RECORDING THE RETRUDED CONTACT

POSITION:
A REVIEW OF CLINICAL TECHNIQUES

P.H.R.WILSON AND A.BANERJEE

BDJ 2004;196:395-402
 • The retruded contact position is an
important maxillomandibular relation
in restorative dentistry. This review
article will describe the RCP , consider
Terminology its importance and use in
prosthodontics.
Importance
Uses
• RCP also known as premature contact
Methods in centric relation, centric relation
Comparison contact position, retruded axis
Summary position, terminal hinge position, &
ligamentous position.
 Terminology
centric relation
The maxillomandibular relationship in which the
condyles articulate with the thinnest avascular portion of
their respective disks with the complex in the anterior-
superior position against the shapes of the articular
eminencies.This position is independent of tooth contact.
This position is clinically discernible when the mandible
is directed superior and anteriorly. It is restricted to a
purely rotary movement about the transverse horizontal
axis (GPT-5)
 Term Abbreviation Definition
Retruded Guided occlusal relationship
contact occuring at the most retruded
position position of the condyles in the
RCP
joint cavities.a position that
may be more retruded than the
centric relation position.
Intercuspal The complete intercuspation of
position ICP the opposing teeth independent
of condylar postion.
Centric The occlusion of opposing teeth
occlusion CO when the mandible is in centric
relation.
 Importance of RCP

• Relative reproducibility

• Stability of denture bases in conjunction with a lack

of interfering contacts in eccentric mandibular
positions.

• Contribute in TMJ health.

• Fenlon et al demonstrated positive correlation

between CD usage & accuracy of CR registration.
 Uses of RCP
• Mounting Models On An Articulator

• Reorganising a Patients Occlusion At A New Occlusal

Vertical Dimension.

• Occlusal Analysis.

• Occlusal Splint Therapy.

• Determining The Magnitude & direction Of RCP to ICP.

• Distalising the mandible to create palatal space for

anterior restorations.

• Restoring the tooth which involved in determining the

RCP
 Factors affecting RCP

• Patient

• Operators experience.

• Registration material.

• Recording method.

• Neuromuscular condition

• Record handling & storage.

• Time of recording
 METHODS OF RECORDING

PATIENT GUIDED RECORDING OF RCP

 schuyler technique

• This technique involves the patient placing the tip of

the tongue to the back of the palate and closing in to a
horse shoe of softened wax with light pressure.
• In edentulous patients this technique can be used with
wax rims.

Drawbacks:
• There is no way of verifying the nature of any
unwanted tooth contact or the retrusion of the
mandible.
• The wax may not be uniformly softened which can lead
to inaccuracies in the recording.
 Physiological technique

• Appropriate for edentulous patients.

• Cones of soft wax placed posteriorly.

• Patients swallows several times, simultaneously mandible

• Retrudes and recording is made.

Draw backs

• No control over mandibular retrusion nor tooth contact.

 Gothic arch tracing(arrow point tracing)

• Used in both edentulous & dentate patients.

• used intra-orally or extra-orally
• Based on tracing movement of mandible.
• Metal plates are added to upper and lower wax rims.
• The lower plate has a central pin, which can be adjusted to
the desired occlusal facial height and at right angles to the
opposing plate.
• Pin is the only point of contact between maxilla and
mandible.
• The patient practices mandibular excursions then fine
spray of occlude is added to maxillary plate.
• Patient replicates the excursive
movements & mandibular pins
scribe an arrow head tracing on the
maxillary plate. The three lines
intersects indicates the retruded
mandibular relation.

Draw backs

• Time consuming
• Requires well defined non
displaceable upper and lower
alveolar ridges to allow stable &
retentive acrylic bases.
• Large tongue movements also cause
base movements during the tracing.
• Recently gnathometer M consists of wax rims with
tracing plates.

• Pantograhs are mechanical or electronic device which

trace mandibular movements similar to gothic arch
tracer.

• Digital pantograph machines have an electronic facebow

& lower incisal plate, which are linked remotely to the
computer and relation to each other is measured and
calculated by specialised software.
 Myo-monitor

It is an electrical device
which is reputed to achieve muscle
relaxation & produce a
neuromuscular mandibular position.

It produces pulsed ultra low

frequency stimulation of facial and
masticatory muscles.

Stimulating electrodes are

placed over the coronoid notches
and a common electrode is located
at the nape of the neck.
OPERATOR GUIDED RECORDING OF RCP
Chin-guided recording method

• Patient is seated upright

position and relaxed, with
clinician in front.

• A softened two layer wax

wafer [1.4mm thick] is
gently pushed against the
cusps of the maxillary
teeth with just enough
force to make to make
cuspal indentations.
• The wafer is removed, chilled & reseated in order to check
fit & stability.

• A registration medium is applied to the mandibular

surface of the wax wafer & the patients mandible is
guided in to a hinge closure by thumb & index finger of
the operator.

• After several smooth movements the hinge closure is

completed when the mandibular teeth just indent the
registration material.

Draw backs:

• It can be over retruded.

 Three finger chin-point guidance method

•Not recommended for edentulous patients

•A tripod is created at the chin-point &

lower border of the mandible on both sides
by the thumb, index finger & third finger.

•Gentle guidance in all three digits in a mid

sagittal plane.

•This encourage anterior–superior

placement of condyles.

Draw backs

•Easy to deflect mandible to one side

 Bimanual manipulation method

This technique is carried out with the patient supine & operator
seated behind.

By opening & closing a few times on the hinge

Axis, the patient will relax & registration can be made.
 Alternative method

• Operator seated in front of the patient is to use

the index fingers to stabilize the lower record
base and guidance is from the thumbs on the
chin.

• Smith has described a modification where one

hand can stabilize both upper & lower denture
bases.
 Anterior guidance by lucia jig
• The basics is to provide an
anterior reference point.
• Lucia jig is made of self curing
resin either in the study cast or
in the mouth.
• The palatal acrylic is
manipulated to just cover the
palatal soft tissues.
• The lingual aspect should slope
posteriorly & superiorly at an
angle of 40-60 degree.
• After setting the jig is adjusted
using articulating paper placed
on the palatal aspect while the
patient performs lateral &
antero-posterior or excursive
movements.
A selected lower incisor scribes an
arrow–head pattern, can be ground
of leaving the apex.

This is the area of the retruded

position of the mandible and vertical
height is then adjusted until the
posterior teeth are just out of
contact.

Then the record is made at this

position.
 Anterior guidance by tongue blade

The tongue blade method uses wooden

spatula instead of custom made lucia jig.
The degree of tooth separation is altered
by number of spatulas used

The patients teeth must be discluded for

a period of time, [10-20min]prior to
registration, in order of proprioceptive
input to be lost.

Once the correct anterior spatula

guidance is achieved registration
material is used to record the relative
position of the mandibular & maxillary
teeth.
 Anterior guidance by leaf gauge

The leaves provide the anterior reference

point & the degree of tooth separation can
be altered until the teeth achieve
disclusion.

A registration support wafer permits the

registration of the inter-dental record.

originally a book of ten acetate leaves were

used.

Now disposable paper versions are also

available.
 Anterior guidance by osu woelfel gauge

• Developed by woelfel.

• The specially designed

device has a graduated
acteate bite platform, the
position of which is
adjusted antero-posteriorly
until the teeth are
minimally out of contact.

• A registration support
wafer can then be added &
the inter–dental record
made.
 Power-centric registration method
• Dentist standing in front and right of the supine
patient ,left thump & fore fingers placed over upper teeth.

• Right thump is placed on superior aspect of the

chin,while second & third fingers along the inferior border
of the mandible.

• Right arm is stiffened ,pressure is applied from shoulder

by leaning.
• Reflex muscle shortened and retrudes the mandible.

Drawbacks

• Mandible may be pushed too posteriorly

 comparison

• It is reported that guided mandibular closure gave more

reproducible RCP recordings than no guidance.
• The most consistent guidance method were the lucia jig,
bilateral manipulation which have been demonstrated by
electromyographic studies to produce the least temporalis
& masseter activity.

• Wise classified patients in to

1. Easy

2. Manipulation with slight difficulty

3. Manipulation with more difficulty.

• For easy patients he suggested bimanual manipulation.

• Anterior guidance from tongue blade followed by

bimanual manipulation for manipulation with slight
difficulty.

• manipulation with more difficulty patients need jucia jig

to be left in situ for 30 min to disrupt proprioception.

• For some very difficult patients proprioceptive

deprogramming may need to be accomplished using an
occlusal splint for an extended period.
 summary

• As a reproducible position, it is useful in the restorative

management of dentate & edentulous patients.

• Reference point for the registration of transfer records.

• It is unknown whether one registration method is better

than other, but it is the accuracy & reproducibility of
achieving the retruded position of the mandible is in the
hands of operator