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Horizontal Jaw RelationHorizontal Jaw Relation
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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CONTENTS:
Introduction
Definition
Significance of centric relation
Retruding the mandible to centric
relation
Methods of recording centric relation
Factors influencing centric relation
record
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Eccentric relation records
Recording of eccentric jaw relations
Review of Articles.
Conclusion
Bibliography.
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INTRODUCTION
Horizontal relation are those that are
established anterio posteriorly &
mediolaterally,
Its classified as
1, Centric relation
2, Eccentric relation- which includes
-Protrusive
-Left & Right lateral movements
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 The principles of good occlusion apply
to both dentulous & edentulous
patients.
 Different requirements are necessary
in the occlusion for the complete
dentures because artificial teeth are
not attached to the bone as in natural
teeth.
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 To maintain stability of complete
dentures,the opposing teeth must meet
evenly on both sides of the dental arch
when the teeth contact anywhere
within the normal functional range of
mandibular movements.
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 An occlusion for complete dentures
that provides these even contacts can
only be developed with centric
occlusion in harmony with centric
relation & smooth gliding contact from
this position to any eccentric position
with in the normal range of mandibular
movements.
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DEFINITION :
The maxillo mandibular relationship in which the
condyles articulate with the thinnest avascular
portion of their respective discs with the complex in
the anterior superior position against the shapes of the
articular eminences.
This position is independent of tooth contact and
is clinically discernible when the mandible is directed
superiorly and anteriorly. It is restricted to a purely
rotary movement about the transverse horizontal axis
- GPT 8
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Significance of Centric
Relation:
It is a definite learned position which is
independent of the presence or
absence of teeth.
It is reproducible ,repeatable and
recordable position.
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When the centric relation & centric
occlusion of natural teeth do not
coincide, the periodontal structures
around the natural teeth are endangered
 If the occlusion of artificial teeth do not
coincide, there is instability of the
dentures leading to pain & discomfort
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Errors in mounting of the cast can be
detected when used as a horizontal
reference point
An accurate record properly orients
the mandibular cast to the opening
axis of the articulator.
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RELATING CENTRIC RELATION
TO THE HINGE AXIS
. During mandibular opening
movement,the condyles rotate initially
in a hinge and later in a translatory
motion.A pure hinge movement of the
condyle occurs only when the condyle
is in its centric position.
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• Combinations of translation and
hinge movement take place when the
condyle moves anterior to centric
relation.
• Hence ,centric relation is known as
the Terminal hinge relation.
• Terminal hinge axis is the horizontal
axis of condyles, when the condyles
are in centric relation.
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CHARACTER OF OCCLUSION IN
CENTRIC RELATION:
There are two concepts:
Point centric :
This happens when centric
occlusion and centric relation coincide.
It is a precise location of centric
occlusion in centric relation. It is a
maximum intercuspation seen or given
in centric relation.
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Long centric/ Freedom in centric /
Area centric:
When centric relation and
centric occlusion do not coincide,
a freedom is given to close the
mandible either into centric relation
or slightly anterior to it in centric
occlusion with a smooth gliding,
without effecting and change in
vertical dimension of occlusion.
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1) Minimal Closing Pressure :
 Minimal displacement of the tissue
 Opposing teeth to touch uniformly and
simultaneously at their first contact.
CONCEPTS AND OBJECTIVES IN
RECORDING CENTRIC RELATION:
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ADVANTAGES
 Uniform contact will not simulate the
patient to clench the teeth
 Relaxes the closing muscles.
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2) Heavy Closing Pressure:
 Tissues under bases is displaced
while the record is made
 Produce same displacement of the
soft tissues as would exist when
heavy closing pressure are applied
on the dentures.
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DISADVANTAGES
 Uneven contacts which tends to
clench the teeth
 Thus causing soreness under the
denture bases & changes in the
residual ridges
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RELATING CENTRIC RELATION
TO CENTRIC OCCLUSION:
 Centric relation is a bone to bone
relation
 Centric occlusion is a relationship of
upper and lower teeth to each other.
 Centric relation must be accurately
recorded so that centric occlusion
can be built to coincide with it.
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When natural teeth are
removed,many receptors that initiate
impulses resulting in positioning of
mandible away from deflective occlusal
contacts into centric occlusion are lost
or destroyed.
Therefore edentulous patients
cannot control mandibular movements
or avoid deflective occlusal contacts in
centric relation as in dentulous patients.
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These deflective occlusal contacts
in centric relation causes movement of
the denture bases or direct the
mandible away from the centric
relation.
Thus centric relation must be
recorded for edentulous patients so
that centric occlusion can be
established in harmony with this
position.
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Retruding the mandible to
centric relation:
Difficulties seen are
Biological
Psychological
Mechanical
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Methods of assisting the patient to
retrude the mandible:
Instructing the patient to:
Relax the jaw ,pull it back and close
slowly and easily on your back teeth.
[ never ask the patient to bite]
Get the feeling of pushing your
upper jaw out and close your
back teeth together.
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Protrude and retrude the mandible
repeatedly as the patient holds the
fingers lightly against the chin.
Turn the tongue backwards towards the
posterior border of the upper denture.
Ask the patient to swallow & conclude
the act with the blocks in contact.
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Tap the occlusal rims or the back teeth
rapidly & repeatedly.
Tilting the head back while all the
exercise is carried out.
Assist the patient to retrude the
mandible by placing the index fingers on
the buccal flanges on the premolar
regions with the thumbs under the
patients chin.
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Verification of Centric
Relation
Palpating the temporais and the
masseter muscles.
Use of guide lines on the occlusion
rims
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Factors Influencing Centric Relation
Records
 The resiliency of the supporting tissue.
 The stability of the recording bases.
 The TMJ and its associated
neuromuscular mechanism.
 The nature of pressure applied in
making the recording.www.indiandentalacademy.com
 The technique in making the recording
& the associated recording devices
used
 The skill of the dentist.
 The health & the co-operation of the
patient.
 The maxillomandibular relationship
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 The posture of the patient.
 The character or size of the residual
arch.
 The size & position of the tongue.
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Requirements for Making Centric
Relation Records
 To record the correct horizontal
relationship of the mandible to the
maxilla.
 To exert equalized vertical pressure.
 To retain the record in an undistorted
condition until the cast has been
accurately mounted on the articulator.
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Methods Of Recording Centric Relation:
 Physiological / tactile / interocclusal
check record method.
 Functional/ chew in method.
-Patterson technique
-Needle house technique
 Graphic method.
-Intra oral tracing
-Extra oral tracingwww.indiandentalacademy.com
OTHER METHODS-
 Strips of celluloid placed between the
rims
 Heating the surface of one of the rims
 Deep heating or pooling method
 Softened wax placed over the occlusal
surface of the mandibular posterior
teeth
 Soft cones of wax placed on the lower
denturel bases
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Physiological / tactile / interocclusal
check record method:
History
In 1756,Philip pfaff, the dentist of
Frederick the great of Germany, was the
first to describe this technique.
The direct interocclusal record during
that period was a non-precision jaw
record obtained with a thermoplastic
material, usually wax or compound.
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This was known as “mush” “biscuit” or
“squash bite.
 Christensen[1905] was one of the
early authors to use impression wax for
bite records.
Brown [1954] recommended repeated
closures into softened wax rims.
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Greene had his patients hold their jaw
apart for 10 sec to fatigue the muscles
and then had them snap the rims
together.
 Wax, compound, plaster & zinc oxide
eugenol paste were used as registration
material for the records
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 Schuyler[1932] preferred modelling
compound to wax for the occlusal
records
 Trappzzano[1955] stated that wax
check bite method was the technique
of preference
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 Payne[1955] & Hickey[1964] stated a
preference for plaster
 Boos[1959] stated that it was important
to avoid torsion when recording centric
relation & felt that plaster & zinc oxide
eugenol paste was more accurate
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 Hanau[1929] was the first individual to
be concerned about equalization of
pressure when recording the bite. He
coined the word “realeff” which is
formed by the beginning letters of the
words “resilient and like effect”.
 This became a major factor in “check
bite” techniques.
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 Wright (1939) described the four
factors which affected the accuracy
of records-
1. Resiliency of tissues.
2. Saliva film,
3. Fit of bases
4. Pressure applied
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 Scyhyler, Payne and Trapozzano
advocated the use of light pressure
 The problem of pressure in any record
was recognized by Boucher (1960)
who wrote, “In addition to technical
errors are the errors which occur as a
result of failure to control jaw activities
and pressure at the time of
registration”.
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 The importance of verifying the
interocclusal records has been stressed
by Greene (1910), Schyuler (1932),
Trapozzano (1950, Beck (1960)
 Most of the criticisms for using “check
bites” for centric relation record were
from individuals who favored some type
of graphic recording.
 Gradually these procedures evolved into
interocclusal records as they are usually
done today.
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Physiological / Tactile /
Interocclusal Check Record
Method:
It is particularly indicated in situation of
Abnormally related jaws
Supporting tissues that are excessively
displaceable
Large tongue.
Uncontrollable or abnormal mandibular
movements
To check the occlusion of the teeth in
try-in dentures
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The technique for this record is
divided into two steps-
1. Tentative records using occlusion
rims attached to accurate stable
bases.
2. Inter occlusal check records with
teeth arranged for try-in.
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 In this method the vertical dimension
is established first .
A tentative centric relation is recorded,
occlusal rims are articulated using
tentative records and artificial teeth are
arranged.
Now the try-in dentures are ready for
making the inter-occlusal check record.
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The try-in dentures are inserted into
patient mouth ,recording material is
loaded onto the occlusal surface of
posterior teeth in the mandibular
occlusal rim and patient is asked to
slowly retrude the mandible and close,
make sure there’s no tooth to tooth
contact.
The horizontal Condylar guide locks in
the articulator are unlocked and the try-
in dentures are placed on their
articulated casts.www.indiandentalacademy.com
Recording material on the buccal aspect
of mandibular teeth is scraped off and the
articulated casts are adjusted to fit into the
check record.
If the tentative record is accurate and is
same as the check record then both
Condylar elements will contact against the
centric stops.
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 If any one of the Condylar elements
are not touching ,then one or the other
record is inaccurate.
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Functional/chew in Method ::
HISTORY
 Functional recordings were described
as early as 1910. by Greene where he
used a pumices and plaster mixture in
one of the rims and instructed the
patient to grind the rims together. The
teeth were set to the generated paths.
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 Needles(1923) mounted studs on the
maxillary rims which cut tracing into the
mandibular rims
 Petterson(1923) used a carborundum
and plaster mixture which were filled in
a trough cut in the upper and lower
rims
 Meyers(1934)used soft wax occlusion
rims.
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 Boos (1959) felt that it was essential
that all registrations be made under
the biting force so that the
displacement of the soft tissues which
occur in function would occur during
bite registration
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Functional/chew in Method ::
Needles-house technique:
Compound occlusal rims with 4 metal
styli placed in the maxillary rim.
When the mandible moves with the
styli contacting the mandibular rim, the
styli cuts 4 diamond shaped tracings.
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The pathways cut into the modeling
compound indicating both the centric
position and the eccentric mandibular
excursions.
The records are placed on a suitable
articulator to receive and duplicate the
records.
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The Patterson method:
Uses wax occlusal rims.
A trench is made in the mandibular rim
and a mixture of half plaster and half
carborundum or pumice paste
is placed in the trench.
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When the plaster & pumice are reduced
to the pre determined height the patient
is asked to retrude the mandible and the
occlusion rims are joined with metal
staple pins.`
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 Plaster pumice rims tends to be rather
messy an alternative is modelling wax
mixed with a little carding wax to
render it displaceable, the rims are
covered with the tin foil to prevent them
sticking together while the patient
squeezes them into his own individual
occlusal curves.
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Disadvantages
1. The displaceable basal tissues, the
resistance of the recording medium
and the lack of control of equalized
pressure in the eccentric relation
contribute to inaccuracies.
2. Patients should have a good
neuromuscular co-ordination and
should be capable of following
instructions.
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NEEDLE POINT TRACING:
HISTORY
• The earliest graphic recording Were
based on mandibular movements by
Blackwil in 1866. The intersections of
the arcs produced by the right and left
condyles formed the apex of what is
known as the “Gothic arch tracing”.
• The first known”Needle point tracing”
was by Hesse in 1897, and the
technique was improved and
popularized by Gysi around 1910”
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 Gysi’s tracer was an Extraoral incisal
tracer in which the plate was attached
to the mandibular rim & spring loaded
pin was mounted on the maxillary rim.
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 Phillips(1927) recognized that any
lateral movement of the jaw would
cause interference of the rims resulting
in a distorted record.
 He developed a plate for the upper rim
under tripoded ball bearing mounted on
a jacks screw for the lower rim. The
innovation was named the “Central
bearing point”, which was supposed to
produce the equalization of pressure on
the edentulous ridges.
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 Stansbery (1929) introduced a
technique which incorporated a curved
plate corresponding to monson’s
curve.
 He mounted this on the upper ring and
a central bearing screw was attached
to a lower plate corresponding to the
reverse monsoon curve. After the
tracing was made , a biconcave centric
registration was obtained using plaster.
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 Later gothic recording methods used
the central bearing point to produce
gothic arch tracing. Various tracing
devices were designed by Flight,
Phillips, Terrell, Sears, House,
Messerman and others
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 The graphic recording like the check
bites records received much praise
and criticism. Critics of Gothic arch
tracing stated that equalization of
pressure did not occur, prognathic and
retrognathic patients could not be
used, flabby tissues and large tongues
could cause shifting of the bases and
finally too much of patient cooperation
was needed.
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Graphic Methods:
Graphic methods are of two types:
 Arrow point tracing.
- Extra oral tracing.
- Intra oral tracing.
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Extra Oral Tracing Assembly
 It has a central bearing device
consisting of a central bearing point & a
plate
 It has a tracing device consisting of a
stylus & a recording plate
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Technique for Gothic Arch Tracing:
 Make accurate stable maxillary and
mandibular record bases.
Contour the wax occlusal rims.
 Establish the vertical jaw relation
 Make a face bow transfer and mount
the maxillary cast .www.indiandentalacademy.com
 With soft wax make a tentative centric
relation record.
 Adjust the articulator with the condylar
elements secured against the centric
stops.
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Relate the maxillary occlusion rims in
the soft wax record and attach the
mandibular cast to the articulator with
plaster.
 Reduce the mandibular occlusal rim to
provide 2 mm while maintaining the
occlusal plane
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 Central bearing device is attached to
the occlusal rims taking care to centre
them laterally & anteroposteriorly.
 Mount the tracing device, be sure to
attach the devices securely to the
occlusion rims.The stylus is attached to
the maxillary rim and the recording
plate on the mandibular.
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 Seat the recording bases with the
attached recording devices ,make sure
that there is no interference between the
occlusion rims when the mandible is
moved in any direction.
 Retract the stylus and conduct training
exercises with the patient.
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 When the patient is
proficient in executing
the mandibular
movements prepare the
tracing plate to record
the tracing by coating
with thin coat of
precipitated chalk in
denatured alcohol.
 Develop an
acceptable tracing by
dropping the stylus to
the record plate.www.indiandentalacademy.com
 When a definite arrow point
tracing with a sharp apex is
made, have the patient retrude
the mandible to the centric
relation.
 Inject quick setting dental
plaster between the occlusion
rims.
 Remove the assembly and
mount the mandibular cast with
the new record.www.indiandentalacademy.com
ADVANTAGES
 Tracing point is much larger because
they are made farther from the centers
of rotation & the apex is more
discernible
 Extra oral tracings are visible when the
tracings are made, therefore patients
can be guided & directed more
intelligently
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 The stylus can be observed in the apex
of the tracing during the process of
injecting plaster between the occlusal
rims & no hole is required.
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Classical, pointed form
The symmetry indicates an
undisturbed movement sequence in
the joints and uniform muscle
guidance.
Evaluation of Gothic Arch Tracings:
Classical flat form
Indicates distinct lateral movements
of the condyles in the fossa.
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Weak Gothic arch tracing
Indicates a lax and negligent performance
of the movements. The registration must be
repeated: Stronger movements must be
demanded from the patient.
Asymmetrical form
The tracing indicates a distinct inhibition of
the forward movement in the right joint.
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Miniature Gothic arch tracing
This tracing points restricted
mandibular movements.
•Due to badly fitting and pain-
causing record bases or
•Long standing edentulous state with
inhibited movement in the joints.
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Intra-oral tracing devices:
 It is a combination of a central –
bearing point and plate with a needle
point tracing made inside the mouth.
The bearing point is sharp which makes
a tracing on the opposing central
bearing plate .
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A hole may be drilled at the apex of the
tracing to ensure that the patients jaw is
in the most retruded position while the
registration is being recorded.
A plastic piece with a hole in the center
can also be placed at the apex.
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DISADVANTAGES
 Tracings are small, hence its difficult
to find the apex.
 The tracer must be seated in the hole
at the point of the apex to assure
accuracy when injecting plaster
between the occlusion rims.
 If the patient moves the rims before
they are secured, the records shift on
their basal seat which destroys the
accuracy.
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Digital Gothic Arch Tracing:
Here the stylus is a plastic sphere of
6mm in diameter and is attached to the
maxillary rim with auto polymerizing
acrylic resin.
A resistance film sensor is attached to
the conventional tracing device ,that is
attached to the mandibular occlusal
rim
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Digital Gothic Arch Tracing:
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Other methods of recording centric
relation:
 Use of celluloid paper.
 Soft cones of wax placed
on the lower denture
trial bases
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 Heating the surface of one of the rims
 Deep heating or pooling method
 Softened wax placed over the occlusal
surface of the mandibular posterior
teeth
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Eccentric relation records
An eccentric maxillo-mandibular
relation is any relationship of the
mandible to the maxillae other than the
centric relation.
It is recorded to adjust the lateral and
horizontal condylar inclinations.
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The adjustment permits the condylar
elements to travel to and from the
centric and eccentric positions and
make it possible to arrange the teeth
for complete dentures in balanced
occlusion.
 The eccentric positions to be
recorded are the protrusive and the
right & left lateral.
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Tactile or Inter Occlusal Check
Record
 The preferred time to make the record
is during the try-in procedure
 The trial dentures are inserted & the
patient is instructed to protrude his
lower jaw to approximately 5-6 mm
 Midline of maxillary & mandibular
incisors should coincide
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 Once the patient has learned this
position, 3 layers of wax is placed over
the mandibular teeth, seal the wax on
the lingual & buccal surface of the
teeth.
 The wax is softened over the controlled
water bath.
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Try-in dentures are re-inserted & the
lower jaw is protruded until the upper
teeth contact the wax.
 The wax is allowed to harden and
transferred to the articulator to record
the horizontal inclination.
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 FUNCTIONAL/ CHEW IN
PROCEDURE
 After the records are used to mount the
mandibular cast, the articulator is
adjusted to the eccentric records.
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Recording of eccentric jaw relations:
Gothic arch tracing :
(protrusive relation records)
Measure a distance of 5 to 6 mm from
the apex of the arrow point tracing on
the protrusive tracing and mark this
point
Instruct the patient to protrude until the
point of the stylus rests in the marked
point
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Inject quick setting dental plaster
between the occlusal rims.
Free the horizontal condylar
adjustment on the articulator.
Raise the incisal pin about one half
inch from the top of the guide table.
Carefully seat the record bases on the
cast.
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Using the locknuts as handles
manipulate one side ,then the other.
An accurate seating of both record
bases must be secured without forcing
so that the protrusive record is not
destroyed.
Secure the lock nuts.
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Lateral relation records ::
Gothic arch tracing:
 Two records are required – one of right
lateral and one of left lateral
 The articulator is adjusted as each
record is made.
 However with complete dentures, it is
more difficult to secure accurate &
reproducible records.
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 Hanau recommended a formula to arrive
an acceptable lateral inclination
• L =H/8+12
L- Lateral condylar guidance
H- Horizontal condylar
inclination in degrees as
established by the protrusive
record
 The value of this formula is neither proved
or disproved
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Review of Articles
1) Millet,Jeannin,Vincent & Malquarti:
Concluded that the record of
the relationship between the jaws in
the swallowing cycle can be used as
the VDO but is not favorable when
used to obtain centric relation.
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2) Dennis B .Gilboe: summarized that
centric relation should be considered as
the most superior position of the
mandibular condyles with the central
bearing area of the disk in contact with
the articular surfaces of the mandibular
condyles and the articular eminences.
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3) Williamson,Bowley and Randy :
Mandibular denture
base stability has been reported to be
increased by using an central bearing
intra oral gothic arch tracing device,as it
provides equalization of occlusal
pressure.
www.indiandentalacademy.com
4)Albert Yurkstas and krishan k kapur
carried out the study to evaluate the
effect of various factors on the
reliability or duplicability of wax records
and the Intraoral tracing procedures for
registering centric relation.They
concluded that the control wax and
central intra oral tracing records show
least variations.
www.indiandentalacademy.com
Conclusion :Conclusion :
The accurate determination,recording
& transfer of jaw relation records from
the edentulous patient to the
articulator is essential for the
restoration of function,facial
appearance and the maintenance of
patient health.
www.indiandentalacademy.com
Therefore it is emphasized that
irrespective of the method used,
subsequent clinical checking and
rechecking must be done throughout the
entire denture construction phases.
The skill of the dentist & the co-operation
of the patient being most important
factor.
www.indiandentalacademy.com
BIBLIOGRAPHY
 Prosthodontic treatment for edentulous
patients. - Boucher
 Syllabus of Complete Denture - Heartwell
 Essentials of complete denture
- Sheldon Winkler
 Occlusion:principles and concepts.
- jose’ dos santwww.indiandentalacademy.com
 Evaluation,diagnosis,and Treatment of
Occlusal Problems.
- Peter E Dawson.
 Text book of complete dentures.
-Swenson.
 Management of –TMJ disorders and
occlusion- Okeson
 The Glossary of Prosthodontic Terms 8th
Edition
- The Academy of Prosthodontics
www.indiandentalacademy.com
 Report on the determination of occlusal
vertical dimension and centric relation using
Swallowing in edentulous patients.
-J Oral Rehab. 2003 Nov;30(11):1118-
1122
 Centric relation records- Historical review.
-J Prosthet Dent. 1982 Feb; 47(2):141-
145.
 Factors influencing centric relation records in
edentulous mouths.
- JPD 2005; 93; 305-310.www.indiandentalacademy.com
 Centric relation as the treatment position.
- J Prosthet Dent. 1983 Nov; 50(5):685-
689.
 Simplified technique of recording edentulous
jaw relationship.
- J Prosthet Dent. 1993 April; 69(4):448-449
 Maximizing Mandibular prosthesis stability
utilizing centric recording.
- J Prosthet Dent. 2004 March; 13(1): 55 -
61
www.indiandentalacademy.com
Thank you
For more details please visit
www.indiandentalacademy.com
www.indiandentalacademy.com

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Horizontal jaw relation final/ cosmetic dentistry training

  • 1. Horizontal Jaw RelationHorizontal Jaw Relation INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. CONTENTS: Introduction Definition Significance of centric relation Retruding the mandible to centric relation Methods of recording centric relation Factors influencing centric relation record www.indiandentalacademy.com
  • 3. Eccentric relation records Recording of eccentric jaw relations Review of Articles. Conclusion Bibliography. www.indiandentalacademy.com
  • 4. INTRODUCTION Horizontal relation are those that are established anterio posteriorly & mediolaterally, Its classified as 1, Centric relation 2, Eccentric relation- which includes -Protrusive -Left & Right lateral movements www.indiandentalacademy.com
  • 5.  The principles of good occlusion apply to both dentulous & edentulous patients.  Different requirements are necessary in the occlusion for the complete dentures because artificial teeth are not attached to the bone as in natural teeth. www.indiandentalacademy.com
  • 6.  To maintain stability of complete dentures,the opposing teeth must meet evenly on both sides of the dental arch when the teeth contact anywhere within the normal functional range of mandibular movements. www.indiandentalacademy.com
  • 7.  An occlusion for complete dentures that provides these even contacts can only be developed with centric occlusion in harmony with centric relation & smooth gliding contact from this position to any eccentric position with in the normal range of mandibular movements. www.indiandentalacademy.com
  • 9. DEFINITION : The maxillo mandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective discs with the complex in the anterior superior position against the shapes of the articular eminences. This position is independent of tooth contact and is clinically discernible when the mandible is directed superiorly and anteriorly. It is restricted to a purely rotary movement about the transverse horizontal axis - GPT 8 www.indiandentalacademy.com
  • 10. Significance of Centric Relation: It is a definite learned position which is independent of the presence or absence of teeth. It is reproducible ,repeatable and recordable position. www.indiandentalacademy.com
  • 11. When the centric relation & centric occlusion of natural teeth do not coincide, the periodontal structures around the natural teeth are endangered  If the occlusion of artificial teeth do not coincide, there is instability of the dentures leading to pain & discomfort www.indiandentalacademy.com
  • 12. Errors in mounting of the cast can be detected when used as a horizontal reference point An accurate record properly orients the mandibular cast to the opening axis of the articulator. www.indiandentalacademy.com
  • 13. RELATING CENTRIC RELATION TO THE HINGE AXIS . During mandibular opening movement,the condyles rotate initially in a hinge and later in a translatory motion.A pure hinge movement of the condyle occurs only when the condyle is in its centric position. www.indiandentalacademy.com
  • 14. • Combinations of translation and hinge movement take place when the condyle moves anterior to centric relation. • Hence ,centric relation is known as the Terminal hinge relation. • Terminal hinge axis is the horizontal axis of condyles, when the condyles are in centric relation. www.indiandentalacademy.com
  • 15. CHARACTER OF OCCLUSION IN CENTRIC RELATION: There are two concepts: Point centric : This happens when centric occlusion and centric relation coincide. It is a precise location of centric occlusion in centric relation. It is a maximum intercuspation seen or given in centric relation. www.indiandentalacademy.com
  • 16. Long centric/ Freedom in centric / Area centric: When centric relation and centric occlusion do not coincide, a freedom is given to close the mandible either into centric relation or slightly anterior to it in centric occlusion with a smooth gliding, without effecting and change in vertical dimension of occlusion. www.indiandentalacademy.com
  • 17. 1) Minimal Closing Pressure :  Minimal displacement of the tissue  Opposing teeth to touch uniformly and simultaneously at their first contact. CONCEPTS AND OBJECTIVES IN RECORDING CENTRIC RELATION: www.indiandentalacademy.com
  • 18. ADVANTAGES  Uniform contact will not simulate the patient to clench the teeth  Relaxes the closing muscles. www.indiandentalacademy.com
  • 19. 2) Heavy Closing Pressure:  Tissues under bases is displaced while the record is made  Produce same displacement of the soft tissues as would exist when heavy closing pressure are applied on the dentures. www.indiandentalacademy.com
  • 20. DISADVANTAGES  Uneven contacts which tends to clench the teeth  Thus causing soreness under the denture bases & changes in the residual ridges www.indiandentalacademy.com
  • 21. RELATING CENTRIC RELATION TO CENTRIC OCCLUSION:  Centric relation is a bone to bone relation  Centric occlusion is a relationship of upper and lower teeth to each other.  Centric relation must be accurately recorded so that centric occlusion can be built to coincide with it. www.indiandentalacademy.com
  • 22. When natural teeth are removed,many receptors that initiate impulses resulting in positioning of mandible away from deflective occlusal contacts into centric occlusion are lost or destroyed. Therefore edentulous patients cannot control mandibular movements or avoid deflective occlusal contacts in centric relation as in dentulous patients. www.indiandentalacademy.com
  • 23. These deflective occlusal contacts in centric relation causes movement of the denture bases or direct the mandible away from the centric relation. Thus centric relation must be recorded for edentulous patients so that centric occlusion can be established in harmony with this position. www.indiandentalacademy.com
  • 24. Retruding the mandible to centric relation: Difficulties seen are Biological Psychological Mechanical www.indiandentalacademy.com
  • 25. Methods of assisting the patient to retrude the mandible: Instructing the patient to: Relax the jaw ,pull it back and close slowly and easily on your back teeth. [ never ask the patient to bite] Get the feeling of pushing your upper jaw out and close your back teeth together. www.indiandentalacademy.com
  • 26. Protrude and retrude the mandible repeatedly as the patient holds the fingers lightly against the chin. Turn the tongue backwards towards the posterior border of the upper denture. Ask the patient to swallow & conclude the act with the blocks in contact. www.indiandentalacademy.com
  • 27. Tap the occlusal rims or the back teeth rapidly & repeatedly. Tilting the head back while all the exercise is carried out. Assist the patient to retrude the mandible by placing the index fingers on the buccal flanges on the premolar regions with the thumbs under the patients chin. www.indiandentalacademy.com
  • 29. Verification of Centric Relation Palpating the temporais and the masseter muscles. Use of guide lines on the occlusion rims www.indiandentalacademy.com
  • 31. Factors Influencing Centric Relation Records  The resiliency of the supporting tissue.  The stability of the recording bases.  The TMJ and its associated neuromuscular mechanism.  The nature of pressure applied in making the recording.www.indiandentalacademy.com
  • 32.  The technique in making the recording & the associated recording devices used  The skill of the dentist.  The health & the co-operation of the patient.  The maxillomandibular relationship www.indiandentalacademy.com
  • 33.  The posture of the patient.  The character or size of the residual arch.  The size & position of the tongue. www.indiandentalacademy.com
  • 34. Requirements for Making Centric Relation Records  To record the correct horizontal relationship of the mandible to the maxilla.  To exert equalized vertical pressure.  To retain the record in an undistorted condition until the cast has been accurately mounted on the articulator. www.indiandentalacademy.com
  • 35. Methods Of Recording Centric Relation:  Physiological / tactile / interocclusal check record method.  Functional/ chew in method. -Patterson technique -Needle house technique  Graphic method. -Intra oral tracing -Extra oral tracingwww.indiandentalacademy.com
  • 36. OTHER METHODS-  Strips of celluloid placed between the rims  Heating the surface of one of the rims  Deep heating or pooling method  Softened wax placed over the occlusal surface of the mandibular posterior teeth  Soft cones of wax placed on the lower denturel bases www.indiandentalacademy.com
  • 37. Physiological / tactile / interocclusal check record method: History In 1756,Philip pfaff, the dentist of Frederick the great of Germany, was the first to describe this technique. The direct interocclusal record during that period was a non-precision jaw record obtained with a thermoplastic material, usually wax or compound. www.indiandentalacademy.com
  • 38. This was known as “mush” “biscuit” or “squash bite.  Christensen[1905] was one of the early authors to use impression wax for bite records. Brown [1954] recommended repeated closures into softened wax rims. www.indiandentalacademy.com
  • 39. Greene had his patients hold their jaw apart for 10 sec to fatigue the muscles and then had them snap the rims together.  Wax, compound, plaster & zinc oxide eugenol paste were used as registration material for the records www.indiandentalacademy.com
  • 40.  Schuyler[1932] preferred modelling compound to wax for the occlusal records  Trappzzano[1955] stated that wax check bite method was the technique of preference www.indiandentalacademy.com
  • 41.  Payne[1955] & Hickey[1964] stated a preference for plaster  Boos[1959] stated that it was important to avoid torsion when recording centric relation & felt that plaster & zinc oxide eugenol paste was more accurate www.indiandentalacademy.com
  • 42.  Hanau[1929] was the first individual to be concerned about equalization of pressure when recording the bite. He coined the word “realeff” which is formed by the beginning letters of the words “resilient and like effect”.  This became a major factor in “check bite” techniques. www.indiandentalacademy.com
  • 43.  Wright (1939) described the four factors which affected the accuracy of records- 1. Resiliency of tissues. 2. Saliva film, 3. Fit of bases 4. Pressure applied www.indiandentalacademy.com
  • 44.  Scyhyler, Payne and Trapozzano advocated the use of light pressure  The problem of pressure in any record was recognized by Boucher (1960) who wrote, “In addition to technical errors are the errors which occur as a result of failure to control jaw activities and pressure at the time of registration”. www.indiandentalacademy.com
  • 45.  The importance of verifying the interocclusal records has been stressed by Greene (1910), Schyuler (1932), Trapozzano (1950, Beck (1960)  Most of the criticisms for using “check bites” for centric relation record were from individuals who favored some type of graphic recording.  Gradually these procedures evolved into interocclusal records as they are usually done today. www.indiandentalacademy.com
  • 46. Physiological / Tactile / Interocclusal Check Record Method: It is particularly indicated in situation of Abnormally related jaws Supporting tissues that are excessively displaceable Large tongue. Uncontrollable or abnormal mandibular movements To check the occlusion of the teeth in try-in dentures www.indiandentalacademy.com
  • 47. The technique for this record is divided into two steps- 1. Tentative records using occlusion rims attached to accurate stable bases. 2. Inter occlusal check records with teeth arranged for try-in. www.indiandentalacademy.com
  • 48.  In this method the vertical dimension is established first . A tentative centric relation is recorded, occlusal rims are articulated using tentative records and artificial teeth are arranged. Now the try-in dentures are ready for making the inter-occlusal check record. www.indiandentalacademy.com
  • 49. The try-in dentures are inserted into patient mouth ,recording material is loaded onto the occlusal surface of posterior teeth in the mandibular occlusal rim and patient is asked to slowly retrude the mandible and close, make sure there’s no tooth to tooth contact. The horizontal Condylar guide locks in the articulator are unlocked and the try- in dentures are placed on their articulated casts.www.indiandentalacademy.com
  • 50. Recording material on the buccal aspect of mandibular teeth is scraped off and the articulated casts are adjusted to fit into the check record. If the tentative record is accurate and is same as the check record then both Condylar elements will contact against the centric stops. www.indiandentalacademy.com
  • 51.  If any one of the Condylar elements are not touching ,then one or the other record is inaccurate. www.indiandentalacademy.com
  • 52. Functional/chew in Method :: HISTORY  Functional recordings were described as early as 1910. by Greene where he used a pumices and plaster mixture in one of the rims and instructed the patient to grind the rims together. The teeth were set to the generated paths. www.indiandentalacademy.com
  • 53.  Needles(1923) mounted studs on the maxillary rims which cut tracing into the mandibular rims  Petterson(1923) used a carborundum and plaster mixture which were filled in a trough cut in the upper and lower rims  Meyers(1934)used soft wax occlusion rims. www.indiandentalacademy.com
  • 54.  Boos (1959) felt that it was essential that all registrations be made under the biting force so that the displacement of the soft tissues which occur in function would occur during bite registration www.indiandentalacademy.com
  • 55. Functional/chew in Method :: Needles-house technique: Compound occlusal rims with 4 metal styli placed in the maxillary rim. When the mandible moves with the styli contacting the mandibular rim, the styli cuts 4 diamond shaped tracings. www.indiandentalacademy.com
  • 56. The pathways cut into the modeling compound indicating both the centric position and the eccentric mandibular excursions. The records are placed on a suitable articulator to receive and duplicate the records. www.indiandentalacademy.com
  • 58. The Patterson method: Uses wax occlusal rims. A trench is made in the mandibular rim and a mixture of half plaster and half carborundum or pumice paste is placed in the trench. www.indiandentalacademy.com
  • 59. When the plaster & pumice are reduced to the pre determined height the patient is asked to retrude the mandible and the occlusion rims are joined with metal staple pins.` www.indiandentalacademy.com
  • 60.  Plaster pumice rims tends to be rather messy an alternative is modelling wax mixed with a little carding wax to render it displaceable, the rims are covered with the tin foil to prevent them sticking together while the patient squeezes them into his own individual occlusal curves. www.indiandentalacademy.com
  • 62. Disadvantages 1. The displaceable basal tissues, the resistance of the recording medium and the lack of control of equalized pressure in the eccentric relation contribute to inaccuracies. 2. Patients should have a good neuromuscular co-ordination and should be capable of following instructions. www.indiandentalacademy.com
  • 63. NEEDLE POINT TRACING: HISTORY • The earliest graphic recording Were based on mandibular movements by Blackwil in 1866. The intersections of the arcs produced by the right and left condyles formed the apex of what is known as the “Gothic arch tracing”. • The first known”Needle point tracing” was by Hesse in 1897, and the technique was improved and popularized by Gysi around 1910” www.indiandentalacademy.com
  • 64.  Gysi’s tracer was an Extraoral incisal tracer in which the plate was attached to the mandibular rim & spring loaded pin was mounted on the maxillary rim. www.indiandentalacademy.com
  • 65.  Phillips(1927) recognized that any lateral movement of the jaw would cause interference of the rims resulting in a distorted record.  He developed a plate for the upper rim under tripoded ball bearing mounted on a jacks screw for the lower rim. The innovation was named the “Central bearing point”, which was supposed to produce the equalization of pressure on the edentulous ridges. www.indiandentalacademy.com
  • 66.  Stansbery (1929) introduced a technique which incorporated a curved plate corresponding to monson’s curve.  He mounted this on the upper ring and a central bearing screw was attached to a lower plate corresponding to the reverse monsoon curve. After the tracing was made , a biconcave centric registration was obtained using plaster. www.indiandentalacademy.com
  • 67.  Later gothic recording methods used the central bearing point to produce gothic arch tracing. Various tracing devices were designed by Flight, Phillips, Terrell, Sears, House, Messerman and others www.indiandentalacademy.com
  • 68.  The graphic recording like the check bites records received much praise and criticism. Critics of Gothic arch tracing stated that equalization of pressure did not occur, prognathic and retrognathic patients could not be used, flabby tissues and large tongues could cause shifting of the bases and finally too much of patient cooperation was needed. www.indiandentalacademy.com
  • 69. Graphic Methods: Graphic methods are of two types:  Arrow point tracing. - Extra oral tracing. - Intra oral tracing. www.indiandentalacademy.com
  • 70. Extra Oral Tracing Assembly  It has a central bearing device consisting of a central bearing point & a plate  It has a tracing device consisting of a stylus & a recording plate www.indiandentalacademy.com
  • 71. Technique for Gothic Arch Tracing:  Make accurate stable maxillary and mandibular record bases. Contour the wax occlusal rims.  Establish the vertical jaw relation  Make a face bow transfer and mount the maxillary cast .www.indiandentalacademy.com
  • 72.  With soft wax make a tentative centric relation record.  Adjust the articulator with the condylar elements secured against the centric stops. www.indiandentalacademy.com
  • 73. Relate the maxillary occlusion rims in the soft wax record and attach the mandibular cast to the articulator with plaster.  Reduce the mandibular occlusal rim to provide 2 mm while maintaining the occlusal plane www.indiandentalacademy.com
  • 74.  Central bearing device is attached to the occlusal rims taking care to centre them laterally & anteroposteriorly.  Mount the tracing device, be sure to attach the devices securely to the occlusion rims.The stylus is attached to the maxillary rim and the recording plate on the mandibular. www.indiandentalacademy.com
  • 75.  Seat the recording bases with the attached recording devices ,make sure that there is no interference between the occlusion rims when the mandible is moved in any direction.  Retract the stylus and conduct training exercises with the patient. www.indiandentalacademy.com
  • 76.  When the patient is proficient in executing the mandibular movements prepare the tracing plate to record the tracing by coating with thin coat of precipitated chalk in denatured alcohol.  Develop an acceptable tracing by dropping the stylus to the record plate.www.indiandentalacademy.com
  • 77.  When a definite arrow point tracing with a sharp apex is made, have the patient retrude the mandible to the centric relation.  Inject quick setting dental plaster between the occlusion rims.  Remove the assembly and mount the mandibular cast with the new record.www.indiandentalacademy.com
  • 78. ADVANTAGES  Tracing point is much larger because they are made farther from the centers of rotation & the apex is more discernible  Extra oral tracings are visible when the tracings are made, therefore patients can be guided & directed more intelligently www.indiandentalacademy.com
  • 79.  The stylus can be observed in the apex of the tracing during the process of injecting plaster between the occlusal rims & no hole is required. www.indiandentalacademy.com
  • 80. Classical, pointed form The symmetry indicates an undisturbed movement sequence in the joints and uniform muscle guidance. Evaluation of Gothic Arch Tracings: Classical flat form Indicates distinct lateral movements of the condyles in the fossa. www.indiandentalacademy.com
  • 81. Weak Gothic arch tracing Indicates a lax and negligent performance of the movements. The registration must be repeated: Stronger movements must be demanded from the patient. Asymmetrical form The tracing indicates a distinct inhibition of the forward movement in the right joint. www.indiandentalacademy.com
  • 82. Miniature Gothic arch tracing This tracing points restricted mandibular movements. •Due to badly fitting and pain- causing record bases or •Long standing edentulous state with inhibited movement in the joints. www.indiandentalacademy.com
  • 83. Intra-oral tracing devices:  It is a combination of a central – bearing point and plate with a needle point tracing made inside the mouth. The bearing point is sharp which makes a tracing on the opposing central bearing plate . www.indiandentalacademy.com
  • 84. A hole may be drilled at the apex of the tracing to ensure that the patients jaw is in the most retruded position while the registration is being recorded. A plastic piece with a hole in the center can also be placed at the apex. www.indiandentalacademy.com
  • 85. DISADVANTAGES  Tracings are small, hence its difficult to find the apex.  The tracer must be seated in the hole at the point of the apex to assure accuracy when injecting plaster between the occlusion rims.  If the patient moves the rims before they are secured, the records shift on their basal seat which destroys the accuracy. www.indiandentalacademy.com
  • 86. Digital Gothic Arch Tracing: Here the stylus is a plastic sphere of 6mm in diameter and is attached to the maxillary rim with auto polymerizing acrylic resin. A resistance film sensor is attached to the conventional tracing device ,that is attached to the mandibular occlusal rim www.indiandentalacademy.com
  • 87. Digital Gothic Arch Tracing: www.indiandentalacademy.com
  • 88. Other methods of recording centric relation:  Use of celluloid paper.  Soft cones of wax placed on the lower denture trial bases www.indiandentalacademy.com
  • 89.  Heating the surface of one of the rims  Deep heating or pooling method  Softened wax placed over the occlusal surface of the mandibular posterior teeth www.indiandentalacademy.com
  • 91. Eccentric relation records An eccentric maxillo-mandibular relation is any relationship of the mandible to the maxillae other than the centric relation. It is recorded to adjust the lateral and horizontal condylar inclinations. www.indiandentalacademy.com
  • 92. The adjustment permits the condylar elements to travel to and from the centric and eccentric positions and make it possible to arrange the teeth for complete dentures in balanced occlusion.  The eccentric positions to be recorded are the protrusive and the right & left lateral. www.indiandentalacademy.com
  • 93. Tactile or Inter Occlusal Check Record  The preferred time to make the record is during the try-in procedure  The trial dentures are inserted & the patient is instructed to protrude his lower jaw to approximately 5-6 mm  Midline of maxillary & mandibular incisors should coincide www.indiandentalacademy.com
  • 94.  Once the patient has learned this position, 3 layers of wax is placed over the mandibular teeth, seal the wax on the lingual & buccal surface of the teeth.  The wax is softened over the controlled water bath. www.indiandentalacademy.com
  • 95. Try-in dentures are re-inserted & the lower jaw is protruded until the upper teeth contact the wax.  The wax is allowed to harden and transferred to the articulator to record the horizontal inclination. www.indiandentalacademy.com
  • 96.  FUNCTIONAL/ CHEW IN PROCEDURE  After the records are used to mount the mandibular cast, the articulator is adjusted to the eccentric records. www.indiandentalacademy.com
  • 97. Recording of eccentric jaw relations: Gothic arch tracing : (protrusive relation records) Measure a distance of 5 to 6 mm from the apex of the arrow point tracing on the protrusive tracing and mark this point Instruct the patient to protrude until the point of the stylus rests in the marked point www.indiandentalacademy.com
  • 98. Inject quick setting dental plaster between the occlusal rims. Free the horizontal condylar adjustment on the articulator. Raise the incisal pin about one half inch from the top of the guide table. Carefully seat the record bases on the cast. www.indiandentalacademy.com
  • 99. Using the locknuts as handles manipulate one side ,then the other. An accurate seating of both record bases must be secured without forcing so that the protrusive record is not destroyed. Secure the lock nuts. www.indiandentalacademy.com
  • 100. Lateral relation records :: Gothic arch tracing:  Two records are required – one of right lateral and one of left lateral  The articulator is adjusted as each record is made.  However with complete dentures, it is more difficult to secure accurate & reproducible records. www.indiandentalacademy.com
  • 101.  Hanau recommended a formula to arrive an acceptable lateral inclination • L =H/8+12 L- Lateral condylar guidance H- Horizontal condylar inclination in degrees as established by the protrusive record  The value of this formula is neither proved or disproved www.indiandentalacademy.com
  • 102. Review of Articles 1) Millet,Jeannin,Vincent & Malquarti: Concluded that the record of the relationship between the jaws in the swallowing cycle can be used as the VDO but is not favorable when used to obtain centric relation. www.indiandentalacademy.com
  • 103. 2) Dennis B .Gilboe: summarized that centric relation should be considered as the most superior position of the mandibular condyles with the central bearing area of the disk in contact with the articular surfaces of the mandibular condyles and the articular eminences. www.indiandentalacademy.com
  • 104. 3) Williamson,Bowley and Randy : Mandibular denture base stability has been reported to be increased by using an central bearing intra oral gothic arch tracing device,as it provides equalization of occlusal pressure. www.indiandentalacademy.com
  • 105. 4)Albert Yurkstas and krishan k kapur carried out the study to evaluate the effect of various factors on the reliability or duplicability of wax records and the Intraoral tracing procedures for registering centric relation.They concluded that the control wax and central intra oral tracing records show least variations. www.indiandentalacademy.com
  • 106. Conclusion :Conclusion : The accurate determination,recording & transfer of jaw relation records from the edentulous patient to the articulator is essential for the restoration of function,facial appearance and the maintenance of patient health. www.indiandentalacademy.com
  • 107. Therefore it is emphasized that irrespective of the method used, subsequent clinical checking and rechecking must be done throughout the entire denture construction phases. The skill of the dentist & the co-operation of the patient being most important factor. www.indiandentalacademy.com
  • 108. BIBLIOGRAPHY  Prosthodontic treatment for edentulous patients. - Boucher  Syllabus of Complete Denture - Heartwell  Essentials of complete denture - Sheldon Winkler  Occlusion:principles and concepts. - jose’ dos santwww.indiandentalacademy.com
  • 109.  Evaluation,diagnosis,and Treatment of Occlusal Problems. - Peter E Dawson.  Text book of complete dentures. -Swenson.  Management of –TMJ disorders and occlusion- Okeson  The Glossary of Prosthodontic Terms 8th Edition - The Academy of Prosthodontics www.indiandentalacademy.com
  • 110.  Report on the determination of occlusal vertical dimension and centric relation using Swallowing in edentulous patients. -J Oral Rehab. 2003 Nov;30(11):1118- 1122  Centric relation records- Historical review. -J Prosthet Dent. 1982 Feb; 47(2):141- 145.  Factors influencing centric relation records in edentulous mouths. - JPD 2005; 93; 305-310.www.indiandentalacademy.com
  • 111.  Centric relation as the treatment position. - J Prosthet Dent. 1983 Nov; 50(5):685- 689.  Simplified technique of recording edentulous jaw relationship. - J Prosthet Dent. 1993 April; 69(4):448-449  Maximizing Mandibular prosthesis stability utilizing centric recording. - J Prosthet Dent. 2004 March; 13(1): 55 - 61 www.indiandentalacademy.com
  • 112. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

Notas del editor

  1. JAW RELATION-Any spatial relationship of the maxilla to the mandible.
  2. Thus an occlusion that is physiologically acceptable or desirable may not be applicable for the complete dentures.
  3. First and the second registration material should be the same.
  4. Path of the condyle in eccentric movmnts is not a straight line. Shape of the mandibular fossa is an OGEE curve viewed in sagital plane This double curve will cause the apparent path of the condyle to be different with varying amounts of protrusion. Ideal amount of protrusion is amount to bring anterior teeth end to end. Mechanical limitation of articulators require a minimum of 6mm to adjust condylar guidance.
  5. Lateral tracing if done, should be recorded 6 mm on the tracing because its moves 3mm at the molar region. Because its appx middle between the tracing & working side condyle