Jaw relation procedures and different methods in partially edentulous patients.

1. Vinay Pavan Kumar K
2nd year P G student
Dept of Prosthodontics
AECS Maaruti College of Dental Sciences

3. Purpose of Recording the Jaw
Relations
 To establish and maintain a harmonious
relationship
 To ensure that all the effects of occlusal loading be
distributed
 To best control the undesirable effects of rotational
or torquing forces on the prosthesis.
 To prevent any deflective contacts of the teeth
during centric or eccentric closures

4. Recording Jaw relation
 Before construction of framework - mounted on
an articulator
 Definitive jaw relation – after functional
impression and altered cast

5. Methods of recording Jaw
relation
 Direct apposition of cast.
This should not influence the path of closure of
mandible

6.  Interocclusal records with posterior teeth
remaining

7.  Occlusal relations using occlusion rims on
record base
 one or more distal extension areas are present
 a tooth supported edentulous space is large
 when opposing teeth do not meet

8.  Jaw relations records made entirely on
occlusion rims
 when either arch has only anterior teeth present
 opposing posterior teeth do not meet

9.  Establishing Occlusion by the Recording of Occlusal
Pathways
 Support the wax occlusion rim with a denture base
 occlusion rim must be worn for 24 hours or longer
 After 24 hours, the occlusal surface of the wax rim should show a
continuous gloss, which indicates functional contact with the
opposing teeth in all extremes of movement.
 After a second 24- to 48-hour period of wear, the registration
should be complete and acceptable

10. Vertical Dimension
 VDO
 VDR
 Freeway space

11. Altering the existing vertical
dimension of occlusion

12. Symptoms of diminished VDO
 like tired aching muscles
 unexplained pain in the head and neck
region
 shortened nose-chin distance
(appearance of premature aging)
 Excessive Free way Space or ‘over-
closure’ of the jaws

13.  Wearing of the teeth does not mean that
VDO should be increased – unless the free-
way space is greater than 4mm.

14. How to alter the existing VDO
1. Confirm the loss of VD by taking
history, cephalometric
examination, and the
presence of excessive free-
way space.
2. Increase the existing VDO
temporarily by fabricating an
acrylic resin occlusal overlay
appliance in maximum
intercuspation, ensuring that
4mm of freeway space must
exist.

15.  3. Restore the desired VDO permanently with
the help of fixed or removable prosthesis only
after the physiologic response of the patient to
this appliance is positive.

17. Facebow transfer
 To relate the maxillary cast to the
condylar elements of the articulator at
the same orientation that the maxillary
teeth have to the mandibular condyles of
the patient.

19. Horizontal jaw relation
centric relation centric occlusion

20. centric relation or centric
occlusion ?
 The most delicate proprioception in your body
is between the upper and lower teeth.

21. In more than 90% of people, C.O is 0.5 - 2mm in
front of the CR
Centric relationCentric occlusion

22.  C.O should be recorded
when there are cusps on
remaining natural teeth
that can guide the
mandible back to its
position.
 C.R should be recorded
for distal extension RPD,
or when the opposing
arch is edentulous.

23. When Not to Use Centric
Relation
 Stable occlusion
 Posterior centric stops present
 No valid reason to change
 Use maximum intercuspation

24. Try In Appointment
 if the RPD opposes a complete denture
 all posterior teeth in both arches are being replaced
 if no opposing natural teeth are in contact
 Provides verification of the jaw relation recorded
 provides an, opportunity to view and approve the esthetic
size, color, and arrangement of the anterior teeth
 Phonetic inspection

25. Desirable occlusal contact relationship
for removable partial dentures
 Simultaneous bilateral contact – centric occlusion
 Tooth supported partial denture – occlusion as in
natural dentition
 Maxillary complete denture opposes partial denture
- bilateral balanced occlusion in eccentric positions

26.  Bilateral upper distal extension base -
simultaneous working and balancing side contact
 Only working contacts need to be formulated for
the maxillary or mandibular unilateral distal
extension removable partial denture

27.  Bilateral distal extension mandibular RPD opposed
by natural dentition in the maxillary arch - Working
contacts are achieved
 Artificial posterior teeth should not be arranged on
the sharp upward incline of the mandibular residual
ridge or over the retro molar pad

28. Possible scenarios adapted from Henderson place
emphasis on RPD stability

29. Three possible sequelae of occlusal error
 If the premature contact is on a natural tooth, damage to
the tooth or its periodontal ligament may occur.
 If the saddle bears the brunt of the force of closure, there
will be localised mucosal inflammation and resorption of
the underlying bone.
 If the patient attempts to steer the mandible around the
premature contact until a more comfortable occlusal
position is found, this abnormal closing pattern throws
increased demands on certain muscles of mastication,
which may result in the patient complaining of facial pain.

30. Maxillary complete denture
opposing a RPD

34. Occlusal consideration in implant
retained partial denture
 axial displacement of teeth in the socket are 25-100 μm,
while that of the osseointegrated dental implants has
been reported approximately 3-5 μm
 natural tooth moves 56-108 μm and rotates at the apical
third of the root upon a lateral load
 Dental implant moves 10-50 μm under a similar lateral
load

35. Conclusion
An ‘ideal occlusion’ in removable
prosthodontics is one which reduced de-
stabilisating forces to a level that is
within the denture’s retentive capacity

36. References
 Carr AB, Brown DT, McCracken’s Removable
Partial Prosthodontics, 12th edition, Canada,
Elsevier Publishers, 2011, pp:242-252
 Stewart, Rudd, Kuebkar, Clinical Removable Partial
Prosthodontics, 2nd edition, India, All India
Publishers and Distributors, 2001, pp:367- 396
 Jones DJ,Gracia LT, Removable Partial Dentures :
A Clinician’s guide, 1st edition, Singapore, Wiley-
Blackwell, 2009, pp : 90-94

37. Jacobs, R. and Van Steenberghe D. (2006),
From osseoperception to implant-mediated
sensory-motor interactions and related clinical
implications. Journal of Oral Rehabilitation,
33: 282–292.
Davies S.J, Gray .R and McCord J.F, Good
occlusal practice in removable prosthodontics
British Dental Journal 2001; 191: 491–502
Davenport .J.C etal The removable partial
denture equation, British Dental Journal 2000;
189: 414–424