IN COMPLETE DENTURES

SL. Contents: Page no:

no
1. Introduction.
2. Definitions.
3. Characteristics.
4. Significance.
5. Factors influencing centric relation.
6. Temperomandibular joint.
7. Terminal hinge axis.
8. Movements of mandible.
9. Methods of recording centric relation.
10. Conclusion.
11. References.
Introduction

Centric relation is an important & significant position this is because of

its usefulness in relating dentulous & edentulous mandible to maxilla,
where teeth, muscles& temporomandibular joint function in harmony. In
other words it is a position of occluso articular harmony. Human
mandible can be related to maxilla in several positions among these;
centric relation is a significant & important position. It serves not only as
a reference position to build centric occlusion in artificial dentures, but is
also important for periodontal & TMJ function.

Various Definitions

According to the International academy of Gnathology in 1979 - The

relation of the mandible to maxilla when condyles are in their rearmost,
uppermost midmost position in the glenoid fossa.

According to GPT 4th edition - The jaw relation when the condyles are in
the most posterior, unstrained position in the glenoid fossae at any given
degree of jaw separation from which lateral movements can be made.

According GPT 5th edition.

The maxillomandibular relationship in which the condyles articulate with
the thinnest avascular portion of their respective disks with the complex
in anteriorsuperior position against the slope of articular eminences

According to Boucher.
The most retruded physiologic position of mandible to maxilla from
which the individual can make lateral movement. It is a condition that can
exist at various degree of jaw separation around terminal hinge axis.
Changing definitions of centric relation
McCollum 1920 defined centric relation as the rearmost condylar
position Granger 1962 defined the centric relation as the uppermost
rearmost position as condyles were unstable in most posterior position.

Stuart 1969 defined the centric relation as the rearmost uppermost

midmost condylar position(RUM). A medial component was added for a
stable condylar position. It was considered physiologic position
harmonious with centric occlusion.
Celenza 1978 defined centric relation as the relation where the condyles
are superior and anteriorly placed against the posterior slope of articular
eminence. Today it is widely accepted for optimum condylar position.

Functional Definition

I t is maxilla-condyle-fossae relationship that is most conductive to

comfort, function and health of stomatognathic system.
The morphologic definition given by GPT is a guide to indicate the
position of condyle & to support/ supplement functional definition.

Charateristics of centric relation

I t is retruded position when condyles are in most posterior position in

glenoid fossa as far as ligament & muscles of TMJ will allow.
I t shows pure rotation without translation & the mandible moves in
hinge motion to a distance of 2 to 2.5 cm at the incisal in the sagittal
plane.
Significance

It is ideal arch to arch relationship & optimum position of jaws for
health comfort and function.
It is the mandibular position where condyledisk assembly is seated in
anterior superior position against the posterior slope of articular
eminence.
In centric relation condyles shows pure rotation without translation
around hinge axis &
the mandible moves in hinge motion to a distance of 15 to 25 mm at the
incisal in the sagittal plane.
It is a reproducible & stable position which can be repeatedly arrived
at, hence used as a reliable guide to develop centric occlusion in dentures.
As a reference position for occlusal rehabilitation of dentulous
condition.
As a reference position to relate & nomenclate several occlusal
position.
The terminal act of masticatory stroke terminates in centric relation.
Position where upper &lower teeth are based together during
deglutition.
It is the postrior border position and posterior limit of envelop
movement .Centric relation is the horizontal reference position of
mandible that can be routinely assumed by edentulous
patient under the direction of dentists.
It orients the lower cast to opening axis of articulator and orient centric
relation to the hinge axis of both articulator and the mandible.
Factors Influencing Centric Relation
Anatomical factors
Temporomandibular joint
Terminal hinge axis
Movements of mandible
Functional
Parafunctional
Neuromuscular factors
Muscles of mastication
E
 ngrams

Temperomandibular Joint:

Glenoid fossa is not a functional load bearing area but a mere pathway
for movement
Medial wall of glenoid fossa and posterior part of articular eminence
can be the functional load bearing area Ligaments
3 functional ligament:
Collateral/ Discal ligament (medial/lateral) - anteroposterior rotation of
disc on articular surface of condyle, responsible for hinging movement
Capsular ligament- resist medial lateral and inferior forces
Temporomandibular ligament- outer oblique & inner horizontal part.
TERMINAL HINGE AXIS

Definition.

1921 McCollum and Stuart – there was recordable transverse axis in

the condylar region about which rotational movements in sagital plane
occur.

1958 Posselt – Hinge rotation is reproducible, in any individual,

conscious or unconscious, errect or recumbent in posture.

Posselt – hinge range 19- 25 mm Clinically, hinge motion can be

trained and recorded. Hinge axis is a horizontal axis arround which
condyles rotate during opening & closing movement upto a range. Since
the rotation of condyles occurs when mandible is in its terminal retruded
centric position, it is also known as Terminal Hinge axis. Due to
changing concept of centric relation (anterior-superior positioning) it is
also called as Transverse horizontal axis.

Importance of Terminal Hinge Axis

Terminal hinge position is advocated for recording centric, because it is

physiologic position of condyle when mandible is elevated firmly by
normal muscle function.
Serves to orient maxilla & to record static point for functional
mandibular movements. – pattern of muscle contraction in centric

Movemnets of mandible

Mandibular movements can be

1) Functional – mastication, speech, yawning
2) Parafunctional – clenching, tapping,grinding
According to Mechanics of mandibular movements
1) Rotationl movement
2) Translational movements

All the movements of mandible starts and ends in the centric relation.

Muscles of mastication

Articular surfaces have no structural attachment or union, so contact and

stability is maintained by muscles that pull across the joint, primarily
elevators. Pattern of muscle contraction in centric relation is contraction
of superior head of lateral pterygoid in centric relation which, braces the
disc against posterior slope of articular eminence, along with superior
positioning by temporalis.
The elevator muscles are situated behind mandibular molars, but their
direction of action during closure positions the condyle against eminence.
No muscle attached to retrude the mandible from behind& to counter
act action of lateral pterygoid.
Retrusion is done by muscles attached anterior to the joint (posterior
fibers of temporalis, posterior belly of digastric )

Methods of Recording Centric Relation:

FUNCTIONAL
a) Needle house technique.
b) Patterson technique.
c) Phonetics-S,F
d) Silverman’s biting point.
e) Mandibulography.
f) Relator.
g) Boos.
h) Gnathodynamo meter.
i) Myomonitor.
j) Myer’s fuctional generated technique.

GRAPHIC
• Extraoral
• Intraoral
• Pantographic

TACTILE/INTEROCCLUSAL
CHECK RECORD
• No Pressure
• Minimal Pressure
• Heavy Pressure
CEPHALOMETRIC METHODS

NEEDLE HOUSE METHOD

4 Metal styli on maxillary occlusion rim
• Movement of mandible i.e retrusion, protrusion and lateral
movements.
• 4 diamond shaped tracings on mandibular rim which in cooperate
movements in 3 planes
• Posterior most point in this denote centric relation

PATTERSON’S METHOD
• Trench made on mandibular rim
• Mixture of half plaster +half carborandum placed in trench
• Insert in pts mouth and make mandibular movements-create
compensating curves in plaster and carborandum
• When plaster is instructed to retrude and occlusal rim are joined by
staples

Graphic Methods of recording Centric Relation

They use graphs or tracing to record centric relation.

Record a tracing of mandibular movement in horizontal plane &
indicate horizontal relation of mandible to maxilla.
Resembles Gothic Architecture characterized by high pointed arches.
Also called as Stylus Tracing, Centric Bearing Tracing, Arrow Point
Tracing, and Needle Point Tracing.
1st introduced by Hesse from Germany, in 1897
Popularized by Alfred Gysi in 1910,with a device called as Gysi’s
Recording Device
Prof. Luksichhas gradually & radically changed it.

Factors considered before carrying out tracing procedures

Displacement of record bases may result if central bearing point is off

center
If central bearing point is not used, occlusion rims offer more
resistance to horizontal movements
It is difficult to locate the center of true arches to centralize the forces
with central bearing device.
It is difficult to stabilize a record base against horizontal forces on
easily displaceable tissue, on ridges with no vertical height, in patient
with large tongue.
Recording devices are not usually compatible with normal physiologic
stimulation in mandibular movements

Central arrow point tracing

Definition given by Gysi in 1910.

‘Central bearing device- Device that provides central point of bearing or
support between maxillary and mandibular dental arches. It consists of
contacting point attached to one dental arch and plate attached to opposite
dental arch. The plate provides the surface on which the bearing point
rests or moves and on which the tracing of mandibular movement is
recorded. It may be used to distribute occlusal forces evenly during jaw
relation.’
 CENTRAL BEARING DEVICE

Central bearing point-

‘Contact point of central bearing device’-GPT It is the triangular plate of

metal with extension
provided to attach itself to occlusal rim. In the center of triangle a metal
pointer is present which can be adjusted in hight.
Central Bearing Plate

It is a triangular piece of metal with extension at the hree corner provide

to attach the plate to the occlusal rim. Mixture of spirit and precipitated
chalk is coated on this plate. Spirit dries to leave fine layer of precipitated
chalk and tracing is marked on this layer.
Arrow Point tracing

It is one dimensional graphic tracing method usually recorded in

horizontal plane.
Principle –
Generally consist of pen like pointer(Central Bearing Pointer) &
recording plate (Central Bearing Plate) attached to each rim. Pointer &
plate together form Central bearing device.
When mandible moves, the characteristic pattern created on recording
plate is called as Arrow point tracing.

Technique for Graphic method

Make accurate & stable record bases and occlusal rims.

Contoure the wax occlusal rims & establish the vertical dimension of
jaw separation with
mandible at rest position.
Make the facebow transfer and mount the maxillary cast
Make tentative centric relation record at predetermined vertical
dimension of occlusion.
Adjust the articulator with condylar elements secured.
Attach the mandibular articulator in centric.
Reduce the mandibular occlusal rim to provide excessive interocclusal
distance.
Mount the central bearing device to the rims.

Intraoral Arrow Point Tracer

Procedure- Central bearing device is located intraoraly. Simpler

compared to extraoral arrow point
tracer.
Disadvantage –
Tracer is not visible during this procedure. Area size of the tracing is very
small, hence difficult to determine the tracing.

Intraoral Arrow Point Tracer procedure

Record bases attached to central bearing point
& central bearing plates are inserted in to patients mouth.
Point is adjusted so that it contacts plate at predetermined vertical
dimenssion.
When the patient closes his mouth central bearing point contacts the
plate .
Patient is asked to do anteroposterior and lateral movement, so that
centric bearing point
will draw tracing pattern on central bearing plate.
After completing the tracing is removed and checked. If the apex is
blunt record is discarded and freshly repeated.

Extra Oral Tracing Device

The Device is similar to intraoral tracing device attached to occlusal rims.

Additional attachments projecting outside the mouth has extraoral tracing
plate and pointer.
Advantage-
Tracing can be examined Size of tracer is also large, hence easy
identification of apex of Tracing

Factors considered after carrying out tracing procedures

Double tracing – lack of coordinated movements or recording at
different vertical dimensions.
Graphic methods can record eccentric relation.
They are the most accurate visual means of making centric relation
records.
Arrow Point Extra Oral Tracing Method

Conduct the training exercise with the patient.

When the patient is proficient in doing the movements prepare the
tracing plate with a coating of precipitated chalk.
L
 ower the stylus to the recording plates so that it maintains contact
with the plate during movements.
Develop an acceptable tracing when sharp apex is made, gliding the
patient to centric relation
Fix the point of stylus at the point of apex , quick setting plaster is
injected between the rims & allowed to set, to take inter occlusal record.
The assembly is removed & mandibular cast is mounted with new
record, if tentative record is wrong.

INTER OCCLUSAL CHECK RECORD:

1. Seat the patient

2. Seat max record base
3. Seat mandibular record base
4. Do not let pt make tooth contact
5. Do not fatigue the pt
6. Remove mandibular rim and train the patient
7. Dry mandibular posterior teeth
8. Adapt two layers of alu wax to occlusal surface of posterior teeth
9. Do not entrap air
10.Soften wax with controlled or 130°F water bath
11.seat mandibular record base
12.ask pt to retrude and close back teeth and stop when contact is
made
13.Allow wax to harden. Dry.
14.Inspect record to see no cusp tip penetrate to make tooth to tooth
contact
15.Remove maxillary record base and place on maxillary cast
16.Release horizontal condylar guide locks on articulator
17.Place mandibular record base on to the cast
18.Carefully seat maxillary teeth in record.
19.Observe condylar elements if they rest against centric stops the
record is same as original if not it is in accurate.
Conclusion
Centric relation is a significant & important position. This is because of
its usefulness in relating dentulous & edentulous mandible to maxilla,
where teeth muscles & temporomandibular joint function in harmony. In
otherwords it is a position oof occluso articular harmony. Today it is
served not only a reference position to build centric occlusion in artificial
dentures, but important for periodontal health and TMJ function.