Gothic Arch Tracer

Gothic arch tracing / certified orthodontic courses
INDIAN DENTAL ACADEMY Leader in continuing dental education

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2. INTRODUCTION The method of recording the jaw 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. If the clinician is not accustomed
to the procedure of softening the wax, it will be difficult to soften the rims evenly.
Without uniformly softened rims, an exact record cannot be expected. When the base
plates poorly fit the alveolar ridges, they are displaced by sliding over the occlusal plane
during recording and thus the jaw registration is carried out with displaced rims. In
addition, as the mucosa of the alveolar ridge is compressible, some portions of 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 joint or wearing an existing denture with a malocclusion for a long
time, the eccentric relation might be easily recorded by a little undue pressure.
3. In any case, it requires great skill for the horizontal and vertical jaw relations to be
recorded simultaneously just by using the baseplates to establish an exact jaw
relationship. The chair time will also be prolonged, and thus the physical fatigue of the
patient will increase. To solve these problems, the author divides the procedure into two
stages. The gothic arch tracer is used for recording the horizontal jaw relation. The patient
must come to the clinic once more, but as the final decision can be left to the use of the
gothic arch tracer, the procedure for recording the vertical relation using base plates can
be performed stress- free and moreover the total chair time for the recording jaw relations
is shortened. www.indiandentalacademy.comwww.indiandentalacademy.com
4. HORIZONTAL PLANE BORDER MOVEMENTS A mandibular element to be
understood before recording maxillomandibular relationships and making tooth
arrangements for complete dentures is border positions. Border refers to the boundary of a
surface and may imply the limiting line. Border position is defined as the most posterior
position of the mandible at any specific vertical relation. The border positions are limited
by nerves, bones, muscle, teeth when present and ligaments. The limiting is not a simple
mechanical stoppage but a physiologic control through the neuromuscular system. The
envelopes of motion of the mandible in the border positions has been recorded in three
planes horizontal, frontal and sagittal and are usually described as three dimensional.
Traditionally, a device known as a Gothic arch tracer has been used to record mandibular
movement in the horizontal plane. It consists of a recording plate attached, to the
maxillary teeth and a recording stylus attached to the mandibular teeth. As the mandible
moves, the stylus generates a line on the recording plate that coincides with this
movement. The border movement of the mandible in the horizontal plane can therefore be
easily recorded and examined.
5. 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). If
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.www.indiandentalacademy.comwww.indiandentalacademy.com
6. The right condyle is called the orbiting condyle, because it is orbiting around the
rotating condyle. The left condyle is also called the working condyle, because it is on the
working side. Likewise, the right condyle is called the nonworking condyle, 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 left border movement.
7. Continued Left Lateral 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. www.indiandentalacademy.comwww.indiandentalacademy.com
8. Right Lateral Border Movements Once 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). If 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).
9. The right condyle in this movement is therefore called the rotating condyle, because the
mandible is rotating around it. The left condyle during this movement is called the
orbiting 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.
10. Continued Right Lateral Border Movements with Protrusion With the mandible in the
rightWith the mandible in the right lateral border positionlateral border position
contraction of the right inferiorcontraction of the right inferior lateral pterygoid muscle
alonglateral pterygoid muscle along with continued contraction ofwith continued
contraction of the left inferior lateral pterygoidthe left inferior lateral pterygoid will cause
the right condyle towill cause the right condyle to move anteriorly and to the left.move
anteriorly and to the left. BecauseBecause the left condyle isthe left condyle is already in
its maximum anterioralready in its maximum anterior position, the movement of

theposition, the movement of the right condyle to its maximumright condyle to its
maximum anterior position will cause aanterior position will cause a shift back in the
mandibularshift back in the mandibular midline to coincide with themidline to coincide
with the midline of the face. Thismidline of the face. This completes the
mandibularcompletes the mandibular border movement in theborder movement in the
horizontal planehorizontal plane..
11. Lateral movements can be generated by varying levels of mandibular opening. The
border movements generated with each increasing degree of 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)Left lateral
2)Continued left lateral with protrusion 3)Right lateral 4)Continued right lateral with
protrusion. CR centric relation ICP intercuspal
position.www.indiandentalacademy.comwww.indiandentalacademy.com
12. Horizontal relations are those that are established anteroposteriorly and mediolaterally
and so are classified as : Centric Relations Eccentric Relations Protrusive Relations
Lateral right lateral left lateral
13. CENTRIC RELATION is defined as the maxillomandibular relationship in which the
condyles articulate with the thinnest avascular portion of their respective discs with the
complex in the anterior superior position against the slopes of the articular eminences.
Features and Significance Of Centric Relation Centric relation is the ideal arch to arch
relationship and an optimum functional position of the jaws for the health, comfort and
function of the musculature. It is a mandibular position where the condyle disc assembly
is seated in anterior superior position against the posterior slope of articular eminence,
which was believed by many to be the rearmost, upmost, midmost position in the glenoid
fossa. (RUM position). Centric relation of the mandible is a hinge position. In Centric
relation condyles exhibit only pure rotation without translation.
14. Mandibular movements return or terminate in centric. It is thus a reproducible
position and therefore serves as a reliable reference to develop centric occlusion in
artificial dentures. It is a starting point for the arrangement of artificial 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 reference
position for the occlusal reconstruction in dentulous situations. It is the posterior border
position and the posterior limit of the envelope of mandibular motion. To summarize
Centric relation is a reproducible, recordable, consistent reference position, and a
physiologically acceptable position for deglutition.
15. Recording Centric Relation in Edentulous Subjects In edentulous subjects, centric jaw
relation is generally recorded by Wax closure method Functional chew in technique
Graphic method Anterior deprogrammers Wax closure method of recording centric
relation with swallowing, phonetics and manual guidance is quick and a simple method.
The arrow point tracing method is a reliable and scientific procedure of recording the
mandibular border movements in the horizontal plane and captures the mandible at its
posterior reproducible border position.
16. Limitations of Wax Occlusal Rim Method to Record Centric Relation Inconsistency
of the record: two centric records taken for the same patient may not always be identical.
Patient co-operation and operator-induced errors should be considered. Possibility of
occlusal rims sliding over the other to any eccentric position either before , during or after
sealing the occlusal rims in centric relation. Tilting, leverage and displacement of record
bases is very common and this may result in inaccurate centric record. There is a
tendency for the patient to bite and protrude the mandible. The term bite registration is
therefore objectionable and obsolete.
17. ECCENTRIC RELATIONS Is defined as any relationship of 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 left lateral. Protrusive relation
is the relation of the mandible to the maxilla when the mandible is thrust forward. If the
motion in every part of the mandible as it is thrust forward has simultaneously the same
velocity and direction, the motion could be correctly termed translatory. The movement in
the joint is downward and forward. The condyles disk assemblies are guided downward
by the articular eminences of the glenoid fossae. The angle of slide varies from patient to
patient and from side to side. The muscles responsible for a straight protrusive movement
are the inferior pterygoid muscles acting simultaneously. Protrusive relation is a bone-tobone relation, which can be recorded.
18. Right and left lateral maxillomandibular relations are the relations of the mandible to
the maxillae when the mandible is moved either to the right or to the left side. The
movement of the mandible is the result of the contraction of contra lateral inferior
external pterygoid muscle. When the external pterygoid of one side contracts, the
corresponding side of the mandible is pulled forward and inward, while the other side
remains comparatively fixed. The side that is pulled forward is termed the nonworking,
balancing, or orbiting side, whereas the side that remains comparatively fixed is termed
the working, or rotating side. The movements in the non-working side are downward,
forward, and inward. The movement is both sliding and rotary. The movements in the
working side are rotational.
19. The question of necessity for eccentric records is controversial, because accuracy is a
problem in the recording methods and the capabilities of the articulator to receive and
reproduce the record. The following factors contribute to inaccuracy: (1) Instability of
records, (2) Resiliency and displaceability of denture-bearing tissues, (3) Materials used
in record making, (4) Equipment used in record making, (5) Lack of muscle coordination
in the patient, and (6) The use of articulators that do not accurately adjust to all lateral
interocclusal check records.
20. The controversy about the merits of eccentric records will exist as long as there are
differences in the concepts of occlusion and posterior tooth form required for complete
dentures. Prosthodontists who prefer a cusp form posterior tooth and balanced occlusion
in eccentric jaw positions or organic occlusion will require eccentric maxillomandibular
relation records. Prosthodontists who prefer a noncusp form posterior tooth and balanced
occlusion in centric jaw position will not require eccentric maxillomandibular relation
records. www.indiandentalacademy.comwww.indiandentalacademy.com
21. GRAPHIC METHOD The graphic methods record a tracing of mandibular
movements in one plane, an arrow point tracing. It indicates the horizontal relation of the
mandible to the maxilla. The apex of a properly made tracing presumably indicates the
most retruded relation of the mandible to the maxilla from which lateral movements can
take place. Graphic records are either intra oral or extraoral, depending on the placement
of the recording device. Even though Balkwill, and Englishman, in 1866 illustrated the
right and left intersection arcs of lateral movement, it was Hesse from Germany, in 1897
introduced the graphic method of recording centric relation, which was later popularized
by the Swiss professor Gysi in 1910. It became known as Gysi gothic arch tracing since it
resembled Gothic architecture characterized by high pointed arches.
22. The Glossary of 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 maxillary 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
may be used to distribute the occlusal forces evenly during the recording of the
maxillomandibular relationships and /or for the correction of disharmonious contacts. All
movements in the horizontal plane initiate from the apex of the Gothic arch. The apex of
tracing is a reproducible reference point, which represents centric relation. Gothic arch
tracing ensures that the centric record is made with minimal closing force equally
distributed over the supporting tissues.
23. HISTORY The earliest graphic recordings were based on studies of mandibular
movements by Balkwill in 1866. The first known needle point tracing was by Hesse in
1897 and the technique was proved and popularized by Gysi around 1910. Clapp in 1914
described the use of a Gysi-tracer, which was attached directly to the impression trays. In
1926 Sears used lubricated rims for easier movement and placed the needlepoint tracer on
the mandibular rim and the plate on the maxillary rim. He believed this made the angle of
the tracing more acute. Philips in 1927 recognized that any lateral movement of the jaws
would cause interference of the rims, which could result in the distorted record. He
developed a plate for the upper rim and a tripoded balls bearing mounted on a jackscrew
for the lower rim. This was named the central bearing point, which produced
equalization of pressure on the edentulous ridges.
24. In 1929, Stansbery introduced a technique, which incorporated a curved plate with a
4" radius mounted on the upper rim and central bearing screw of 3" radius on the lower
rim. Plaster was injected after tracing was made. HalI 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 . Hardy 1942 and
Pleasure 1955 described the use of the Coble balancer The patient would hold the bearing
point in the depression while plaster was injected for the centric record. Pleasure1955
used a plastic disk, which was attached to the tracing plate with a hole over the apex of
the Gothic arch. The centric relation record could then be made without a change of
vertical dimension and Hardy later designed a modified intra oral trace similar to the
Coble. www.indiandentalacademy.comwww.indiandentalacademy.com
25. 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 functional record of centric relation with a uniform distribution of stress over
the basal seat. Silverman 1957 used an intraoral Gothic arch tracer to locate the "biting
point" of a patient. The patient was told to bite hard on the tracing plate. This developed
the functional resultant of the closing muscles, which would retrude the mandible. The
indentation made by the patient would be used for 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. www.indiandentalacademy.comwww.indiandentalacademy.com
26. Hardy introduced a central bearing device with 2 heads. One end was brass pointed
and used in recording the tracing; the other end consisted of a mounted steel ball bearing,
which was used as an anatomical teeth set to a flat plane of occlusion. Height, Sears,
House and many others who had devised tracing procedures of their own which enabled
them to secure dependable centric relation. To make a needlepoint tracing one condyle
moves forward and inward during a lateral movement followed 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 of both condyles.
Therefore when both condyles are resting in the most retruded position the needlepoint of
the tracing will be resting at the apex of the tracing thus created. A needlepoint tracing is
fundamentally a single representation of the portion of the mandible and its movements in
a horizontal plane. www.indiandentalacademy.comwww.indiandentalacademy.com
27. Limitations Of Graphic Method Gothic arch tracing method is preferred in good
edentulous ridges with normal interarch relation. Arrow point tracing is difficult in
excessively resorbed and flabby ridges as it causes instability of the recording bases and
this restricts its use. Graphic method is not indicated when there is inadequate inter arch
distance, as it is difficult 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 few complete
denture patients develop habitual centric either due to faulty centric relation, or due to
prolonged use of very old denture with marked attrition which causes a forward habitual
positioning of the lower jaw.
28. This is a case of "habitual eccentric occlusion". When the patient has worn
inappropriate dentures for a long time, the occlusion is habitually out of the centric
occlusal position due to the functional adaptation of the body in which one masticates in a
position comfortable to him/herself. In these patients it is difficult to record centric
relation with wax closures as they tend to move the jaw 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 from occlusal rims and therefore the habitual neuromuscular memory or engram
is absent. The likelihood of sliding the lower jaw forward and laterally is hence
eliminated. www.indiandentalacademy.comwww.indiandentalacademy.com
29. PARTS OF THE GOTHIC ARCH TRACER The device used is called a gothic arch
tracer which essentially consists of 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 of bearing or support between the maxillary and
mandibular occlusal rims. It consists of a contracting point which is attached to one
occlusal rim and a plate attached to the other occlusal rims which provide the surface 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 of the
supporting areas of the maxillary and mandibular jaws.
30. Hight extra oral tracer assembly Sears extra oral tracer assembly Swissdent ball
bearing bite recorder Microtracer for intra oral use
31. It is used for the purpose of distributing closing forces, evenly throughout the areas of
the supporting structures during recording of maxillomandibular relations. The central
bearing helps to maintain the unstrained relation of the base plates to the supporting
mucosa, with an almost ideal distribution of contact pressure. Means of locking the tracer
at the apex of the needle point tracing: 1) a hole or a depression into which the needle
point would fall. 2) a plastic/ metal disk with a hole which was placed over the apex of
the tracing. This served as a convience and as a guide for the patient to hold a centric
position while the registration was secured.
32. Positioning Of The Central Tracing Point It is important to direct the force uniformly
to the basal structures and thereby ensuring stability of the base plates and uniform
vertical contact. The central bearing point can be placed at the midline of the upper arch
at the point where it is intersected by a line joining the distal surfaces of the second
premolars. Stansberry has suggested placing the central bearing point at the point of
intersection of the lines drawn from 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 of mandible.
33. EXTRA ORAL TRACINGS AND DEVICES A Gothic arch tracing, as the name
implies, is a pinpoint tracing on soot or carding wax that is shaped after a type of
architecture known as the Gothic arch. It sometimes is referred 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 from a point, which is the
most retruded position of the rotating condyle. When the opposite condyle is caused to
move on its path, it starts from the same point and cuts a line at an angle to the other line.
Therefore, when both condyles are resting in their most retruded positions, the
needlepoint of the tracer will be resting on the apex of the Gothic arch thus created. A
Gothic arch tracing is fundamentally a single representation of the position of the
mandible and its movement on one plane. This statement should be modified if several
pins are used, such as the Sears trivet and further modified if the tracing is of the type
suggested by Phillips. The Phillips tracer indicates the condyle path as well as the
direction and centric position of the mandible.
34. Techniques Of Graphic Tracings Gysi suggested 3 main point of movement of
mandible namely, the 2 condyles and the incisal point. If 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 of which is most retruded position of
the mandible from which lateral movements are made. Different technique were designed
since 1910. EXTRA ORAL: Gysi tribyte This technique omits the use of central bearing
plates which necessitates special care in establishing the contacting areas of the two bite
plates. Failure to produce equal contact over the entire occlusal area of the opposing bite
planes in centric relation introduces tilting forces on the bases.
35. Gysi technique In the original Gysi technique the occlusal plane is determined by
locating the correct height of the upper occlusion rim. Then the lower occlusion rim is
adapted to the upper rim at the correct vertical dimension of occlusion. The Gothic arch
tracer is fixed to the upper rim at the occlusion rims with the tracing table paralell to, or
continous with, the plane of occlusion. The central bearing point is not used. No mention
is made of the inclination of the tracing point. No cusp height is introduced. This means
that even contact of the occlusion rims is lost when the patient makes forward or lateral
excursions of the mandible because of the forward and downward movement of the
condyles. www.indiandentalacademy.comwww.indiandentalacademy.com
36. The Sears trivet is a central bearing point tracer with two registration pins. The pins
are attached to the mandibular plate therefore 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 facility of making the records extra orally with plaster of paris.
37. A Boos Bio-meter with tracing table and marker is another extra oral method for
obtaining gothic arch tracing. The biometer provides an indication of the position of the
mandibular by tracing and records the forces of closing. (The V.R. is adjusted using biometer). www.indiandentalacademy.comwww.indiandentalacademy.com
38. Stansberry cheek bite method - Stansberry developed and popularized the use of
central bearing point in connection with the tracing device for recording positional
relations of the jaw. With the Stanberrys 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 maxillary and mandibular bearing plates. The Phillips
Graphic record registers the centric relation and the condylar paths. Phillips tracer is
another type of tracing device that registers centric relation and the condyle path
simultaneously. www.indiandentalacademy.comwww.indiandentalacademy.com
39. The technique for an arrow point tracing using a Hight tracing device Make accurate,
stable maxillary and mandibular record bases. Attach occlusal rims of hard base plate wax
Contour the wax occlusion rims Establish the vertical dimension of jaw separation with
the mandible at physiologic rest. Reduce the mandibular occlusion rim to provide
excessive interocclusal distance
40. Make a face bow transfer and mount the maxillary cast With the soft wax make a
tentative centric relation record at a predetermined vertical dimension of occlusion.
Adjust the articulator with the condylar elements secured against the centric stops Relate
the maxillary 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 anteroposteriorly and laterally. Mount the
tracing device. Be sure to attach the devices securely to the occlusion rims. The stylus is
attached to the maxillary rim and the recording plate to the mandibular. This arrangement
develops an arrow point tracing with the apex anteriorly. The reverse develops an arrow
point tracing with the apex posteriorly.
41. Seat the patient with the head upright, in a comfortable position in the dental chair
Place the record bases in the patients mouth with the attached recording devices. Inspect
the record bases and the recording devices for stability. Make sure that there is no
interference between the occlusion rim when the mandible is moved in any direction.
Lower the stylus to the recording plate and determine that the stylus maintains contact
with the recording plate during mandibular movements. Retract the stylus and conduct the
training exercises with the patient. Place the tips of the index fingers under the mandible
in the bicuspid areas. Place the tip of the thumb under the mandible near the chin. Calmly
and quietly instruct the patient to move the jaw forward, backward and to the right and
left while gently applying guiding pressure with the thumb. It is possible to dislodge the
mandibular record base by improperly placing the thumbs or by exerting excessive
pressure. The Ney Excursion Guide is an aid in training the patient.
42. When the patient is proficient in executing the mandibular movements, prepare the
tracing plate to record the tracing. A thin coating of precipitated chalk in denatured
alcohol applied evenly with a brush provides a medium that offers no resistance to the
movement of the stylus and produces a clearly visible tracing. Develop an acceptable
tracing by dropping the stylus 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 stylus 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 assembly 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.
43. The appliance used consists of two bearing plates to which a stylus holder and graph
plate may be attached. A template for proper spacing of the bearing plates and a glass
syringe to aid in placing plaster. Technique 1)The occlusal rims adjusted to the correct
vertical relation 2)They are mounted on an articulator with the screw tightened to
maintain the relation of the casts. STANSBERRY FUNCTIONAL POSITION CHECK
BITE METHOD www.indiandentalacademy.comwww.indiandentalacademy.com
44. 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 for 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 injected when the plaster is injected.
When the plaster has set the record is marked and set aside for later use.
5)Accommodation for 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 of this tracing a mark 1/4 inch or 6mm
distant is made on each lateral path. This marks the position of the needle point for lateral
records. 6)The central bearing point is raised one half turn more for the protrusive
registration. www.indiandentalacademy.comwww.indiandentalacademy.com
45. Classification Of Arrow Point Tracing Gerber described six different types of Gothic
arch tracings. Typical seen as a welldefined apex with a symmetrical left and right
lateral component. The mean Gothic arch angle is about 120 degrees. It reflects a healthy
TMJ without interferences in condylar path and a balanced muscle guidance. The
symmetrical form indicates an undisturbed movement of the condyle in fossa and distal
slope of eminence with symmetrically balanced muscle guidance. Flat form it is similar
to typical arrow point except that it has more obtuse left and right lateral tracings. This
type of arrow point signifies a marked lateral movement of condyle in the fossa. The
Gothic arch angle is more than 120 degrees. Asymmetrical form the left and right
tracings meet in an arrow point, however their inclination to the protrusive path is not
symmetrical one of the lateral tracing is shorter. This form of tracing indicates an
inhibition of the forward movement, either in the left or right joint.
46. Apex absent /round form instead of a sharp arrow point, the tracing is rather round.
It shows a weak retrusive movement. Tracing should be repeated till a definite arrow
point is obtained. Patient training is necessary. Miniature arrow point similar to the
typical arrow point, however the extension of tracing is very limited. This can be due to
restricted mandibular movements, improper seating of record bases and painfully fitting
record bases during registration. It is also an indication of a long period of edentulous
ness with an inhibition in condylar movements. Double arrow point it is a record of
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.
47. Dorsally extended arrow point the protrusive path extends beyond the apex of the
gothic arch. This signifies a forced strained retrusive movement of the lower jaw either by
the patient or the operator. During registration procedure lower jaw is either forcibly
retruded by patient (active retrusion) or forcibly retruded manually by the operator
(passive retrusion). It is sometimes an artifact caused by the forward displacement of
upper occlusal rim or backward dislodgement of the lower rim while moving them in the
mouth. The arrow point tracing is correct but at a particular stage there was sliding of
upper occlusal rim forward and lower displacing backward. It can occur when the head of
the patient is tilted too far posteriorly. Gerber felt that occasionally the distal extension is
correct, but the tracing was obtained with the mandible in protruded position. Interrupted
Gothic arch break or loss of continuity of lateral incisal path of gothic arch. This
happens due to posterior interference at heels of occlusal rims during lateral movements.
Atypical form protrusive component does not meet at apex but on one of the lateral
path. This may happen in dentulous because of faulty muscular pattern due to
parafunctional habits like bruxism. Also seen in very old edentulous patients, who are
using complete dentures with incorrect centric relation.
48. Classical, pointed form The symmetry indicates an undisturbed movement sequence
in the joints and uniform muscle guidance. EVALUATION OF GOTHIC ARCH
TRACING Classical flat form The picture indicates distinct lateral movements of the
condyles in the fossae. Weak Gothic arch tracing The picture indicates a lax and negligent
performance of the movements, most of all of the backward components. The registration
must be repeated. Stronger movements must be demanded from the patient.
49. Assymmetrical form The tracing indicates a distinct inhibition of the forward
movement in the right joint. Miniature Gothic arch tracing The tracing points to cramplike movements, badly fitting and paincausing record blocks, edentulous state of long
standing with inhibited movement in the joints, badly constructed prosthetic appliances,
etc. Vertical line protrudes beyond the arrow point This tracing was produced either by
forcible retraction or pushing of the mandible. It is, however, possible that the Gothic arch
was obtained with a protruded mandible.
50. www.indiandentalacademy.comwww.indiandentalacademy.com
52. Vincent R Trapozzano (1955) When making a tracing for establishing centric relation
on a patient with a normal temporomandibular joint, the apex of the initial tracing will be
mounted frequently instead of having a definite apex. Aside from the technical factors the
rounded apex may result from the patients failure to understand what is required when
the right and left lateral movements are made, habit or a slight filling in of tissues behind
one or both of the condyles. With some persistence on the part of the patient and operator,
the patient may produce a needle point tracing with a definite apex. Sedation may be
indicated to relax the patient. Suppose the blunted apex of the needle point tracing had
been accepted as the position of centric relation, and that occlusal reconstruction,
correction of occlusal disharmony of natural teeth, or denture reconstruction had been
completed. www.indiandentalacademy.comwww.indiandentalacademy.com
53. a definite malocclusion would result whenever the patient decided to close in the
more retruded position (at the apex). In complete denture construction , the resulting area
of malocclusion would produce an inevitable shifting and sliding of the denture bases,
which would result in instability of the dentures and all of its undesirable sequalae. Since
it is recognized that the individual will undoubtedly make many initial tooth contacts
which vary from 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 before inclined plane contact is made. If the cusp teeth are
used, this is accomplished by allowing for free play, a slight widening of the central
grooves or fossa of the posterior teeth is made to provide an area larger than the size of
the cusp which fits into the groove or fossa when initial tooth contact is made. Thus,
provision is made for a limited range of horizontal movement of the mandible without
engaging the inclined planes of the teeth.
54. Howard F. Smith (1975) A class III jaw relationship classically exhibits little
anteroposterior movement, while a class II exhibits much. One may suggest little
importance for anteroposterior precision, while the other may suggest great importance.
An arthritic patient may exhibit limited movement in either direction.
55. Significance Of Gothic Arch Tracing It is important not to accept any other part of the
tracing except the very apex as an indication of centric relation. When the patient chews
lightly, they may often close their jaws in eccentric positions. However, patients will pull
the mandible to complete retrusion many times under heavy closing pressure exerted
during function of mastication. Therefore if 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 factor
in the retention and stability of dentures, and it can cause soreness of the tissues
supporting the dentures. On the other hand, if centric occlusion is in harmony with centric
relation, the patient can function properly with his mandible in all positions under light
and heavy chewing pressures.
56. Extra oral tracings made without a central bearing point are not considered
satisfactory because although they indicate the correct anteroposterior position of the
mandible, they may not record the correct maxillomandibular relation (superioinferior
relation of the jaw). It is extremely difficult to maintain equalized pressure on the blocks
of wax. Therefore there is not much to be gained by securing a tracing without using a
central bearing point. www.indiandentalacademy.comwww.indiandentalacademy.com
57. SIGNIFICANT POINTS IN MAKING A GOTHIC ARCH TRACING 1.
Displacement of the record bases may result from pressure, if the central bearing point is
off center when the mandible moves into eccentric relation to the mouth. 2. If a central
bearing device is not used the occlusal rims offer more resistance to horizontal
movements. 3. It is difficult to locate the center of the arches to centralize the forces with
a central bearing device when the jaws are in favorable relation and far more difficult if
the jaws are in excessive protrusive or retrusive relation 4. It is difficult to stabilize a
record base against horizontal forces on tissues that are pendulous or other wise easily
displaceable. 5. It is difficult to stabilize a record base against horizontal forces on
residual ridges that have no vertical height. 6. It is difficult to stabilize a record base or
bearing device with patients who have large tongues.
58. 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 functional relationship. 9.
Double tracing usually indicates lack of coordinated movements or recording at the
different vertical dimension of jaw separation. In either events additional tracing should
be made. 10. A graphic tracing to determine centric relation is made at a predetermined
vertical dimension of 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 of the mandibular to the maxillary. 12. Graphic
methods can be considered the most accurate visual means of making a centric relation
record with mechanical instrument, however all graphic tracings are not accurate.
59. INTRA ORAL TRACING 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 of 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 of
intraoral tracing devices. Another type of intraoral registration is afforded 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 of the mandible by
means of three Gothic arches. They indicate both the centric position and the condylar
paths . www.indiandentalacademy.comwww.indiandentalacademy.com
60. Needles method Make accurate record bases with occlusal rims. Three pieces of wire
are now imbedded in the rim of the upper base plate. One end of the wire is heated and
forced into the modeling compound in the incisal region and the soft compound is packed
firmly about the base of the wire. A wire is similarly placed on each side about the
position of the distal side of the first molar. The wires are then cut off about 1.5 mm.
above the surface of 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 of the lower bite rim, so that the tracing will not run off the
edge of the lower bite rim. Each of these wires acts as a stylus to trace the paths of the
respective points upon the surface of the lower bite rim. The insides of the bite plates are
dusted with powdered gum tragacanth to help maintain them firmly on the ridges. They
are then placed in the patient's mouth and the patient is requested to close until one or
more of the pins come into light contact with the lower bite
rim.www.indiandentalacademy.comwww.indiandentalacademy.com
61. The patient is then asked to move the mandible forward 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 of its path in the lower bite rim, which gives the path of straight protrusion.
Before these paths are cut too deep, the patient is requested to retrude the mandible to its
fullest extent and slide it to one side and back again, slight contact of the pins being
maintained. This movement is repeated a few times and then the same is performed on the
opposite side. Thus the three paths are deepened evenly, thoroughly cut to the full depth
of the respective pins; in this way a balanced three point contact has been maintained and
the path of each point has been recorded for protrusion and for 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 form of the
tracings will be found the same as Gysi's three-point tracing. The depth of the tracings
also gives a record of the vertical relations. When the three pins are in the anterior angles
of their respective tracings, the bite plates are accurately held in centric occlusion without
the need of guide lines. www.indiandentalacademy.comwww.indiandentalacademy.com
62. The Needles technique modified by the use of 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 first
bicuspid and second molar region on the right and left sides of the maxillary occlusion
rims. By placing the pins in this position we are enabled to cut away the anterior portion
of the maxillary occlusion rim to provide a window for observing the tracing appliance.
The stylus portion of the tracer is attached to the vault of the maxillary trial base by
imbedding the tripod prongs into Compound or wax. The graph plate is attached to the
mandibular rim flush with the occluding surface of the rim. The two units should be
mounted in a manner, which will permit the point of the maxillary appliance to rest near
the center of the mandibular graph plate.
63. The relationship plates are returned to the mouth, and the screw on the maxillary
appliance is adjusted so that it makes contact with the graph plate simultaneously with the
contact of 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 of the setscrew on the maxillary appliance. This is continued until the surfaces of
the occlusion rim make
contact.www.indiandentalacademy.comwww.indiandentalacademy.com
64. COBLE INTRA ORAL TRACING DEVICE Coble Balancer is a type of intraoral
central bearing device. The central bearing point is attached with modeling compound to
the upper Base plate in the center of the palate at the intersection of the midline and a line
joining the centers of left and right chewing areas.
65. When placed in the mouth, the upper and lower base plates makeWhen placed in the
mouth, the upper and lower base plates make contact only through the central bearing
point at or very near the centercontact only through the central bearing point at or very
near the center of the supporting areas of the upper and lower ridges.of the supporting
areas of the upper and lower ridges. The central bearing screw is raised or lowered to
establish the verticalThe central bearing screw is raised or lowered to establish the
vertical dimension that provides an adequate free way space and the clearancedimension
that provides an adequate free way space and the clearance between the base plates at the
distal borders is checked.between the base plates at the distal borders is checked. At the
chosen vertical dimension, the central bearing point, acting as aAt the chosen vertical
dimension, the central bearing point, acting as a stylus, quickly draws a Gothic arch
tracing as the patient performsstylus, quickly draws a Gothic arch tracing as the patient
performs excursive gliding jaw movements. To lock the patients jaw in centricexcursive
gliding jaw movements. To lock the patients jaw in centric relation at the apex of the
Gothic arch tracing without changing therelation at the apex of the Gothic arch tracing
without changing the vertical dimension, use a thin sheet about 1mm of clear Lucite as
anvertical dimension, use a thin sheet about 1mm of clear Lucite as an overlay, and drill a
small hole through it down to, but not into, theoverlay, and drill a small hole through it
down to, but not into, the aluminum graph plate. The patient is then asked to perform a
glidingaluminum graph plate. The patient is then asked to perform a gliding jaw
movement and to stop when the central bearing point drops intojaw movement and to stop
when the central bearing point drops into the hole which was drilled over the apex of the
tracing.the hole which was drilled over the apex of the tracing. At the time of insertion of
the processed dentures, the Coble Balancer is used again to integrate the gliding
movements of the jawwww.indiandentalacademy.comwww.indiandentalacademy.com
66. with the occlusion of the teeth, to perfect occlusal balance, and to eliminate cuspal
prematurities and collisions. At first the central bearing screw is adjusted to keep all teeth
out of contact in all gliding movements. With the sole point of contact between the upper
and the lower dentures located where the central bearing point touches the graph plate,
the patient can perform jaw movements that are uninhibited by occlusal interferences.
And a Gothic arch tracing is quickly scribed. The central bearing screw is shortened by
half turn (0.5mm) at a time until a tooth to tooth contact occurs somewhere on the arch
during the excursive gliding movements. Usually the first contact occurs on one or both
second molars or on the canines. Sometimes it occurs between the denture bases behind
the second molars if the interridge space is small. These occlusal contacts occur while the
remaining teeth are still held out of contact by the central bearing point. They are treated
as functional prematurities, and are ground down until they no longer interfere. The
central bearing point is then shortened by one-fourth turn, and articulating paper is
reinserted to mark the contact areas during the jaw excursions.
67. All the prematurities are thus located, marked and reduced until the majority of 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 of a mounted steel ball bearing which was used as an anatomic teeth
set to a flat plane of occlusion. made a depression on the tracing plate with a round bur at
the apex of the tracing. The patient would hold the bearing point in the depression while
plaster was injected for centric record. PLEASURE improved this technique by using a
hole which was attached to the tracing plate after the tracing was made, with the hole
coinciding over the apex of the Gothic arch tracing. The central bearing point was held in
a hole when a plaster was injected the centric would then be made without a change of
vertical dimension. www.indiandentalacademy.comwww.indiandentalacademy.com
68. Ballard intra oral tracing device Metal points attached to the upper modeling
compound rim will cut pathways in the occlusal surface of the lower modeling compound
rim as the patient moves the mandible from side to side. 1. Palatal bearing plate 2.
Rounded head of correlator pin 3. Tension spring 4. Adjustable screw 5. Mounting plate
6. Pointed end of correlator pin
75. ADVANTAGES AND DISADVANTAGES The intra oral tracing device has less
assembly. Hence it is more comfortable for the patient. Also it makes the procedure of
assembling the device and recording procedure easier for the operator. Since the intra oral
tracing are small, it is difficult to find the apex compared to the extra oral tracing. The
tracers must be definitely seated in the hole made by a round bur to assure accuracy when
plaster is injected between the rims. Any shift in the position of the stylus from the
position of the apex of the tracing cannot be prevented or corrected when plaster is being
injected. Since any shift 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 of its value.
77. R.H. Kingery (1952)reviewed the problems associated with centric relation which
were PROBLEMS OF REQUIREMENTS Recording the correct anteroposterior or
horizontal realtionship of the mandible to the maxilla in a position. Equalization of
contact on the denture supporting areas Equalization of vertical contact PROBLEMS
OF ERRORS Positional Errors caused by Failure of the operator in his registration of
the correct horizontal relationship. Failure of the operator to record equalized vertical
contact Application of excessive closure pressure by the patient at the time of recording
Changes in the supporting
areaswww.indiandentalacademy.comwww.indiandentalacademy.com
78. Technical Errors may be caused by Ill fitting occlusal rims Indiscriminate opening
or closing of the occluding device or articulator The slight shifting of the teeth which
occurs between the stage of final arrangement and the transfer to a permanent base
material. PROBLEM OF RECOGNIZING THE SYMPTOMS OF ERRORS
ASSOCIATED WITH CENTRIC REALTION Symptoms Of Unequalized Vertical
Contact Loss of retention Irritation on the crest of the lower ridge in the area of
premature contact One tooth or several teeth on one side seem too long to the patient or
seem to strike first The patient may complain of clicking if the teeth are porcelain
premature contact anteriorly or posteriorly
79. Symptoms Of Error In Horizontal Relationship Anterior to CR o Looseness of lower
denture o denture consciousness o Irritation under the anterior lingual flange of the lower
denture Symptoms Of An Error In Horizontal Relationship Posterior to CR Looseness,
especially of lower denture Irritation under the anterior labial flange of the lower
denture (occasionally) www.indiandentalacademy.comwww.indiandentalacademy.com
80. PROBLEMS OF RECORDING CENTRIC 1. The correctness of an individual

registration is never assured until it is checked and verified by the observation of the
operator 2. Methods Of Recording Centric Limitations of Graphic recording No
control over the amount of closure pressure Difficulty in placement of central bearing
point when patients present extreme protrusion or retrusion of the mandible Central
bearing point is troublesome to use when patients present large clumsy tongues, extreme
resorption of ridges or extensive amounts of displaceable tissues on the supporting areas.
81. Comparsion between intra oral and extra oral devices Heartwell states that intraoral
tracings cannot be observed during tracing, therefore the method loses some of its value
of a visible method. Since the intraoral tracings are very small, it is difficult to find a true
apex. The tracer must be seated in a hole at the point of the apex to assure accuracy when
recording the relation. If the patient moves the mandible before the occlusal rims are
secured, the records shift on their basal seat, this destroys the accuracy of the record. The
extra oral tracings are larger and therefore the patient can be directed and guided more
intelligently during the mandibular movements. The stylus can be observed in the apex of
the tracing during the process of injecting the plaster between the occlusal rims and
recording the relation and no holes are required. Boucher prefers the extra oral device.
Boucher also recommended that centric relation should be made with minimal pressure to
prevent displacement of the tissues supporting
thewww.indiandentalacademy.comwww.indiandentalacademy.com
82. Solomon claimed that in intraoral method the errors are likely to be less because the
tracing is situated closer to the centers of movements in the temporomandibular joint in
comparison to the flexible extra oral device which inscribes mandibular movement in a
plate situated outside the mouth further away from the centers of mandibular movement.
Further the presence of extra oral tracer attachments prevents the lips from meeting each
other and remains passive. According to him , the distinct advantage of intraoral tracing is
the ability of the subject to perform mandibular movements with the lips in passive
contact position. www.indiandentalacademy.comwww.indiandentalacademy.com
83. Kapur K K and Yurkstas A A (1957) compared the duplicability of 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
flabby ridges as compared to patients with good and flat ridges The consistency of the
extra oral procedure did not vary significantly with different types of ridges The degree
of consistency with the intra oral procedure decreased to a significant level in patients
flabby ridges The wax method was less consistent than the other two procedures. It
showed least consistency on flat ridges and the highest consistency on flabby ridges
84. REVIEW OF LITERATURE In 1910 Gysi stated needle points tracing has been
accepted as an accurate method of locating the centric maxillomandibular relation at a
given degree of jaw separation. In 1940 Boos in his study in maxillomandibular
relations established by biting power stated in his research on maxillomandibular
relationship with the use of the power point, reports that centric relation is not at the apex
of the gothic arch. He stated that he found by use of 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 of the needle point tracing in some patient,
anterior to the apex in others. In 1952 Granger stated that the apex of 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 of the mandible.
85. In 1954 Stansbery proposes a method to check the correctness of 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.
86. In 1959 Elmer E Francis in his article jaw 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 of study of Gysi.
Horizontal position of the mandible is registered by the gothic arch tracing. Vertical tracer
consist of 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 joints which
holds Gysi face bow and a vertical marker. In 1961 Huges and Regli : In his study of
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 fossa. When using a central bearing
point for patients with prognathic or orthognathic occlusions it is difficult, not if possible
to secure equalization of pressure.
87. In 1962 Jones PM : In his study of eleven aids for 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 for
locating centric relation. The apex of a tracing is indented with a bur. A plaster intra
occlusal record is made by injecting 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 from ten subjects at five different degree
of jaw separation. Two subject showed negligible lateral deviation at any degree of
opening when one subject showed consistent deviation from midline when the vertical
dimension between the jaw was increased The needle point tracing at a given vertical
dimension of jaw separation under same controlled condition, on the same individual at
same sitting were not significantly different. So needle point tracing is reliable.
88. In 1968, Joseph E Grasso and John sharry in the study of the duplicability of arrow
point tracing in dentulous patients did a study with 15 white men (Detail students between
age group of 20 35) tracing were obtained at a fixed vertical dimension for each subject.
The vertical jaw separation varied from subject to subject depending upon the cuspal
teeth height of the posterior teeth and or the vertical overlap of the anterior teeth.
Variation pattern of the apex position of the needle point tracing were greater in an
anteroposterior direction than in a mediolateral direction.
89. In 1969 A langer and J. Michmann studying the intra oral technique for 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
fulfils basic requirements for correct complete denture construction. The physiologic rest
position is used as a reference for establishing an acceptable interocclusal distance and
the most retruded mandibular position is recorded in centric relation. The use of central
bearing point ensures equal distribution of pressure throughout the basal seat while the
records are made. In 1970 Clayton, Kotowiez and Myers : conducted a research on
graphic recording of mandibular movements concluded the orientation of styli and
recording table affected graphic tracing of mandibular movements when the vertical
dimension is changed, cusp gliding on inclines involves change in vertical
dimension.www.indiandentalacademy.comwww.indiandentalacademy.com
90. In 1975 Smith in study in comparison of empirical centric relation record and
location of terminal hinge axis and apex of 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 of the three methods. In 1980 Michael Myer in his article relation of 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 unfounded. It also states that dentist assisted jaw relation is more reproducible
than relation indicating gothic arch apex.
91. In 1987 Winstanly : In his article gothic arch tracing and condylar inclination
concluded that records and the patient referred for treatment of temperomandibular joint
disorders were used to compare condylar inclination found by drawing a tangent and by
using a mathematical technique. Needle point tracing angles were also measured for 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 of the same patient and there is no direct relationship between condylar
inclination and the needle point tracing angle.
92. In 1989 Winstanly : in his article the gothic arch tracing and the upper canine teeth
as guide in the positioning of the upper posterior teeth concluded that the relationship
between the position of the buccal cusps of the natural upper posterior teeth and the
distance between the upper canine teeth has been found to be constant within + 1-2mm
this may be of value when setting up artificial teeth for denture patients, enabling them to
be positioned close to the natural predecessors.
93. 1996 Obrez A, Stohler CS conducted a study to test whether pain can cause
significant changes in position of the mandible and therefore form the basis for any
perceived changes in the maxillomandibular relationship. A second objective was to
determine whether pain can cause changes in the mandibular range of motion. Five
subjects 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 infusion
of 5% hypertonic saline solution into the central portion of the superficial masseter
muscle. Isotonic saline solution was used as a control, with subjects blinded to the type of
substance given. The effect of pain on the position of the apex of the gothic arch tracing,
the direction of the lateral mandibular border movements, and the mandibular range of
motion was studied in a horizontal plane with minimal occlusal separation. Pain
significantly affected the position of the apex of the gothic arch tracing in anterior
Similarly, pain affected the orientation of the mandibular lateral border movements and
their magnitude www.indiandentalacademy.comwww.indiandentalacademy.com
94. All pain-induced effects proved to be reversible. The observed effect of pain can
explain the perceived change of bite that is frequently noted by patients with orofacial
pain. This study provided evidence of an alternative causal relationship between pain and
changes in occlusal relationship and questions occlusal therapy as treatment, directed
toward the elimination of the underlying cause in patients with masticatory muscle pain.
95. 1998 Raigrodski AJ, Sadan A, Carruth PL Clinicians have long expressed concern
about the accuracy of the Gothic arch tracing for recording centric relation in edentulous
patients. With the use of dental implants to assist in retaining complete dentures, the
problem of inaccurate recordings, made for patients without natural teeth, can be
significantly 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
different guidance systems. Twenty-six edentulous subjects with no clinical evidence of
abnormality of temporomandibular disorder were selected. Horizontal position data for
the mandible obtained by gothic arch tracing was loaded into a personal computer by
setting the sensor portion of a digitizer into the oral cavity to serve as a miniature
lightweight tracing board.
96. 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 effective data concerning mandibular positions for fabrication of
dentures. 2003 Keshvad A, Winstanley RB. conducted to determine statistically the most
repeatable mandibular position of 3 centric relation methods. Three centric relation
recording methods commonly reported in the literature were selected: bimanual
mandibular manipulation with a jig, chin point guidance with a jig, and Gothic arch
tracing. Fourteen healthy adult volunteers (7 males and 7 females), with an average age of
26 years and no history of extractions, temporomandibular joint dysfunction, or
orthodontic treatment, were selected for the
study.www.indiandentalacademy.comwww.indiandentalacademy.com
97. Accurate casts were mounted on an articulator (Denar D4A) by means of a facebow
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,
superoinferior; z, mediolateral shift). Each centric relation method was recorded four
times on each subject (at baseline, 1 hour, 1 day, and 1 week at approximately the same
time of day). Records were transferred to the articulator, and data were extracted using a
stereomicroscope modified to accept the mandibular position indicator. The results of this
study showed that of the 3 centric relation methods evaluated, the bimanual manipulation
method positioned the condyles in the temporomandibular joint with a more consistent
repeatability than the other 2 methods, whereas the Gothic arch was the least consistent
method. www.indiandentalacademy.comwww.indiandentalacademy.com
98. REFERENCES El-Gheriani AS, Winstanley RB.The Gothic arch (needle point)
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