Centric relation records-Historical review

Michael L. Myers, D.M.D. *

Medical University of South Carolina, College of Dental Medicine, Charleston, S.C

M any prosthodontists feel that recording centric

relation is the most difficult, yet the most important,
One early method was to adjust the occlusion rims
to the chosen vertical dimension of occlusion, have
step in treating edentulous patients with complete the patient close in a retruded position, and attach
dentures.‘-3 However, a review of dental literature the rims together for mounting on an articulator.
reveals that the philosophies and methods vary This was usually done with staples or by sealing the
greatly on how to make the actual registration. rims with a hot instrument.!‘. I0 Another practice was
Centric relation is generally defined as “the most to soften one of the occlusion rims and have the
retruded relation of the mandible to the maxillae patient close to a vertical dimension determined by
when the condyles are in their most posterior the dentist.; In 1954, Brown “’ recommended
unstrained positions in the glenoid fossa from which repeated closures into softened wax rims. Greene;
lateral movements can be made, at any given degree had his patients hold their jaws apart for IO seconds
of jaw separation.“’ This definition is open to various to fatigue the muscles and then had them snap the
interpretations, and many prosthodontists disagree rims together. He then made lines in the rims to
with it in part or entirely. It is generally agreed that orient them after removal from the mouth.
centric relation records can be grouped into four Gradually, these procedures evolved into interoc-
categories-direct checkbite (interocclusal) tecord- clusal records as they are usually done today. Small
ings, graphic recordings (intraoral and extraoral), amounts of wax, compound, plaster. or zinc
functional recordings,’ and cephalometrics. oxide-eugenol paste were placed between the
occluding rims, and the patient closed the jaws into
DIRECT CHECKBITE INTEROCCLUSAL centric relation. These improvements were an
RECORDINGS attempt to equalize the pressure of vertical contact.
The direct interocclusal record is the oldest type of Some methods relied on removing the posterior
centric relation record. In 1756, Phillip Pfaff, the portions of the mandibular occlusion rim. Then the
dentist of Frederick the Great of Germany, was the anterior segment would maintain the vertical dimen-
first to describe this technique of “taking a bite.“’ sion of occlusion as the patient closed into a softened
Until the end of the nineteenth century it was the material which was on the posterior portion.” Other
most commonly used method.‘ The direct interoc- methods incorporated closure of cones, pyramids, or
clusal record during that period, was a nonprecision ridges of wax into grooves which had been cut in the
,jaw record obtained by placing a thermoplastic maxillarv rims.“-”
material, usually wax or compound, between the There are many opinions regarding the best mate-
edentulous ridges and having the patient close into rial for interocclusal record. Trapozzano” stated
the material. This was known as the “mush,” “bis- that the wax “checkbite method is the technique of
cuit,” or “squash” bite.’ In 1905, Christensen” was preference in recording and checking centric rela-
one of the early authors to use “impression wax” for tion.” Schuyler” observed that if the recording
“bite” records. In 1910, Greene’ described a mush- medium was not of uniform density and viscosity,
bite made from modeling compound in which he uneven pressures would be transmitted to the record
used a plaster wash to achieve a more accurate bases which would cause a disharmony of occlusion.
record. Occlusion rims were later added to the He said that modeling compound was preferable to
technique to provide a more stable base. wax for occlusal records because it can be softened
more evenly, cools slower, and doesn’t distort as
much as wax. Payne’” and Hickey”* stated a prefer-
*.i\ssociate Professor, Crown and Bridge Dentistry. ence for plaster because less material had to be

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 MYERS

placed in the patient’s mouth for the record. BOOS” The importance of verifying the interocclusal
wrote that it was important to avoid torsion when records has been stressed by many authors.?. ‘*. ”
recording centric relation. Wax or compound, which Schuyler” stated that he did not “consider a record
required the application of force, could displace the secured on compound or wax occluding rims suffi-
mandible. Therefore, Boos thought a material such ciently free from error to complete the restorations
as plaster or zinc oxide-eugenol paste was more without additional checks.”
accurate. There have been many criticisms of “checkbites”
HanaulP was one of the first individuals to be for centric relation records. Most of these criticisms
concerned about equalization of pressure when were from individuals who favored some type of
recording the bite. He wrote, “I attribute the total of graphic recording. Simpson28 felt that wax records
the causative factor of denture mobility and conse- were unscientific. PhillipszY stated that “in the hands
quent change of positional relation to the resilient of by far the largest majority of operators, it is worse
and like effect of saliva, tissues, restorations, gluey than useless.” Gysi ‘3o tested this method on manikins
adhesives, and possibly of films of food interposed and never got the same recording twice with wax or
between the masticatory surfaces during function.” compound. He concluded that the uneven cooling of
He coined the word “Realeff,” which is formed by the material produced distortion. The only accurate
the beginning letters of the words “resilient and like material he found for interocclusal records was
effect.” This consideration of the resiliency of the plaster. Page3’ said that centric records were “worth-
oral tissues became a major factor in “checkbite” less the instant the apposition or the surfaces are
techniques. Wright I1 described the four factors he altered.”
believed affected the accuracy of records: resiliency
of tissue, saliva film, fit of bases, and pressure
GRAPHIC RECORDINGS
applied. He concluded that the dentist couldn’t The earliest graphic recordings were based on
control the pressure at which the record was made, so studies of mandibular movements by Balkwi1P2 in
the best technique was to record the occlusal record 1866. The intersection of the arcs produced by the
at zero pressure. It could thus be duplicated. right and left condyles formed the apex of what is
Hanua,‘” Block,20 and other? agreed with the zero known as the Gothic arch tracing.3’ The first known
pressure philosophy. Schuyler,‘* Payne,‘” and Tra- “needle point tracing” was by Hesse in 1897, and the
pozzano,lg among othersZ’-‘” advocated the use of technique was improved and popularized by Gysi
light pressure. The problem of pressure in any record around 1910.“3
was recognized by BoucherZ4 who wrote, “In addi- The tracer made by Gysi was an extraoral incisal
tion to technical errors are the errors which occur as tracer. The tracing plate, coated with wax, was
a result of failure to control jaw activities and attached to the mandibular rim. A spring-loaded pin
pressure at the time of registration.” In 1910, Greene? or marker was mounted on the maxillary rim. The
invented his “Pressometer” in an early attempt to rims were made of modeling compound to maintain
equalize the pressure of recording centric relation. It the vertical dimension of occlusion. When a good
consisted of two celluloid strips placed between the tracing was recorded, the patient held the rims in the
maxillary and mandibular occlusion rims on the apex of the tracing while notches were scored in the
right and left sides. If the pressures were unequal, the rims for orientation. 34 Clapp35 described the use of a
rims would “hold” one strip while the other could be Gysi tracer which was attached directly to the
removed. impression trays. Sears”@ used lubricated rims for
The techniques for “getting the jaw back” were as easier movement. He placed the needle point tracer
varied as the types of materials. Most prosthodontists on the mandibular rim and the plate on the maxil-
had the patients close, unassisted, into a retruded lary rim. He believed this made the angle of the
mandibular position. This was combined with hav- tracing more acute and more easily discernible. He
ing the patient swallow, touch his tongue to the soft would then cement the rims together for removal.
palate, make rapid jaw movements to tire muscles, PhillipF recognized that any lateral movements
and other techniques, in an attempt to achieve the of the jaw would cause interference of the rims which
retruded position of the mandible.25 Many authors could result in a distorted record.’ He developed a
advocated some degree of control over the jaw plate for the upper rim and a tripoded ballbearing
movement. This was generally light pressure on the mounted on a jackscrew for the lower rim. The
chin or guiding of the mandible.“-13. *6 occlusion rims were removed, and when the patient

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CENTRIC RELATION RECORDS

had produced the proper extraoral tracing, softened it must be admitted, they found a goodly number of
compound was inserted between the trial bases. This fanatical believers and blind followers, whose mental
innovation was named the “central bearing point,” inertia probably did not care to penetrate even the
which supposedly produced equalization of pressure polish of the nickel-plated instrument under consid-
on the edentulous ridges. In 1929, Stansbe@’ intro- eration.” In 1927, Hanauls conceded that the Gysi
duced a technique which incorporated a curved tracing was satisfactory to check records, but that
plate with a 4-inch radius (corresponding to Mon- universal usage was not good. On the other hand,
son’s curve) mounted on the upper rim. A central Tenth’” stated that the Gysi tracing technique was
bearing screw was attached to a lower plate with a the only means that should be used for centric
3-inch radius curve (reverse-Monson curve). After records; all other methods were “mere deceptions
the extraoral tracing was made, plaster was injected and playthings.” Gysi:‘” concluded that his tracing
between the plates to form a biconcave centric technique had only a 5-degree error. whereas wax
registration. HallZh (1929) used Stanbery’s method and compound bites had a 25-degree error.
but substituted compound for the centric relation Criticisms of Gothic arch tracings stated that
record. equalization of pressures did not occur, prognathic
Later graphic recording methods used the central or retrognathic patients could not be used, and
bearing point to produce the Gothic arch tracing. flabby tissues or large tongues could cause shifting of
Hardy”!’ and Pleasure”’ described the use of the bases.‘ Payne” stated that the tracing was difficult to
Coble Balancer, and Hardy later designed a modi- see and too much patient cooperation was needed.
fied intraoral tracer similar to the Coble. Hardy:l” Trapozzano ‘-I believed that “checkbites” were far
and Porter” made a depression with a round bur at more accurate than the central bearing point could
the apex of the tracing. The patient would hold the possibly be, due to the unequal pressure produced.
bearing point in the depression while plaster was Block”’ made the point that any sore spot under the
injected for the centric record. Pleasure’” used a baseplate could cause an eccentric tracing. Grange?:
plastic disk which was attached to the tracing plate stated that the Gothic arch produced was generally
with a hole over the apex of the Gothic arch. The rounded and was not precise enough.
centric relation record could then be made without a
change of vertical dimension.” Various tracing FUNCTIONAL RECORDINGS
devices were designed by Hight, Phillips, Terrell, Functional records were described in dental litera-
Sears, House, Messerman, and others.‘“, -)?The Sears’ ture as early as 1910. Greene’ used a pumice and
Recording Trivet had an intraoral central bearing plaster mixture in one of the rims and instructed the
point and two extraoral tracing plates. The maxil- patient to grind the rims together. The denture teeth
lary and mandibular tracing arms were locked into were set to the generated paths. Needles-l” mounted
c&tric relation with two lumps of plaster. Robin- three studs on maxillary rims which cut arrow
son”:’ designed the Equilibrator, a tracing device with tracings into mandibular compound rims. .4fter
a hydraulic system and four bearing pistons, one removal from the mouth, the rims were reassembled
each in the bicuspid and molar region. It produced a with the functinal grooves. Patterson”’ cut a trough
functional record of centric relation with a uniform in the upper and lower rims. These were filled with a
distribution of stress over the basal seat. Carborundum and plaster mixture. The patient
Sliverman” used an intraoral Gothic arch tracer would move his jaw and grind the rims until the
to locate the “biting point” of a patient. The patient proper curvature had been established. This would
was told to bite hard on the tracing plate. This ensure equalized pressure and uniform tooth contact
developed the functional resultant of the closing in all excursions. The functional technique devel-
muscles which would retrude the mandible. The oped by Meyer”” used soft wax occlusion rims.
indentation made by the patient would be used for Tinfoil was placed over the wax and lubricated. The
the centric record whether or not it corresponded to patient performed the functional movements to
the Gothic arch apex. produce a wax path. A plaster index was made of the
The graphic recording, like the “checkbite wax path and the teeth were set to the plaster
records,” received much praise and criticism. In index.
1923, Hanau’” wrote, “The most naive of our BOOS” used the Gnathodynamometer to deter-
geniuses had intuitions, molded into metal, attached mine the vertical and horizontal position at which a
a decorative theory onto their accomplishment and, maximum biting force could tx produced. His

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 MYERS

Bimeter was mounted on the lower occlusion rim 6. Schlosser, R. 0.: Methods of securing centric relation and
other positional relation records in complete denture pros-
with a central bearing point against a plate on the
thesis. J Am Dent Assoc 28:17, 1941.
upper occlusion rim. Plaster registrations were made 7. Greene, J. W.: Greene Brothers’ Clinical Course in Dental
with the Bimeter in the mouth and the patient Prosthesis, 1910.
exerting pressure. Boos theorized that optimum 8. Christensen, C.: The problem of the bite. Dent Cosmos
occlusal position and the position of maximum 47:1184, 1905.
9. Prothero, J. H.: Prosthetic Dentistry. Chicago, 1921, Medi-
biting force would coincide. He also thought that it
cal-Dental Publishing Co.
was essential that all registrations be made under 10. Brown, J. C.: Articular mechanisms for inducing condyle
biting force so that the displacement of soft tissues migration. J PROSTHET DENT 4:208, 1954.
which occur in function, would occur during bite 11. Wright, W. H.: Use of intraoral jaw relation wax records in
registration.j*, 53 complete denture prosthesis. J Am Dent Assoc 26~542,
1939.
Shanahan,j4 in his physiologic technique, placed
12. Schuyler, C.: Intraoral method of establishing maxilloman-
cones of soft wax on the mandibular rim and had the dibular relation. J Am Dent Assoc 19:1012, 1932.
patient swallow several times. During swallowing, 13. Brill, N.: Reflexes, registrations, and prosthetic therapy. J
the tongue forced the mandible into its centric PROSTHET DENT 7:341, 1957.
relation position. The cones of soft wax were moved 14. Trapozzano, V. R.: Occlusal records. J PROSTHET Dwr
5~325, 1955.
and the physiologic centric relation was recorded.
15. Payne, S. H.: Selective occlusion. J PROSTHET DENT 5:302,
1955.
CEPHALOMETRICS
16. Hickey, J. C.: Centric relation-A must for complete den-
The use of cephalometrics to record centric rela- tures. Dent Clin North Am, November, 1964.
tion was described by Pyott and Schaeffer.55 The 17. Boos, R. H.: Centric relation and functional areas. J PROS-
THET DENT 9: 191, 1959.
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18. Hanau, R. L.: Why Is Centric Relation Once Established
occlusion were determined by cephalometric radio- Not Retained Subsequently? Unpublished Paper, North-
graphs. This method, however, was somewhat western University Dental School Library, 1929.
impractical and never gained widespread usage. 19. Hanau, R. L.: Dental Engineering, vol I, part II. Buffalo,
It is apparent from the dental literature, that there 1927, Hanau Engineering Co.
20. Block, L. S.: Common factors in complete denture prosthe-
are many opinions and much confusion concerning
tics. J PROSTHETDENT 3:736, 1953.
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with Sear9 who wrote 3 “The problem has confused PRO~THET DENT 6~582, 1956.
a great number of readers, which is not surprising, as 22. Trapozzano, V. R.: An analysis of current concepts of
many of the writers are also confused.” BOOSTS occlusion. J PRO~THETDENT 5:764, 1955.
probably came closest to the solution when he stated 23. Kazis, H.: Functional aspects of complete mouth rehabilita-
tion. J PROSTHETDENT 2:575, 1952.
that “in normal cases, the .occlusion, the temporo-
24. Boucher, C. 0.: Current status of prosthodontics. J PROS-
mandibular joints, the bone, the soft tissue, and the THET DENT 10:421, 1960.
musculature all produce the same relation to each 25. Yasaki, M.: The height of the occlusion rim and the
other and any one of the many registration tech- interocclusal distance. J PROSTHETDENT 11:26, 1961.
niques may be used.” A certain technique might be 26. Lucia, V. 0.: Modern Gnathological Concepts. St. Louis,
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required for an unusual situation or a problem
27. Beck, H.: Selection of an articulator and jaw registration. J
patient. In the final analysis, the skill of the dentist PRO~THET DENT 10:884, 1960.
and the cooperation of the patient are probably the 28. Simpson, H.: Registration of centric relation in complete
most important factors in securing an accurate denture prosthesis. J Am Dent Assoc 26:1682, 1939.
centric relation record. 29. Phillips, G. B.: Fundamentals in the mandibular movements
in edentulous mouths. J Am Dent Assoc 14:409, 1927.
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