CLINICAL SCIENCES Malcolm D. Jendresen ▲ William F. P. Malone ▲ Thomas D.

Taylor

The anterior acrylic resin platform and centric relation verification:

A clinical report
Roger A. Solow, DDSa
Mill Valley, Calif.

Diagnostic casts mounted in centric relation are

essential in comprehensive diagnosis, treatment plan-
ning, and predictable restorative procedures. Dawson’s
bimanual manipulation, to locate centric relation and
to confirm this position of the condyles in the glenoid
fossae with load testing, has been detailed.1-4 A light
touch is initially used to guide the mandible into cen-
tric relation, followed by increasing increments of
force to perform the load test. This approach is
designed to avoid protective muscle bracing initiated
by the stretch-reflex mechanism that could alter the
anterior-posterior or medial-lateral position of the
mandible; or confuse load testing pain in the lateral
pterygoid muscle with intraarticular temporo-
mandibular joint (TMJ) pain. Fig. 1. Mandibular incisor mark on flat platform in centric
Correct bimanual manipulation technique to record relation.
centric relation is a skill that requires hands-on learn-
ing. Improper finger position, heavy initial force in arc-
ing the mandible, patients overassisting while closing in
variable paths, or muscle hypertonicity can produce
errors with this technique. The purpose of this article is
to present a clinical case of recording centric relation
with the bimanual manipulation technique. A modified
anterior deprogrammer was used to visualize mandibu-
lar central incisor position before and during centric
relation records, which allows these errors to be con-
trolled. Interocclusal dimension and the accuracy of
cast mounting on the articulator were also verified.
CLINICAL REPORT
A doughy cylinder of Snap (Parkell, Farmingdale,
N.Y.), low shrinkage, fast-set acrylic resin, was com-
pressed over the patient’s maxillary central and lateral Fig. 2. Lower incisor protrusion-retrusion mark against plat-
incisors. The labial flange was trimmed to 2 mm past form.
the incisal with the close adaptation to the enamel sur-
face evident. Dawson’s bimanual manipulation was
practiced with the patient until a repeatable smooth
arcing of the mandible was felt, with no discomfort in Protruding and retruding on the appliance or resting
the TMJ area. Mandibular central incisor contact on against the flat platform as posterior teeth disengage
the flat platform was marked with articulating ribbon may allow for comfortable centric relation arc of clo-
(Fig. 1). Bimanual manipulation was repeated while sure on load testing (Fig. 2).
observing coincident mandibular central incisor con- When consistent, comfortable manipulation was
tact on the mark. achieved, an interocclusal record was generated. Blu-
If incisor contacts are off the mark or if load testing Mousse (Parkell, Farmingdale, N.Y.), low resistance
is painful, a centric relation record should not be made. polyvinyl siloxane, was placed on the occlusal
surfaces and the patient closed the mandible in centric
aPrivate practice. relation (Fig. 3). Alternatively, the mandibular central
J Prosthet Dent 1999;81:255-7. incisors are positioned into contact on the acrylic resin

MARCH 1999 THE JOURNAL OF PROSTHETIC DENTISTRY 255

THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 3. Occlusal record generated with bimanual manipula-
tion and anterior acrylic resin platform.
platform and the material injected between the occlusal
surfaces.
After face-bow mounting of the maxillary cast, the
mandibular cast was mounted with the interocclusal
record. The anterior acrylic resin platform was trimmed
to remove the interproximal septae and any palatal soft
tissue contact, and repositioned on the cast (Fig. 4).
Mandibular incisor contact must be on the intraoral
mark to rule out distortion in the centric relation
record or plaster mounting.
DISCUSSION
Accurate centric relation registration requires that
only elevator muscles be active during operator assisted
arc of closure. Dentists who are learning bimanual
manipulation become aware of how small forces on the
mandible can activate protrusive musculature and
displace the condyles inferior and anterior to centric
relation.2,3,5 The anterior acrylic resin platform reveals
any deviation from centric relation closure objectively,
without the dentist relying on obtaining the proper
“feel.” Mandibular incisor contact is on a flat plane and
ensures no distalizing force on the mandible that would
result in a posterior-inferior condylar position away
from centric relation.1,4
Leaf gauges do not provide a flat plane contact
against the mandibular anterior teeth and cannot con-
trol this error. This is especially true when mandibular
closure is from the patient’s biting force and the den-
tist is not providing external force through the
condyle.6,9 Leaf gauges require sterilization between
patients, are difficult to mark, and are not secure on
the maxillary teeth. Therefore assistance is needed
during bimanual manipulation. Modeling compound
covering a central incisor has been described as a jig or
anterior stop to the arc of mandibular closure when
taking centric relation records.1,6-8,10 It is a brittle
256
SOLOW
Fig. 4. Platform placed on maxillary cast to check for accu-
racy of mounting. Acrylic resin fits precisely on stone model.
material that can fracture if thin, it must be heated to
generate indents that mark mandibular teeth, and it is
not as stable as a broad platform of acrylic resin to
transfer to the mounted cast to verify accuracy of
mounting.
For patients with occlusomuscular disharmony caus-
ing muscle hypertonicity, mandibular manipulation can
be challenging. The anterior acrylic resin platform acts
as a deprogrammer similar to the leaf gauge and biting
jig, and allows condyles to reposition superiorly as pos-
terior teeth disengage and neuromuscular feedback
from occluding teeth subsides.1,4,6,8,11 As patients
protrude and retrude on the appliance to find the start-
ing point for centric relation manipulation, it serves as
an intraoral gothic arch tracing.1,8,10 This definite end-
point trains patients to relax, generating a smooth arc
of closure before manipulation and load testing.
The anterior acrylic resin platform allows the dentist
to confirm that no posterior teeth are in contact during
bimanual manipulation by a minimal dimension to
reduce error that earbows incorporate in arc of closure
compared with true hinge axis face-bow. The anterior
acrylic resin platform can be combined with Dawson
bimanual manipulation to improve several aspects of
occlusal record taking. It is a simple, stable, inexpensive
appliance that is kept in the permanent record of each
patient and enables a single operator to make and
verify occlusal records.
REFERENCES
1. Dawson PK. Evaluation, diagnosis, and treatment of occlusal problems.
2nd ed. St Louis: CV Mosby; 1989. p. 41-169.
2. Tarantola GJ, Becker IM, Gremillion H. The reproducibility of centric rela-
tion: a clinical approach. J Am Dent Assoc 1997;128:1245-51.
3. Dawson PK. Temporomandibular joint pain-dysfunction problems can be
solved. J Prosthet Dent 1973;29:100-12.
4. Dawson PK. Optimum TMJ condyle position in clinical practice. Int J Peri-
odont Restorative Dent 1985;5:11-30.
VOLUME 81 NUMBER 3
SOLOW THE JOURNAL OF PROSTHETIC DENTISTRY

5. McKee JR. Comparing condylar position repeatability for standardized 11. Golsen LF, Shaw AF. Use of a leaf gauge in occlusal diagnosis and thera-
versus nonstandardized methods of achieving centric relation. J Prosthet py. Quintessence Int 1984;15:611-21.
Dent 1997;77:280-4.
6. Carroll WJ, Woelfel JB, Huffman RW. Simple application of anterior jig or Reprint requests to:
leaf gauge in routine clinical practice. J Prosthet Dent 1988;59:611-7. DR ROGER A. SOLOW
7. Levinson E. Centric relation—the anterior biting jig for recording the 655 REDWOOD HIGHWAY
clenching position. Int J Periodont Restorative Dent 1982;2:8-21. SUITE 251
8. Lucia VO. A technique for recording centric relation. J Prosthet Dent MILL VALLEY, CA 94941
1964;14:492-505.
9. Long JH. Locating centric relation with a leaf gauge. J Prosthet Dent Copyright © 1999 by The Editorial Council of The Journal of Prosthetic
1973;29:608-10. Dentistry.
10. Lundeen HC. Centric relation records: the effect of muscle action. J Pros- 0022-3913/99/$8.00 + 0. 10/1/94938
thet Dent 1974;31:244-53.

Structural integrity of resin-modified glass ionomers as

Noteworthy Abstracts affected by the delay or omission of light activation
of the De Gee AJ, Leloup G, Werner A, Vreven J, Davidson CL. J
Current Literature Dent Res 1998;77:1658-63.

Purpose. This study investigated the effect of postponing or omitting photopolymerization on

the structural integrity of 3 resin-modified and 2 conventional glass ionomer luting agents using
3-body wear testing.
Material and methods. Two conventional glass ionomer luting agents (Fuji Cap II, GC Dental
Corp.; Ketac-Fil Aplicap, Espe GmbH) and 3 resin-modified glass ionomer luting agents (Fuji II
LC capsule, GC Dental Corp.; Photac-Fil Aplicap, Espe; Vitremer, 3M Corp) were obtained. All
materials were mixed in capsule form and then placed into the compartments of a wheel in a wear-
testing machine. Five specimens from the resin-modified glass ionomers and 4 specimens from
conventional glass ionomers were fabricated for the experimental conditions. Specimens from
each of the resin-modified glass ionomers were photopolymerized 2 minutes after mixing; other
specimens were photopolymerized 1 hour after mixing. The next specimen groups received no
photopolymerization. Additional specimens were prepared from Photac-Fil, and photopolymer-
ization was initiated on these specimens 3 hours after mixing. Specimens were attached to the
compartments with cyanoacrylate, then stored at room temperature in 100% humidity at all times.
All experimental procedures were completed in a dark room. Three-body wear experiments were
completed by using the machine 8 hours after specimen preparation, after 1 week, and after 4
months. Each wear experiment consisted of 3 wear runs of 200,000 cycles. Data were analyzed
with an analysis of variance (α=.05).
Results. When photopolymerization occurred 1 hour after mixing, the structural integrity of Fuji
II LC and Photac-Fil significantly improve. However, structural integrity of Vitremer decreased
significantly after 1-hour delay in photopolymerization; this structural integrity further declined
when photopolymerization was omitted. Fuji II LC was not affected by photopolymerization
omission; however, Photac-Fil was weakened. After 4 months, most specimens that were poly-
merized by the various methods reached equal structural integrity, except for the nonphotopoly-
merized Vitremer specimens, which remained weaker.
Conclusions. The structural integrity of the Photac-Fil and Fuji II LC materials may be improved
if the acid-base reactions of these 2 materials are allowed to begin before chemical and pho-
topolymerization of HEMA. Structural integrity of Vitremer specimens is increased if photopoly-
merization is completed immediately after mixing rather than being delayed because Vitremer
benefits from a chemical integration of the polyalkenoate and poly-HEMA networks. 26 Refer-
ences. —DL Dixon

MARCH 1999 257