figure I

A = Superiormost Fosilion
B = Reormost Position

"The Internotianal Joumol ol Periodortics ond Reslorotive Dentistry" 2/1982

Centric Relation - The Anterior
Biting Jig for Recording
the Clenching Position
Edward Levinso
Honarary Profe.
Department of Endodontics
ond Rehabilitation,
University of Pretoria
In restoring an acclusion, it is desira-
ble ta use a maxillomandibular re-
latianship that is physiolagically ac-
ceptable to the patient and reliably
reproducible far the dentist. Centric
relation (RC) has been used for many
years and has been found fo satisfy
both requirements.
It has thus evalved as a clinical can-
cept rather than a biologic entity [Sil-
verman, 1975) and its definition has
undergone change from time to time.
In that period of its history, when
prosthetic dentistry was primarily
concerned with the provision af full
dentures, a position of the mandible
relative ta the cranium was saught,
where maximum intercuspation (IC)
of the artificial teeth cauld be estab-
lished. The act of swallowing is nor-
mally accompanied by retrusian af
the mandible, and its stabilisation
against the cranium by tooth contact
in this retruded pasition. It is under-
standable, then, that the IC which
was found clinically to be most cam-
fortable for the patient was at, ar
near, this distalised pasition, and the
fact that this could be duplicated
within acceptable limits was expedient
far the prosthadontist. Stated differ-
ently, IC was ta be established close
to the most retruded position of the
mandible |RC}.
Thompson (194Ó) pointed aut the
need far an adequafe interocclusal
clearance (freeway space) between
the opposing teeth in fhe rest position
of the mandible, hie faund this to
average 2-3 mm in the narmal den-
tition- This implies that, in addition fo
its determination in a harizanfal
plane, there is a vertical component
to the RC/IC positian.
When dentistry entered an era af
fixed prosthetic resfaratlon, fhe con-
cept af establishing the occlusion at
ilemorional Journal of PerLodonrics ond Reslororive Dentistry" 2/1982
the retruded positian of the mandible
was developed still further. Whereas
the full denture was supparted by a
resilient tissue {Hanau, 1926), which
enhanced the adaptive capacity of
the mechanism, the fixed restoration
had ta be constructed ia finer toler-
ances. In addition, the presence of
natural teeth, with their periadantal
ligaments richly endowed with pro-
prioceptors, provided an input which
was capable oi triggering the neuro-
muscular mechanism înta parafunc-
tianol activity.
At that time, the definition of centric
relation was based on fhe concept
that in this pasition fhecondyles occu-
pied their mast posterior pasition in
the fassa [Clossory of Prostfiodontic
Terms, 1977). In the clinical record-
ing af centric relatian position, tech-
niques were adopted which concen-
trated on placing candyles in their
rearmost pasitian. These included
chin-paint guidance, placing the tip
af the tongue far back in the palate,
swallowing, etc. Several authors
painted out, hawever, that in this rear-
most position the condyies would nat
necessarily be in their uppermost po-
sitian (Fig. 1). Kaplan (19Ó3) painted
out the possibility of recording an in-
ferior "sagged" positian af the can-
dyles. Lang (1973] emphasized
the necessity far getting the condyies
into a superior rather than a posteriar
positian. Dowson (1974) stated that
chin guidance with ane-handed tech-
niques pushing backwards on the
symphysis would tend fo record an in-
ferior pasitian af the condyies. This is
borne aut by the work o\Rees (1954)
who showed that the configu-
rafion of the temporamandibular lig-
ament is such as ta limit distal posi-
tianing af the condyle, but permit an
inferiar placement at the same time.
 10
The definition of centric relatian has
subsequently been chonged to en-
compass the concept of the eondyle
being in its superiarmost, onterior-
most position, where it is braced by
ligament ond bone.
The vorious methods that hove been
used to determine RC position in-
clude gathic arch trocings, guided and
free unguided closure, bilateral ma-
nipulation, chin-point guidonce ond
swallowing. Such is the adoptobility
of the masticatory mechanism with its
delicote neuromuscular control thot
all these vorious methods have met
with success. It is likely thot care, pa-
tient selection ond attention to detail
were more important thon the choice
of technique.
Funclion and Parafuncflon
Telemetric studies [Jankekon, 1953)
show that teeth make but fleeting
contact in function. The impartonce,
then, of the RC/IC position wos not in
relation to function, where light for-
ces, fovourable in direction, distribu-
tian ond duration, ore employed. In
porafunctian, on the other hand,
heovy forces, sustoined ond unfa-
vourable in direction ond distribution,
ore placed an the teeth. In clenching,
the concomitant activity of the dos-
ing muscles tends to seat the con-
"Ttie hternolional Journol af Periodontics and Restorative Dentistry" 2/1982
dyles in their superiormost, onterior-
most position [Rabetis, 1974) (Fig. 2).
This could well be described as the
physiologic denchtng positioti of the
condyles (CP), where they are
braced by ligoment and bane, and
can maintain their position without
activity af externol pterygoid muscle
{Dawson, 1974) (Fig. 3].
In providing o new occlusion, its
component parts should be most in
hormony when the condyles are in
CP, where they are best able to with-
stand heovy parafunctional forces.
This is especiolly important as poro-
function is often initiated by alterations
to the occlusion. The bilateral man-
dibular manipulotion of Dawson is
intended to guide the condyles to
their CP. The technique to be de-
scribed utilizes the activity of the
clenching muscles to ochieve this
purpose.
Description of Tecfinique
Lucia (1964) advocated the registra-
tion of RC with an onterior bite ¡ig, to
record the most posterior position of
the condyles. A madificotion of this,
anterior biting jig (ABJ), is can-
structed, either of self-curing acrylic
or compound, in order to record fhe
uppermost, anteriormost eondylar
position (Fig. 4),
Fig. 2 Muscle force loccording ta Rabertsl Fig. 3 Clenching position of the candyle (
t = temporatis RP = Rest Position
m = mosseter
bf — resultant ol elevator musdes

Fig. 4 Construction af anterior biting

1 Indexing incisor teeth
2 Trimming of index
3 Jig ready to receive linal index

The International Jaurral of Peiiadontics and Reslorotive Denlistry" 2/1982

 12

Stepl

The Centrol Incisor Index

The mandible is guided in a terminal
hinge movement and an index of the
incisol tips of the opposing central in-
cisors is made against compound
fused fo the ¡ig (Fig. 5j.
If the CP record is being made for a
reconstruction of the occlusion, the
index is mode of the vertical dimen-
sion fo which it is proposed to rebuild
the occlusion ¡Fig. 6]. If the CP is
being recorded for functional analysis
of the natural dentition, the index is
made with the vertical dimension in-
creased minimally, so that the poste-
rior teeth are only ¡usf held out of oc-
clusion (Fig. 7].
Fig. 5 Anleriar biting {ig for CP registrotian ior reconslruclian, mth compound inde.
Jigs may be used in either one or
both ¡aws, depending on skeletal and
faoth relationships and the presence
of missing teeth (Fig. 8].
The CP record should be made in the
absence of abnormal tonus of the
masticatory musculature. If a Hawley
bite plane has been used ta achieve
Fig 6 CP registrotian for reconstruction this, it can serve well as a biting
brp = bile registrotion moterial
;ig-
It is imperative that the anferiar con-
tact does nof praduce o vector of
force at an inclination to the closing
path of the lower anteriors. This
would tend to displace the condyles
either mechanically or by proprio-
ceptively induced muscle octivity.
This situation applies porticularly in
the case of a posterior reconstruc-
tion, where the anterior maxillary and
mandibular teefh are often used,
after equilibration, ta serve the pur-
pose of the anterior jig (Fig. 9]. In an
edge-to-edge situotion (Fig. 10] or
with prominent cingula (develop-
mental, or following attrition), no
problem arises. FHowever, where the
anterior guidance could tend to dis-

'The Interrotionoi Jourrol of Periadortccs ond Restorotive Dentisln^" 2/1982

 13

Fig. 7 CP registration for functional anolysis

o = acrylic jig
c = coTipound
brp = bite regi^lrotion material

Fig 8 Inde' mode on tower incisor leeth for CP registrolion in Closs III situation.
1 lormmg inde>
2 trimming inde^
3 indei reody lo receive compound

"The International Jaurnol of Periodortics ord Restoralive Dentistry" 2/1982

14

Fig. 9 In the absence af posterior Iooth contact, a biting force cauld couse o distol vector of (orce (orrowl

Fig. 10 I, 2 Edge to edge, ar cingulum siluolions do not require compound reinforcement.

3 Anteriar guidance requiring compaund reinforcement

"The Inrernatronol Journal of Periodonrics ond Restorotive Dentisrry" 2/1982

 15

ploce the eandyles os described

above, a thermoplastic material'
that adheres to the teeth is used to
prevent this (Fig. 11).

Step II

Conditioning ¡be Patient

The patient is conditioned to bite with

moderote force, by instructing him to
close his teeth an the operator's fin-
ger held in the mid-sagittal plane,
until discomfort is felt (by the opera-
tarl). The amount of biting force is
not criticol, as increased farce does
not alter condyiar position within
clinically measurable parameters
Fig. 1} Compound reinfarcement lc¡ la pn [Levinson, 1980).
Because the fulcrum at the central in-
cisar biting point is situoted on a
lower plane than the candyle, the ac-
tion of the closing muscles is to direct
the condyles upwards and forwords,
complementing their action as de-
scribed by Raberts above (Fig. 12).

Step III
Fig. 12 Condyle being directed upwards and forwords by resultoni bile torco vector ofclastng

abj = anterior biting ¡ig The onteriar teeth ore then guided to
the previously made indentations in
the ¡ig, and the patient is instructed to
mointain the moderate biting farce
while a saft recording medium is al-
lowed to set between the posterior
teeth (Figs. 13 and 14]. Where mast af
the posteriors are present, bite reg-
istration paste is preferred, its consis-
tency being such as to minimise stim-
ulation af the periodontal propria-
ceptors of the posterior teeth. It must
be emphasised that this is a "hand-
off" procedure once the correct on-
terior contact is made.
Where there ore missing posteriors,
or where the intra-occlusal space

* Kerr's greenstick.

The Internotional Jaumol of Periodartics and Restorolive Dentislrv' 2/1982

16

is lorge, a platform of self-curing

ocrylic carrying c soft mix of the
same material is used (Fig. 15),

Investigation of Reproducibility

Previous studies comparing the dis-

persion patterns of condylar repro-
ducibility with different techniques
have been reported (Celenza, 1973;
Kantor et al., 1973], From all these
studies, it emerged thot the tech-
nique of bilaterol manipulation of the
Fig ¡3 Ar h ng ;ig of compound, with index of single inosor tooth
mandible {Dawson, 1974) was the
most reproducible. With this in mind,
it was decided to compare the ante-
rior biting jig method with the bilat-
erol manipulation technique.

Method
The spatial patterning of the condyle
Fig. 14 Bite registrofíoti poste recording C'P while notier.i maintains biting fo
position as recorded by the two
techniques was determined by the
method ta be described.

From a group of dentol students, four

subjects were selected with

1, unmutilated dentitions (except for

absence of lower third molars) with
only minor restorotive dentistry,
2, absence of tooth mobility at a
clinical level,
3, no subjective symptoms of dys-
function of the masticatory mecha-
nism.

Maxillary and mandibular arch im-

pressions were taken with irreversi-
ble hydrocolloid and poured without
delay in vacuumed dental stone. Ten

'The Internalional Journai ot PeriodonticB ard Restorative Dentistry" 2/1982

 17

registrations of centric relation were

made for each patient, five using the
bilateral manipulation technique,
ond five by the onterior biting ¡ig meth-
od. The registrations with bilateral
manipulation were made by an oper-
ator well versed in this technique,
and those with the anterior biting jig
by the author.
The mandibular cast was fixed ta the
lower member of the Denar Vari-
check instrument with dental stone
(Fig. 16]. The maxillary cast was then
Fig. 15 CP registration formed by acrylic platform corrying o soft mix of ¡elf-curing ocrylic. Resincap
ííainglar Duralay ¡Relioncel related to the mandibular cast using
each of the five records of one tech-
nique in turn, and indentatians were
made by pressing the styli of the up-
per member inta millimetre-ruled
graph paper held vertically and hori-
zontally by fhe lower member
(Fig-16].
The graph recarding papers were
Fig. IÓ Denar Voricheclr inilrumenl. Styli recording position af a regrilralion.
then photographed and replaced.
Transparencies of the groupings
were projected on a screen so that
each millimetre graduotion was en-
larged ta one cm., thus giving lOOx
magnification. The diameter af the
smallest circle which covered the five
indentatians was measured with ver-
nier calipers to 0.1 mm. This figure di-
vided by ten was recorded, giving the
acfual dimension (Fig. 17].
The position of the indentations rela-
tive to X (vertical], Y (horizontal, sag-
ittal] and Z (horizontal, frantal) axes
was also recorded. X, Y and Z axes
were farmed by the boundaries of
the surfaces holding fhe recording
graph paper.

Tfie International Jouriral of Periodoiilic5 ond Restorotive Dentistry' 2/1982

18

Results

1. The spatiol pafterning, as evi-

denced by the diameter af the small-
est circle, was significantly more
constricted for the ABJ recordings.
Recordings made by the ABJ are
thus more reproducible fhon those
made wifh biloteral mandibular ma-
nipulotion.
1. On investigoting the indento-
tions with reference to the X. Y and Z
axes, the ABJ method consistently re-
corded o more superior ond onterior
position.

Investigaffon of Physiologic
Acceptance
This is assessed subjectively by inves-
tigating the potient far camfart and
freedom from symptoms of dysfunc-
tion, and objectively by the reoction
of the periodontium. The latter can
anIy be determined from clinicol ex-
amination of pafienfs with proven
susceptibility to periodontai diseose
[Levinson. 1981).

Reaction of the Periodontium Fig, ¡7 Grouping of live registrotions recorded on groph paper on Oenor Vanctieck inslrun
Seventy-four patients who hod been
treated for odvanced periodontai
disease were examined. An integral
part of the treotment had been the
provision of periodontol prostheses,
which were constructed to centric re-
lation records obtoined by the ABJ
method described above. Exomina-
tion consisted of determination of
bleeding from the sulcus on genfle
probing, and quantifotive ossess-
ment of residuol alvealar bone from
rodiogrophs.
Post-operotive periods ronged from
fhree to twelve years with a mean of 5.2
years. In every instance, the dentition
as o whole was surviving with im-
proved periodonfal stotus (Fig. 18). A

"Tfie Internotional Journal af Periodontics and Restarattve Dentistr/" 2/1982

Figs. I8o ond b Betöre (o) and alle: (b) tracings ol radiographs
oi poliGnl
p shownQ Q n'iciinfenoncG of osseous levels
potfçnt withh pGriooonlQi d'S
d

•Tfie hrernationol Journal ol Perjodontics ond Resrorative Denrislry- 2/1982

 20

a
SYMPTOMS

ELIMINATED H l

•
200
IMPROVED j 1

UNCHANGED |¿ÉB¿É<J
160

120

80

40
1
1
ZI
PAIN
(208)
d]
IMITATION
(32)
CLICKING
(122)
OCCLUSAL
AWARENESS
(47)
,
MPDS - REGRESSION OF SYMPTOMS - RECONSTRUCTED OCCLUSIONS

Fig. 19 Bar graph showing resolution of

symptoms in investigation of 208 patients with
myofoscia! pain dysfunction syndrotne.

Fiq. 20 Showing initoi contact posteriorly on

clenching when RC registration is mode with co
dyte ¡n a "sagged" position.

••The InlematiOfiol Journal oi Periodonlics and Re&torofiv


total of l,145teeth were involved in this
survey ond of these only eighteen units
had been lost. Most of these were
roots of molar teeth which had been
treoted for Grade 111 furcation prob-
lems [Rosenberg, 1979), and were
breaking down due to a combina-
tion of periodontal and endodontal
factors.
Patient Acceptance
Extending the principle underlying
the periodontal assessment, only
patients with a history of myofascial
pain dysfunction syndrome (MPDS)
were included in this investigation
[Levinson, 1976), The symptoms of
MPDS recorded were poin, limitation
of movement, clicking and ocdusol
awareness. Two hundred eight po-
tients who had been provided with a
new occlusion treatment of their over-
all dental condition were exomined
after o follow-up period varying from
six months to twelve yeors with a
mean of 4,2 years. The results are
shown in the bar graph (Fig, 19),
Whereas it is conceded that the high
success rate was influenced by other
than acdusal foctors, at least it may
be said that the occlusion provided
wos acceptable to a significant num-
ber of patients with proven suscepti-
bility to problems of dysfunction of the
masticatory mechanism.
Discussion
Potients who experience sensitivity,
and or symptoms of dysfunction of
the masticatory mechanism following
occlusal reconstruction, are often
found to hove occlusal interferences
relating to the terminal molars, when
examined by the method advocated
by Lang (1973), This would indicate
that the inter-occlusal registrations
employed in fabricating the restoro-
tions could have been made with the
condyles in a "sogged" position
(Fig. 20), The object of the bilateral
manipulation technique is to record
the mandibular positian with con-
dyles seated superiorly ond onteriorly,
i.e,, where the elevator muscles would
take them in o terminal hinge closure.
It seems logical to direct the closing
muscles to achieve this seating while
moking the recard. This investigation
shows this to be a more reproducible
method.
In considering the spatial patterning
as recorded on the Varicheck instru-
ment, a pontographic effect results
from the styli being remote from the
zone of registration. The cusp tips
undergo less deviation than that
shown, by o factor of approximately
four. At best, however, it is evident
that the occlusal morphology thot is
provided when the posterior occlu-
sion is restored should have a built-in
tolerance, rather than a precise point
relationship. This aspect is the sub-
ject of a subsequent article.
Conclusion
The object of the bimanual manipu-
lation technique is to record the man-
dibular position with the condyles
positioned where the elevotor mus-
des would seat them in a terminal
hinge dosure, • Jaint Dysfunction Syndrome, Am J. Orthod.,
Reprints
Dr. Edward Levinson
UHorcourt House
19a Cavendish Squore
LondonW, I.England
"Tfie irlemofionol Journal of Perbdonlics ond Reslorolive Dentistry' 2/1982
21
Refe
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The Centnc Position: Replacement and
Chorader, J. Prosthet, Dent, 30:591-598,
1973.
Dowson, P E •
Evaluation, Diognosis, and Treatment of
Ocdusal Problems, St, Louis: C, V Mosby
C o , 1974.
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Honau.
Dentol Engineering, Val. I. Buffalo: Hanau
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Jankelson, B., Hoffmann, G., and Hender-
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Kontor, M E., Silvermon, S, 1., ond Garfmi<el,
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Centric Relotion Recording Tecinniques, o
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Kaplan, R. L:
Concepts ol Ocdusion 8, Gnothology.
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Levinson, E.'
Ocdusol Factors in Treatment of MPDS,
Post-Grad Date Seminar on MPDS, Univer-
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Levinson, E,:
Investigation of Condyle Position with
Elevator Muscle Activity Using Anterior Bit-
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Levinson, E.'
Periodontal Postulotes for ihe Prosthodon-
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Ocdusol Adjustment. J. Prosthet, Dent.,
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Tine Etiology of the Temporomandibulor
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Management ot Osseous Defects, Furcation
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Silverman, S. I,:
Centric Relotion. J, Dent. Assoc, S. Afs
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The Rest Position of the Mandible and Its
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33:151-180,1946,