HORIZONTAL JAW

RELATION
 INDEX
 INTRODUCTION
 DEFINITION
 TYPES
 SIGNIFICANCE
 METHODS OF GUIDING MANDIBLE TO
CENTRIC RELATION
 DIFFICULTIES IN RETRUDING MANDIBLE
 METHODS TO RECORD CENTRIC RELATION
 ECCENTRIC RECORDS
 JOURNALS
 REFERENCES
 AIMS AND OBJECTIVES

 The act and frequency of swallow determine

tooth position and relation
 To record the maxillo mandibular relation
 To have a thorough knowledge on different
types of centric relations.
 DEFINITION
 Centric relation is the maxillo-mandibular
relationship in which the condyles articulate with the
thinnest avascular portion of their respective discs
with the complex in the antero-superior position
against the shapes of the articular eminences.
 Centric relation is a clinically determined position of
the mandible placing both condyles into their
anterior uppermost position
(GPT – 8)
 TYPES
 CENTRIC RELATION

 ECCENTRIC RELATIONS
 Protrusion

 Right lateral excursion

 Left lateral excursion

SIGNIFICANCE OF CENTRIC RELATION

 Horizontal reference position of mandible that

can be assumed by edentulous patients under
dentist control.

 For accurate construction of complete dentures,

centric relation registration is essential.

 In centric relation, verifying the cast relationship

on articulator is possible.
 It is a learnable, repeatable & recordable
position which remains constant throughout
our life.
 It is a definite learned position from which
mandible can move to any eccentric position
& return back.
 It is a definite entity.
METHODS OF GUIDING MANDIBLE TO
CENTRIC RELATION
 Instruct the patient to protrude or retrude the
mandible repeatedly while holding his/her fingers
lightly against the chin.
 Instruct the patient to turn the tongue backward
toward the posterior border of the maxillary denture.
 Instruct the patient to tap the occlusal rims (or)
posterior teeth together repeatedly.
 Instruct the patient to tilt his head back and ask him
to close his mouth.
 Instruct the patient by saying

“ Let your lower jaw relax, pull it back and

close slowly and easily an your back
teeth.”

“Get the feeling of pushing your upper jaw

out and close your back teeth together”
 METHODS TO RECORD CENTRIC
RELATION
(HEART WELL)
 FUNCTIONAL METHOD

Needle House method

Chew in Method
Patterson Method
 STATIC METHOD
Graphic methods
1. Intra oral method
2. Extra oral method

PHYSIOLOGIC METHOD
1. Tactile or inter – occlusal check record method.
2. Swallowing threshold
3. Pressure less Method – Nick and Notch Method
 FUNCTIONAL METHOD
CHEW IN METHOD
1. NEEDLE HOUSE METHOD

 This Method uses occlusal rims with four metal styli

placed in maxillary occlusal rims.
 When the mandible moves with styli contacting
mandibular occlusal rim, styli cut four diamond shaped
tracings.
 This record is used as centric relation.
2. PATTERSON METHOD
 A trench is made in mandibular rim.

 Mixture of plaster & carborundum is placed in the trench.

 Patient is instructed to retrude the mandible & close his

mouth.

 At the same time, plaster and carboundum mix in trench

are reduced to pre determined VDO.

 The record obtained is used as centric relation record.

DEMERITS OF FUNCTIONAL
METHOD
 Requires very stable occlusal rims.

 Displaceable basal seat tissues & lack of control

of equalised pressure led to inaccurate record.

 Patient must have good neuromuscular co-

ordination to participate in functional methods
of recording centric relation.
 GRAPHIC METHODS

 The apex of a properly placed tracing indicated

the most retruded position of the mandible to the
maxillae from which lateral movements can take
place.
 Can be intra – oral or extra – oral depending upon
the placement of the recording device.
IMPORTANT CONSIDERATIONS
(Heart well)

 Occlusal rims offer more resistance to horizontal movements

if a central bearing device is not used.
 Sharp apex indicates centric relation position.
 A graphic tracing to determine centric relation is made at the
predetermined VDO.
 Graphic records are the most accurate visual method of
recording centric relation with mechanical instruments.
 ARROW POINT TRACING
 One dimentional graphic tracing made using
gothic arch tracers.
 Usually recorded in the horizontal plane.
 Proper tracing apex indicates the most retruded
relation of the mandible to the maxilla.
 PARTS OF A TRACER
 CENTRAL BEARING POINT
 CENTRAL BEARING PLATE
 Central bearing point & central bearing plate
together called as CENTRAL BEARING
TRACING DEVICE.
 CENTRAL BEARING TRACING DEVICE is
a device that provides a central bearing point
between maxillary & mandibular dental
arches.It has a contacting point that is attached
to one dental arch & a plate attached to
another arch.he plate provides the surface on
which the central bearing point rests or moves
& on which mandibular movement tracing is
recorded.
 TYPES OF ARROW POINT
TRACERS [Heartwell]
 INTRA-ORAL TRACER
 EXTRA-ORAL TRACER
 In Intra oral tracing method, tracer is placed
within the mouth.Disadvantage is that tracer is
invisible during the procedure & the tracing
size is very small making difficult to
determine tracing apex.
 EXTRA ORAL TRACING
ADVANTAGES

 The extra-oral tracing is larger & visible while

tracing is being made.

 The patient can be directed & guided during

the mandibular movements.
 TECHNIQUE FOR AN EXTRA ORAL
ARROW POINT TRACING

 Maxillary & mandibular occlusal rims are

inserted into patient’s mouth.
 As procedure, central bearing point is attached
to maxillary occlusal rim & central bearing plate
[recording plate] is attached to mandibular
occlusal rim.
 The recording plate projecting extra-orally is coated
with precipitated chalk & denatured alcohol.
The central bearing point is positioned to
touch the central bearing plate
The patient is asked to perform
protrusive, lateral & antero-posterior
movements.
 The tracing is made extra – orally by pointer
on recording plate.
 After getting a sharp apex, ask patient to
retrude mandible to centric relation. Dental
plaster is injected between occlusal rims.
 The assembly is removed & articulated.
CORRECT IN CORRECT
 TACTILE OR INTER-
OCCLUSAL CHECK RECORD
 Physiologic method.

 Normal patient’s tactile sense is essential.

 The visual acuity & sense of touch of the

dentist is essential for centric relation record
using this method.
 FACTORS INFLUENCING
INTEROCCLUSAL RECORD
 Amount & equalization of pressure depends
upon uniform consistency of recording material.

 The accuracy of the record is in direct

proportion to the equalization of pressure.

 patient’s comfort depends upon stability &

compatibility of occlusal rims.
 INDICATIONS
Abnormally related jaws

large tongues

abnormal mandibular movements

 PROCEDURE

 It involves 2 steps

 In the first step, a tentative centric jaw relation

relation is recorded using occlusal rims.

 In the second step, an inter-occlusal record is

made during try in procedure.
 FIRST STEP

 Maxillary occlusal rim is inserted into patient’s

mouth.
 Reference points one on nose tip & other on
prominent point of chin are noted.
 After asking patient to say ‘M’,distance between
two points is measured.This denotes the Vertical
dimension at rest position.
 Now mandibular occlusal rim is inserted.
 Distance between two points is measured. This
denotes vertical dimension at occlusion.
 Difference between VDR & VDO should be 2-4
mm.This denotes inter-occlusal distance.
 A tentative centric jaw relation is recorded by asking
patient to have his mandible in retruded position.
 Maxillary & mandibular occlusal rims with their casts
are articulated.Then artificial teeth are arranged.
 SECOND STEP

 Maxillary & mandibular trial dentures are

inserted into patient’s mouth.
 Two cotton rolls are placed posteriorly
between two trial dentures.
 This prevents contact between artificial teeth.
 Then cotton rolls are removed & mandibular
occlusal rim is taken out.
 Softened Aluwax is placed over mandibular
occlusal rim & inserted.
 The patient is asked to retrude the mandible
& close his mouth.
 Trial dentures are removed & wax is
allowed
 Aluwax on buccal aspect of mandibular teeth
is scrapped off.
 Before keeping trial dentures in their
articulated casts, the horizontal condylar guide
lock in articulator is released.
 If inter-occlusal check record is the same as
original record, then condylar elements in
articulator will rest against centric stops in
same position as when casts are mounted.

 This indicates an accurate tentative centric

relation record.
SWALLOWING THRESHOLD
 Soft wax cones attached to the mandibular
occlusal rim form an inter occlusal record as
they are forced against maxillary occlusal rim
when patient swallows.

 Swallowing establishes centric relation

position.
NICK AND NOTCH METHOD
 PROCEDURE
 Upto 3 mm of wax in mandibular occlusal rim is
removed from premolar area till distal end producing a
depression called TROUGH.
 Two notches in ‘ V’ shaped are given in corresponding
area of maxillary occlusal rim.
 A nick anterior to notch in ‘V’ shaped is given.
 Notch extends through entire occlusal rim but nick does
not extend.
 Nick prevents lateral movement & notch prevents antero-
posterior movement.
 Maxillary occlusal rim is inserted into patient’s
mouth.
 Now softened aluwax is placed on mandibular
occlusal rim trough & inserted.
 Then patient is instructed to close his mouth in
centric relation.
 Anterior portions of rim almost should touch but
not press against each other.
 Aluwax on trough will flow into nick & notches.
 ECCENTRIC RELATION

 Eccentric jaw relation is any relationship

between jaws other than centric relation.

 The eccentric relations to be recorded are

PROTRUSIVE,right & left LATERAL
MOVEMENTS.
 PROTRUSIVE RECORD

 Maxillary trial denture is inserted into patient’s

mouth.
 Four layers of softened wax are placed over
mandibular trial denture and inserted.
 Patient is instructed to protrude the mandible
& close until artificial teeth in maxillary trial
denture contact the wax.
 Then both trial dentures are taken out & kept in their
mounted casts in articulator.

Now horizontal condylar guide lock is released in

articulator & incisal pin is raised from its table.
 Then maxillary trial denture with artificial
teeth is related to wax protrusive records.

 Protrusion has to be 5-6 mm.

 LATERAL EXCURSIVE
RECORD
 Hanau derived a formula for lateral record

L= H/8+12
H- horizontal condylar inclination
established by protrusive record
L- lateral condylar inclination
PANTOGRAPHIC TRACING
 Pantographic tracing is a graphic record of
mandibular movement usually recorded in the
horizontal,sagittal,frontal planes as registered by
styli on the recording tables of a pantograph or by
means of electronic sensors.
 This is a three dimentional graphic tracer.
 Most accurate method.
 Used for full mouth rehabilitation of dentulous
patients.
 EVALUATION OF NEEDLE
POINT TRACING
MOHAMED A. ARAMANY ET AL [ JPD
1965]
 Craddock postulated that when mandible
assumes rest position , it is in centric relation.
 Mohamed states that needle point tracings at
given vertical dimension at same individual on
same sitting were not significantly different.
 Needle point tracing is reliable.
 A STUDY OF CENTRIC
RELATION
HARRY SPUNTOFF ET AL [1955]
 Reproducibility is a good way for attaining
centric relation.
 Jankelson states that movement from rest
position to centric telation is accompanied by
salivary swallowing.
 Centric relation in cases of jaw malposture is
influenced by salivary swallowing.
 CONCLUSION

 Horizontal jaw relations play a very important

role in jaw relation recording which has to be
correctly recorded for successful treatment of
complete denture patients.

 Proper centric relation method should be

carried out to obtain an ideal centric relation.
 REFERENCES
 ZARB-BOLENDER: PROSTHODONTIC
TREATMENT FOR PATIENTS, COMPLETE
DENTURES & IMPLANT-SUPPORTED
PROSTHESIS, 12th ed.
 SHELDON WINKLER:ESSENTIALS OF
COMPLETE DENTURE PROSTHODONTICS,2nd
ed.
 CHARLES M.HEARTWELL,Jr: SYLLABUS OF
COMPLETE DENTURES,4th ed.
 HARRY SPUNTOFF ET AL: A STUDY OF
CENTRIC RELATION; JPD 1955.

 MOHAMED A. ARAMANY ET AL:

EVALUATION OF THE NEEDLE POINT
TRACING AS A METHOD FOR DETERMINING
CENTRIC RELATION; JPD 1965.
 Frequently asked questions
 1) Define centric relation,write in detail about
different types of centric relation.
 2) Graphic tracing method
 3) Nick and notch method
 4)Patterson method
 5)what are the types of jaw relations,add a
note on centric relation.
THANK
YOU