HORIZONTAL JAW

RELATION

Presented by: Dr. shailja katiyar

JR 1
DEPT. OF PROSTHODONTICS
INTRODUCTION
Jaw relation / Maxillomandibular relationship:
Any spatial relationship of the maxillae to the mandible ; any one of the infinite
relationships of maxilla and , mandible GPT 9.

Classification
Orientation jaw relation
Vertical jaw relation
Horizontal jaw relationof the mandible to the maxillae (GPT 9)
DEFINITION:
■ GPT 9 Centric relation is defined as a maxillomandibular relationship independent of
tooth contact, in which the condyles articulate in the anterior-superior position against
the posterior slopes of the articular eminences; in this position the mandible is restricted
to a purely rotary movement; from this unstrained, physiologic, maxillomandibular
relationship, the patient can make vertical, lateral or protrusive movements; it is a
clinically useful, repeatable reference position
 DEFINITION:

GPT 8
“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. 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”
HORIZONTAL JAW RELATION:
■ Horizontal jaw relation is the maxillomandibular relation in a horizontal plane.
■ Described as relationship of mandible to maxilla in the anteroposterior
direction.

2 TYPES:
1) CENTRIC jaw relation
2) ECCENTRIC jaw relation
■ Protrusive relation
■ Lateral relation
 Left lateral
 Right latera
SIGNIFICANCE OF CENTRIC RELATION
■ More definite than VD
■ Most comfortable position(home of the mandible)
■ Optimum position for health comfort and functioning of TMJ
■ Movements of mandible start from here and end up here.
■ physiologically acceptable position for mastication of food.
■ Most posterior border position
■ Pure rotations take place.
■ Bone to bone relation
■ Independent of position of tooth.
■ Constant for an individual. Reproducible, repeatable and recordable.
■ Acts as a reference point.

JohnJohn J Sharry Complete Denture Prosthodontics Third Edition

 CENTRIC RELATION

Anatomical

S. Davies and R. M. J. Gray, What is occlusion? British Dental Journal, Vol 191, No. 5, September 2001
THEORIES OF CENTRIC RELATION

The Ligament theory

The Osteofibre theory

The Muscle theory

The Meniscus theory

Saizer P. Centric relation and condylar

movement: anatomic mechanism. J
Prosthet Dent 1971;26(6):581-91
THEORIES OF CENTRIC RELATION:
Ligament theory
Bind the elements of the
Articulation

• Lateral radiographic views

• ‘Suspended’ or ‘Floating’
Condyle

• Anatomic arrangement- not

well suited to halt retrusive
movement
 Osteofibre theory

• By posslet

• Fibrous stop – buffer

• Retroarticular cushion

• retrusive terminal stop

Muscle theory

Defense reflex

External pterygoid
muscles contracts
DRAWBACKS OF THE THEORY :

• Does not explain centric relation is same at all VD

Halts the jaw • No anatomic explanation for posterior hinge movement
• No explanation for acuteness of needle point tracing
• If lateral pterygoid responsible: elliptical tracings
 Meniscus theory

The posterosuperior surface unfolds along

the roof of the glenoid fossa

• Discswith their retromeniscal fibrous

tissues--stop the retrusive condylar
movements
FACTORS INFLUENCING CENTRIC RELATION RECORDS

The resiliency of the supporting tissues

Fit of the denture bases
Residual alveolar arch
Saliva
Tongue
The health and cooperation of the patient
The posture of the patient
The temporomandibular joint and its associated neuromuscular mechanisms
The skill of the dentist
Pressure applied in making the recording
The technique used and the recording devices used
Methods of assisting the patient to retrude the mandible

■ Let the jaw relax, pull it back and

close slowly on the posterior teeth
■ Push the upper jaw out and close
on the back teeth
■ Protrude and retrude the mandible
repeatedly

DAWSON BIMANUAL PALPATION

 Roll the tongue backwards towards the posterior
border of upper denture and close the rims until
they meet:

Bissasu M. Use of the tongue for recording centric relation for edentulous patients. J Prosthet Dent
1999;82:369-70
HARMONY BETWEEN CENTRIC RELATION
AND CENTRIC OCCLUSION

CENTRIC OCCLUSION- The occlusion of the opposing teeth when the mandible is in centric
relation.
This may or may not coincide with MIP

MAXIMUM INTERCUSPAL POSITION- complete intercuspation of the opposing teeth

independent of the condylar position

CENTRIC SLIDE- movement of the mandible while in centric relation from initial occlusal
contact into maximum intercuspation
IN THE NATURAL DENTITION CO IS USUALLY LOCATED ANTERIOR TO CR,
THE AVERAGE DISTANCE BEING 0.5 TO 1 MM.

If natural tooth has interferences in CR

initiate impulses and responses that direct the mandible away from deflective
occlusal contacts into CO.

Impulses created by closure of the teeth into CO establish memorypatterns that

permit the mandible to return to this position, usually without tooth

interferences
Recording the centric relation
Minimum closing pressure
■ Opposing teeth to touch uniformly and simultaneously at their first contact

Heavy closing pressure

■ To produce same displacement of the soft tissues as on the dentures during
function
METHODS OF RECORDING CENTRIC RELATION

Classification by Different Authors:

1. By Boucher
a. STATIC METHODS — interocclusal record with/with out central bearing
devices and tracing devices

b. FUNCTIONAL METHODS — chew-in technique

a) Needles technique
b) House technique
c) Patterson technique
2. By Heartwell

1. FUNCTIONAL METHODS (CHEW-IN)

a) Needles House method
b) Meyers method
c) Patterson method

2. GRAPHIC METHOD
a) Intraoral devices
b) Extraoral devices

3. PHYSIOLOGICAL OR TACTILE OR INTER OCCLUSAL CHECK RECORD METHOD

ECCENTRIC RELATION RECORDS

■ An eccentric maxillomandibular relation is any relation ship of the mandible

other then centric position.
■ The relation recorded by moving the mandible forward is called protrusive
relation record.
■ The relation recorded by moving the mandible mesiolaterally is called lateral
relation record.
■ Eccentric relation depends on the shape of the mandibular fossae.
 METHODS OF RECORDING ECCENTRIC
RELATION
1. Functional method- Needles-House and Patterson technique.

2. Graphic method.

3. Tactile or Direct check methods.

4.Pantography
CENTRIC RELATION
FUNCTIONAL ( CHEW IN )

1)Patterson and Needle House Technique.

Both based on same principle.

i.e. the patient produces a pattern of mandibular movements by moving the mandible to
protrusion, retrusion, and right and left lateral.
FUNCTIONAL OR CHEW IN METHOD
Needle house method
Needle-House
Method
■ Meyer’s technique:

-used soft wax occlusal rims.

-tinfoil was placed over the wax and lubricated.
-patient performed functional movements to produce a wax path
-plaster index was made
FUNCTIONAL OR CHEW IN METHOD:

Patterson’s technique
Patterson Method
STATIC OR PRESSURELESS METHOD
NICK AND NOTCH METHOD:

Nick:prevent lateral movement

Notch: anteroposterior movement
Bite registration/recording materials

■ Waxes
■ Quick setting plaster
■ Impression compound
■ Bite registration paste (ZnO-E)
■ Bite registration silicone
Materials used

Aluwax
Recording centric relation
Mounting of the casts
Staple pin method:
DIRECT INTEROCCLUSAL RECORDS

Physiologic method or static method.

1756 Phillip Pfaff first described
Three factors influence the record :
1. Amount of pressure exerted on the displaceable tissues in the joints
2. The patient's comfort.
3. The number of reference points used to make the record.
■ A non precise jaw record obtained by placing a thermoplastic material, usually
wax or compound, between the edentulous ridges and having the patient close
into the material.
Also known as the 'mush', 'biscuit' or 'squash bite
Gothic arch tracing :
TYPES:

1. Intraoral tracings

2. Extraoral tracings
Ney excursion guide . Patient is trained to make mandibular movement in numerical order
Excursive (graphic) methods:
■ Gothic arch tracing
■ Arrow point tracing
■ Tracing in one plane
■ Apex - the most retruded position
■ Uses-
Verify centric relation
Obtain protrusive and lateral records

■ Types-
Intraoral tracer
Extraoral tracer
Intraoral tracing assembly
Intraoral tracing
EXTRAORAL TRACING:
Extaoral tracing device:
CONTRAINDICATIONS:

 Severely resorbed ridges

 Excessively flabby ridges

INSTABILITY OF DENTURE BASES

• Decreased arch space

• In patients with temporomandibular joint disorders
• In patients with abnormal jaw relation
EVALUATION OF GOTHIC ARCH
TRACINGS:
Classical, pointed form
The symmetry indicates an undisturbed
movement sequence in the joints and uniform
muscle guidance

Classical flat form

Indicates distinct flat lateral movements of the
condyles in the fossa.
Weak Gothic arch tracing
Indicates a lax and negligent performance of the
movements. The registration must be repeated:
Stronger movements must be demanded from
the patient.

Asymmetrical form
The tracing indicates a distinct inhibition of the
forward component of the lateral movement in
the right joint
Miniature Gothic arch tracing
This tracing points restricted mandibular
movements.
•Due to badly fitting and pain-causing record
bases or
•Long standing edentulous state with inhibited
movement in the joints

Vertical line protrudes beyond the arrow

point
forcible retraction or pushing of the mandible
or tracing obtained with protruded mandible
Other methods-
■ Deglutition
■ Pantography
■ Deglutition

■ Physiologic method
‘swallow and hold’
Centric-relation recording techniques

■ Swallowing or free closure (Shanahan)

■ Chin point guidance
■ Chin-point guidance with anterior jig
■ Bilateral manipulation(Dawson method)

Kantor ME, Silverman SI and Garfinkel L. Centric-relation recording techniques-a

comparative investigation. J Prosthet Dent 1972;28(6):593-600.
 Physiologic Centric Relation (Shanahan)

Shanahan (1955)

Cones of soft wax placed on the mandibular occlusal rim

Patient was asked to swallow repeatedly.

He believed that during swallowing, the tongue forced the

mandible into Centric relation position.

The cones of soft were then moved and Centric relation

was recorded using this method Shanahan TEJ. Physiologic jaw relations and occlusion of
complete dentures. J Prosthet Dent 2004;91(3):203-05
Indications:

• abnormally related jaws

• excessively displaceable supporting tissues
• large tongue
• abnormal mandibular movements
• verify occlusion in existing dentures
Chin point guidance:
■ Chin-point guidance with

 anterior jig
 Bilateral manipulation
PANTOGRAPHY

• Used clinically to measure mandibular movement

• Graphic record in three planes
Eccentric relation records:
■ Protrusive relation

■ Lateral relation
• Left lateral
• Right lateral
Protrusive jaw relation:
■ Register the influence of the condylar paths over the movements of the
mandible
■ Christensen’s phenomenon
Protusive interocclusal record
whipmix
 Whip mix
1.Set side shift guide at 45◦.

2.6mm from centric relation along LL.

3.Right condyle is in protrusion.

Lateral interocclusal records Hanau:

L = H/8 + 12

( H – Horizontal condylar inclination

L – Lateral condylar inclination)
 Unstability of record base

 Resiliency and displaceability of denture bearing tissues

 Materials used in record making

 Equipment used in record making

 Lack of muscle coordination by the patient

 Use of articulators not adjusting to all interocclusal check records

 Clinical protocol

Nair CK. Programming the semiadjustable articulator. Trends in

Prosthodontics 2011;2(1):12-14.
Protrusive records made of plaster at 2mm, 4mm,
6mm, 8mm and 10mm

Nair CK et al. Relationship between protrusive record and horizontal

condylar guidance angle. Trends in Prosthodontics 2011;2(1):15-16
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