Centric and eccentric jaw relation / dental courses

SIGNIFICANCE OF
CENTRIC AND ECCENTRIC
JAW RELATION
FOR PATIENT
COMFORT AND FUNCTION.
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

INTRODUCTION
 The human mandible can be related to the maxilla in several positions
in the horizontal plane. Among these centric relation is a significant
position, because of its usefulness in relating the dentulous and
edentulous mandible to maxilla, where the teeth , muscles and
temporomandibular joint function in harmony. It is a position of
occluso-articular harmony.

CONTENTS
 Definitions
 Characteristics of CR
 Importance of CR
 Rationale of CR
 Applied anatomy
 Centric musculature
 Complications in recording CR
 Errors in CR
 Review of literature

 Significance of centric and eccentric relation
 Classification of methods of recording CR
 Recording of centric relation
- Manipulation of the mandible for centric relation
- Methods of recording centric jaw relation
 Eccentric relation and its recording
 Other methods of recording CR
 Summary and conclusion
 References

DEFINITIONSGPT,7, 1999
“The maxillomandibular relationship in
which the condyles articulate with the
thinnest avascular position 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”

 GPT 4,
The jaw relation when the condyles are in the most posterior, unstrained
position in the glenoid fossa at any given degree of jaw separation from
which the lateral movements can be made.
 BOUCHER
The most posterior relation of the lower to the upper jaw from which lateral
movements can be made at a given vertical dimension .

 THE GLOSSARY OF OCCLUSAL TERMS,
INTERNATIONAL ACADEMY OF GNATHOLOGY 1979,
The relation of the mandible to the maxilla when the condyles are in their
rearmost,uppermost,midmost positions in the glenoid fossae.centric
relation can exist over a range of jaw openings and is not violated until
the condyles leave their posterior positions in the glenoid fossae, the
unstrained hinge position of the mandible.

Differences in GPT definitions on
centric relation position
 The two definitions of centric relation taken from
GPTs(GPT4 and GPT5)appear to contradict each
other.the earlier definition mentions of a most
posterior position of condyles in glenoid fossa,
while the later definition speaks of an anterior
superior position of the condyle against the
slopes of the articular eminences. Surprisingly the
discrepancy between RUM position and anterior
superior position is only 0.2mm.Theorotically the
difference is only on the emphasis of the condylar
position of the centric

Two characteristics of the centric relation
1. CR is a retruded mandibular position where the condyles
are located in their most posterior position in the glenoid
fosssae as far as the ligaments and muscles of the TMJ
will permit or an antero-posterior position of the
condyles against the slope of articular eminences.
2. In centric position the condyles exhibit pure rotation
without any translation and the mandible moves in hinge
motion to a distance of 2.0-2.5 cm at the incisor in the
sagittal plane.This characteristic retruded mandibular or
antero-superior condylar relation together with the hinge
axis concept of centric relation differentiates it from
eccentric positions

Importance of centric relation
 Centric relation is a reproducible and stable
position.Therefore it is used as a reference when
mounting dentulous and edentulous casts in
articulator.Thus CR serves as a reference
relationship for establishing an occlusion.
 When CR and CO of artificial teeth do not
coincide or a freedom of centric is not present the
stability of denture bases is in jeopardy and
patient will have unnecessary pain or discomfort.

Importance of centric relation
cont..
 Edentulous patients use CR closures in
mastication and in other mandibular
activities such as swallowing.
 An accurate CR record will properly orient
the lower cast to the opening axis of the
articulator and orient CR to the hinge axis
of both the articulator and the mandible

 The irregular loss of teeth has often shunted the mandible
into a protrusive or lateral position or both.The most
favorable position for the mandible for complete dentures
is exactly in centric relation.The muscles,the bones,the
ligaments,the teeth and all structures grow into what
might be termed a muscle center.
 To change,haphazardly,this muscle center is to imperil
the stability of the dentures.The stability of the natural
teeth is jeopardized when the mandible loses its CR;
dentures can even less afford an off centric relation.For
these reasons it is well worth the time and efforts
necessary to obtain an accurate centric relation record.

Long Centric
 According to Peter Dawson “it is the
freedom to close the mandible either into
centric relation or slightly anterior to it
without varying the vertical dimension at
the anterior teeth.”

Two points to understand about
long centric are:
1) Long centric involves primarily the anterior
teeth.
2) Long centric refers to freedom from centric,not
freedom in centric.
 According to Dawson in the absence of any CR
interferences difference between centric closure
and light closure from rest rarely exceeds
0.5mm,the usual long centric would be close to
0.2mm,and there are patients who do not require
“long centric”at all because their light closure
from rest is identical to their firm closure into
CR. www.indiandentalacademy.com

Applied anatomy
 Glenoid fossa is not a functional load
bearing unit of the joint but a mere
pathway for mandibular movements.
 Medial wall of the glenoid fossa and
posterior part of the articular eminence can
be the functional elements.

Centric musculature
 Williamson studied the pattern of muscle
contraction in centric relation.
 He found out: contraction of superior head of
MP placed the disc against the posterior
slope……and contraction of temporalis placed
the condyle superiorly in close approximation to
the articular disc
 This condyle disc assembly was finally
seated…………….by massater and temporalis

 Boucher observed that posterior and
middle fibers of temporalis and suprahyoid
(mainly digastric and geniohyoid) move
and fix the mandible in its most retruded
position relative to the maxilla

Complications in recording CR: The structure of TMJs are such that one joint can be
displaced downward by uneven pressure when records
are made and yet the condyles be in their most retruded
position. This situation cannot occur on the articulator
and thus a deflective occlusal contact may be the source
of instability,soreness and resorption despite the
correctness of the other relations.
 Realeff effect by Hanau: according to it, there is uneven
resiliency in the soft tissues.This resiliency is present in
both the mucosa and the TMJs,thus undue pressure in
securing the relation must be avoided lest excessive
displacement of soft tissues occur
 Even though a balanced and equilized registration has
been made it often is lost due to:
I. Cast mounting procedures
II. Processing of denturewww.indiandentalacademy.com

ECCENTRIC RELATION
Any relationship of the mandible to the maxilla other than centric
relation.
The eccentric relations that are recorded and used in complete
dentures are
Protrusive
Right lateral
Left lateral

CENTRIC OCCLUSION
According to Peter Dawson(1974) : Centric occlusion refers to the
relationship of the mandible to the maxilla when the teeth are in
maximum occlusal contact, irrespective of the position or alignment
of the condyle-disk assemblies. This is also referred as acquired
position of the mandible or maximum interocclusal position ( MIOP)
Centric occlusion should coincide with centric relation in artificial teeth.

REVIEW OF LITERATURE
 McCollum in 1920 explained the centric
relation as the ---Rearmost condylar
position. He was the first person to name
this relation as the centric relation.
 Granger (1962)---- added a second
component to this existing explanation of
McCollum, he said CR is the
Upmost,Rearmost position

 Stuart(1969)--- A medial component was added
for a stable condylar position(3D position).It was
considered a physiological condylar position
harmonious with CR.
 Celenza(1978)---condyle disk assembly braced
superiorly and anteriorly against the posterior
slope of eminentia.Today this is widely accepted
for optimum condylar position

 According to schugler:,1932
He observed that if the recording medium was not of uniform density and
viscosity, uneven pressures would be transmitted to the record bases
which would cause a disharmony of occlusion. He said that modeling
compound was preferable to wax for occlusal records, because it doesn't
distort as much as wax records.

According to Wright - 1939,
He described four factors that affect the accuracy of centric relation
a) Resiliency of the tissues,
b) Salivary film
c) Fit of bases
d) Pressure applied.
He concluded that dentist couldn't control the pressure at which the record
was made, so the best technique was to record at zero pressure.

BOOS IN 1940,
Used the gnathodyanamo-meter to determine the vertical and horizontal
position at which a maximum biting force could be produced. This
bimeter was mounted on the lower occlusion rim. Plaster registrations
were made with the bimeter in the mouth and the patient exerting
pressure.
BOOS theorised that optimum occlusal position and the position of
maximum biting force would coincide. He also thought that it was
essential that all registrations be made under biting force so that the
displacement of soft tissues which occur in function would occur during
bite registration.

According to shanahan:1955
In this physiologic technique, placed cones of soft wax on the
mandibular rim and asked the patient to swallow several times.
During swallowing the tongue forced the mandible into the centric
relation position. The soft wax cones were reduced due to the act of
swallowing and physiologic centric relation was recorded.

According to PETER DAWSON,1974
Suggested Bimanipulation technique.He suggested that condyles do not
always move superiorly, but sometimes ,in response to posterior
guidance from the operators, they move inferiorly. Because of this
clinical observation, they concluded that posterior should be used
sparingly and with great care. He emphasized the importance of
superior placement of the condyles in the fossa when attempting to
record centric relation.

Mohammed A El Armany et al (1965)
He noted that the needle point tracings at a given VD of jaw separation
under the same controlled settings,on the same individual at the same
sitting were not significantly different.
On the basis of his study, needle point tracing is reliable.
He also pointed out that if the jaw separation is increased the apex of the
needle tracing moves posteriorly in a constant manner.

SIGNIFICANCE OF
CENTRIC-RELATION

1.It is the ideal arch to arch relationship and hence optimum position of jaws
for the health, comfort and function of TMJ
2.It is a mandibular position where the condyle-disc assembly is seated/braced
in anterior-superior position against the posterior slope of articular
eminence. Although it was believed to be the upmost, rearmost position in
the glenoid fossa(RUM)
3.Centric relation is related to terminal hinge axis. In centric relation condyles
exhibit pure rotation without any translation. In this position the mandible
moves in a hinge motion to a distance of 15-25 mm at the incisal in the
sagittal plane. It is therefore a relationship of mandible to maxilla when
both the condyles are in terminal hinge location/hinge closure

4.Errors in mounting of the cast can be detected, when centric relation is
used as a horizontal reference position.
5.An accurate centric relation record properly orients the lower cast to the
opening axis of the articulator and the mandible
6.Accurately recorded centric relation when transferred to the articulator
permits proper adjustments of the condylar guidances for the control
of eccentric movements of the instrument.

7.It is a reproducible position which can be repeatedly arrived at and thus
serves as a reliable guide to develop centric occlusion in artificial
dentures.
8. It serves as a reference position for the institution of occlusal rehabilitation
in dentulous condition.
9.It serves as the reference position to relate and nomenclate several occlusal
positions of upper and lower teeth.

10. The terminal act of masticatory stroke terminates in centric relation.
11. It is a posterior border position and the posterior limit of the envelop of
motion.
12. It is repeatable, recordable and a physiologically acceptable position for
mastication and deglutition.

CONDYLES ARE HEALTHY AND COMFORTABLE ONLY
IN CENTRIC RELATION
1. If they are correctly aligned with their discs.
2.Stopped by bony stop.

APEX OF FORCE POSITION OF THE CONDYLES
Is the position a healthy condyle assumes if its disk is properly aligned
and there is no muscle bracing to prevent it from going to the most
superior position against the eminentia.
If the disc is properly related to the condyle the position at the apex of
force relates to the most superior position against the eminencies.This
position can be recorded with extremely accurate repeatability and
Dawson describe it as Centric Relation

 Reasons for advocating the uppermost position
 Mechanical standpoint
 Physiological standpoint

PROPRIOCEPTIVE –ENGRAM
Because of constant repetition of proprioceptive triggers to the muscles,
They become patterned to the devious closure due to interferences
These patterns get memorized
Results in physiologic disharmony between the teeth and joints.

TMJ DISCOMFORT IS DUE TO :
1.Improper position of the condyle.
2.Improper alignment of the disc
3. Pathosis of articulating surfaces.

DIAGNOSIS OF IMPROPER CONDLYE POSITION

MISALIGNMENT OF THE DISC

PATHOSIS OF THE ARTICULATING SURFACES

ADAPTED CENTRIC POSTURE:
Is the relationship of the mandible to the maxilla that is achieved when
the deformed TMJ have adapted to the degree that they can
comfortably accept firm loading when completely seated at the most
superior position against the eminentia.

The mandible is in adapted centric posture if 4 criteria are fulfilled
1. the condyles are comfortably seated at the highest point against the
eminentia
2.The medial pole of each condyle is braced by bone.
3.The inferior pterygoid muscles have released contraction and are passive.
4.The condyle-fossa relationships occur at a manageable level of stability.

ERRORS IN CENTRIC RELATION
When centric relation is not coinciding with centric relation of the patient
Due to:
1.Incorrect horizontal relation of the mandible to the maxilla
2.Incorrect equalization of vertical contact.
Errors may be positional errors, technical errors.

POSITIONAL ERRORS:
1.Failure of the operator in his registration of the correct horizontal relationship.
2.Failure of the operator to record equalized vertical contact
3.Application of excessive closure pressure by the patient at the time of recording
4.Changes in the supporting area

TECHNICAL ERRORS:
1.ill fitting occlusion rims: if record bases are not stable
2.Indiscriminate opening and closing of the occluding device or articulator;
an articulator in reality is a jig which maintains a record of position. Even
if the casts are mounted correctly, the amount which we can arbitrarily
vary the vertical distance between the casts is limited.
3.Too frequently the lab technician opens and closes the vertical distance of
the articulator for the convenience in tooth arrangement. this results in
the establishment of the centric occlusion which is not coinciding with
centric relation.
4.The slight shifting teeth which occurs between the stage of final
arrangement in wax and the transfer to a permanent base material.
5.A movement by the tooth or several teeth either horizontally, or vertically,
introduces an error.

SYMPTOMS WHICH RESULT FROM ERRORS IN
RECORDING CENTRIC RELATION.
1.Symptoms due to unequalised vertical contact are:
a) Loss of retention
b) Irritation on the crest of lower ridge in the area of premature
contact.
c) One tooth or several teeth on one side seem long to the patient
or seem to strike first.
d) Premature contact may be anteriorly or posteriorly.

ANTERIOR ERROR - when the
centric occlusion established in
the arrangement of teeth is
anterior to the centric relation.
POSTERIOR ERRORS - when
centric occlusion established is
posterior to the centric relation of
the patient.

RECORDING OF CENTRIC
RELATION
There are two aspects :
1.Assisting the patient to retrude the mandible
2.Recording.

Effective manipulation of mandible requires delicacy and firmness.
METHODS FOR ASSISTING THE PATIENT TO RETRUDE THE
MANDIBLE.
 Relaxing the jaw and closing
 Repeatedly protruding and retruding the mandible
 Boo’s series of stretch relax exercises
 Swallowing and closing
 Tapping the rims or back teeth repeatedly
 Touching the tip of the tongue to the posterior aspect of the palate or
denture border and bite.
 Palpate the temporal and massater muscles to relax them.

Difficulties encountered in
retruding the mandible to centric
relation:
 Biologic:- lack of coordination of opposing
muscles……
 Psychologic:-difficulties involving both the dentist
and the patient
 Mechanical:-encountered in securing CR in poorly
fitted baseplates……

Methods to guide mandible in CR
 Chin point guidance-GUICHET(1970)
Thumb and forefinger –position the condyle in RUM position
 Bimanual method-peter dawson(1974),
Guides the mandible in anterosuperior position.
 Three finger method- Peter thomas(1980)
Thumb,forefinger and middle finger positions condyle in anterior superior
position.
 Leaf gauge principle(Anterior Deprogrammer)-Long,Wiliamson(1980)
guides the mandible to obtain maximum superior anterior braced position of
condyles against the disk.

Anterior deprogrammer
 Provides anterior stop to eliminate tooth contacts thereby eliminating
proprioceptive influence from teeth. This allows the condyles to seat
in centric relation without the influence of engram
Types: 1.Tongue blade-Stuart
2. Anterior jig - Lucia
3.Leaf gauge - Long

Dawson’s Bilateral Manipulation
method
Step1.Recline the patient all the way back;point
the chin up

Working from a back position
stabilize the head
Place 4 fingers on lower border
of mandible
Bring thumbs to form a C

Factors influencing centric
relation records:
 The resiliency of the supporting tisssues
 The stability of the record bases
 The TMJ and its associated neuromuscular mechanism
 The skill of the dentist
 The health and cooperation of the patient.
 The maxillomandibular relationship
 Posture of the patient.
 Character or size of the residual alveolar arch
 Amount and character of the saliva
 Size and position of the tongue
 Character of the pressure applied in making of the
recording www.indiandentalacademy.com

METHODS OF RECORDING CENTRIC JAW RELATION
1.Functional method:
Needles house method
Patterson method
2.Graphic method:
Intra oral method
Extra oral method
3.Physiological method:
Tactile or interocclusal check record method
Pressure less method
Pressure method
4. Radiographic method:

Kingery classified techniques for
recording centric relation as:
 Graphic
 Direct
 Functional

The Tripodal method of recording
centric relation comes under direct
method.It has following advantages:
1. It results in a stable relationship with minimum contact
and maximum visibility.
2. It allows more accurate control of the mandibular record
base while the operator guides the mandible into the
centric relation position.
3. Records can be made with minimum pressure.
4. Records can be verified quickly in the mouth.
5. If metal tacks are used,the patient’s habitual or
undirected pattern of closure can be recorded and
compared with the centric relation prior to selecting or
arranging the teeth.www.indiandentalacademy.com

FUNCTIONAL METHOD OR CHEW IN
METHOD
These methods utilize the functional movements of the jaws to record the
centric relation.
The patient is asked to do the movements in protrusion ,retrusion,and
right lateral and left lateral.

NEEDLES HOUSE METHOD

PATTERSON’S METHOD

GRAPHIC METHOD
These methods are so called because they use graphs to record the centric
relation
Two types:
1.Arrow point tracing
2.Pantograph

ARROW POINT TRACING
 Measured across a single plane
 Central bearing device is used.
 Defined as" a device that provides a central point of bearing or support
between the maxillary and mandibular dental arches. It consists of a
contacting point attached to one dental arch and a plate attached to the
opposing dental arch. The plate provides the surface on which the bearing
point rests or moves and on which the tracing of the mandibular
movement recorded. It may be used to distribute the occlusal forces
evenly during jaw relation and/or the correction of disharmonious
occlusal contacts.-GPT

CENTRAL BEARING DEVICE CONSISTS OF :
 Central bearing point
 Central bearing plate

 Central bearing point Central bearing plate

TYPES OF ARROW POINT TRACERS
Depending upon the placement of recording device:
Intra oral
Extra oral

EXTRAORAL ARROW POINT TRACING
 Larger than intraoral because they are made farther from centers of
rotation
 Apex is more discernible.
 It is visible while tracing is being done
 Patient can be guided properly.

Types of Extra Oral Tracers
 Hight tracers(with or without central
bearing point)
 Stransbery tracers
 Sears trivet (is a central bearing point
tracer with two registration pins)
 Phillips tracer (it registers CR and condyle
paths simultaneously)

INTRAORAL ARROW POINT TRACING
 Located intraorally
 Simple compared to extraoral
 Disadvantage:
1. it cannot be observed during the tracing
2.small, it is difficult to find the true apex.
 Procedure……..

Types of INTRAORAL ARROW
Tracers
 Seidel
 Ballard
 Masserman

Extra oral tracing procedure

PANTOGRAPHS -is an instrument used to graphically record
one or more planes/paths of mandibular movement and to provide
information for the programming of the articulator-GPT
PANTOGRAPHIC TRACING;
A graphic record of mandibular movement in three
directional planes as registered by the styli on the recording tables of a
pantograph; Tracings of mandibular movement recorded on plates
in horizontal and sagittal planes-GPT.

PHYSIOLOGICAL METHODS
 They are called so they are based on the proprioceptive impulses of
the patient.
 Kinesthetic sense helps to direct mandibular movements
 Visual acuity and sense of touch of the dentist.
 No pressure is exerted on the interocclusal record.

TACTILE SENSE OR INTEROCCLUSAL CHECK RECORD
METHOD.
 INDICATIONS:
 abnormally related jaws
 Displaceable, flabby tissues.
 Large tongue
 Uncontrollable mandibular movements.
 Patients already using complete dentures.

 FACTORS AFFECTING ……
 Uniform consistency of the recording material.
 Accurate vertical jaw relation records.
 Stability and fit of the record base
 Presence of reference points embedded in the record like
metal pins or styli.

MATERIALS USED ….
1.Waxes.
2.Impression compound
3.Zinc oxide eugenol

PROCEDURE:
2 Steps
1.Tentative records using occlusion rims attached to stable record bases.
2.Interocclusal check records made at the try in appointment after the teeth
arrangement is done

STATIC OR PRESSURELESS METHOD:

PRESSURE METHOD
 The entire lower occlusal rim is softened in water bath and inserted
carefully into patient mouth.
 Patient is guided in centric relation till predetermined vertical
dimension is achieved. Cooled and articulated.

Other methods to record CR are:

ECCENTRIC RELATION
 An eccentric relation is any relationship of the mandible to the maxillae
other than centric relation.
 The purpose in making an eccentric relation record is to adjust the
horizontal and lateral condylar inclinations so that the articulator jaw
members perform eccentric movements equivalent.
 This permits to arrange the teeth in balanced occlusion
 Eccentric positions: protrusive, retrusive, right lateral and left lateral.
METHODS TO RECORD.
 Functional or chew in
 Graphic
 Tactile or direct check record.www.indiandentalacademy.com

LATERAL RELATION RECORD:
 Hanau recorded a formula to arrive at an acceptable lateral inclination
 L=H/8+12 where L= lateral condylar guidance,H= horizontal
condylar guidance

 Eccentric maxillomandibular
relation records is performed at
the same setting,same sitting and
with the same equipment used for
centric relation
 Procedure……..

GOTHIC ARCH TRACING

TACTILE OR DIRECT CHECK
RECORD

VERIFICATION OF CENTRIC RELATION

SUMMARY
 Centric relation is a most reproducible , reliable, repeatable , recordable,
and reference position
 CENTRIC RELATION IS DEFINED AS THE maxillomandibular
relation in which the condyles articulate with the thinnest avascular
portion of their respective articular disks with the complex in an anterio
superior position against the slopes of articular eminences.
 Eccentric relations are any other positions other than centric relation-p
 Centric relation should coincide with centric occlusion otherwise will
affect the stability of the dentures.
 It can be recorded by various methods:
Direct recording
Graphic recording
Functional recording
Cephalometric recording

CONCLUSION
 Any dentist who is willing to spend the time and energy to master the
technique of recording and verifying precisely correct centric relation
will benefit in untold ways.There is no procedure in dentistry that can
produce as many tangible benefits to both the doctor and the patient
as the routine correct recoding of centric relation,verified for
accuracy as it affects the health ,comfort, function of the muscles,
and TMJ.

REFERENCES
 Charles M .Heartwell JR. and rahn a. o:syllabus of complete
dentures.fourth edition.
 John sharry:complete denture prosthodontics.
 Winkler.s:essentials of complete denture prosthodontics
 Carl . O. boucher :prosthodontic treatment for edentulous patients,10
edition.
 Dawson.p.e:evaluation,diagnosis and treatment of occlusal problems:2
edition
 Ernest.r. granger:centric relation,j.p.d 1952:2 160-169
 Kingery.r.h:problems associated with centric relation;j.p.d1952;2;307..
 Krishan k. kapur, and albert yurkstas: an evaluation of centric relation
records obtained by various techniques;jpd 1957;7;770-786
 Boos, R.H:centric relation and functional areas.Jpd1959;9 ,191
 Shanahan.T.E;physiologic vertical dimension and centric
relation;J.P.D1956,6,741-747

 William E Avant: using the term centric,JPD,1982, 47, 141-145
 Peter E Dawson :
 new definition for relating occlusion to varying conditions of
TMJ,JPD1995,74 :619-627
 Donna L. Dixon:overview of for articulation material and methods
prosthodontic patiet:JPD 2000;83;235-247

 Langer A:the validity of maxillomandibular records made with trial and
processed acrylic resin; JPD 1981(45) 253-258
 Myers ML: Centric Relation records historical review,JPD 1982(47)141-145
 Yurkstas ,kk kapur factors influencing centric relation records in edentulous
mouths,JPD(14):1054-1065,1964
 Physiologic vertical dimension and centric relation,JPD mar2004vol91(3)
 Centric relation,centric occlusion and posterior teeth arrangement JPD
1977Jan37(1)5-11
 Need for eccentric balance during masticationJPD1990Dec64(6)689-690

Centric and eccentric jaw relation / dental courses

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