Centric-relotion recording fechniques-o

comporotive investigotion

Mortin E. Konlor, D.M.D., M.S.D.,* Sidney l. Silvermon, D.D.5.,** ond

Lowrence Gorfinkel, M.A.***c
College of Dentistry, Brookdale Dental Center of New York Uniaersity,
Neu York, N. Y.

his study was undertahen to investigate the v-ariability of centric jaw relation
records obtained utilizing diflerent clinically acceptable techniques that are currently
in use.
A great deal of controversy exists regarding the various concepts of centric relation.
Many feel that centric jaw relation is important, because it is used as a reference
position for the restoration of occlusion. The validity of information derived from
examination of articulated casts depends upon the reproducibility of the clinical situ-
ation. The most posterior position is said to be relatively reproducible and, therefore,
a good reference position. IIowever, as stated by .A.twood,1 the fact that this position
exhibits reproducibility is not necessarily indicative of physiologic desirabiiity or cor-
rectness. For this reason, the controversy is both real ancl important and has been
the subject of considerable serious study.
Kingery'z has reviewed some of the problems associated with centric relation. He
claimed that any record of a position of the mandible other than centric position
(sometimes referred to as functional centric, acquired centric, habitual centric, and
so on) is that of an eccentric position. Our awareness of these so-called "easy posi-
tions" should serve to stimulate our care"in proper articulation of teeth, but these
positions should not be confused with centric relation. We record centric relation;
we establish centric occlusion to coincide r.vith this position.

This is a condensed report of research submitted in partial fulfiliment of the requirements

for a Master of Science (Dentistry) Degree, College of Dentistry, Brookdale Dental Center
of New York University.
This investigation was supported by Grant No. 56T71, Department of Health, Education
and Welfare, Rehabilitation Services Administration.
Presented before the Greater New York Academy of Prosthodontics, New York, N. Y.
*Assistant Clinical Professor, Department of Removable Prosthodontics.
**Professor and Chairman, Department of Removable Prosthodontics.
*x*Assistant Clinical Professor, Department of Removable Prosthodontics.

593
/-

594 Kantor, Siluerman, and Garfinkel J. Prosthet. Dent.

Dccember, 197?
Volnrne
N tr rrrbe r
2^8
b

oI
l'ig' 3' Inhing
the interchangeab
Fig. 1. The anterior jig designed to separate the teeth minimaily and to attempt to erase the
proprioceptive patterns of habitual tooth contact. Chi'n'Point
Fig. 2. Bilateral manipulation seats the condyles in their most superior position. Luciall rvho Pt
centric relatior
cisors would h
OBJECTIVES ing' This ante
It is not the purpose of this investigation to determine the most physiologically to erase the Pr
desirable mandibular position. However, this study will attempt to shed light upon acts to carry t
the relative replicabiiity and spacial patterning of maxillomandibular records ob- record making
tained by using four clinically acceptable techniques currently in use. Bilateral r
, -' those who ad
TECHNIQUES that the conc
The four techniques used in this study to record centric jaw relation are listed terior guidan
below. servation' as
swallowing or lree closure. This technique was advocated by Shanahans when should be us
he stated that, "Swallowing saliva is the determinative factor for obtaining vertical suPerior PIa(
dimension and centric relation." Freese and Schemana have referred to swallowing relation'
as "an accurate physiolog'ic means of checking and even of recording centric This biia
relation." the dentist's
A preformed wax wafer was held in position against the maxillary teeth while sure with hi
the patient was verbally instructed to "swailow and hold." There was no contact Li
Position'
between the dentist and the patient's mandible; manual guidance was totally avoided. made to ol
Chin-point guidance. A second method investigated in this study was described (Fig' 2)'
by Mccollums when he suggested the importance of the hinge axis in centric re-
METHODS
lation records. Granger6 stated that centric relation is that position where the mandi-
ble rotates around the hinge axis. fn securing maxillomandibular records, both in- Fi{tee'n
vestigators recommend the use of chin-point guidance in retruding the mandible. selected fo:
Others who advocated this technique include Kornfeld,? Thompson,8 Aull,e and and 3 wer
SIoan,lo Patients v
 Y

t
Vohrrne 28
Nuurber 6
Centric-relation recording technirlues 595

crt

Fig. 3. Inking of the fixed scribe which, when lowered, records a specific point recorded on
llre interchangeable plate.

Chin-point guidance with anterior jig. Tkrc third method was described by
Lucia'1 who proposed the use of what he referred to as an "anterior jig" in securing
centric relation records. He felt that an inclined plane attached to the maxillary in-
cisors would help to fully seat the condyles in their fossae and aid in record mak-
ing. This anterior jig was designed to separate the teeth minimally and, if possible,
to erase the proprioceptive patterns of habitual tooth contact. The wax wafer merely
acts to carry the metallic-oxide paste and is not in contact with the dentition during
record making (Fig. 1) .
Bilateral manipulation The fourth method for investigation has been used by
r. those who adhere to functionally generated-path techniques. They have suggested
that the condyles do not alwavs move superiorly, but sometimes, in response to pos-
terior guidance from the dentist, they move inferiorly. Because of this clinic'al ob-
servation, as reported recently by Long,12 they concluded that posterior guidance
should be used sparingly and with great care. They emphasized the importance of
superior placement of the condyles in the fossae when attempting to record centric
relation.
This bilateral technique employs a specific superior guidance to the mandible by
the dentist's finger position. At the same time, the dentist applies downward pres-
sure with his thumbs, thereby attempting to seat the condyles in their most superior
position. Little effort is made in gaining a posterior placement. An attempt is
made to obtain an arcing motion of the mandible in its most superior position
(Fig. 2).

I
METHODS AND MATERIAIS
Fiftee,n subjects with complete dentitions and minimal dental restorations were
I
selected for this study. Their ages ranged from 21 to 45 years; 12 subjects were men,
and 3 were women. No evidence of systemic or psychologic dysfunction was present.
1
Patients with removable prostheses were not considered acceptable. A total of 24
e
i

;
 T}

596 l{antor, Siluerrnott, and Garfinkel Prosthet. Dent. Volume 28

Ntrmber 6
Dccernber, 1972

:!

Fig. 5. The
cast and the

ments. The r

tem, were jc
Fls' a' The interchangeable piate is positioned on a toolmaker's mechanical system was l
microscope stage
where it is magnified 25 times for data recording.
RESUtIS
This inv
centric relation records were made for each padent. Six records were macle tionshiP bel
by using
each of the four techniques: (1) swailowing, (2) chin-point guidance, (3j
chin- r? The me'
point guidance with an anterior jig, and (4) bilateral *unip,r1uior.. is, a mean
Each record was made by using a preformecl wax wafer refined with a metallic- from this n
oxide paste. Stone casts of both arches were made from impressions in an determined
elastic im-
pression material. The casts were oriented on an articulator by Swallov
,sing a face-bow
transfer. these recor
A machined receptacle was attached to the maxillary cast. Interchangeable plates ords Produ
r'vere designed for insertion into the receptacle for the purpose of record terior jig,
evaluation.
Attached to the upper member of the articurator was a fixed scribe which, when
lowered, recorded a specific point on the interchangeable plate (Fig.
3).
A FIFTH ]

A duplicate machined receptacle was mounted on a mechanical microscope As nel

stage. The removable plate was transferred from the articulator to the imPortant
mechanical
stage where it was magnified 25 times for data recording (Fig. 4). The best suiter
specific point
marking made for each centric relation record was carefrlly clntered under the cross- was taken
hair mounting within the eyepiece of the microscope. The mechanical stage was de_ ciallY Prel
signed with millimeter calibr:ation, which coulct be read to the nearest hundredth The ir
of a millimeter (Fig. 5)' Values obtained for each maxiilomandibular record were the soft, r

expressed in an x-axis and y-axis value. The anteroposterior measurement mandibul

was shown
on the y-axis coordinate, while the x-axis coorclinate expressed meciiolateral measure- livered tt
,l
lcnt.
ltJi'2 Volumc 28
Number 6
Centric-relation recording techniques 597

Fig. 5. The interchangeable plate is designed to fit the receptacle attached to the maxillary
cast and the tooimaker's mechanical microscope stage.
t,

ments. The cluster of six dots, representing the six tests done with one guidance sys-
tem, were joined to give an indication of the degree to which that specific guidance
system was replicable and consistent with the others (Fig. 6).
RESUTTS

This investigation was undertaken to determine if there was any significant rela-
tionship between centric relation records made by using four different techniques.
f
t The median variability was computed for each of the four methods studied. That
is, a mean point was determined for each cluster of six dots. The average deviation
from this mean was then computed for a1l subjects. The median variability was then
determined.
Swallowing or free-closure records produced a median variability of 0.40 mm.:
these records deviated 0.40 mm. frbm their mean point. Chin-point guidance rec-
ords produced a median variabi,lity of 0.14 mm.; chin-point griidance with an an'
terior jig, 0.07 mm.; and bilateral manipulation, 0.05 mm.
A FIFTH TECHNIQUE S

As nerv instruments ancl techniques are introduced, it will become increasingly

important for each individual dentist to have a means for determining which are
best suited for his use. With this in mind, a fifth method was studied. Extreme care
was taken in adhering to the Myomonitor technique. Records were made of a spe-
cially prepared resin material. Myojel was used as the electrolpe sohr,tion.
The input electrodes supplied with the Myomonitor were placed just anterior to
the soft, movable, lower lobe of the ear. This places the electrodes directly over each
mandibular notch where, according to the manufacturer, the impulse is best de-
livered to the motor center of the 5th cranial nerye, as well as to the mandibular
 i
Voluoe 2-B
598 Kantor, Siloerman, and Garfinkel J" Prosthet. Dent. Number ti
December, 1972

of free-closure a

i iess dePendable
pioYed the antet
Poster ior
DlscussloN
The PurPost
Lef, techniques for
(
termine variabi
l
The results
Anterior the MYomoniti
swallowing tecl
casts doubt on
means of chec

*4 Over 85 P
bilaterallY mat
This
records of
studY
mi
\ conjunction !
\- 'a'
associated wil
terior jig mal
the Posterior
Placement'
I
indicated'
In an efl
tested bY a s

character as

lateral mani
produced th
terns that w

SUMMARY
A measr
terning of c

tested were
centric rela
z?. were then

5.5 "6 J "8 .96.0 .t .2.3 4.5 coNCtusl

,6 I .8 .9 7.O
x The re
Fig. 6. X-axis and y-axis values are expressed for each record: Habitual or centric occlusion, clusions:
c,' swallowing, s,. chin-point guidance, c.p.g.; chin-point and anterior jig, j; bilateral manipu- 1' Bila
lation, b; Myomonitor, rz.
mandibuia
tested' Elt
division of the 4th cranial nerve. The dispersal electrode was praced cont:rct tion. Rec'
and was laterally centered with the nape of the neck.
while the
The Myomonitor produced a median variability of 0.38 mm" Lowest values indi-
2' Th
cate least variability, while highest values indicate greatest variability. The techniques
t. Dent. Volume 2B
et, 1972 Number 6 Centric-relation recotding techniques 599

of free-closure and Myomonitor recods proved to be approximately 700 per cent

Iess dependable when compard with the two most replicable techniques, which em-
ployed the anterior jig and bilateral manipulation.

DISCUSSION
The purpose of this study was to investigate the relative replicability of specific
techniques for recording centric jaw relation utilizing a measuring device to de-
termine variability.
The results obtained raise serious questions regarding the use of free-closure or
the Myomonitor methods to register an accurate centric position. The fact that the
swallowing technique produced the greatest variability among the techniques tested
casts doubt on the statement that "the swallowine reflex is an accurate physiologic
means of checking and even of recording centric relation."13
Over 85 per cent of the subjects tested showed greatest replicability with the
bilaterally manipulated recording technique.
This study provided data which clearly indicated that the most posteriorly placed
records of mandibular position were obtained with the use of an anterior jig in
conjunction with chin-point guidance. It is possible that condylar "drop" may be
associated with records made by this method. The deconditioning effect of the an-
terior jig may allow the mandible to r:etrude to the point where it is influenced by
the posterior slope of the articular (mandibular) fossa, thereby causing an inferior
placement. Further investigation into this aspect of the present study is clearly
indicated.
fn an effort to examine intraoperator variability, two additional subjects were
tested by a second dentist. Results obtained produced graphic tracings of the same
character as those produced on the 15 subjects tested under this investigation. Bi-
lateral manipulation produced the smallest displacement pattern, while swallowing
( produced the largest. Chin-point guidance with the anterior jig produced the pat-
I
terns that were most posterior.

SUMMARY
A measuring device was used to determine levels of consisten'cy and relative pat-
terning of centric relation records obtained from 15 dentulous subjects. The subjects
tested were betw-een the ages of 21 and 45 years. Clinical methods used for recording
centric relation were tested. Six records were made with each technique. The data
were then analyzed in relation to consistency and dispiacement patterns.

coNcrusroNs
The results, based upon this experimental design, brought the following con-
clusions:
1. Bilateral manipulation produced the smallest area of displacement of maxillo-
mandibular relation records when compared with the other recording techniques
tested. Eleven of 15 subjects showed greatest consistency with bilateral manipula-
tion. Records made with chin-point guidance showed relatively less consistency,
while the free-closure and Myomonitor techniques produced the least consistency.
2. Three of the four subjects in whorn bilateral manipulation did not produce
600 Kantor, Siloerman, and Garftnkel .I. Prosthet. Dcnt.
December, 1972 Opet
the most consistency clisplayed generally records reeardless of the tech-
nique employed.
3. The most protrusive positions u,ere recorded with the free-closure and Myo-
monitor techniques.
4. The most retrusive records were produced with the technique of chin-point
guidance with an anterior jig. The other two techniques-chin-point guidance (with-
PulPr
out an anterior jig) and biiateral manipulation-were intermediate.
5. With respect to mediolateral placement, bilateral manipulation appeared to
produce records farthest to the subject's left. However, differences were small and G. GO

not statistically significant. Facul'

6. Centric relation can be located by using an)r one of many techniques. There is .: Lond,
variability in the results obtained by any technique. Dentists should evaluate and
compare their registrations so that an objective technique selection can be made.
7. Further investigation is indicated to evaluate this problem in all three dimen-
sions simultaneously. This would help determine if a condylar drop creates a greater
number of posterior readings when viewed only on the horizontal plane.
The authors wish to acknowledge the assistance of Dr. Frank V. Celenza in designing this
I,,.."o
fession fol
study.
proPerties
References cePtabilit\
cal ProPe:
1. Atwood, D. A.: A Critique of Research of the Posterior Limit of the Mandibular Position,
J. Pnostun:r. DBNI. 20: 2i-36, 1968. such as A
2. Kingery, R. H.: A Review of Some of the Problems Associated With Centric Relation, J. However'
Pxosrrrsr. DBNI. 2: 307-319,1952. have not
3. Shanahan, T. E. J.: Physiologic Jaw Relations and Occlusion of Complete Dentures, J. The 1

Pnosrnrt. DrNr'. 5: 319-324, 1955.

posite-rel
4. Freese, A. S., and Scheman, P.: Management o{ Temporomandibular Joint Problems, St.
Louis, 1962, The C. V. Mosby Company, p. 162.
MATERIi
5. McCollum, B. B.: Function-Factors That Make Mouth and Teeth a Vital Organ, J. A-. J

Dent. Assoc. 14l. 1261-1271, 1927. Seve:

6. Granger, E. R.: Centric Relation, J. Pnosrnrr. DnNt.2:160-171, 1952. sodium'
7. Kornfeld, M.: Problems of Function in Restorative Dentistry, J. Pnosrnor. DrNr. 5:
670-676,1955.
with Nc
B. Thompson, J. R.: Anatomic and Physiologic Oonsiderations for the Positions of the Man- resin re
dible, Aust. Dent. J. 572 22-25, 1953. cording
9. Aull, A. E.: A Study of the Transverse Axis, J. Pxosrnrt. DBNI. 13: 469-+79, 1963, Zinc o>
10. Sloan, R. B.: Recording and Transferring the Mandibular Axis, J. Pnosrnrr. DnNt. 2: asaco
1.72-181, 1952.
A{t'
11. Lucia, V. D.: A Technique for Recording Centric Relation, J. Pnosr:uor. f)eNr. 14:
492-5A5,1964. 3i an intr
12. Long, J" H.: Location of the Terminal Hinge Axis by Intraoral Means, J. Pnosrur:r. in serir
DeNr. 23: 1l-24,1970.
i3. Freese, A. S., and Scheman, P.: Management of Temporomandibular Joint Problems, St. +Al
Louis, 1962, The C. V. Mosby Company. + jl'l

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