INTRODUCTION

The method oI recording the iaw relationships using base
plates and occlusion rims, is widely carried out in clinical practice.
However, as many dentures with an unstable occlusion are seen, it is
thought that minor errors tend to occur easily using this technique.
There are various reasons to explain this. II the clinician is not
accustomed to the procedure oI soItening the wax, it will be diIIicult
to soIten the rims evenly. Without uniIormly soItened rims, an exact
record cannot be expected. When the base plates poorly Iit the
alveolar ridges, they are displaced by sliding over the occlusal plane
during recording and thus the iaw registration is carried out with
displaced rims. In addition, as the mucosa oI the alveolar ridge is
compressible, some portions oI the base plate settle into the mucosa
slightly and another portion is raised up. In a case with severe ridge
resorption, the base plate will be easily displaced. In a patient with a
loose temporomandibular ioint or wearing an existing denture with a
malocclusion Ior a long time, the eccentric relation might be easily
recorded by a little undue pressure.
In any case, it requires great skill Ior the horizontal and vertical iaw
relations to be recorded simultaneously iust by using the baseplates to
establish an exact iaw relationship. The chair time will also be
prolonged, and thus the physical Iatigue oI the patient will increase. To
solve these problems, the author divides the procedure into two stages.
The gothic arch tracer is used Ior recording the horizontal iaw relation.
The patient must come to the clinic once more, but as the Iinal decision
can be leIt to the use oI the gothic arch tracer, the procedure Ior
recording the vertical relation using base plates can be perIormed stress-
Iree and moreover the total chair time Ior the recording iaw relations is
shortened.
ORIZONTAL PLANE BORDER MOVEMENTS
A mandibuIar eIement to be understood before recording
maxiIIomandibuIar reIationships and making tooth arrangements for
compIete dentures is border positions. Border refers to the boundary
of a surface and may impIy the Iimiting Iine. Border position is defined
as the most posterior position of the mandibIe at any specific verticaI
reIation.
The border positions are Iimited by nerves, bones, muscIe, teeth when
present and Iigaments. The Iimiting is not a simpIe mechanicaI
stoppage but a physioIogic controI through the neuromuscuIar system.
The enveIopes of motion of the mandibIe in the border positions has
been recorded in three pIanes horizontaI, frontaI and sagittaI and are
usuaIIy described as three dimensionaI.
TraditionaIIy, a device known as a Gothic arch tracer has been used to
record mandibuIar movement in the horizontaI pIane. It consists of a
recording pIate attached, to the maxiIIary teeth and a recording styIus
attached to the mandibuIar teeth. As the mandibIe moves, the styIus
generates a Iine on the recording pIate that coincides with this
movement. The border movement of the mandibIe in the horizontaI
pIane can therefore be easiIy recorded and examined.
When mandibular movements are viewed in the horizontal plane,
a rhomboid-shaped pattern can be seen that has a functional
component, as well as four distinct movement components.
Left lateral border
Continued left lateral border with protrusion
Right lateral border
Continued right lateral border with protrusion
Left Lateral Border Movements
With the condyles in the CR position, contraction of the right
inferior lateral pterygoid will cause the right condyle to move
anteriorly and medially (also inferiorly). Ìf the left inferior lateral
pterygoid stays relaxed, the left condyle will remain situated in CR
and the result will be a left lateral border movement (i.e., the right
condyle orbiting around the frontal axis of the left condyle).
Therefore the left condyle is called the rotating condyle, because
the mandible is rotating around it.
The right condyle is called the orbiting condvle. because it is
orbiting around the rotating condyle. The leIt condyle is also called
the working condvle. because it is on the working side. Likewise, the
right condyle is called the nonworking condvle. because it is located
on the nonworking-side. During this movement the stylus will
generate a line on the recording plate that coincides with the leIt
border movement.
Continued Left LateraI Border Movements with Protrusion
With the mandible in the left lateral border position, contraction of
the left inferior lateral pterygoid muscle along with continued
contraction of the right inferior lateral pterygoid muscle will cause
the left condyle to move anteriorly and to the right. Because the
right condyle is already in its maximal anterior position. The
movement of the left condyle to its maximum anterior position will
cause a shift in the mandibular
midline back to coincide with
the midline of the face.
Right Lateral Border Movements
nce the left border movements have been recorded on the
tracing, the mandible is returned to CR and the right lateral border
movements are recorded.
Contracting of the left inferior lateral pterygoid muscle will
cause the left condyle to move anteriorly and medially (also
inferiorly). Ìf the right inferior lateral pterygoid muscle stays
relaxed, the right condyle will remain situated in the CR position.
The resultant mandibular movement will be a right lateral border
movement (e.g., the left condyle orbiting around the frontal axis of
the right condyle).
The right condyle in this movement is therefore called the 7otating
condyle, because the mandible is rotating around it. The left
condyle during this movement is called the o7-iting condyle,
because it is orbiting around the rotating condyle. During this
movement the stylus will generate a line on the recording plate
that coincides with the right lateral border movement.
Continued Right LateraI Border
Movements with Protrusion
With With the the mandible mandible in in the the right right
lateral lateral border border position position
contraction contraction of of the the right right inferior inferior
lateral lateral pterygoid pterygoid muscle muscle along along
with with continued continued contraction contraction of of
the the left left inferior inferior lateral lateral pterygoid pterygoid
will will cause cause the the right right condyle condyle to to
move move anteriorly anteriorly and and to to the the left left..
Because Because the the left left condyle condyle is is
already already in in its its maximum maximum anterior anterior
position, position, the the movement movement of of the the
right right condyle condyle to to its its maximum maximum
anterior anterior position position will will cause cause a a
shift shift back back in in the the mandibular mandibular
midline midline to to coincide coincide with with the the
midline midline of of the the face face.. This This
completes completes the the mandibular mandibular
border border movement movement in in the the
horizontal horizontal plane plane..
Lateral movements can be generated by varying levels oI mandibular
opening. The border movements generated with each increasing
degree oI opening will result in increasingly smaller tracings until, at
the maximally open position, little or no lateral movement can be
made.
Mandibular movements in
the horizontal plane:-
1)LeIt lateral
2)Continued leIt lateral
with protrusion
3)Right lateral
4)Continued right lateral
with protrusion.
CR centric relation
ICP intercuspal position.
Horizontal relations are those that are established anteroposteriorly and
mediolaterally and so are classiIied as :
Centric Relations
Eccentric Relations Protrusive Relations
Lateral right lateral
leIt lateral
CENTRIC RELATION is defined as the maxillomandibulai
ielationship in which the condyles aiticulate with the thinnest
avasculai poition of theii iespective discs with the complex in the
anteiioi ÷supeiioi position against the slopes of the aiticulai
eminences.
Fcaturcs and Significancc Of Ccntric Rclatinn
Centiic ielation is the ideal aich to aich ielationship and an
optimum functional position of the íaws foi the health, comfoit and
function of the musculatuie.
It is a mandibulai position wheie the condyle disc assembly is
seated in anteiioi supeiioi position against the posteiioi slope of
aiticulai eminence, which was believed by many to be the ieaimost,
upmost, midmost position in the glenoid fossa. (RUM position).
Centiic ielation of the mandible is a hinge position. In Centiic
ielation condyles exhibit only puie iotation without tianslation.
Mandibular movements return or terminate in centric. It is thus a
reproducible position and thereIore serves as a reliable reIerence to
develop centric occlusion in artiIicial dentures. It is a starting point Ior
the arrangement oI artiIicial teeth in articulator to develop maximum
intercuspation in complete dentures.
It is a position where upper and lower teeth are braced against each
other during deglutition.
It serves as a reIerence position Ior the occlusal reconstruction in
dentulous situations.
It is the posterior border position and the posterior limit oI the
envelope oI mandibular motion.
To summarize Centric relation is a reproducible, recordable, consistent
reIerence position, and a physiologically acceptable position Ior
deglutition.
Recording Centric Relation in Edentulous Subjects
In edentulous subiects, centric iaw relation is generally recorded by
Wax closure method
Functional chew in technique
Graphic method
Anterior deprogrammers
Wax closure method oI recording centric relation with swallowing,
phonetics and manual guidance is quick and a simple method.
The arrow point tracing method is a reliable and scientiIic procedure oI
recording the mandibular border movements in the horizontal plane and
captures the mandible at its posterior reproducible border position.
imitations of Wax Occlusal Rim Method to Record Centric
Relation
Inconsistency oI the record: two centric records taken Ior the same
patient may not always be identical. Patient co-operation and operator-
induced errors should be considered.
Possibility oI occlusal rims sliding over the other to any eccentric
position either beIore , during or aIter sealing the occlusal rims in
centric relation.
Tilting, leverage and displacement oI record bases is very common
and this may result in inaccurate centric record.
There is a tendency Ior the patient to bite and protrude the
mandible. The term bite registration is thereIore obiectionable and
obsolete.
ECCENTRIC RETIONS
Is deIined as any relationship oI the mandible to the maxilla other
than centric relation.
The eccentric relations that are recorded and used in complete denture
construction are protrusive and right and leIt lateral.
Protrusive relation is the relation oI the mandible to the maxilla when
the mandible is thrust Iorward. II the motion in every part oI the
mandible as it is thrust Iorward has simultaneously the same velocity and
direction, the motion could be correctly termed translatorv. The
movement in the ioint is downward and Iorward. The condyles disk
assemblies are guided downward by the articular eminences oI the
glenoid Iossae. The angle oI slide varies Irom patient to patient and Irom
side to side. The muscles responsible Ior a straight protrusive movement
are the inIerior pterygoid muscles acting simultaneously. Protrusive
relation is a bone-to- bone relation, which can be recorded.
Right and leIt lateral maxillomandibular relations are the relations oI
the mandible to the maxillae when the mandible is moved either to the
right or to the leIt side. The movement oI the mandible is the result oI the
contraction oI contra lateral inIerior external pterygoid muscle. When the
external pterygoid oI one side contracts, the corresponding side oI the
mandible is pulled Iorward and inward, while the other side remains
comparatively Iixed. The side that is pulled Iorward is termed the
nonworking, balancing. or orbiting side, whereas the side that remains
comparatively Iixed is termed the working, or rotating side.
The movements in the non-working side are downward, Iorward, and
inward. The movement is both sliding and rotary. The movements in the
working side are rotational.
The question oI necessity Ior eccentric records is controversial,
because accuracy is a problem in the recording methods and the
capabilities oI the articulator to receive and reproduce the record. The
Iollowing Iactors contribute to inaccuracy:
(1) Instability oI records,
(2) Resiliency and displaceability oI denture-bearing tissues,
(3) Materials used in record making,
(4) Equipment used in record making,
(5) Lack oI muscle coordination in the patient, and
(6) The use oI articulators that do not accurately adiust to all lateral
interocclusal check records.
The controversy about the merits oI eccentric records will exist as long
as there are diIIerences in the concepts oI occlusion and posterior tooth
Iorm required Ior complete dentures. Prosthodontists who preIer a cusp
Iorm posterior tooth and balanced occlusion in eccentric iaw positions or
organic occlusion will require eccentric maxillomandibular relation
records. Prosthodontists who preIer a noncusp Iorm posterior tooth and
balanced occlusion in centric iaw position will not require eccentric
maxillomandibular relation records.
R!IC METOD
The graphic methods record a tracing oI mandibular movements in one
plane, an arrow point tracing. It indicates the horizontal relation oI the
mandible to the maxilla. The apex oI a properly made tracing
presumably indicates the most retruded relation oI the mandible to the
maxilla Irom which lateral movements can take place.
Graphic records are either intra oral or extraoral, depending on the
placement oI the recording device.
Even though Balkwill, and Englishman, in 1866 illustrated the right and
leIt intersection arcs oI lateral movement, it was Hesse Irom Germany,
in 1897 introduced the graphic method oI recording centric relation,
which was later popularized by the Swiss proIessor Gysi in 1910.
It became known as Gysi gothic arch tracing since it resembled Gothic
architecture characterized by high pointed arches.
The Glossary oI Prosthodontic terms recommends
Central Bearing Tracing, Gothic Arch Tracing, Needle-point Tracing as
the pattern obtained on the horizontal plate used with a central bearing
tracing device.
Central bearing tracing device is a device that provides a central point of
bearing or support between maxillarv and mandibular dental arches. It
consists of a contacting point that is attached to one dental arch and a
plate attached to the opposing 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 mav be used to
distribute the occlusal forces evenlv during the recording of the
maxillomandibular relationships and /or for the correction of
disharmonious contacts.
All movements in the horizontal plane initiate Irom the apex oI the
Gothic arch. The apex oI tracing is a reproducible reIerence point, which
represents centric relation. Gothic arch tracing ensures that the centric
record is made with minimal closing Iorce equally distributed over the
supporting tissues.
ISTORY
The earliest graphic recordings were based on studies oI mandibular
movements by Balkwill in 1866.
The Iirst known 'needle point tracing¨ was by esse in 1897 and the
technique was proved and popularized by si around 1910.
Clapp in 1914 described the use oI a Gysi-tracer, which was attached
directly to the impression trays.
In 1926 Sears used lubricated rims Ior easier movement and placed the
needlepoint tracer on the mandibular rim and the plate on the maxillary
rim. He believed this made the angle oI the tracing more acute.
!hilips in 1927 recognized that any lateral movement oI the iaws
would cause interIerence oI the rims, which could result in the distorted
record. He developed a plate Ior the upper rim and a tripoded balls bearing
mounted on a iackscrew Ior the lower rim. This was named the 'central
bearing point¨, which produced equalization oI pressure on the edentulous
ridges.
In 1929. Stansber introduced a technique, which incorporated a
curved plate with a 4" radius mounted on the upper rim and central
bearing screw oI 3" radius on the lower rim. Plaster was iniected aIter
tracing was made.
alI in 1929 use the Stansbery technique but he used compound as
record. Later graphic recording methods were developed which used the
central bearing point to produce the gothic arch tracing .
ard 1942 and !leasure 1955 described the use oI the Coble
balancer The patient would hold the bearing point in the depression
while plaster was iniected Ior the centric record.
!leasure1955 used a plastic disk, which was attached to the tracing
plate with a hole over the apex oI the Gothic arch. The centric relation
record could then be made without a change oI vertical dimension and
ard later designed a modiIied intra oral trace similar to the Coble.
The Sears Recording Trivet had an intraoral central bearing point and
two extraoral tracing plates.
Robinson designed the equilibrator in 1952 , a tracing device with a
hydraulic system and 4 bearing pistons, one each in the bicuspid and
molar region. It produced a Iunctional record oI centric relation with a
uniIorm distribution oI stress over the basal seat.
Silverman 1957 used an intraoral Gothic arch tracer to locate the
"biting point" oI a patient. The patient was told to bite hard on the tracing
plate. This developed the Iunctional resultant oI the closing muscles,
which would retrude the mandible. The indentation made by the patient
would be used Ior the centric record whether or not it corresponded to
the Gothic arch apex.
Another change in the graphic method was using the central bearing as
a tracer to register intra oral gothic by Blanchad. Musseinan. Copie.
Wastrow.
ard introduced a central bearing device with 2 heads. One end was
brass pointed and used in recording the tracing; the other end consisted
oI a mounted steel ball bearing, which was used as an anatomical teeth
set to a Ilat plane oI occlusion.
eight. Sears, House and many others who had devised tracing
procedures oI their own which enabled them to secure dependable
centric relation.
To make a needlepoint tracing one condyle moves Iorward and inward
during a lateral movement Iollowed by a movement in opposite direction
with rotation occurring around the opposite condyle, these movement cut
lines extending to the point representing the most retruded position oI
both condyles. ThereIore when both condyles are resting in the most
retruded position the needlepoint oI the tracing will be resting at the apex
oI the tracing thus created. A needlepoint tracing is Iundamentally a
single representation oI the portion oI the mandible and its movements in
a horizontal plane.
imitations Of raphic Method
Gothic arch tracing method is preIerred in good edentulous ridges with
normal interarch relation.
Arrow point tracing is diIIicult in excessively resorbed and Ilabby
ridges as it causes instability oI the recording bases and this restricts its
use.
Graphic method is not indicated when there is inadequate inter arch
distance, as it is diIIicult to accommodate the tracing device without
increasing the vertical dimension.
A sharp arrow point cannot be traced in persons with TMJ arthropathy.
In these instances conventional wax closure method is the alternative
choice.
Intra oral gothic tracing method is ideal in patients with habitual
centric. A Iew complete denture patients develop habitual centric either
due to Iaulty centric relation, or due to prolonged use oI very old denture
with marked attrition which causes a Iorward habitual positioning oI the
lower iaw.
This is a case oI "habitual eccentric occlusion". When the patient has
worn inappropriate dentures Ior a long time, the occlusion is habitually
out oI the centric occlusal position due to the Iunctional adaptation oI the
body in which one masticates in a position comIortable to him/herselI. In
these patients it is diIIicult to record centric relation with wax closures as
they tend to move the iaw to habitual centric relation position, which is
anterior to the actual centric. The Gothic arch method is indicated in
these patients. With intra oral gothic arch tracing method, the stylus
eliminates occlusal contact Irom occlusal rims and thereIore the habitual
neuromuscular memory or engram is absent. The likelihood oI sliding
the lower iaw Iorward and laterally is hence eliminated.
!RTS OF TE OTICRCTRCER
The device used is called a gothic arch tracer which essentially
consists oI -
1 A marking or recording and a tracing or recording table attached to
the upper or lower arches.
2.Stabilized base plates to prevent lateral movement and rocking thus
ensuring minimum errors in recording.
3 A central bearing device/screw to provide a central point oI bearing
or support between the maxillary and mandibular occlusal rims. It
consists oI a contracting point which is attached to one occlusal rim
and a plate attached to the other occlusal rims which provide the
surIace on which the bearing point rests or moves without any change
in the vertical dimension. The device is placed at the central bearing
point, which is located as the center oI the supporting areas oI the
maxillary and mandibular iaws.
Hight extra oral tracer assembly
Sears extra oral tracer assembly
Swissdent ball bearing bite recorder Microtracer Ior intra oral use
It is used Ior the purpose oI distributing closing Iorces, evenly
throughout the areas oI the supporting structures during recording oI
maxillomandibular relations. The central bearing helps to maintain the
unstrained relation oI the base plates to the supporting mucosa, with an
almost ideal distribution oI contact pressure.
Means oI locking the tracer at the apex oI the needle point tracing:-
1) a hole or a depression into which the needle point would Iall.
2) a plastic/ metal disk with a hole which was placed over the apex oI the
tracing.
This served as a convience and as a guide Ior the patient to hold a centric
position while the registration was secured.
!ositioning Of The Central Tracing !oint
It is important to direct the Iorce uniIormly to the basal structures and
thereby ensuring stability oI the base plates and uniIorm vertical
contact.
The central bearing point can be placed at the midline oI the upper
arch at the point where it is intersected by a line ioining the distal
surIaces oI the second premolars.
Stansberry has suggested placing the central bearing point at the point
oI intersection oI the lines drawn Irom the cuspid on the side to the
second molar on the other side.
Positioning the tracer (H.Villa)
The tracer is locted in a vertical position in some procedures, while in
others it is at variable inclinations. To obtain correct gothic arch
tracing stabilized base plates and central bearing point must be used
and it must be perpendicular to condylar hinge axis oI mandible.
EXTRORTRCINS ND DEVICES
A Gothic arch tracing, as the name implies, is a pin-point tracing on
soot or carding wax that is shaped aIter a type oI architecture known as
the Gothic arch. It sometimes is reIerred to as the arrow point tracing.
When one condyle moves out in lateral, the movement approximately
rotates around the other condyle. This movement cuts a line starting Irom
a point, which is the most retruded position oI the rotating condyle.
When the opposite condyle is caused to move on its path, it starts Irom
the same point and cuts a line at an angle to the other line. ThereIore,
when both condyles are resting in their most retruded positions, the
needlepoint oI the tracer will be resting on the apex oI the Gothic arch
thus created.
A Gothic arch tracing is Iundamentally a single representation oI the
position oI the mandible and its movement on one plane. This statement
should be modiIied iI several pins are used, such as the Sears trivet and
Iurther modiIied iI the tracing is oI the type suggested by Phillips. The
Phillips tracer indicates the condyle path as well as the direction and
centric position oI the mandible.
Techniques Of raphic Tracings
Gysi suggested 3 main point oI movement oI mandible namely, the 2
condyles and the incisal point.
II a recording device is used to record the incisor point as the mandible is
moved laterally a V -shaped tracing is obtained. This is called by Gysi as
the gothic arch. The apex oI which is most retruded position oI the
mandible Irom which lateral movements are made. DiIIerent technique
were designed since 1910.
EXTROR
si tribte - This technique omits the use oI central bearing plates
which necessitates special care in establishing the contacting areas oI the
two bite plates. Failure to produce equal contact over the entire occlusal
area oI the opposing bite planes in centric relation introduces tilting
Iorces on the bases.
Gysi technique
In the original Gysi technique the occlusal plane is determined by
locating the correct height oI the upper occlusion rim. Then the lower
occlusion rim is adapted to the upper rim at the correct vertical
dimension oI occlusion. The Gothic arch tracer is Iixed to the upper rim
at the occlusion rims with the tracing table paralell to, or continous with,
the plane oI occlusion. The central bearing point is not used. No mention
is made oI the inclination oI the tracing point. No cusp height is
introduced. This means that even contact oI the occlusion rims is lost
when the patient makes Iorward or lateral excursions oI the mandible
because oI the Iorward and downward movement oI the condyles.
The Sears trivet is a central
bearing point tracer with two
registration pins. The pins are
attached to the mandibular
plate thereIore they will give
a reverse gothic arch as
compared to those with the
pin attached to the maxillary
plate.
It traces 2 gothic arches
simultaneously. It has the
Iacility oI making the records
extra orally with plaster oI
paris.
Boos Bio-meter with
tracing table and marker is
another extra oral method
Ior obtaining gothic arch
tracing. The bio-meter
provides an indication oI the
position oI the mandibular
by tracing and records the
Iorces oI closing. (The V.R.
is adiusted using bio-meter).
Stansberr cheek bite method - Stansberr developed and
popularized the use of central bearing point in connection with
the tracing device for recording positional relations of the jaw.
With the Stanberrs cheek bite appliance records can be made
of centric jaw relations and protrusive relations. The tracing
device is removable from its attachment locations on the
maxillar and mandibular bearing plates.
The !hillips raphic record registers the centric relation and
the condlar paths.
!hillips tracer is another tpe of tracing device that registers
centric relation and the condle path simultaneousl.
The technique for an arrow point tracing using a ight tracing
device
Make accurate. stable
maxillar and
mandibular record
bases.
ttach occlusal rims of
hard base plate wax
Contour the wax
occlusion rims
Establish the vertical
dimension of jaw
separation with the
mandible at phsiologic
rest.
Reduce the mandibular
occlusion rim to provide
excessive interocclusal
distance
Make a face bow transfer and mount the maxillar cast
With the soft wax make a tentative centric relation record at a
predetermined vertical dimension of occlusion.
djust the articulator with the condlar elements secured against
the centric stops
Relate the maxillar occlusion rims of the soft wax record and
attach the mandibular cast to the articulator with plaster.
Mount a central bearing device. Exercise care to center the central
bearing point in relation to the plate. both anteroposteriorl and
laterall.
Mount the tracing device. Be sure to attach the devices securel to
the occlusion rims. The stlus is attached to the maxillar rim and
the recording plate to the mandibular. This arrangement develops an
arrow point tracing with the apex anteriorl. The reverse develops
an arrow point tracing with the apex posteriorl.
Seat the patient with the head upright. in a comfortable position in
the dental chair
!lace the record bases in the patients mouth with the attached
recording devices. Inspect the record bases and the recording devices
for stabilit. Make sure that there is no interference between the
occlusion rim when the mandible is moved in an direction. ower
the stlus to the recording plate and determine that the stlus
maintains contact with the recording plate during mandibular
movements.
Retract the stlus and conduct the training exercises with the
patient. !lace the tips of the index fingers under the mandible in the
bicuspid areas. !lace the tip of the thumb under the mandible near
the chin. Calml and quietl instruct the patient to move the jaw
forward. backward and to the right and left while gentl appling
guiding pressure with the thumb. It is possible to dislodge the
mandibular record base b improperl placing the thumbs or b
exerting excessive pressure. The Ne Excursion uide is an aid in
training the patient.
When the patient is proficient in executing the mandibular
movements. prepare the tracing plate to record the tracing. thin
coating of precipitated chalk in denatured alcohol applied evenl
with a brush provides a medium that offers no resistance to the
movement of the stlus and produces a clearl visible tracing.
Develop an acceptable tracing b dropping the stlus to the record
plate.
When a definite arrow point tracing with a sharp apex is made.
have the patient retrude the mandible to centric relation. The point
of the stlus should be at the point of the apex of the arrow point
tracing. Inject quick setting dental plaster between the occlusion
rims and allow the plaster to harden.
Remove the assembl and mount with the mandibular cast with
the new record.
This record is a tentative record and will be checked with an
interocclusal check record when the teeth are arranged and the wax
is contoured.
The appliance used consists
oI two bearing plates to which a
stylus holder and graph plate
may be attached. A template Ior
proper spacing oI the bearing
plates and a glass syringe to aid
in placing plaster.
Technique
1)The occlusal rims adiusted to
the correct vertical relation
2)They are mounted on an
articulator with the screw
tightened to maintain the relation
oI the casts.
STNSBERRY FUNCTION !OSITION CECK BITE METOD
2)The central bearing plates are placed in the template which has been
placed on the bite plates that had been shortened to provide space Ior it.
3)With the central bearing plates attached to the bite plates, the central
bearing screw is brought into contact and the tracing table and the stylus
are attached.
4)A gothic arch tracing is developed by the patient. This relation is
maintained and the plaster is iniected when the plaster is iniected. When
the plaster has set the record is marked and set aside Ior later use.
5)Accommodation Ior cusp height in lateral movements is accomplished
by raising the screw in the bearing plate by one and 1/2 turn. A second 9
inch is developed due to the increased vertical dimension. From the apex
oI this tracing a mark 1/4 inch or 6mm distant is made on each lateral
path. This marks the position oI the needle point Ior lateral records.
6)The central bearing point is raised one halI turn more Ior the protrusive
registration.
Classification Of rrow !oint Tracing
Gerber described six diIIerent types oI Gothic arch tracings.
1vpical seen as a well-deIined apex with a symmetrical leIt and right
lateral component. The mean Gothic arch angle is about 120 degrees. It
reIlects a healthy TMJ without interIerences in condylar path and a
balanced muscle guidance. The symmetrical Iorm indicates an undisturbed
movement oI the condyle in Iossa and distal slope oI eminence with
symmetrically balanced muscle guidance.
Flat form it is similar to typical arrow point except that it has more
obtuse leIt and right lateral tracings. This type oI arrow point signiIies a
marked lateral movement oI condyle in the Iossa. The Gothic arch angle is
more than 120 degrees.
Asvmmetrical form the leIt and right tracings meet in an arrow point,
however their inclination to the protrusive path is not symmetrical one oI
the lateral tracing is shorter. This Iorm oI tracing indicates an inhibition oI
the Iorward movement, either in the leIt or right ioint.
Apex absent /round form instead oI a sharp arrow point, the tracing is
rather round. It shows a weak retrusive movement. Tracing should be
repeated till a deIinite arrow point is obtained. Patient training is
necessary.
Miniature arrow point similar to the typical arrow point, however the
extension oI tracing is very limited. This can be due to restricted
mandibular movements, improper seating oI record bases and painIully
Iitting record bases during registration. It is also an indication oI a long
period oI edentulous ness with an inhibition in condylar movements.
Double arrow point it is a record oI habitual and retruded centric
relation. Allow patient training and repeat till a single gothic arch is
obtained. It is also seen when vertical dimension is altered during
registration.
Dorsallv extended arrow point the protrusive path extends beyond the apex
oI the gothic arch. This signiIies a Iorced strained retrusive movement oI the
lower iaw either by the patient or the operator. During registration procedure
lower iaw is either Iorcibly retruded by patient (active retrusion) or Iorcibly
retruded manually by the operator (passive retrusion). It is sometimes an
artiIact caused by the Iorward displacement oI upper occlusal rim or backward
dislodgement oI the lower rim while moving them in the mouth. The arrow
point tracing is correct but at a particular stage there was sliding oI upper
occlusal rim Iorward and lower displacing backward.
It can occur when the head oI the patient is tilted too Iar posteriorly. Gerber Ielt
that occasionally the distal extension is correct, but the tracing was obtained
with the mandible in protruded position.
Interrupted Cothic arch break or loss oI continuity oI lateral incisal path oI
gothic arch. This happens due to posterior interIerence at heels oI occlusal rims
during lateral movements.
Atvpical form protrusive component does not meet at apex but on one oI the
lateral path. This may happen in dentulous because oI Iaulty muscular pattern
due to paraIunctional habits like bruxism. Also seen in very old edentulous
patients, who are using complete dentures with incorrect centric relation.
Classical. pointed form
The symmetry indicates an undisturbed
movement sequence in the ioints and uniIorm
muscle guidance.
EVUTION OF OTIC RC TRCIN
Classical flat form
The picture indicates distinct lateral
movements oI the condyles in the Iossae.
Weak othic arch tracing
The picture indicates a lax and negligent
perIormance oI the movements, most oI all oI the
backward components. The registration must be
repeated. Stronger movements must be
demanded Irom the patient.
ssmmetrical form
The tracing indicates a distinct inhibition
oI the Iorward movement in the right ioint.
Miniature othic arch tracing
The tracing points to cramp-like
movements, badly Iitting and pain-causing
record blocks, edentulous state oI long standing
with inhibited movement in the ioints, badly
constructed prosthetic appliances, etc.
Vertical line protrudes beond the arrow point
This tracing was produced either by
Iorcible retraction or pushing oI the mandible. It
is, however, possible that the Gothic arch was
obtained with a protruded mandible.
Vincent R Trapozzano (1955) When making a tracing Ior establishing
centric relation on a patient with a normal temporomandibular ioint,
the apex oI the initial tracing will be mounted Irequently instead oI
having a deIinite apex. Aside Irom the technical Iactors the rounded
apex may result Irom the patient`s Iailure to understand what is
required when the right and leIt lateral movements are made, habit or
a slight Iilling in oI tissues behind one or both oI the condyles.
With some persistence on the part oI the patient and operator, the
patient may produce a needle point tracing with a deIinite apex.
Sedation may be indicated to relax the patient.
Suppose the blunted apex oI the needle point tracing had been
accepted as the position oI centric relation, and that occlusal
reconstruction, correction oI occlusal disharmony oI natural teeth, or
denture reconstruction had been completed.
a deIinite malocclusion would result whenever the patient decided to
close in the more retruded position (at the apex). In complete denture
construction , the resulting area oI malocclusion would produce an
inevitable shiIting and sliding oI the denture bases, which would result in
instability oI the dentures and all oI its undesirable sequalae.
Since it is recognized that the individual will undoubtedly make many
initial tooth contacts which vary Irom the most retrusive position (at the
apex) to a slightly anterior (eccentric) position (on the blunted apex),
provision must be made to avoid 'grooving¨ the patient to the most
retruded position beIore inclined plane contact is made. II the cusp teeth
are used, this is accomplished by allowing Ior 'Iree play¨, a slight
widening oI the central grooves or Iossa oI the posterior teeth is made to
provide an area larger than the size oI the cusp which Iits into the groove
or Iossa when initial tooth contact is made. Thus, provision is made Ior a
limited range oI horizontal movement oI the mandible without engaging
the inclined planes oI the teeth.
Howard F. Smith (1975)
A class III iaw relationship classically exhibits little anteroposterior
movement, while a class II exhibits much. One may suggest little
importance Ior anteroposterior precision, while the other may suggest
great importance. An arthritic patient may exhibit limited movement in
either direction.
Significance Of othic rch Tracing
It is important not to accept any other part oI the tracing except the
very apex as an indication oI centric relation. When the patient chews
lightly, they may oIten close their iaws in eccentric positions. However,
patients will pull the mandible to complete retrusion many times under
heavy closing pressure exerted during Iunction oI mastication. ThereIore
iI the dentures are not constructed with centric occlusion in harmony
with centric relation, the teeth will not contact evenly when under
considerable closing pressure. This uneven or premature contacting is a
disturbing Iactor in the retention and stability oI dentures, and it can
cause soreness oI the tissues supporting the dentures. On the other hand,
iI centric occlusion is in harmony with centric relation, the patient can
Iunction properly with his mandible in all positions under light and
heavy chewing pressures.
Extra oral tracings made without a central bearing point are not
considered satisIactory because although they indicate the correct
anteroposterior position oI the mandible, they may not record the
correct maxillomandibular relation (superioinIerior relation oI the
iaw). It is extremely diIIicult to maintain equalized pressure on the
blocks oI wax. ThereIore there is not much to be gained by securing a
tracing without using a central bearing point.
SINIFICNT !OINTS IN MKIN OTIC RC
TRCIN
1. Displacement oI the record bases may result Irom pressure, iI the
central bearing point is oII center when the mandible moves into
eccentric relation to the mouth.
2. II a central bearing device is not used the occlusal rims oIIer more
resistance to horizontal movements.
3. It is diIIicult to locate the center oI the arches to centralize the Iorces
with a central bearing device when the iaws are in Iavorable relation and
Iar more diIIicult iI the iaws are in excessive protrusive or retrusive
relation
4. It is diIIicult to stabilize a record base against horizontal Iorces on
tissues that are pendulous or other wise easily displaceable.
5. It is diIIicult to stabilize a record base against horizontal Iorces on
residual ridges that have no vertical height.
6. It is diIIicult to stabilize a record base or bearing device with patients
who have large tongues.
7. Recording devices are not considered compatible with normal
physiologic stimulation in mandibular movements.
8 The tracing is not acceptable unless a pointed apex is developed, a
blunt apex usually indicates an acquired Iunctional relationship.
9. Double tracing usually indicates lack oI coordinated movements or
recording at the diIIerent vertical dimension oI iaw separation. In either
events additional tracing should be made.
10. A graphic tracing to determine centric relation is made at a
predetermined vertical dimension oI occlusion. This harmonizes centric
relation with centric occlusion and the antero-posterior bone, to bone
relation with the tooth - tooth contact.
11. Graphic methods can record eccentric relation oI the mandibular to
the maxillary.
12. Graphic methods can be considered the most accurate visual means
oI making a centric relation record with mechanical instrument, however
all graphic tracings are not accurate.
INTRORTRCIN DEVICE
Intra oral tracings combine a central bearing point with a pinpoint
tracing. The bearing point is pointed and records a tracing on the
opposing plate. A hole is drilled in the plate at the apex oI the Gothic
arch in some techniques that employ intra oral tracing devices. This hole
or depression is used to hold the patient in this retruded position while
the registration is being recorded with plaster or some such material.
The Seidel, Ballard and the Messerman tracers are examples oI intraoral
tracing devices. Another type oI intraoral registration is aIIorded by the
Needles technique in which three pins attached to the maxillary rim, one
in the anterior portion and one on either side in the posterior region,
register the movements oI the mandible by means oI three Gothic arches.
They indicate both the centric position and the condylar paths .
Needles method
Make accurate record bases with occlusal rims.
Three pieces oI wire are now imbedded in the rim oI the upper base
plate. One end oI the wire is heated and Iorced into the modeling
compound in the incisal region and the soIt compound is packed Iirmly
about the base oI the wire. A wire is similarly placed on each side about
the position oI the distal side oI the Iirst molar. The wires are then cut oII
about 1.5 mm. above the surIace oI the bite rim. The incisal wire should
strike the lower bite rim near the anterior border with the plates in centric
occlusion, and the molar wires should strike slightly outside the middle
oI the lower bite rim, so that the tracing will not run oII the edge oI the
lower bite rim. Each oI these wires acts as a stylus to trace the paths oI
the respective points upon the surIace oI the lower bite rim.
The insides oI the bite plates are dusted with powdered gum tragacanth
to help maintain them Iirmly on the ridges. They are then placed in the
patient's mouth and the patient is requested to close until one or more oI
the pins come into light contact with the lower bite rim.
The patient is then asked to move the mandible Iorward and back in the
median line, maintaining a light pressure on the bite rims, the pins come
into equal bearing and each cuts a record oI its path in the lower bite rim,
which gives the path oI straight protrusion. BeIore these paths are cut too
deep, the patient is requested to retrude the mandible to its Iullest extent
and slide it to one side and back again, slight contact oI the pins being
maintained. This movement is repeated a Iew times and then the same is
perIormed on the opposite side. Thus the three paths are deepened
evenly, thoroughly cut to the Iull depth oI the respective pins; in this way
a balanced three point contact has been maintained and the path oI each
point has been recorded Ior protrusion and Ior working bite on each side,
while any separation that has taken place between the bite rims at any
point during these movements has been recorded by a shallower tracing
at that point. The Iorm oI the tracings will be Iound the same as Gysi's
three-point tracing. The depth oI the tracings also gives a record oI the
vertical relations. When the three pins are in the anterior angles oI their
respective tracings, the bite plates are accurately held in centric occlusion
without the need oI guide lines.
The Needles technique modiIied by the use oI a Messerman central-
bearing point tracer is suggested by Frahm. In this procedure the
occlusion rims are constructed in exactly the same manner as was
described by Needles. Four pins are, attached in the Iirst bicuspid and
second molar region on the right and leIt sides oI the maxillary occlusion
rims. By placing the pins in this position we are enabled to cut away the
anterior portion oI the maxillary occlusion rim to provide a window Ior
observing the tracing appliance. The stylus portion oI the tracer is
attached to the vault oI the maxillary trial base by imbedding the tripod
prongs into Compound or wax.
The graph plate is attached to the mandibular rim Ilush with the
occluding surIace oI the rim. The two units should be mounted in a
manner, which will permit the point oI the maxillary appliance to rest
near the center oI the mandibular graph plate.
The relationship plates are returned
to the mouth, and the screw on the
maxillary appliance is adiusted so
that it makes contact with the
graph plate simultaneously with
the contact oI the maxillary
occlusion rim pins on the
mandibular occlusion rim. The
patient then is instructed to make
lateral and protrusive movements.
As the pins scribe the Gothic
arches on the mandibular rim, the
vertical dimension is diminished a
little at a time by means oI the
setscrew on the maxillary
appliance. This is continued until
the surIaces oI the occlusion rim
make contact.
COBE INTR
OR TRCIN
DEVICE
Coble Balancer is a
type oI intraoral central
bearing device. The
central bearing point is
attached with modeling
compound to the upper
Base plate in the center
oI the palate at the
intersection oI the
midline and a line
ioining the centers oI
leIt and right chewing
areas.
When When placed placed in in the the mouth, mouth, the the upper upper and and lower lower base base plates plates make make
contact contact only only through through the the central central bearing bearing point point at at or or very very near near the the center center
oI oI the the supporting supporting areas areas oI oI the the upper upper and and lower lower ridges ridges..
The The central central bearing bearing screw screw is is raised raised or or lowered lowered to to establish establish the the vertical vertical
dimension dimension that that provides provides an an adequate adequate Iree Iree way way space space and and the the clearance clearance
between between the the base base plates plates at at the the distal distal borders borders is is checked checked..
At At the the chosen chosen vertical vertical dimension, dimension, the the central central bearing bearing point, point, acting acting as as aa
stylus, stylus, quickly quickly draws draws aa Gothic Gothic arch arch tracing tracing as as the the patient patient perIorms perIorms
excursive excursive gliding gliding iaw iaw movements movements.. To To lock lock the the patients patients iaw iaw in in centric centric
relation relation at at the the apex apex oI oI the the Gothic Gothic arch arch tracing tracing without without changing changing the the
vertical vertical dimension, dimension, use use aa thin thin sheet sheet about about 11mm mm oI oI clear clear Lucite Lucite as as an an
overlay, overlay, and and drill drill aa small small hole hole through through it it down down to, to, but but not not into, into, the the
aluminum aluminum graph graph plate plate.. The The patient patient is is then then asked asked to to perIorm perIorm aa gliding gliding
iaw iaw movement movement and and to to stop stop when when the the central central bearing bearing point point drops drops into into
the the hole hole which which was was drilled drilled over over the the apex apex oI oI the the tracing tracing..
At the time oI insertion oI the processed dentures, the Coble Balancer
is used again to integrate the gliding movements oI the iaw
with the occlusion oI the teeth, to perIect occlusal balance, and to
eliminate cuspal prematurities and collisions. At Iirst the central bearing
screw is adiusted to keep all teeth out oI contact in all gliding
movements. With the sole point oI contact between the upper and the
lower dentures located where the central bearing point touches the graph
plate, the patient can perIorm iaw movements that are uninhibited by
occlusal interIerences. And a Gothic arch tracing is quickly scribed. The
central bearing screw is shortened by halI turn (0.5mm) at a time until a
tooth to tooth contact occurs somewhere on the arch during the excursive
gliding movements. Usually the Iirst contact occurs on one or both
second molars or on the canines. Sometimes it occurs between the
denture bases behind the second molars iI the interridge space is small.
These occlusal contacts occur while the remaining teeth are still held out
oI contact by the central bearing point. They are treated as Iunctional
prematurities, and are ground down until they no longer interIere. The
central bearing point is then shortened by one-Iourth turn, and
articulating paper is reinserted to mark the contact areas during the iaw
excursions.
All the prematurities are thus located, marked and reduced until the
maiority oI the teeth make contact during the gliding movements, with
the central bearing point still riding on the graph plate.
HARDY and PORTER Hardy introduced a central bearing device with 2
heads. One end was brass pointed and used in recording the tracing. The
other end consisted oI a mounted steel ball bearing which was used as an
anatomic teeth set to a Ilat plane oI occlusion.
made a depression on the tracing plate with a round bur at the apex oI the
tracing. The patient would hold the bearing point in the depression while
plaster was iniected Ior centric record.
PLEASURE improved this technique by using a hole which was attached
to the tracing plate aIter the tracing was made, with the hole coinciding
over the apex oI the Gothic arch tracing. The central bearing point was
held in a hole when a plaster was iniected the centric would then be made
without a change oI vertical dimension.
Ballard intra oral tracing
device
Metal points attached to the
upper modeling compound rim
will cut pathways in the
occlusal surIace oI the lower
modeling compound rim as the
patient moves the mandible
Irom side to side.
1. Palatal bearing plate
2. Rounded head oI correlator pin
3. Tension spring
4. Adiustable screw
5. Mounting plate
6. Pointed end oI correlator pin
DVNTES ND DISDVNTES
The intra oral tracing device has less assembly. Hence it is more
comIortable Ior the patient. Also it makes the procedure oI assembling
the device and recording procedure easier Ior the operator.
Since the intra oral tracing are small, it is diIIicult to Iind the apex
compared to the extra oral tracing.
The tracers must be deIinitely seated in the hole made by a round bur
to assure accuracy when plaster is iniected between the rims. Any shiIt
in the position oI the stylus Irom the position oI the apex oI the tracing
cannot be prevented or corrected when plaster is being iniected. Since
any shiIt made is not seen and the procedure has to be repeated.
The intra oral tracings cannot be observed properly during the
tracing procedure and hence the method loses some oI its value.
R.H. Kingery (1952)reviewed the problems associated with centric
relation which were
PROBLEMS OF REQUIREMENTS
Recording the correct anteroposterior or horizontal realtionship oI the
mandible to the maxilla in a position.
Equalization oI contact on the denture supporting areas Equalization
oI vertical contact
PROBLEMS OF ERRORS
Positional Errors caused by
Failure oI the operator in his registration oI the correct horizontal
relationship.
Failure oI the operator to record equalized vertical contact
Application oI excessive closure pressure by the patient at the time oI
recording
Changes in the supporting areas
Technical Errors may be caused by
Ill Iitting occlusal rims
Indiscriminate opening or closing oI the occluding device or articulator
The slight shiIting oI the teeth which occurs between the stage oI Iinal
arrangement and the transIer to a permanent base material.
PROBLEM OF RECOGNIZING THE SYMPTOMS OF ERRORS
ASSOCIATED WITH CENTRIC REALTION
Symptoms OI Unequalized Vertical Contact
Loss oI retention
Irritation on the crest oI the lower ridge in the area oI premature
contact
One tooth or several teeth on one side seem too long to the patient or
seem to strike Iirst
The patient may complain oI clicking iI the teeth are porcelain
premature contact anteriorly or posteriorly
Symptoms OI Error In Horizontal Relationship Anterior to CR
o Looseness oI lower denture
o denture consciousness
o Irritation under the anterior lingual Ilange oI the lower denture
Symptoms OI An Error In Horizontal Relationship Posterior to CR
· Looseness, especially oI lower denture
· Irritation under the anterior labial Ilange oI the lower denture
(occasionally)
PROBLEMS OF RECORDING CENTRIC
1. The correctness oI an individual registration is never assured
until it is checked and veriIied by the observation oI the operator
2. Methods OI Recording Centric
· Limitations oI Graphic recording
· No control over the amount oI closure pressure
· DiIIiculty in placement oI central bearing point when patients
present extreme protrusion or retrusion oI the mandible
· Central bearing point is troublesome to use when patients
present large clumsy tongues, extreme resorption oI ridges or
extensive amounts oI displaceable tissues on the supporting
areas.
Comparsion between intra oral and extra oral devices
Heartwell states that intraoral tracings cannot be observed during tracing,
thereIore the method loses some oI its value oI a visible method. Since
the intraoral tracings are very small, it is diIIicult to Iind a true apex. The
tracer must be seated in a hole at the point oI the apex to assure accuracy
when recording the relation. II the patient moves the mandible beIore the
occlusal rims are secured, the records shiIt on their basal seat, this
destroys the accuracy oI the record.
The extra oral tracings are larger and thereIore the patient can be directed
and guided more intelligently during the mandibular movements. The
stylus can be observed in the apex oI the tracing during the process oI
iniecting the plaster between the occlusal rims and recording the relation
and no holes are required. Boucher preIers the extra oral device.
oucher also recommended that centric relation should be made with
minimal pressure to prevent displacement oI the tissues supporting the
bases, in order to achieve uniIorm simultaneous contact oI the dentures.
$olomon claimed that in intraoral method the errors are likely to be less
because the tracing is situated closer to the centers oI movements in the
temporomandibular ioint in comparison to the Ilexible extra oral device
which inscribes mandibular movement in a plate situated outside the
mouth Iurther away Irom the centers oI mandibular movement. Further
the presence oI extra oral tracer attachments prevents the lips Irom
meeting each other and remains passive. According to him , the distinct
advantage oI intraoral tracing is the ability oI the subiect to perIorm
mandibular movements with the lips in passive contact position.
Kapur K K and Yurkstas A A (1957) compared the duplicability oI
records using various techniques
The intra oral tracing procedure (hardy)
The wax registration procedure (hanau)
The extra oral tracing procedure (stansberry)
He concluded that
·The intra oral and extra oral procedures were more consistent compared
the wax registration method
·The intra oral and extra oral procedures became less consistent in
patients with Ilabby ridges as compared to patients with good and Ilat
ridges
·The consistency oI the extra oral procedure did not vary signiIicantly
with diIIerent types oI ridges
·The degree oI consistency with the intra oral procedure decreased to a
signiIicant level in patients Ilabby ridges
·The wax method was less consistent than the other two procedures. It
showed least consistency on Ilat ridges and the highest consistency on
Ilabby ridges
REVIEW OF ITERTURE
In 1910 Gysi stated needle points tracing has been accepted as
an accurate method oI locating the centric maxillomandibular relation at
a given degree oI iaw separation.
In 1940 Boos in his study in maxillomandibular relations
established by biting power stated in his research on maxillomandibular
relationship with the use oI the power point, reports that centric relation
is not at the apex oI the gothic arch. He stated that he Iound by use oI
resultant biting power (point) that the needle point tracing is extremely
accurate in some patient and in others it is unreliable, the resultant biting
point is located at apex oI the needle point tracing in some patient,
anterior to the apex in others.
In 1952 Granger stated that the apex oI the Gothic arch tracing
shows a sharp apex. It does however have one value. In order to do an
accurate tracing it is necessary to do two tracing one on each side oI the
mandible.
In 1954 Stansbery proposes a method to check the
correctness oI the central bearing position. One rod it passed through the
a needle holder and other placed on the tracing plate. They should be
parallel in all directions.
In 1959 Elmer E Francis in his article iaw relation in C D construction
described vertical tracer is that which registers and determines the proper
vertical dimension, centric relation and condyle path records. This
vertical dimension is result oI study oI Gysi. Horizontal position oI the
mandible is registered by the gothic arch tracing. Vertical tracer consist
oI upper and lower metal plate which are shaped like balanced occlusal
guide plates. These two plates are attached to upper and lower base
plates, upper plate has a vertical plate and a gothic arch tracer. The lower
plate has a horizontal tracing table, an intra oral removable screw
attachment that constitute vertical stop and slip ioints which holds Gysi
Iace bow and a vertical marker.
In 1961 Huges and Regli : In his study oI what is centric
relation observed that a sharp gothic arch tracing may be obtained with
the condyles in more than one location in the glenoid Iossa.
When using a central bearing point Ior patients with prognathic
or orthognathic occlusions it is diIIicult, not iI possible to secure
equalization oI pressure.
In 1962 Jones PM : In his study oI eleven aids Ior a better CD
stated in intra oral gothic arch tracer is used to determine the centric
relation at the established vertical relation. The needle point tracing
device is a reliable, accurate and practical method Ior locating centric
relation. The apex oI a tracing is indented with a bur. A plaster intra
occlusal record is made by iniecting plaster into the patients mouth with
the Stanberry plaster syringe.
In 1965 Mohammed A, W Arthur George and Russel H Scott :
summarized Needle point tracing were obtained Irom ten subiects at Iive
diIIerent degree oI iaw separation. Two subiect showed negligible lateral
deviation at any degree oI opening when one subiect showed consistent
deviation Irom midline when the vertical dimension between the iaw was
increased The needle point tracing at a given vertical dimension oI iaw
separation under same controlled condition, on the same individual at
same sitting were not signiIicantly diIIerent. So needle point tracing is
reliable.
In 1968, Joseph E Grasso and John sharry in the study oI the
duplicability oI arrow point tracing in dentulous patients did a study with
15 white men (Detail students between age group oI 20 35) tracing
were obtained at a Iixed vertical dimension Ior each subiect. The vertical
iaw separation varied Irom subiect to subiect depending upon the cuspal
teeth height oI the posterior teeth and or the vertical overlap oI the
anterior teeth.
Variation pattern oI the apex position oI the needle point tracing
were greater in an anteroposterior direction than in a mediolateral
direction.
In 1969 A langer and J. Michmann studying the intra oral technique Ior
recording vertical and horizontal maxillomandibular relation in complete
dentures wrote that the instrument used the Barnae stylus tracer is an
intra oral tracing device. This technique is recording vertical and
horizontal maxillomandibular relation is suggested. This technique IulIils
basic requirements Ior correct complete denture construction. The
physiologic rest position is used as a reIerence Ior establishing an
acceptable interocclusal distance and the most retruded mandibular
position is recorded in centric relation. The use oI central bearing point
ensures equal distribution oI pressure throughout the basal seat while the
records are made.
In 1970 Clayton, Kotowiez and Myers : conducted a research
on graphic recording oI mandibular movements concluded the
orientation oI styli and recording table aIIected graphic tracing oI
mandibular movements when the vertical dimension is changed, cusp
gliding on inclines involves change in vertical dimension.
In 1975 Smith in study in comparison oI empirical centric relation
record and location oI terminal hinge axis and apex oI the gothic arch
tracing concluded that average empirical determination provided a
centric relation point anterior to that determined by either the gothic arch
and the hinge axis location . Gothic arch method was the most repeatable
oI the three methods.
In 1980 Michael Myer in his article relation oI gothic arch apex
to dentist assisted centric relation concluded that thumb pressure can
position the mandible consistently more posterior than the position
indicated by the gothic arch apex is unIounded. It also states that dentist
assisted iaw relation is more reproducible than relation indicating gothic
arch apex.
In 1987 Winstanly : In his article gothic arch tracing and condylar
inclination concluded that records and the patient reIerred Ior treatment
oI temperomandibular ioint disorders were used to compare condylar
inclination Iound by drawing a tangent and by using a mathematical
technique. Needle point tracing angles were also measured Ior the same
patient and were compared with the condylar inclination. It can be
concluded that the mathematical technique outlines records a more
accurate value between patient and L & R sides oI the same patient and
there is no direct relationship between condylar inclination and the
needle point tracing angle.
In 1989 Winstanly : in his article the gothic arch tracing and the
upper canine teeth as guide in the positioning oI the upper posterior
teeth concluded that the relationship between the position oI the buccal
cusps oI the natural upper posterior teeth and the distance between the
upper canine teeth has been Iound to be constant within ¹ 1-2mm this
may be oI value when setting up artiIicial teeth Ior denture patients,
enabling them to be positioned close to the natural predecessors.
1996 Obrez . Stohler CS conducted a study to test whether pain can
cause signiIicant changes in position oI the mandible and thereIore Iorm
the basis Ior any perceived changes in the maxillomandibular
relationship. Asecond obiective was to determine whether pain can cause
changes in the mandibular range oI motion. Five subiects who rated pain
intensity on a visual analog scale were used in a single-blind,
randomized, repeated-measures study design. Tonic muscle pain was
induced by inIusion oI 5° hypertonic saline solution into the central
portion oI the superIicial masseter muscle. Isotonic saline solution was
used as a control, with subiects blinded to the type oI substance given.
The eIIect oI pain on the position oI the apex oI the gothic arch tracing,
the direction oI the lateral mandibular border movements, and the
mandibular range oI motion was studied in a horizontal plane with
minimal occlusal separation. Pain signiIicantly aIIected the position oI
the apex oI the gothic arch tracing in anterior Similarly, pain aIIected the
orientation oI the mandibular lateral border movements and their
magnitude
All pain-induced eIIects proved to be reversible. The observed eIIect oI
pain can explain the perceived change oI bite that is Irequently noted by
patients with oroIacial pain. This study provided evidence oI an
alternative causal relationship between pain and changes in occlusal
relationship and questions occlusal therapy as treatment, directed toward
the elimination oI the underlying cause in patients with masticatory
muscle pain.
1998 Raigrodski . Sadan . Carruth ! Clinicians have long
expressed concern about the accuracy oI the Gothic arch tracing Ior
recording centric relation in edentulous patients. With the use oI dental
implants to assist in retaining complete dentures, the problem oI
inaccurate recordings, made Ior patients without natural teeth, can be
signiIicantly reduced. This article presents a technique that uses healing
abutments to stabilize the record bases so that an accurate Gothic arch
tracing can be made.
1999 Watanabe Y Analyzed and evaluated the horizontal mandibular
positions produced by diIIerent guidance systems. Twenty-six edentulous
subiects with no clinical evidence oI abnormality oI temporomandibular
disorder were selected. Horizontal position data Ior the mandible
obtained by gothic arch tracing was loaded into a personal computer by
setting the sensor portion oI a digitizer into the oral cavity to serve as a
miniature lightweight tracing board.
By connecting this with a digitizer control circuit set in an extraoral
location, each mandibular position was displayed in a distinguishable
manner on a computer display in real time, then recorded and analyzed.
The gothic arch apex and tapping point varied, depending on body
position. In the supine position, the gothic arch apex and the tapping
point were close to the mandibular position determined by bilateral
manipulation. This system provides eIIective data concerning mandibular
positions Ior Iabrication oI dentures.
2003 Keshvad . Winstanle RB. conducted to determine statistically
the most repeatable mandibular position oI 3 centric relation methods.
Three centric relation recording methods commonly reported in the
literature were selected: bimanual mandibular manipulation with a iig,
chin point guidance with a iig, and Gothic arch tracing. Fourteen healthy
adult volunteers (7 males and 7 Iemales), with an average age oI 26 years
and no history oI extractions, temporomandibular ioint dysIunction, or
orthodontic treatment, were selected Ior the study.
Accurate casts were mounted on an articulator (Denar D4A) by means oI
a Iacebow and maximum intercuspation silicone registration record.
A mechanical 3-dimensional mandibular position indicator was
constructed and mounted on the articulator enabling the operator to
analyze the mandibular positions in 3 spatial axes (x, anteroposterior; y,
superoinIerior; z, mediolateral shiIt). Each centric relation method was
recorded Iour times on each subiect (at baseline, 1 hour, 1 day, and 1
week at approximately the same time oI day). Records were transIerred
to the articulator, and data were extracted using a stereomicroscope
modiIied to accept the mandibular position indicator. The results oI this
study showed that oI the 3 centric relation methods evaluated, the
bimanual manipulation method positioned the condyles in the
temporomandibular ioint with a more consistent repeatability than the
other 2 methods, whereas the Gothic arch was the least consistent
method.
REFERENCES
·El-Gheriani AS, Winstanley RB.The Gothic arch (needle point)
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·El-Gheriani AS, Winstanley RB.The value oI the Gothic arch
tracing in the positioning oI denture teeth. J Oral Rehabil. 1988
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·El-Gheriani AS, Davies AL, Winstanley RB.The gothic arch
tracing and the upper canine teeth as guides in the positioning oI
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·Honorato Villa: Gothic arch tracing:JPD; 1959:9:624-628
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records with location oI terminal hinge axis and the apex oI the
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·Max A Pleasure: occlusion oI cuspless teeth Ior balance and comIort
JPD: 1955:5:305-312
·Obrez A, Stohler CS.Jaw muscle pain and its eIIect on gothic arch
tracings. J Prosthet Dent. 1996 Apr;75(4):393-8.
·Raigrodski AJ, Sadan A, Carruth PL.A technique to stabilize record
bases Ior Gothic arch tracings in patients with implant-retained
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·Vincent R Trapozzano: An analysis oI current concepts oI occlusion:
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·Watanabe Y.:Use oI personal computers Ior Gothic arch tracing:
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