What is the panky mann philosophy for fmr what are steps and how they performed. What is difference between panky mann and hobo philosophy
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Pankey Mann Schuyler philosophy steps FMR Hobo difference
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Pankey Mann Schuyler philosophy steps quadrant technique Hobo difference FMR
Here is a thorough breakdown of the Pankey-Mann-Schuyler (PMS) philosophy for Full Mouth Rehabilitation (FMR) and how it differs from the Hobo philosophy.
Pankey-Mann-Schuyler (PMS) Philosophy for FMR
The PMS philosophy was developed by L.D. Pankey, A.D. Mann, and C.H. Schuyler. It is the most widely used philosophy for full mouth rehabilitation worldwide (used in ~58% of FMR cases per systematic review data). Its core principle is that stable, harmonious occlusion can be achieved by first establishing proper anterior guidance, then restoring posterior teeth in harmony with that guidance and condylar guidance - without interference between them.
Core Principles
- There must be a physiologic rest position for the mandible
- Centric relation (CR) is the ideal occlusal starting point
- Anterior guidance must be established first, and posterior occlusal morphology must not interfere with it
- The occlusal plane orientation must be selected carefully (Broadrick Flag Analysis)
The 4 Steps of PMS Philosophy
Step 1 - Examination, Diagnosis, and Treatment Planning
- Thorough clinical and radiographic examination
- Study casts are mounted on a semi-adjustable articulator in centric relation
- Diagnosis of wear, vertical dimension loss, periodontal status, and TMJ health
- Treatment planning is done with a focus on prognosis
Step 2 - Determination of Anterior Incisal Guidance
- This is the most critical step in PMS
- The anterior teeth (maxillary incisors and canines) are restored first, provisionally or permanently
- Anterior guidance is designed to provide:
- Best possible aesthetics (lip support, smile line)
- Proper phonetics (especially "S" and "F/V" sounds)
- Function (disocclusion of posterior teeth in excursive movements)
- Comfort for the patient
- The incisal guidance table on the articulator is customized to match this anterior guidance
Step 3 - Selection of Occlusal Plane and Restoration of Lower Posterior Teeth
- The acceptable occlusal plane is selected using Broadrick's flag (occlusal plane analyzer)
- Lower posterior teeth (mandibular molars and premolars) are restored first, in harmony with the established anterior guidance
- The cusp morphology of lower posteriors must not interfere with condylar guidance or anterior guidance during excursive movements
- This is the quadrant technique: lower right posterior, then lower left posterior
Step 4 - Restoration of Upper Posterior Teeth
- Upper posterior teeth are restored last
- Their occlusal morphology is developed to occlude harmoniously with the already-restored lower posteriors
- Contacts are established in centric relation, with smooth lateral and protrusive excursions
- The sequence goes: upper right posterior, then upper left posterior
Sequence Summary (the "Quadrant Technique"):
- Anteriors first (Step 2)
- Lower posteriors second (Step 3, using Broadrick flag)
- Upper posteriors last (Step 4)
Each stage uses short laboratory procedures, and appointments are staged - making it less demanding for both patient and clinician.
Hobo Philosophy - Two Variants
Hobo Twin Table Technique
- Posterior occlusal morphology is reproduced first, based on condylar guidance recorded from the patient
- An incisal guide table is then fabricated based on the condylar guidance angle
- Anterior morphology is derived after - based on that condylar guidance
- Limitation: If condylar guidance is steep, the incisal table becomes steep too, producing anterior crowns with undesirable morphology; the patient may be uncomfortable. It is also highly technique-sensitive
Hobo Twin Stage Technique
- Occlusal morphology is reproduced using standard/predetermined cusp angles - no need to record condylar guidance from the patient
- Anterior crown morphology is made based on an "acceptable incisal guidance" that fits best for esthetics, phonetics, function, and comfort
- Limitation: Cannot be used for teeth with maloccluded positions
Key Differences: PMS vs Hobo Philosophy
| Feature | PMS Philosophy | Hobo Philosophy |
|---|---|---|
| Starting point | Anterior teeth restored first | Posterior occlusion established first (Twin Table) or standard cusp angles used (Twin Stage) |
| Condylar guidance recording | Required and used to set articulator | Not required in Twin Stage; used in Twin Table |
| Basis of posterior morphology | Derived from anterior guidance + condylar guidance | Based on pre-set condylar angles (Twin Stage) or patient's condylar guidance (Twin Table) |
| Sequence | Anterior → Lower posteriors → Upper posteriors | Twin Table: Posterior → Anterior; Twin Stage: Standardized |
| Technique sensitivity | Moderate - flexible concept | Twin Table is highly technique sensitive |
| Use of Broadrick flag | Yes - to select occlusal plane | Not standard |
| Applicability | Flexible, can be adapted to most cases | Twin Stage cannot be used for maloccluded teeth |
| Laboratory work | Short, simpler procedures | Twin Table requires more complex instruments |
| Occlusal basis | Neuromuscular, centric relation-based | Mechanical articulation, preset values (Twin Stage) |
| Patient comfort | High - anterior guidance tailored to patient | Twin Table can cause steep anterior morphology; less comfortable |
| Esthetic outcomes | Excellent, patient-tailored | Hobo Twin Stage has shown slightly higher short-term patient esthetic satisfaction in some studies |
| Functional outcomes | Comparable to Hobo in long-term | Comparable to PMS in long-term |
Clinical Bottom Line
- PMS is preferred in most clinical settings because it is logical, well-organized, flexible, requires no complicated instruments, and allows staged appointments
- Hobo Twin Stage is a reasonable alternative when a more standardized, protocol-driven approach is preferred, but it cannot handle malocclusion cases
- Hobo Twin Table is now less commonly used due to its technique sensitivity and patient comfort issues
- Both PMS and Hobo show similar long-term functional outcomes, but PMS remains the most widely used and taught philosophy in prosthodontics
Sources: PMC10700051 (case report, PMS in amelogenesis imperfecta); IJISRT meta-analysis (2025, Hobo vs PMS); IPS Journal systematic review (2021, philosophies of FMR); ResearchGate case reports on PMS and Hobo techniques.
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