Review of Maxillo-Mandibular Relationships

Prof Nikolai Attard

With Kind Permission from Dr Jack Gerrow

UoT and Dalhousie University

Session 10 This presentation includes images from the UCLA/APC/Ivoclar

Educational Curriculum
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 No Easily Determined Reference Position
• Unlike dentate patient where existing teeth establish:
– Vertical height
– Position of maximum intercuspation
– Fine sensory input to find maximum intercuspation

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 Require a Reference Position to Set Teeth

• When complete dentures are removed, no

easily determined position to set teeth
• Differences in dentures and wax rims
confuse some patients
• Without rims, no way to record centric
position

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 Difficulties
Maxillo-mandibular Relationships

• Difference in sensation (no teeth, changed lip support,

height, contact with tissue)
• Edentulous patients have more difficulty determining
where their teeth should contact

– No periodontal membrane

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 Finding a Treatment Position
Acceptable position should be:
• Conducive to health
• Relatively repeatable
– position should be checked before dentures
completed

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 Conducive to Health
– Relatively Symmetrical Position
– Not ‘absolute’ symmetry
– Less chance of muscle strain which might occur
in non-centered positions

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 Centric Relation (CR)
– Treatment Position
– Centric position of mandible to maxilla
– Defined by position of condyles, not teeth
– Hinge position

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 Hinge Position is Repeatable

• Relatively centered
• Patient can find stable occlusal contacts easily
• Allows change in vertical dimension

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 Centric Relation
– Treatment position
– Not necessarily ‘ideal’ or ‘normal’

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 Centric Occlusion (CO)
– Occlusion of opposing teeth when mandible in
centric relation
– Treatment position for Complete Dentures
– Sometimes coincident with ‘maximum
intercuspation’ in natural dentitions

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 CR and CO have been defined
differently by various investigators,
and differently over different time
periods

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 Where is Centric Relation?
Glossary of Prosthodontic Terms:

– Independent of tooth
contact
– Clinically discernible
when mandible is
directed superiorly and
anteriorly

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 Where is Centric Relation?

Glossary of Prosthodontic Terms no9

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 Where is Centric Relation?
Glossary of Prosthodontic Terms:

• Purely rotary movement

about transverse
horizontal axis

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 Why Anterior-Superior?
Thickening (buttressing)
bone is present where
joint articulation occurs
– Thickest part of eminence is
anterior portion of fossae

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 Why Anterior-Superior?
The articular disk is in a anterior-
superior position

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 Why Anterior-Superior?
Cartilage covers articular surfaces

• Fibrocartilage on anterior
surface of glenoid fossae
• Articular cartilage on superior
and anterior of condyles

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 Why not Posterior Position?

• Neurovascular supply of
retro-discal pad is
posterior to disk

• If condyles articulated
in a posterior position –
impingement

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For the purpose of fabricating complete
dentures, the superior-anterior position
of Centric Relation will be used

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 Clinically dentist cannot determine
actual position of condyles at time of
jaw relations records

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 Centric Relation - Why?
• Allows function to all positions
• Conducive to health (non-pathologic)
– Brill et al - pain & loss of occlusal sense when not in CR
– Renyolds - 24% of normal population has CR=CO

• Convenient - relatively centered (Celenza)

• More reproducible (Grasser)
– Easier to set a stable occlusion

• OVD can be changed and condylar

inclination will not have to be readjusted
(arcon articulators) (Celenza)

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 Centric Occlusion - Why Not?

Position is difficult to determine - not as reproducible

– Patients cannot tell where CO or a habitual
position is with bulky wax rims in position
– No habitual position with new wax rims

(Crum and Loiselle; Brill et al)

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When to Use Centric Relation
– When entire occlusion being restored
• No remaining posterior centric stops
– When complete, fixed, or removable partial
dentures involve entire occlusion

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 When to Not to Use Centric Relation

– Stable occlusion
– No pathology
– Posterior centric stops present
– No valid reason to change
– Use maximum intercuspation

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 Thank you!

For any questions:

Contact me via email: nikolai.attard@um.edu.mt
Phone: 23401876

Or wait for the tutorial that will be organised to discuss the lecture

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