Jaw

Jaw Registration
Registration

 Dr
Dr Macharia
Macharia JJ KK
Definition
Definition of
of Jaw
Jaw Registration
Registration

 The
The relative
relative position
position of
of the mandible to
the mandible to

the maxilla,
the maxilla, usually
usually relating
relating to centric,
to centric, lateral,
lateral,

protrusive, retrusive or vertical positions
protrusive, retrusive or vertical positions of
of

the mandible.
the mandible.
 Centric
Centric occlusion
occlusion
Definition
Definition
1.
1. The
The maximum occlusion
maximum occlusion of opposing
of opposing
teeth,
teeth, regardless
regardless of condylar
of condylar position.
position.
2.
2. Contact
Contact between opposing
between opposing teeth when
teeth when
the mandible is
the mandible is in centric
in centric relation.
relation.
The steps for construction complete denture
Record
Record Bases
Bases &
&
Occlusion
Occlusion Rims
Rims
Record
Record Bases
Bases
 An
An interim
interim denture
denture base
base used
used to
to
support
support the
the record
record rim
rim material
material forfor
recording
recording maxillo-mandibular
maxillo-mandibular
records
records
 The
The primary
primary function
function isis to
to serve
serve as
as
aa base
base to
to fabricate
fabricate and
and support
support the the
wax
wax occlusion
occlusion rims
rims and
and trial
trial
dentures
dentures
Record
Record Bases
Bases &
& Occlusion
Occlusion
Rims
Rims
Wax
Wax occlusion
occlusion
rims
rims simulate
simulate
the
the position
position
of
of the
the teeth
teeth
Record
Record Bases
Bases &
& Occlusion
Occlusion
Rims
Rims

Occlusion
Occlusion rims
rims
slightly
slightly bulkier
bulkier to
to
provide
provide additional
additional
stability
stability during
during
record
record making
making
 Arbitrary
Arbitrary Adjustment
Adjustment of
of
Occlusion
Occlusion Rims
Rims (Refer
(Refer to
to lab.
lab.
manual
manual))
 Adjust
Adjust separately
separately using
using
average
average dimensions:
dimensions:

Maxillary
Maxillary -- 22
22 mm
mm
Mandibular
Mandibular -- 1818 mm
mm
Maxillary
Maxillary Occlusion
Occlusion Rim
Rim
Adjustment
Adjustment
Maxillary
Maxillary rimrim
slightly
slightly facial
facial
to
to
compensate
compensate
for
for ridge
ridge
resorption
resorption
Mandibular
Mandibular Occlusion
Occlusion Rim
Rim
Adjustment
Adjustment

Centered
Centered
over
over the
the
ridge
ridge to
to
maximize
maximize
stability
stability
Mandibular
Mandibular Occlusion
Occlusion Rim
Rim
Adjustment
Adjustment
Posteriorly,
Posteriorly, the
the
occlusion
occlusion rim
rim
intersects
intersects 1/2
1/2 -- 2/3
2/3
up
up the
the retromolar
retromolar
pad
pad
Requirements
Requirements of
of Record
Record
Bases
Bases
 Well
Welladapted
adapted
 Stable
Stableand
andretentive
retentivein
inmouth
mouth
 Rigid
Rigidand
anddimensionally
dimensionallystable
stable
 Smooth
Smooth
 No
Nomore
morethan
than11mm mmthick
thickononthe
thecrest
crestand
andfacial
facial
slope
slopeof
ofridge
ridge
 22mm
mmthick
thickininthe
thepalatal
palataland
andlingual
lingualslope
sloperegion
region
for
forrigidity
rigidity
 Smooth
Smoothandandrounded
roundedborders
borders
Record
Record Bases
Bases

 Temporary
Temporary bases
bases

 Permanent
Permanent bases
bases
Temporary
Temporary Record
Record Bases’
Bases’
Materials
Materials
 Shellac
Shellac
 Auto-polymerizing
Auto-polymerizing acrylic
acrylic resin
resin
 Vacuum
Vacuum formed
formed vinyl
vinyl or
or
polystyrene
polystyrene
 Baseplate
Baseplate wax
wax
Permanent
Permanent Record
Record Bases’
Bases’
Materials
Materials
 Heat
Heat cured
cured acrylic
acrylic resin
resin
 Gold
Gold alloy
alloy
 Chrome
Chrome cobalt
cobalt alloy
alloy
 Chrome
Chrome nickel
nickel alloy
alloy
 Swaged
Swaged metal
metal base
base
Occlusion
Occlusion Rims
Rims

Occluding
Occluding surfaces
surfaces fabricated
fabricated
on
on interim
interim or
or final
final denture
denture
bases
bases for
for making
making maxillo-
maxillo-
mandibular
mandibular relationship
relationship
records
records and
and arranging
arranging teeth
teeth
Uses
Uses of
of Occlusion
Occlusion Rims
Rims
 Determination
Determinationof oflip
lipsupport
support
 Arch
Archform
form
 Plane
Planeofofocclusion
occlusion
 Teeth
Teethsize
sizeand
andposition
position
 Contour
Contourof ofthe
thepolished
polishedsurface
surface
 Transfer
Transferjawjawrelation
relation
 Arrangement
Arrangementof ofteeth
teeth
Jaw
Jaw Relations
Relations
Basic
Basic Mandibular
Mandibular Positions
Positions
1)
1) Rest
Rest position
position (physiologic
(physiologic rest
rest
position)
position) PRP
PRP
2)
2) Inter-cuspal
Inter-cuspal position
position (maximum
(maximum
inter-cuspation,
inter-cuspation, centric
centricocclusion,
occlusion,
tooth
tooth position)
position) CO
CO
3)
3) Centric
Centric relation
relation (ligamentous
(ligamentous
position,
position, posterior
posterior border
border position,
position,
Retruded
Retruded contact
contact position
position )) CR
CR
 Physiologic
Physiologic Rest
Rest Position
Position
(PRP)
(PRP)
 The
Thevertical
verticaland
andhorizontal
horizontalposition
positionthe
themandible
mandibleassumes
assumes
when
whenthethemandibular
mandibularmusculature
musculatureisisrelaxed
relaxedand
andthethepatient
patientisis
upright.
upright.
 When
Whenthe themandible
mandibleisisin
inthe
therest
restposition
positionthere
thereisisaaspace
space
between
betweenthetheocclusal
occlusalsurfaces
surfacesof ofthe
theteeth
teethwhich
whichisisknown
knownasas
the
thefreeway
freewayspace
spaceor
orinterocclusal
interocclusalrest
restspace.
space.
 This
Thisspace
spaceisiswedge-shaped,
wedge-shaped,being
beinglarger
largeranteriorly
anteriorlywhere
wherethe
the
separation
separationbetween
betweenthetheteeth
teethisismost
mostcommonly
commonlywithin
withinthe
the
range
range2–42–4mm.
mm.
Physiologic
Physiologic Rest
Rest Position
Position (PRP)
(PRP)
 At
At rest,
rest, lips
lips barely
barely
touching
touching
 Occlusion
Occlusion rims
rims
should
should not
not touch
touch

Intraorally no contact
Occlusal
Occlusal Vertical
Vertical Dimension
Dimension
(OVD)
(OVD)
•• The
Thedistance
distancebetween
betweentwo
twoselected
selectedpoints,
points,one
one
related
relatedto tothe
themaxilla
maxillaand
andoneonerelated
relatedtotothe
the
mandible,
mandible,when whenthe
theupper
upperandandlower
lowerteeth
teethare
arein
in
contact.
contact.
•• When
Whenthe themandible
mandibleisisin
inits
itsresting
restingposition,
position,this
this
distance
distanceisisthe
therest
restvertical
verticaldimension
dimension
•• The
Thedifference
differencebetween
betweenthethemeasurements
measurements
isisthe
thefreeway
freewayspace.
space.
 Occlusal
Occlusal Vertical
Vertical Dimension
Dimension
(OVD)
(OVD)

 Distance
Distance between
between
maxilla
maxilla && mandible
mandible
when
when teeth
teeth or
or wax
wax
rims
rims contact
contact in
in
centric
centric position
position
Freeway
Freeway Space
Space or
or Interocclusal
Interocclusal
Distance
Distance (ID)
(ID)

 Space
Space between
between wax
wax rims
rims at
at
physiologic
physiologic rest
rest position
position
 Usually
Usually 2-4
2-4 mm
mm
Variation
Variation in
in the
the Rest
Rest Position
Position
 It
It isis found
found that
that the
the rest
rest position
position of
of the
the
mandible
mandible was was not
not constant
constant
throughout
throughout life. life.
 The
The rest rest position
position of
of the
the edentulous
edentulous
patient
patient can can be
be affected
affected byby short-term
short-term
variables,
variables, and and by
by long-term
long-term variables.
variables.
 Short-Term
Short-Term Variables
Variables
 Patient
Patient supine:
supine: Reduced
Reduced
 Head
Head tilted
tilted back:
back: Increased
Increased
 Head
Head tilted
tilted forwards:
forwards: Reduced
Reduced
 Insertion
Insertion ofof lower
lower denture
denture or
or record
record block:
block:
Increased
Increased
 Stress:
Stress: Reduced
Reduced
 Pain:
Pain: Reduced
Reduced
 Drugs:
Drugs: Variable
Variable
Long-Term
Long-Term Variables
Variables
IfIfthe
thesame
samedentures
denturesare
areworn
wornfor
formany
many
years
yearsand
andare
arenot
notmaintained,
maintained,aareduction
reduction
in
inthe
theocclusal
occlusalvertical
verticaldimension
dimensionoccurs
occurs
as
asaaresult
resultof
ofalveolar
alveolarresorption
resorptionand
and
occlusal
occlusalwear.
wear.The
Therest
restposition
positionof
ofthe
the
mandible
mandibleadapts
adaptstotothis
thischange
changeand
andtakes
takes
up
upaaposition
positioncloser
closerto
tothe
themaxilla.
maxilla.As
Asaa
result,
result,the
thefreeway
freewayspace
spacebecomes
becomeslarger.
larger.
 Long-Term
Long-Term Variables
Variables
 Where
Wherethese
thesechanges
changeshave havetaken
takenplace
placein
in
young
youngpatients,
patients,ititisisoften
oftenpossible
possibleto
to
recover
recovermuch
muchof ofthe
thelost
lostvertical
verticaldimension
dimension
when
whennew
newdentures
denturesare areconstructed.
constructed.
 However,
However,with
withthe
theelderly
elderlypatient,
patient,any
any
attempt
attemptto
torestore
restorethe theocclusal
occlusalvertical
vertical
dimension
dimensiontotoits
itsoriginal
originallevel
levelmay
maybebemet
met
with
withproblems.
problems.
 Long-Term
Long-Term Variables
Variables

 The
The long-term
long-term variables
variables will
will
not
not affect
affect the
the reproducibility
reproducibility
of
of the
the rest
rest vertical
vertical dimension
dimension
during
during the
the period
period of
of aa dental
dental
appointment
appointment
 Intercuspal
Intercuspal Position
Position
(Centric
(Centric Occlusion
Occlusion))
 The
The intercuspal
intercuspal position
position isis the
the
vertical
vertical and
and horizontal
horizontal position
position of of the
the
mandible
mandible in in which
which maximum
maximum occlusalocclusal
contact
contact occurs.
occurs.
 In
In the
the denture
denture wearer,
wearer, the
the
intercuspal
intercuspal and
and centric
centric relation
relation
positions
positions should
should coincide.
coincide.
 Centric
Centric Relation
Relation
The
Themaxillo-mandibular
maxillo-mandibularrelationship
relationshipin inwhich
whichthe
thecondyles
condyles
articulate
articulatewith
withthe
thethinnest
thinnestavascular
avascularportion
portionof
oftheir
their
respective
respectivedisks
diskswith
withthe
thecomplex
complexin inthe
theanterior-superior
anterior-superior
position
positionagainst
againstthetheshapes
shapesofofthe
thearticular
articulareminencies.
eminencies.
This
Thisposition
positionisisindependent
independentof oftooth
toothcontact.
contact.This
Thisposition
positionisis
clinically
clinicallydiscernible
discerniblewhenwhenthethemandible
mandibleisisdirected
directedsuperior
superior
and
andanteriorly.
anteriorly.ItItisisrestricted
restrictedtotoaapurely
purelyrotary
rotarymovement
movement
about
aboutthe
thetransverse
transversehorizontal
horizontalaxis
axis(GPT-5)
(GPT-5)
 Centric
Centric Relation
Relation (CR)
(CR)
 ItItisisusually
usuallydefined
definedbybythe
theposition
positionof
ofthe
thecondyles,
condyles,
rather
ratherthanthanthe
theteeth.
teeth.Therefore
Thereforeititdoes
doesnot
notalter
alter
when
whenthe thenatural
naturalteeth
teethare
areextracted
extractedororwhen
whenaanew
new
occlusal
occlusalsurface
surfacereplaces
replacesan
anunsatisfactory
unsatisfactoryone.
one.

 Centric
Centricrelation
relationcan
canbebethought
thoughtof
of as
asaatreatment
treatment
position,
position,which
whichisisnot
notnecessarily
necessarilyideal
idealor
ornormal
normalin
in
the
thenatural
naturaldentition.
dentition.
When
When to
to Use
Use CR?
CR?
 When
Whenentire
entireocclusion
occlusionbeing
beingrestored
restored(i.e.
(i.e.no
no
remaining
remainingposterior
posteriorcentric
centricstops)
stops)
 When
Whencomplex
complexfixed,
fixed,or
orremovable
removablepartial
partialdentures
dentures
involve
involvethetheentire
entireocclusion
occlusion
 ififaanon-pathologic
non-pathologicnatural
naturalocclusion
occlusionexists
exists
(posterior
(posteriorcentric
centricstops
stopspresent),
present),and
andthere
there isisno
no
valid
validreason
reasonto tochange
changeit,it,then
thenrestorations
restorationsshould
shouldbe
be
made
madein inmaximum
maximumintercuspation
intercuspation
 Significance
Significance of
of CR
CR ((Reasons
Reasons for
for Using
Using
CR
CR in
in Edentulous
Edentulous Patients)
Patients)

1.
1. Artificial
Artificialteeth
teethare
arebest
besttotoocclude
occludeevenly
evenlyatatCR
CR
2.
2. Conducive
Conduciveto tohealth
health--not
notpathogenic
pathogenic
3.
3. Relatively
Relativelyrepeatable
repeatable(reproducable)
(reproducable)over overaaperiod
period
of
oftime
time--so
sothe
thepatient
patientcancanfind
findstable
stableocclusal
occlusal
contacts
contactseasily
easily
4.
4. AAhinge
hingeposition
position--allows
allowschange
changein inthe
thevertical
vertical
dimension
dimensioneasily
easilyand
andso sothe
thepatient
patientcan
canfind
findstable
stable
occlusal
occlusalcontacts
contactseasily
easily
5.
5. AArelatively
relativelysymmetrical
symmetricalposition
position--avoids
avoidsmuscle
muscle
strain
strainwhich
whichmight
mightoccur
occurin inexcursive
excursivepositions
positions
 Significance
Significance of
of CR
CR ((Reasons
Reasons for
for Using
Using
CR
CR in
in Edentulous
Edentulous Patients)
Patients)

6.
6. This
This position
position isis independent
independent of
of presence
presence or
or
absence
absence of
of teeth
teeth

7.
7. If
If CR
CR and
and CO CO of
of artificial
artificial teeth
teeth don’t
don’t coincide
coincide ,,
there
there isis instability
instability of
of dentures
dentures and
and patient
patient
subjected
subjected to to pain
pain or
or discomfort
discomfort
Significance
Significance of
of CR
CR ((Reasons
Reasons for
for Using
Using
CR
CR in
in Edentulous
Edentulous Patients)
Patients)

8.
8. Allows
Allows function
function to
to all
all positions
positions

9.
9. 24%
24% of
of normal
normal population
population has
has
CR=CO
CR=CO