Horizontal Jaw Relation

HORIZONTAL
JAW RELATION
Ruchika Iyer
Dept of Prosthodontics
CONTENTS
2
• Introduction
• Definition
• Chronology of changing definitions
• Theories of centric relation
• Anatomy of TMJ pertaining to centric relation
• Muscle involvement in centric relation
• Physiology of Centric Relation
Horizontal Jaw Relation 18-08-2019

3
• Relating centric relation to centric occlusion
• Methods to retrude the mandible
• Methods of recording centric relation
• Eccentric Relation
• Conclusion
• References

4
INTRODUCTION
The principles of good occlusion apply to both dentulous and
edentulous patients.
However different requirements are necessary in the occlusion of

complete dentures because artificial teeth are not attached to the
bone in the same manner as natural teeth.
Thus an occlusion that is physiologically acceptable or desirable for

the preservation of the attachment apparatus of natural teeth may
not be applicable for complete dentures.
5
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
movement.
Such an occlusion can only be developed with centric occlusion in

harmony with centric relation.

6
HORIZONTAL
JAW
RELATION
CENTRIC ECCENTRIC
RELATION RELATION
PROTRUSIVE LATERAL
RELATION RELATION

7
CENTRIC RELATION-DEFINITION
A maxillomandibular relation independent of tooth contact in which the

condyles articulate in the anterosuperior position against the posterior slopes
of the articular eminences, in this position the mandible is restricted to a purely
rotatory movement; from this unstrained physiologic maxillomandibular
relationship, the patient can make vertical, lateral or protrusive movements; it
is a clinically useful, repeatable, reference point. (GPT 9)

CHRONOLOGY OF CHANGING
8
DEFINITIONS
• Hanau(1929) - the position of the mandible in which the condylar heads are
resting upon the menisci in the sockets of the glenoid fossa, regardless of the
opening of the jaws
• Goodfriend [1933] - considered the ‘centricity of the condyles in centric

relation to be an abnormal position
• McCollum and Stuart [1955] - the condyles are in a ‘rearmost, uppermost

and midmost (RUM) position in the glenoid fossae
Centric Relation Definition: A Historical and Contemporary Prosthodontic Perspective

J Indian Prosthodont Soc (July-Sept 2013) 13(3):149–154
9
• GPT-1 [1956] - the most retruded relation of the mandible to the maxilla when the
condyles are in the most posterior unstrained position in the glenoid fossa from which
lateral movements can be made, at any given degrees of jaw separation
• Boucher [1964] - most posterior relation of the mandible to maxillae at the

established vertical relation
• Dawson (1973) – most superior position the condyle can assume in the glenoid fossa
and it is not unstrained.

10
• GPT-5 and 6 [1987, 1994] - ‘the relation of the mandible to the maxilla when
the condyles are in their most posterior position in the glenoid fossa from
which unstrained lateral movements can be made at occluding vertical
dimension normal for the individual.
• GPT- 7 (1999) - a maxillomandibular relationship in which the condyles

articulate with the thinnest avascular portion of their respective disks with the
complex in the anterosuperior position against the shapes of the articular
eminences. This position is independent of tooth contact. This position is
clinically discernible when the mandible is directed superiorly and anteriorly
and restricted to a purely rotary movement about a transverse horizontal axis

11
CENTRIC RELATION-DEFINITION
A maxillomandibular relation independent of tooth contact in which the

condyles articulate in the anterosuperior position against the posterior slopes
of the articular eminences, in this position the mandible is restricted to a purely
rotatory movement; from this unstrained physiologic maxillomandibular
relationship, the patient can make vertical, lateral or protrusive movements; it
is a clinically useful, repeatable, reference point. (GPT 9)

12
THE MUSCLE
THEORY
THEORIES OF
CENTRIC THE
MENISCUS THEORIES
OF CR
THE
LIGAMENT
RELATION
THEORY THEORY
THE
OSTEOFIBRE
THEORY

J Prosth Dent December, 1971
MUSCLE THEORY 13
External
pterygoid
Defense reflex Jaw halts
muscle
contracts
Horizontal Jaw Relation J Prosth Dent December, 1971 18-08-2019
14
LIGAMENT THEORY
-Given by Ferrien
-ligaments determine the

retrusive movement.
-in lateral radiographic

views : SUSPENDED OR
FLOATING APPEARANCE
Horizontal Jaw Relation J Prosth Dent December, 1971 18-08-2019

15

16
OSTEOFIBRE THEORY
-Given by Meyer
-soft tissues of posterior part of
glenoid fossa responsible for centric
relation
-tissues were found to be loose,
fibrous and functionally differentiated
-RETROARTICULAR CUSHION
Horizontal Jaw Relation

J Prosth Dent December, 1971 18-08-2019
MENISCUS THEORY 17
SAGITTAL SECTION OF TMJ IN CENTRIC RELATION

J Prosth Dent December, 1971
18
SAGITTAL SECTION OF TMJ IN GLIDING SAGITTAL SECTION OF TMJ WHEN

POSITION MOUTH IF FULLY OPEN

ANATOMY OF TMJ AS PERTAINING TO 19
CENTRIC RELATION
• Articular eminence:
-shape and size not constant throughout life
-mandibular fossa shallow at birth and gradually

deepens
-eminence starts to develop at the age of 8 to 9years
-by 12 to 13years has attained adult proportions
-about 40th year begins to flatten again but slightly

J Prosth Dent ; May-June 1962; Vol 12 No. 3 18-08-2019
1.The external pterygoid muscle supports the mandibular condyle on the articular
eminence.
2. Muscles limit the functional posterior border movements of the mandible.
3. Centric relation is controlled by a neuromuscular reflex which does not necessarily

always function in the same anteroposterior position.
4. The terminal hinge position and the apex of the needle point tracings of the
retruded mandible may be desirable positions from which to start the construction of
dentures because they are reference positions, but this does not imply that it may be
the ideal functional position of the mandible for all patients.
J Prosth Dent ; May-June 1962; Vol 12 No. 3

MUSCLE INVOLVEMENT IN CENTRIC 21
RELATION
• Under most conditions of posture, there are
muscles whose function is to maintain the
body in position.
• This process is made possible’ by the stretch

or myotatic reflex.
• Position maintained against gravity is

postural position.
• Thus when mandibular muscles in

equilibrium: physiologic position.
Horizontal Jaw Relation J. Prosth Dent March 1956 18-08-2019

22
• Centric relation is not a resting or postural position of the mandible.
• Contraction of the muscles is necessary to move and fix the mandible in this
position.
• The temporalis masseter and medial pterygoid muscles elevate the

mandible to a certain vertical height in relation to the maxilla.
• According to electromyographic studies; the middle parts of temporalis and

the suprahyoid muscles i.e. geniohyoid and digastric fix the mandible in the
most retruded position.
• The lateral pterygoid muscle shows little activity when the mandible is in
centric relation.

23
PHYSIOLOGY OF CENTRIC RELATION
• CR is established during the early stages of the primary dentition when

occlusal anomalies are minimal.
• It is the first established neuromuscular reflex concerning mandibular position

when the teeth are in occlusion.
• Not only is it controlled by the stretch receptors in the muscles of mastication

but also by the receptor organs in the periodontal membrane.

24
• Limits of centric:
-anteroposterior : on eruption of primary incisiors
-mediolateral: on eruption of teeth in lateral segments of arch
-vertical limits: never precisely defined

25
ALTERATIONS IN THE REFLEXES CONTROLLING MANDIBULAR POSITION:
-During growth of the craniofacial complex of bones; the centric relation

changes as the mandible grows at a faster rate in a downward and forward
direction than the maxillae.
-the most number of alterations in this position occur due to altered or

impaired occlusal harmony.
-Mixed dentition stage: occlusal interferences are many and thus the muscles
repeatedly learn new patterns of closure.

26
-It is at this time that the muscles usually adapt to an occlusal position that
does not coincide with centric relation.
-The earlier in life an eccentric occlusion is adopted and used, the firmer the
hold on the nervous system, for it is simply a habit.
-Later in life as more teeth are lost; it necessitates the learning of a new muscle
reflex and establishment of an occlusal eccentricity.
-Centric relation in edentulous individuals is determined solely by muscle

proprioceptors and thus poses problems in recording it.

J. Prosth Dent March 1956 18-08-2019
RELATING CENTRIC RELATION TO 27
CENTRIC OCCLUSION
• Centric is an adjective.
• Centric relation: bone to bone
• Centric occlusion: relationship of

upper to lower teeth

28
Radiographic study of condylar position in centric

relation and centric occlusion
J Prosth Dent March 1980 Volume 43 Number 3

29

30
METHODS TO RETRUDE THE MANDIBLE
• Instruct the patient by saying ‘let your jaw relax, pull it back and close slowly
and easily on your back’.
• Get the feeling of pushing your upper jaw out and close your back teeth
together.
• Protrude and retrude the mandible repeatedly while the patient holds the
fingers lightly against the chin.

31
• Turn the tongue backward towards the posterior border of the upper
denture.
• Tap the occlusal rims or back teeth together repeatedly.
• Tilt the patients head back while the above listed exercises are carried out.

32
• Boo’s series of stretch relax exercises:
-The patient is instructed to open wide and relax, to move the jaws to the left
and relax, to move the jaw to the right and relax and to move the jaw forward
and relax in series of movements.

33
DAWSON BILATERAL MANIPULATION

34
CHIN POINT GUIDANCE
Recommended by Guichet in 1970 for

retruding the mandible. 18-08-2019
DIFFICULTIES IN RETRUDING THE MANDIBLE
35
• Biologic difficulties:
-lack of co-ordination between the groups of opposing muscles when the

patient is asked to retrude the mandible.
• Psychological difficulties:
-difficulties involve both the dentist and the patient
-more the dentist becomes irritated over the ability of the patient to retrude
the mandible more confused the patient becomes.

36
• Mechanical difficulties:
-encountered because of poorly placed baseplates.
-amount of pressure exerted by the patient while recording centric relation is

difficult to control.

37
FACTORS INFLUENCING CENTRIC RELATION

RECORDS
• The resiliency of the supporting tissues
• The stability of the recording bases
• The temporomandibular joint and its associated neuromuscular mechanisms
• The character of the pressure applied in making the recording
• The technique used in making the recording and the associated recording
devices used
• The skill of the dentist

Horizontal Jaw Relation J Prosth Dent Nov-Dec; 1964 18-08-2019
38
• The health and cooperation of the patient
• The maxillomandibular relationship
• The posture of the patient
• The character or size of the residual alveolar arch
• The amount and character of the saliva
• The size and position of the tongue
Horizontal Jaw Relation J Prosth Dent Nov-Dec; 1964 18-08-2019

METHODS OF RECORDING CENTRIC 39
RELATION
• ACCORDING TO BOUCHER:
1)Static methods
2)Functional methods
Both of which can be further classified into inta oral and extra oral techniques

40
• By Heartwell:
1)Functional methods:
-Needles house method
-Patterson method
2)Graphic methods:
-Intraoral tracings
-Extraoral tracings
3)Physiologic or tactile or
interocclusal check record methods

41
Horizontal Jaw Relation J Prosth Dent; Dec 2008; Vol 8 18-08-2019

42

43
PHYSIOLOGIC FUNCTIONAL GRAPHIC

METHODS METHODS TRACING
• Pressure • Needles House • Intraoral
method method tracing
• Pressureless • Patterson • Extra oral
method method tracing
• Meyers
• Interocclusal method
check record

44
PHYSIOLOGIC METHODS
• These methods are based on the following:
-proprioceptive impulse of patient
-movement of mandible
-visual acuity and sense of touch of dentist
• In 1976, Phillip Pfaff was the first one to describe the technique of taking a
bite.

45
PRESSURE METHOD
Vertical dimension is established and

upper rim placed in patient’s mouth
Lower rim softened in water bath and

patient asked to close in centric
relation
This record is then articulated

46
PRESSURELESS METHOD
Wax occlusal rims are contoured and the vertical dimension is

established ensuring even contact of the rims both anteriorly and
posteriorly
The patient is trained to retrude the mandible and the various

guidelines are marked on the occlusal rims after which patient
is asked to close in centric and hold the position
The rims are joined or sealed in this position and then removed
from the mouth and articulated.

47
• Different methods are used to seal the occlusal rims in position:
-Heat
-Stapler pins
These methods are not recommended due to:
-chances of burning and injuring lips and cheeks
-no equalization of pressure
-difficult to prevent movement of rims while sealing

48
• NICK AND NOTCH METHOD:

49
DIRECT CHECKBITE INTEROCCLUSAL

RECORDINGS
• Oldest type of centric relation record.
• Most commonly used till the end of the 19th century.
• The direct interocculusal record during that period, was a non-precision jaw
record obtained by placing a thermoplastic material, usually wax or
compound, between the edentulous ridge and having the patient close into
the material. This was known as the “Mush, “Biscuit”, or “Squash” Bite.

J Prosth Dent; Dec 2008; Vol 8 18-08-2019
50
• 1954: Browne recommended repeated closure into softened wax rims
• Greene: instructed patient to keep mouth open for 10seconds causing

muscle fatigue and then had them snap the rims together.
• Gradually procedures evolved into how they are done today.
-materials like ZnOE paste, impression plaster, wax or compound are placed
between the occluding rims and the patient closes the jaw in centric relation.

51
INDICATIONS:
- Abnormally related jaws.
- Supporting tissues that are excessively displaceable.
- Large awkward tongue.
- Uncontrollable or abnormal mandibular movements.
- Check the occlusion of the teeth in existing dentures.

52
Occlusal rims articulated with static records; artificial

teeth are arranged and trial dentures are fabricated
Centric relation verified with the help of this method

in try in stage. Patient is asked to rehearse to retrude
the mandible
Maxillary trial denture placed into the patients mouth

and recording medium is loaded onto occlusal
surfaces of the mandibular trial denture
Patient is asked to slowly retrude the mandible and

close on the wax till tooth contact occurs. Recording
medium allowed to set and the trial dentures are
removed from the mouth along with the record
53
Mandibular trial denture

with record is now returned
to the mandibular cast on
the articulator
Horizontal condylar
locks of the articulator
are released and the
maxillary teeth are now
seated over the record.

54

55
• If the previous record of centric relation is the same as the check record,
then the condylar elements of the articulator will contact the centric stops;
i.e the articulated casts need not move to fit into the check records
• If anyone or both of the condylar elements of the articulator does not

contact the centric stops, it indicates that one of the records is inaccurate.

56
• CRITICAL EVALUATION:
-1932: Shuyler observed that if the recording medium was not of uniform
density and viscosity, uneven pressures would be transmitted to the record
bases which would cause a disharmony of occlusion.
-1939: Wright described 4 factors he believed affected the accuracy of

records;
a)Resiliency of tissues
b)Saliva film
c)Fit of bases
d)Pressure applied

57
-Payne(1955) and Hickey(1964) stated a preference for dental plaster

because less material had to be placed in the patient’s mouth for the record.
-Hanau(1923), considered various factors that influenced the recording of

Centric Relation and he modified the intra-oral wax method. He pointed out
the “Resiliency And Like Effect” (REALEFF) of the denture supporting tissues.

58
IDEAL REQUIREMENTS OF INTEROCCLUSAL BITE REGISTRATION MATERIALS:
• Limited resistance before setting to avoid displacing the mandibular teeth during
closure.
• Rigid or resilient after setting.
• Minimal dimensional changes after setting.
• Accurate record of incisal and occlusal surface of teeth.
• Easy to manipulate.
• No adverse effects on the tissues involved in recording procedure.
• The interocclusal record is verifiable.

59
• TYPES OF MATERIALS WHICH CAN BE USED:
• Plaster of paris.
• Waxes.
• Zinc oxide eugenol paste.
• Silicone elastomers.

FUNCTIONAL METHODS 60
• These methods utilise the functional movements of the mandible in recording

centric relation.
• The patient is asked to do the movements in protrusion, retrusion, right lateral

and left lateral.
• Methods are:
-Needles House method
-Patterson method

NEEDLES-HOUSE METHOD
61

PATTERSON METHOD 62

63
CRITICAL ANALYSIS OF FUNCTIONAL METHODS:
-Requires stability of the recording bases.
-The displaceable basal seat tissues, the resistance of the recording mediums,
and the lack of control of equalized pressure in the eccentric relations
contribute to inaccuracy in these methods.
-patient must have good neuromuscular coordination and should be able to

comprehend correctly the instructions given to him.
Horizontal Jaw Relation Journal of Indian Prosthodontic Society; Dec 2008; Vol 8 18-08-2019
64
GRAPHIC METHODS
GOTHIC ARCH PANTOGRAPHIC

TRACING TRACING

65
GOTHIC ARCH TRACING
• The graphic methods record a tracing of mandibular movements in one

plane, an arrow point tracing.
• It indicates the horizontal relation of the mandible to the maxillae.
• The apex of a properly made tracing presumably indicates the most

retruded relation of the mandible to the maxillae from which lateral
movements can take place.

66
REVIEW OF LITERATURE
• 1987: Hesse gave the first known needle point tracing
• 1910: Gysi popularised needle point tracing. Extra oral incisal tracer.
• 1914: Clapp described a type of gysi tracer in which the tracers are
attached to the impression trays
• Sears: lubricated the rims for easier movement. Tracer on mandibular rim
and recording plate on maxillary rim
67
• 1927: Phillips introduced the central bearing point because any lateral
movement of the jaws would cause interference of the rims and thus would
distort the records.
• Later all the tracers introduced used the central bearing device for the
gothic arch tracing.
68

69
Cobble Tracing Device
Swissdent Ball bearing

bite recorder
Microtracer
70
Stansberry Tracer Sears Trivet

71
INTRA ORAL TRACERS EXTRA ORAL TRACERS
• Tracing is not visible when it is made-thus

• Tracing is visible while being made and
verification of mandibular movements not
thus mandibular movements can be
possible.
verified.
• Tracings given are small thus locating
• Tracing is larger-thus apex is more
apex is difficult.
discernible
• Tracings are produced closer to the
• Tracings produced further away from
centre of rotation of the condyles.
the centre of rotation of the condyles.

72
FACTORS TO BE CONSIDERED WHILE USING GOTHIC ARCH TRACING:

-Displacement of the record bases may result from pressure if the central bearing point
is off center, when the mandible moves into eccentric relations to the maxillae.
-If a central bearing device is not used, the occlusion rims offer more resistance to
horizontal movements.
-It is difficult to locate the center of the true arches to centralize the forces with a
central bearing device when the jaws are in favorable relation and far more difficult if
the jaws are in excessive protrusive or retrusive relation.
-It is difficult to stabilize a record base against horizontal force on residual ridge that
have no vertical height.

73
- It is difficult to stabilize a record base against horizontal forces on tissues that

are pendulous or otherwise easily displaceable.
- It is difficult to stabilize a record base or bearing device with patients who

have large awkward tongues.
-The tracing is not acceptable unless a pointed apex is developed.

74
INTRA ORAL TRACING DEVICE

75

76
HIGHT EXTRA ORAL TRACING DEVICE
FUNCTIONS:
-maintains vertical dimension
-equalizes the pressure by
distributing the forces
throughout the supporting
tissues
CENTRAL BEARING PLATE CENTRAL BEARING POINT

77
CENTRAL BEARING TRACING DEVICE:
A device that provides a central point of bearing or support between the

maxillary and mandibular dental arches; it consists of a contacting point that is
attached to one dental arch and a plate attached to the opposite dental
arch; the plate provides the surface on which the bearing point rests or moves
and on which the tracing of the mandibular movement is recorded; it may be
used to distribute occlusal forces evenly during the recording of
maxillomandibular relationships and/or for the correction of disharmonious
occlusal contacts.(GPT 9)

78
STYLUS RECORDING
PLATE

79

80

81

82
EVALUATION OF GOTHIC ARCH TRACING
Given by Gerber:
1)Typical: well defined apex with 2)Flat form: similar to typical

symmetrical right and left arrow point but has more
components. obtuse tracings.
Horizontal Jaw Relation Int J of Allied Med Sci and Clin Res 2015 18-08-2019
83
3)Asymmetrical Form: 4)Apex Absent/ Round form:
Inclination of lateral tracings not Tracing is obtained with a round

symmetrical to the protrusive path. apex.
84
5)Miniature arrow point: 6) Double arrow point:
Similar to typical arrow point but the Record of habitual and retruded
extensions are very limited. centric position.
85
7)Dorsally extended 8)Interrupted Gothic Arch: 9)Atypical Form:

arrow point: Break or loss in the tracing Protrusive component does
Protrusive path extends not meet at the apex but with
beyond gothic arch. one of the lateral paths.
Int J of Allied Med Sci and Clin Res 2015

86
ADVANTAGES: DISADVANTAGES:
-allows equalisation of pressure on -difficult to locate centre of the
supporting tissues. arches
-easily verifiable -time consuming
-can also be used to record -training patient in mandibular
eccentric relations. movements is strenuous.

87
PANTOGRAPHIC TRACING
Pantograph: An instrument used to graphically record in, one or more planes,
paths of mandibular movement and to provide information for the
programming of an articulator. (GPT-9)
Pantographic Tracing: A graphic record of mandibular movement usually

recorded in the horizontal, sagittal and frontal planes as registered by styli on
the recording tables of a pantograph or by means of electronic sensors.
(GPT-9)

88
DENAR PANTOGRAPH

89
PANTOGRAPHIC TRACINGS

90
RADIOGRAPHIC METHODS
• The use of cephalometrics to record Centric Relation was described by Pyott

and Schaeffer.
• Centric Relation and vertical dimension of occlusion were determined by

cephalometric radiographs.
• This method, however, was somewhat impractical and never gained

widespread usage.

91
ECCENTRIC RELATION
• Eccentric jaw relations is defined as, “Any relationship of the mandible to the
maxilla other than the centric relation” – (GPT 9)

92
• FACTORS TO BE CONSIDERED WHILE MAKING ECCENTRIC JAW RELATIONS:
-The condyles do not travel in straight lines during eccentric jaw movements.
-Semi-adjustable articulators in which the condyles travel on a flat path

cannot be used to reproduce eccentric movements.
-Most complete denture articulators do not support lateral records.
-Fully adjustable articulators where the condylar and incisal guidances are
fabricated individually with acrylic can travel in the path of the condyle using
pantographic tracings.

ECCENTRIC INTEROCCLUSAL
93
REGISTRATIONS
• The purpose of eccentric interocclusal registrations or "check-bites" is to assist

the clinician in setting the articulator fossa elements on a semi adjustable
articulator.
• Two types of records:
-lateral records
Protrusive records

94
PROTRUSIVE RELATION RECORD
• The purpose of recording protrusive jaw relation is to adjust the condylar

elements of the articulator such that they have inclinations as near as
possible to those in the temporomandibular articulation

95

96
LATERAL INTEROCCLUSAL RECORDS

Used to establish lateral guidance on certain adjustable articulators.
Graphic methods are used in the same manner as protrusive relation record
except that the records required are one of the right lateral and one of the
left lateral.
Wax check bites are taken to lateral positions and it is desirable to have more
than on record at each position.
Hanau formula: To arrive at acceptable lateral inclination.
L=H/8 + 12

97
CONCLUSION
• The biologic considerations that have been enumerated should be

essentially considered by the prosthodontist during jaw relation procedures
to relate its useful clinical application in the healthy service of the edentulous
patients.
• It is obvious that the skill of the prosthodontist and the cooperation of the
patient are probably the most important factors in securing an accurate
centric relation records.

98
• The use of various methods enables the prosthodontist to make just

preliminary and tentative determinations of the various jaw relation records.
The final determination cannot be made by any method until the teeth are
set in position in the wax trial dentures and verified in the mouth.

REFERENCES 99
• Zarb-Bolender: Prosthodontic treatment for edentulous patients. 9th ed
• Charles M. Heartwell: Syllabus of complete denture prosthesis. 4th ed.
• Sheldon Winkler: Essentials of complete denture prosthdontics. 2nd ed.
• Centric Relation Definition: A Historical and Contemporary Prosthodontic

Perspective J Indian Prosthodontic Soc (July-Sept 2013) 13(3):149–154
• Centric relation and condylar movement: Anatomic mechanism; J Prosth Dent; Dec
1971
• Anatomy of temporomandibular joint as it pertains to centric relation; J Prosth dent;

May-June 1962

100
• Radiographic study of the condylar position in centric relation and centric occlusion;
J Prosth Dent; March 1980
• Some physiologic considerations of centric and other jaw relations; J Prosth Dent;
March 1956
• Factors influencing centric relation records in edentulous mouths; J Prosth Dent; Nov-
Dec 1964
• Critical evaluation of various methods of recording centric jaw relation; Journal of

Indian Prosthodontic society; December 2008
• A pathway to centric: Gothic Arch; Int Journal of Allied Med Sci and Clin Res; July-
sept 2015

101

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HORIZONTAL

• Chronology of changing definitions

• Theories of centric relation

• Anatomy of TMJ pertaining to centric relation

• Muscle involvement in centric relation

• Physiology of Centric Relation

Horizontal Jaw Relation 18-08-2019

• Relating centric relation to centric occlusion

• Methods to retrude the mandible

• Methods of recording centric relation

Horizontal Jaw Relation 18-08-2019

However different requirements are necessary in the occlusion of

Thus an occlusion that is physiologically acceptable or desirable for

To maintain stability of complete dentures the opposing teeth must

Such an occlusion can only be developed with centric occlusion in

Horizontal Jaw Relation 18-08-2019

Horizontal Jaw Relation 18-08-2019

A maxillomandibular relation independent of tooth contact in which the

Horizontal Jaw Relation 18-08-2019

• Goodfriend [1933] - considered the ‘centricity of the condyles in centric

• McCollum and Stuart [1955] - the condyles are in a ‘rearmost, uppermost

Centric Relation Definition: A Historical and Contemporary Prosthodontic Perspective

• Boucher [1964] - most posterior relation of the mandible to maxillae at the

Horizontal Jaw Relation 18-08-2019

• GPT- 7 (1999) - a maxillomandibular relationship in which the condyles

Horizontal Jaw Relation 18-08-2019

A maxillomandibular relation independent of tooth contact in which the

Horizontal Jaw Relation 18-08-2019

Horizontal Jaw Relation 18-08-2019

-ligaments determine the

-in lateral radiographic

Horizontal Jaw Relation J Prosth Dent December, 1971 18-08-2019

Horizontal Jaw Relation 18-08-2019

Horizontal Jaw Relation

SAGITTAL SECTION OF TMJ IN CENTRIC RELATION

SAGITTAL SECTION OF TMJ IN GLIDING SAGITTAL SECTION OF TMJ WHEN

Horizontal Jaw Relation 18-08-2019

-shape and size not constant throughout life

-mandibular fossa shallow at birth and gradually

-eminence starts to develop at the age of 8 to 9years

-by 12 to 13years has attained adult proportions

-about 40th year begins to flatten again but slightly

Horizontal Jaw Relation

2. Muscles limit the functional posterior border movements of the mandible.

3. Centric relation is controlled by a neuromuscular reflex which does not necessarily

J Prosth Dent ; May-June 1962; Vol 12 No. 3

• This process is made possible’ by the stretch

• Position maintained against gravity is

• Thus when mandibular muscles in

Horizontal Jaw Relation J. Prosth Dent March 1956 18-08-2019

• Centric relation is not a resting or postural position of the mandible.

• The temporalis masseter and medial pterygoid muscles elevate the

• According to electromyographic studies; the middle parts of temporalis and

Horizontal Jaw Relation 18-08-2019

PHYSIOLOGY OF CENTRIC RELATION

• CR is established during the early stages of the primary dentition when

• It is the first established neuromuscular reflex concerning mandibular position

• Not only is it controlled by the stretch receptors in the muscles of mastication

Horizontal Jaw Relation J. Prosth Dent March 1956 18-08-2019

-anteroposterior : on eruption of primary incisiors

-mediolateral: on eruption of teeth in lateral segments of arch

-vertical limits: never precisely defined

Horizontal Jaw Relation J. Prosth Dent March 1956 18-08-2019

ALTERATIONS IN THE REFLEXES CONTROLLING MANDIBULAR POSITION: