CONTENTS

 Introduction
 Change in definition
 Significance of centric relation
 Muscle involvement in CR
 Theories of CR
 Harmony between CR and CO
CONTENTS
 Recording CR
 Factors influencing CR record
 Methods of recording CR
 Complications and errors in
recording
 Methods of recording eccentric
relation
 Review of literature
 Conclusion
 INTRODUCTION
What is
Maxillo mandibular relation ?
Types
Horizontal Jaw relation ?
 CHANGING DEFINITIONS
1920- Mc Collum-
Rearmost position

1952-Granger-
uppermost,rearmost

1969-Stuart-RUM position
1977-American equilibration society –AS
position
 CHANGING DEFINITIONS
1977-American equilibration
society –AS position

GPT (1) -1956

The most retruded relation of the
mandible to the maxillae when the
condyles are in the most posterior
unstrained position in the glenoid fossae
from which lateral movements can be
made at any given degree of jaw
separation.
 CHANGING DEFINITIONS
GPT (3) -1968

The most retruded physiologic

relation of the mandible to the maxilla
to and from which the individual can
make lateral movements. It is a
condition that can exist at various
degrees of jaw separation. It occurs
around the terminal hinge axis.
 CHANGING DEFINITIONS
GPT (5) –(8) 1987

condyles articulate with the thinnest

avascular portion of their respective
disks with the complex in the anterior-
superior positions against the shapes
of the articular eminencies.
This position is independent of
tooth contact.
 CHANGING DEFINITIONS
GPT (5) –(8) 1987

It is purely rotary movement about

the transverse horizontal movement .
 CHANGING DEFINITIONS
GPT (9)-2017:
Centric relation is defined as a
maxillomandibular relationship
independent of tooth contact, in which
the condyles articulate in the
anterior-superior position against the
posterior slopes of the articular
eminences;
 CHANGING DEFINITIONS
GPT (9)-2017:
in this position the mandible is
restricted to a purely rotary
movement; from this unstrained,
physiologic, maxillomandibular
relationship, the patient can make
vertical, lateral or protrusive
movements; it is a clinically useful,
repeatable reference position.
 SIGNIFICANCE OF CENTRIC
RELATION
According to John Sharry

 More definite than VD

 Most comfortable position
 Optimum position for health
comfort and functioning of TMJ
 Movements of mandible start from
here and end up here.
 Physiologically acceptable position
for mastication of food.
 SIGNIFICANCE OF CENTRIC
RELATION
According to John Sharry

 Most posterior border position

 Pure rotations take place.
 Bone to bone relation
 Independent of position of tooth.
 Constant for an individual.
 Reproducible, repeatable and
recordable.
 Acts as a reference point.
 HARMONY BETWEEN CENTRIC
RELATION & CENTRIC OCCLUSION
CENTRIC OCCLUSION
MIP
- This may or may not coincide with
MIP.
CENTRIC SLIDE-
movement of the mandible while
in centric relation from initial occlusal
contact into maximum intercuspation.
 HARMONY BETWEEN CENTRIC
RELATION & CENTRIC OCCLUSION

In the natural dentition CO is

usually located anterior to CR, the
average distance being 0.5 to 1 mm.
 OBJECTIVES OF CENTRIC
RELATION
Minimal closing pressure:
to make opposing denture teeth
touch uniformly & simultaneously at
first contact

Heavy closing pressure:

to produce the same displacement
of the soft tissues that occur when
patient masticates
 METHODS OF RECORDING
CENTRIC RELATION
By Boucher

1.Static methods
interocclusal record with/with out
central bearing devices & tracing devices

2. Functional methods - chew-in technique

- Needles technique
- House technique
- Patterson technique
 METHODS OF RECORDING
CENTRIC RELATION
By Heartwell

1. Functional methods (chew-in)

- Needles House method
- Patterson method

2.Graphic Method
- Intraoral devices
- Extraoral devices

3.Physiological or tactile or inter occlusal check

record method
 METHODS OF RECORDING
CENTRIC RELATION
By Kapur & Yurkstas(1957)
 Physiologic method/Static method:
DIRECT INTEROCCLUSAL RECORD:
1756 Phillip Pfaff first described.
Also called as mush,biscuit /squash bite.

3 factors are considered

- pressure
- no of reference points
- patients comfort
 Physiologic method/Static method:
DIRECT INTEROCCLUSAL RECORD:
wax or compound, between the
edentulous ridges.
STATIC METHOD –
WAX OCCLUSAL RIM
 STATIC METHOD –
WAX OCCLUSAL RIM
 STATIC METHOD
NICK AND NOTCH METHOD
 46
STATIC METHOD
NICK AND NOTCH METHOD
 PHYSIOLOGICAL TECHNIQUE
(SHANAHAN- 1955)
 Uses cones of soft wax placed
posteriorly while patient swallows
several times.
 More appropriate for edentulous
patients.
Functional method “Historical development”
Greene – Used plaster and pumice mixture.

Needles – Mounted three studs on maxillary rims.

Patterson – Used corborandum and plaster mixture.

Meyer – Used soft wax occlusal rims, tin foil

placed and functional movements done.

Boose – Used Gnathodynomometer.

Shanahan– Cones of soft wax.

 41

CR

Needle-
House
Method
4
2
PATTERSON METHOD
PATTERSON METHOD
 MEYER’S METHOD

 used soft wax occlusal rims.

 tinfoil was placed over wax
 produce a wax path
 plaster index was made
 EXCURSIVE METHOD
GOTHIC ARCH TRACING - Balkwill in 1866

Gothic” name originate from ancient Gothic

people’s houses (Barbarian tribes of Rome)
 GRAPHIC METHOD
Classification of Graphic recordings
1. Intra oral tracer
 Example:Coble tracer
b. Swissdent ball bearing bite tracer
c. Micro tracer
Functiograph
GRAPHIC METHOD
 GRAPHIC METHOD
2. Extra oral tracer
Hight tracer
b. Sears tracer
c. Phillips tracer
d. Chandra tracer
e. Stansbery tracing device
CHANDRA TRACER
K.Chandrasekharan Nair
2 component assembly.
- The upper bearing plate – pencil holder
- The lower bearing plate –
central bearing screw
and tracing platform of
dimensions 35×47mm,
pins to hold a
drawing sheet.
INTRA ORAL TRACING
INTRA ORAL TRACING
EXTRA ORAL TRACING
EXTRA ORAL TRACING
DIGITAL INTRA ORAL TRACING
DIGITAL INTRA ORAL TRACING
EVALUATION OF GOTHIC ARCH TRACINGS

Classical, pointed form

The symmetry indicates an
undisturbed movement
sequence in the joints and
uniform muscle guidance.
EVALUATION OF GOTHIC ARCH TRACING

Classical flat form

Indicates distinct flat lateral
movements of the
condyles in the fossa.
EVALUATION OF GOTHIC ARCH TRACING

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.
EVALUATION OF GOTHIC ARCH TRACING

Asymmetrical form
The tracing indicates
a distinct inhibition
of the forward
component of the
lateral movement in
the right joint.
EVALUATION OF GOTHIC ARCH TRACING

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.
EVALUATION OF GOTHIC ARCH TRACING

Vertical line protrudes beyond

the arrow point
forcible retraction or pushing
of the mandible or tracing
obtained with protruded
mandible
 DRAWBACKS
 Relatively time consuming.
 Requires well defined, non-
displaceable upper and lower alveolar
ridges to allow stable, retentive acrylic
bases
 DRAWBACKS
 Large tongues can cause base
movement during tracing.
 Truly excursive movements are
often difficult to recreate by patients
thus producing an imperfect arrow
head tracing which then requires
element of interpretation.
PANTOGRAPHIC RECORD
PANTOGRAPHIC RECORD
OTHER METHODS:
- Strips of celluloid placed between the rims
- Heating the surface of one of the rim
- Deep healing and pooling
- Soft cones of wax placed on the lower denture
bases
J Indian Prosthodont Soc 2012;19:175-181

A comparative evaluation of functional and

static methods for recording centric relation and
condylar guidance:A clinical study

Aim:
To evaluate and compare the centric relation and
horizontal condylar guidance using interocclusal
wax and extraoral gothic arch methods and
subjective evaluation of denture thus fabricated.
J Indian Prosthodont Soc 2019;19:159-65
28 –completely edentulous patient
Records transferred to articulators and difference
in both the values was recorded .
2 groups – centric relation & horizontal condylar
guidance
Subjective response calculated using “Woelfel
subjective evaluation criteria”
J Indian Prosthodont Soc 2019;19:159-65
Conclusion :
Gothic arch tracing found to be more technique
sensitive and greater chair side time .
Conventional method was found to more
acceptable by patient and operator.
J Indian Prosthodont Soc 2019;19:159-65

Validity and reliability of intraoral

conventional tracer and intraoral digital tracer
in different positions for recording horizontal
jaw relation in edentulous patients
Nikhil Bharat Abbad
Aim:
The purpose of the study is to evaluate and
compare the horizontal mandibular positions
recorded between intraoral conventional tracer and
intraoral digital tracer in upright and supine
position.
J Indian Prosthodont Soc 2019;19:159-65
24 edentulous patients with well-formed ridge and
adequate interarch distance space were selected.
MATLAB software was assimilated with intraoral
digital tracer and was utilized in the study for recording
the horizontal movements of the mandible
For each subject, multiple mandibular readings were
recorded and analyzed through software, and similar
readings were recorded with conventional intraoral
tracers.
The comparison between intraoral conventional
tracer and intraoral digital tracer was done to assess the
reliability. Moreover, the consistency of recording
horizontal mandibular position was also compared
between upright and supine position.
J Indian Prosthodont Soc 2019;19:159-65
Conclusion:
On evaluation and comparison of horizontal
mandibular position, it was found that the intraoral
digital tracing technique is more valid compared to
conventional intraoral tracer technique. It was also
observed that the consistency of reproducibility in
recording horizontal mandibular position in supine
position is significantly higher than upright position.
J Indian Prosthodont Soc 2018;19:263-70
Aim:
The aim of the study is to evaluate and to compare
the correlation between HCG values in edentulous
people using protrusive interocclusal records
mounted on semi adjustable articulator with the
manual tracing of panoramic radiograph and lateral
cephalogram

A study on the accuracy of horizontal condylar

guidance value in edentulous patients using
preprosthetic diagnostic radiographs :Paul.R et al
J Indian Prosthodont Soc 2018;19:263-70
Materials and methods:
20 – completely edentulous patient
Age – 45-75 years
HCG angles are calculated using protrusive
interocclusal record and semiadjustable articulator
after intraoral gothic arch tracing
Conclusion :
HCG values from cephalometric tracing of
diagnostic radiographs can be used as a adjunt to
the clinical method but cannot be used
independently for programming a semiadjustable
articulator.
METHODS FOR RETRUDING THE
MANDIBLE
 Instruct the patient by saying, "Let
your jaw relax, pull it back, and close
slowly and easily on your back teeth.“

 Instruct the patient by saying, "Get

the feeling of pushing your upper jaw
out and closing your back teeth
together."
METHODS FOR RETRUDING THE
MANDIBLE

 Instruct the patient to protrude and

retrude the mandible repeatedly while
he holds his fingers lightly against his
chin.
METHODS FOR RETRUDING THE
MANDIBLE
 Instruct the patient to turn the
tongue backward toward the posterior
border of the upper denture.

 Instruct the patient to tap the

occlusion rims or back teeth together
repeatedly. It is believed that the
center of muscle pull will gradually
work the mandible back.
METHODS FOR RETRUDING THE
MANDIBLE
 Tilt the patient's head back while
the various exercises just listed are
carried out. This will place tension on
theinframandibular muscles and tend
to pull the mandible to a retruded
position.
METHODS FOR RETRUDING THE
MANDIBLE
 Having the patient swallow.
Swallowing may bring the mandible to
a retruded position and may be an aid
in retruding the mandible to CR.
 93

Complications
in recording
Centric relation

Biological Psychological Mechanical

difficulties difficulties difficulties
 Mandibular
Guidance
methods

Patient guided Operator guided

recording recording

78
 Schyulor
technique

Patient
Physiological Gothic arch
technique
guided Tracing
Recording

myomonitor

79
 SCHYULOR TECHNIQUE

placing the tip of the tongue to the

back of the palate and closing into a
horseshoe shape of softened wax with
light pressure.
Limitations:
Wax may or may not be uniformly
softened which can lead to inaccuracies
in recording
SCHYULOR TECHNIQUE
GOTHIC ARCH TRACING
MYOMONITOR
 Operator
guided
recording

3 point Power
Chinpoint Bimanual Anterior
Finger chin centric
Guidance Manipulation guidance :
guidance registration
method method Lucia jig
method method
Tongue blade
Leaf gauge
OSU woelfel
CHIN POINT GUIDANCE METHOD
GUICHET(1970)
BIMANUAL PALPATION –DAWSON 1980
BIMANUAL PALPATION –DAWSON 1980
ANTERIOR GUIDANCE BY OSU WOELFEL
GAUGE
Factors influencing centric relation record
(FIRST)
• Fit of the denture bases
• Residual alveolar arch
• Resiliency of the supporting tissues
• Saliva
• Tongue

Yurkstas AA, Kapur KK. Factors influencing centric

relation records in edentulous mouths. J Prosthet Dent
2005;93:305-10
 Consequences of recording incorrect
centric relation
 TMJ dysfunction

 Mucosal ulceration and irritation

 Spasm of muscles

 Resorption of bone
 ECCENTRIC RECORDS
Relation of mandible other than
centric relation.
Depends on the shape of the
mandibular fossa.

2 types:
Protrusive
Lateral
 ECCENTRIC RECORDS
Method of recording eccentric record :
1. Functional method- Needles-House
and patterson technique.

2. Graphic method.

3.Tactile or Direct check methods.

4. Pantography
PROTRUSIVE RECORDS
(CHRISTRNSEN’S PHENOMENON)
1. Direct interocclusal check record

2. Graphic Method

3. Functional procedures

In all these protrusion of mandible made

about 5-6mm and these records are registered
with bite registeration material. These are
transferred to the adjustable articulator
 LATERAL JAW RELATIONS
-Mandible moved side to side
movements.
- Bennett movement
 LATERAL JAW RELATIONS
 Graphic method
 Lateral check records
 Functional methods
 Pantography
 LATERAL JAW RELATIONS
HANAU FORMULA :
L = H +12
8
L = Lateral condylar inclination
H = Horizontal condylar inclination
CONCLUSION
The accurate determination , recording, and
transfer of jaw relation records from edentulous
patient to articulator is essential for restoring
function, facial apperance, and maintainance of
patients health.
Unsatisfactory maxillomandibular relations
will eventually lead to failure of complete denture
REFERENCES
Prosthodontic treatment for edentulous
patient . Boucher’s, 10th edition
Syllabus of complete dentures. Heartwell,3rd
edition
Critical evaluation of methods to record
centric jaw relation –journal of indian
prosthodontic society july 2009
Physiologic vertical dimension and centric
relation –JPD 2004;91
Complete dentrue prosthodontics
John.J.Manappalli ,2nd edition
REFERENCES
Validity and reliability of intraoral
conventional tracer and intraoral digital tracer
in different positions for recording horizontal
jaw relation in edentulous patients. Nikhil
Bharat Abbad et al J Indian Prosthodont Soc
2019;19:159-65.

A comparative evaluation of functional and

static methods for recording centric relation
and condylar guidance:A clinical study J Indian
Prosthodont Soc 2012