correctional device at the same time.

The main results were comparable between Broadrick Flag Occlusal Plane Analyzer and Yurkstas Metal Occlusal Plane, whereas the amounts of teeth reduction of over-erupted teeth were significantly more conservative with Yurkstas metal occlusal plane groups.

The main limitation of this study was the number of the samples used. For future research, to get accurate results, the sample size should be increased. In addition, comparison between two methods in all the surfaces of the tooth is recommended and it should be considered it as one unit.


  Conclusion Top


  1. The Broadrick Flag method produced occlusal curve closely approximated the natural occlusal curve
  2. Broadrick Flag may be considered as an acceptable alternative for providing Curve of Spee
  3. Yurkstas Metal Occlusal Template is more conservative than Broadrick Flag Occlusal Plane Analyzer
  4. Yurkstas Metal Occlusal Plane is commonly used for the analysis and correction of the plane of occlusion.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Lundquist DO, Luther WW. Occlusal plane determination. J Prosthet Dent 1970;23:489-98.  Back to cited text no. 1
    
2.
Craddock HL, Lynch CD, Franklin P, Youngson CC, Manogue M. A study of the proximity of the Broadrick ideal occlusal curve to the existing occlusal curve in dentate patients. J Oral Rehabil 2005;32:895-900.  Back to cited text no. 2
    
3.
Bowley JF, Stockstill JW, Attanasio R. A preliminary diagnostic and treatment protocol. Dent Clin North Am 1992;36:551-68.  Back to cited text no. 3
    
4.
Manvi S, Miglani S, Rajeswari CL, Srivatsa G, Arora S. Occlusal plane determination using custom made Broadrick occlusal plane analyser: A case control study. ISRN Dent 2012;2012:373870.  Back to cited text no. 4
    
5.
Becker CM, Kaiser DA. Evolution of occlusion and occlusal instruments. J Prosthodont 1993;2:33-43.  Back to cited text no. 5
    
6.
Dawson PE. Functional Occlusion from TMJ to Smile Design. St. Louis: Mosby Elsevier; 2007. p. 199.  Back to cited text no. 6
    
7.
Davies SJ, Gray RM, Whitehead SA. Good occlusal practice in advanced restorative dentistry. Br Dent J 2001;191:421-4, 427-30, 433-4.  Back to cited text no. 7
    
8.
Lynch CD, McConnell RJ. Prosthodontic management of the curve of spee: Use of the Broadrick flag. J Prosthet Dent 2002;87:593-7.  Back to cited text no. 8
    
9.
Craddock HL, Youngson CC. A study of the incidence of overeruption and occlusal interferences in unopposed posterior teeth. Br Dent J 2004;196:341-8.  Back to cited text no. 9
    
10.
Banasr F. Accuracy of broadrick flag occlusal plane analyzer utilizing two different posterior survey. Br Dent J 2016;209:541-7.  Back to cited text no. 10
    
11.
Yurkstas AA. Single dentures. In: Sharry JJ, editor. Complete Denture Prosthodontics. 2nd ed. New York: McGraw Hill;1968. p. 300.  Back to cited text no. 11
    
12.
Gragg KL, Shugars DA, Bader JD, Elter JR, White BA. Movement of teeth adjacent to posterior bounded edentulous spaces. J Dent Res 2001;80:2021-4.  Back to cited text no. 12
    
13.
Norton LA, Prolfit WR. Molar uprighting as an adjunct to fixed prostheses. J Am Dent Assoc 1968;76:312-5.  Back to cited text no. 13
    
14.
Phoenix RD, Cogna DR, DeFreest CE. Stewart's Clinical Removable Partial Prosthodontics. 4th ed. The New York State: Quintessence Publishing Co.; 2008. p. 195-7.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13]



 

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