Centric relation: Controversies surrounding it

CENTRIC RELATION: CONTROVERSIES SURROUNDING IT

INTRODUCTION:
“Gnathology is dentistry” – Niles Guichet
Though the primary function of teeth is mastication, teeth are not chewing
organs by themselves. They are capable of performing their functions only when it is
used collectively with the other components of stomatognathic system.
Beverly McCollum of California in 1926, with Dr. Harvey Stallard coined the
term “Gnathology” to describe the study and treatment of the entire masticatory
apparatus as one functional unit.

CONFUSION IN TERMINOLOGIES
Centric relation has no function – A realistic supposition:
Even though centric relation is considered as the terminal position in the act of
mastication, it does not directly contribute to mastication. In reality, teeth do not come
in contact during chewing. Thompson has shown that teeth should not and need not
contact during mastication and a portion of food bolus is always present between the
upper and lower cusps of teeth during mastication.
Earlier, Stuart also claimed that all the functions of the mandible are in front
of centric relation. When occlusion is reached, masticatory function is finished. He
stated that the closure of the jaws does its function on the way to occlusion. When
occlusion or closure is reached, function is already finished. This is also true with
centric relation. Masticatory function of the mandible is in front of centric relation
before the mandible reaches centric relation. Stuart also mentioned that “by placing
interferences, deflections and premature contacts in the path to centric relation, we
disallow full function”.
McCollum described centric relation as the most retruded idle position
because function is completed by the time jaw reached centric relation position.
Ramjford aptly described centric relation to a ‘polar star’; you have to follow it to
orient the mandible in the right direction.

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 Centric relation: Controversies surrounding it
Chronology of the changing definitions on the condylar position in centric jaw
relation during the past century:

1. Rear most condylar position – McCollum (1920)

McCollum demonstrated that the condyle executed a pure rotational hinge
movement when the operator guided the mandible to position the condyles in the most
retruded position in the glenoid fossa. McCollum named this position as centric
relation and was the first to record the hinge axis of mandible.

2. Upmost, rear most condylar position – Granger (1952)

A second component namely a most superior position was considered
necessary for bracing, since the condyle was unstable when it was only in the most
posterior position.

3. Rearmost, uppermost, midmost condylar position (RUM position) – Stuart

(1969)
A medial component was added for a stable condylar position (three
dimensional position). It was considered a physiological condylar position harmonius
with centric occlusion. RUM position was accepted by the International Academy of
Gnathology.

4. GPT – 7 gives a series of seven definitions which have changed over a period
of time. The definitions are:
a) A clinically determined position of the mandible placing both condyles into
their anterior uppermost position. This can be determined in patients without pain
or derangement in the TMJ (Ramfjord).
b) The relation of the mandible to maxilla, when the condyles are in the
uppermost and rearmost position in the glenoid fossa. This position may not be
able to be recorded in the presence of dysfunction of the masticatory system.
c) A maxilla to mandible relationship in which the condyles and discs are
thought to be in the midmost, uppermost position. The position has been difficult
to define anatomically but is determined clinically by assessing when the jaw can
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 Centric relation: Controversies surrounding it
hinge on a fixed terminal axis (upto 25 mm). It is a clinically determined
relationship of mandible to the maxilla when the condyle disc assemblies are
positioned in their most superior position in the mandibular fossae and against the
distal slope of articular eminence (Ash).
d) The most posterior relation of the lower to the upper jaw from which lateral
movements can be made at a given vertical dimension. (Boucher)
e) The next definition was the most accepted definition for years, that is, “the
most retruded relation of the mandible to the maxilla, when the condyles are in
most posterior unstrained position in the glenoid fossae from which lateral
movements can be made, at any given degree of jaw separation.”
f) The sixth definition given in GPT is “the most retruded physiologic relation of
the mandible to the maxillae to and from which the individual can make lateral
movements. It is a condition that can exist at various degrees of jaw separation. It
occurs around the terminal hinge axis”.
This included term ‘physiologic relation’ as the emphasis was given more on
anatomical relationship of condyles and fossae. Also, it defines centric relation ‘at
various degrees of jaw separation’, although centric relation and centric occlusion
must be at the same vertical level. Robinson and others have defined it erroneously as
physiologic rest position. Silverman and other believers of constancy concept of rest
position proved that vertical dimension must not be increased. Therefore, this portion
of the definition was not accepted by all the prosthodontists and stayed contradictory
to scientific facts and added further confusions to jaw relation.

g) The latest definition which is prevalent and has been supported by anatomical,
physiological and clinical facts, states, “the maxillo-mandibular relationship in
which the condyles articulate with the thinnest avascular portion of their
respective discs with the complex in the anterior-superior position against the
shapes of the articular eminences. 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”.

Criteria for redefining centric position of the condyles from RUM to Superior
anterior position – An anatomical overview

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 Centric relation: Controversies surrounding it
1. It has been shown that the roof of glenoid fossa is extremely thin and
translucent in some dry specimens. There is also no articular cartilage in the glenoid
fossa, but there are many minute foramina presumably for the passage of blood
vessels and nerves. The ‘glenoid space’ is occupied by the thickened posterior zone of
articular disc. This portion contains blood vessels and nerves and therefore not suited
for function of articulation.
2. The superior portion of the condylar head is covered with articular cartilage
extending forward over the anterior face of the condyles and it is designed for stress.
Similarly, the bone trabecular struts on the curved surface of the posterior portion of
eminentia are oriented parallel to the direction of forces. This shows, the bone of the
distal slopes of the articular eminence is designed to withstand stress. Therefore,
Celenza felt that the posterior slope rather than the glenoid fossa is the articular
portion of the joint.
3. The center of the articular disc which is interposed between the condyle and
the posterior slope of the articular eminence is devoid of nerves and blood vessels,
indicating a stress bearing portion or functioning area of the disc, while the non stress-
bearing thick periphery of the disc is rich in blood vessels and nerves. The disc is
thickest posteriorly (2.9 mm) and thinnest in the middle part (1.1 mm). Therefore,
from an anatomical point of view, neither the roof of glenoid fossa nor the retrodiscal
bilaminar zone is considered suitable for articulation or as a stress bearing site.
Rather, the posterior portion of the eminence articulating with the thin intermediate
zone of the articular disc opposed by the anterior face of the condylar head appears to
be the most logical functional arrangement for centric positioning of condyles
(Celenza, Lucia).
Further in a longitudinal study, Celenza (1973) re-examined 32 of his best all
gold posterior reconstructions restored to centric relation with tripodised centric stops
(point centric), several years after insertion and found that all patients subsequently
established a more anterior position. A discrepancy of 0.02 to 0.36 mm between
centric relation and maximum intercuspation was noticed.
Therefore, Celenza questioned whether RUM position was physiological to
the joint and concluded that the anterior-superior bracing of the condyle disc assembly
against the slope of eminence was the optimum condylar position in centric. The
discrepancy between the two positions is 0.2 mm (Hobo).

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 Centric relation: Controversies surrounding it
The two definitions of centric relation taken from the Glossary of
Prosthodontic terms (GPT-4 and GPT-5) appear to contradict each other. The earlier
definition mentions of “a most posterior position of condyles in glenoid fossa”, while
the latter definition speaks of “an anterior superior position of condyle against the
slopes of the articular eminence”. Which one do we teach and how to we explain the
difference? Surprisingly the discrepancy between RUM position and anterior-superior
position is only approximately 0.2 mm. Theoretically, the difference is only on the
emphasis on the condylar position of centric.

AN EXPOSITION OF CENTRIC RELATION:

A. Two dimensions of centric relation – Dual centric
Centric relation should be understood as a complex term with a condylar and
mandibular dimension. The condylar centric position should be differentiated from
mandibular centric position.
a) Condylar centric position is a condyle disc- fossa/eminentia relationship.
b) Mandibular centric position is a maxillo-mandibular relationship.

B. Two definitions of centric relation

a) Anatomical or location-based definition:
. All the seven definitions given in GPT-7 are location-oriented. These
location-based definitions provide information as to how to secure this position of the
lower jaw. Besides this, they have no importance.
b) Significance based definition:
A functional definition of centric relation explains why centric relation is
important. The definitions of centric relation given in GPT and by others are
anatomical definitions, which describe only about the location of condyles or the
mandible in centric relation. For example, the anatomical definition of GPT-7 is only
guide to indicate the status of condyles.
C) Two characteristic features of centric relation:
1) It is a reproducible position: There are two reproducible or repeatable
positions. One is centric relation while the other is the postural rest position of the
mandible. Since centric relation is a hinge position, it is a repeatable position.
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 Centric relation: Controversies surrounding it
2) It is an untranslated hinge position of the mandible : When the condyles are in
centric relation position, condyles are capable of executing only pure rotation
movement.
D. Two interpretations of centric relation:
Articulator v/s an in-vivo centric relation
A static centric should be differentiated from dynamic power centric relation.
CENTRIC RELATION AS A LOADING POSITION
Centric relation should be interpreted according to loading at the
temporomandibular joint. Depending on the loading of the temporomandibular joint,
centric relation should be identified as
1) A passive centric: Seen during passive closure of jaws in centric relation or as
projected in the articulator.
2) A power centric: A dynamic centric observed during mastication and
deglutition.

SIGNIFICANCE OF CENTRIC RELATION

1. Nature provides a centric relation position at birth. Centric relation is the
first established neuromuscular reflex concerning mandibular position when the teeth
are in occlusion. It remains relatively constant throughout life.
2. All movements of the mandible are governed by the centers of rotation
located in the condyle.
3. In centric relation the condyles exhibit pure rotation without any
translation. The mandible moves in a hinge motion to a distance of 15-25 mm at the
incisal in the sagittal plane.
4. It is a retruded mandibular position where the condyle is situated in its
uppermost, foremost position in glenoid fossa determined by musculature and
ligaments of the TMJ i.e., in physiologic harmony.
5. Centric relation position is a border position and therefore repeatable and
reproducible. It serves as a reliable guide for the development of an occlusion that is
in harmony with the entire stomatognathic system in both dentulous and edentulous
patients.
6. The mandible unconsciously returns to this position during deglutition and
terminal stages of mastication.

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 Centric relation: Controversies surrounding it
7. It is a repeatable, recordable and physiologically acceptable position for
mastication, deglutition and reconstruction of occlusion in an edentulous case or a
disorganized occlusion.
8. Centric relation is the only position which is in functional harmony with
the health of TMJ, where condyles articulate with the thin avascular portion of discs
and brace against hard compact bone to bear the forces.
9. Maximum muscular function and maximum biting pressures are attained
only in a centric position (Loeff, 1966).
10. Casts mounted in centric relation permit a change of vertical dimension to
a slight degree on articulator because the procedure includes an effort to place the
casts on the habitual closure axis.
11. It serves as a reference for occlusal reconstruction in dentulous situations.

Character of occlusion in centric relation (Single centric or Dual centric

occlusion)

1. Point centric or the gnathological centric occlusion (Lucia, Granger)

This happens when centric occlusion and centric relation coincide. It is a
precise location of centric occlusion in centric relation. It is a maximum
intercuspation seen or given in centric relation. The organic occlusion is an example
of point centric. The Glossary of occlusal terms recommends the term centric relation
occlusion.

2. Long centric (Freedom in centric, Area centric) (Pankey, Mann)

When centric relation and centric occlusion do not coincide, a freedom is
given to close the mandible either into centric relation or slightly anterior to it in
centric occlusion with a smooth gliding, without effecting any change in vertical
dimension of occlusion. Schuyler felt that absence of such eccentric freedom is an
important contributory factor to trauma and loss of alveolar bone structure in natural
and restorative dentition. He preferred the term freedom in centric to denote an
occlusal pattern, which allows the patient to move forth and back from centric relation
to centric occlusion, when both of them do not coincide.
It is a freedom into centric and out of centric. Ramfjord refers this freedom in
centric as play in centric. Beyron prefers the term area centric, since an area contact is
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 Centric relation: Controversies surrounding it
obtained during function in centric. Patient can use ICP (intercuspal position, Syn.
centric occlusion) for mastication and RCP (retruded contact position Syn. centric
relation) for deglutition.

Note: Long centric or freedom in centric does not exist in normal human occlusion but
represents a principle to be followed in for patients who need occlusal reconstruction.
Caution: Freedom in centric concepts does not in any way compensate for incorrect
recording of centric relation in a patient. It is not an adjustment for incorrect centric in
restorations, but a planned laboratory procedure of obtaining a functional occlusal
area of an occlusal field in restorations.

Basis of long centric occlusion:

This concept of dual centric is based on the findings that mastication occurs
generally near centric occlusion and seldom in centric relation, while deglutition is
near centric relation. Hence the need to establish freedom between these two positions
to have a harmonious mastication as well as deglutition within the centric field. The
masticatory musculature is thus able to select a favorable position without cusp
interferences, which occur during centric slide. The functional stamp cusps are free to
move in the opposing fossa without interference. Freedom in centric is essentially a
term used is occlusal rehabilitation. It is about 0.5 mm at the occlusal, most often is
less than 0.3 mm.
According to Dawson, two points about long centric are essential to be
clarified.
1) Long centric involves primarily the anterior teeth
In a healthy articulation of the condyles there can be no horizontal protrusive
path of posterior teeth. Even with a zero degree anterior guidance the condyles must
move downward as the jaw moves forward. The lower posterior teeth must move
downward with them. Thus, a flat protrusive area is usually not necessary on posterior
teeth especially in the molar region.

2) Long centric refers to freedom from centric, not freedom in centric

The principle concern regarding long centric is the restrictive effect that can
result from the lingual inclines of the upper anterior teeth. If the lower incisal edges
are in contact with steep lingual inclines at the centric jaw relation, those same
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 Centric relation: Controversies surrounding it
inclines may interfere with postural closing patterns that do not conform to the centric
relation axis. If no horizontal freedom is provided for a slightly protruded postural
closure, the lower incisal edges will strike the lingual inclines of the upper anterior
teeth. If those inclines are steep enough, they can provide a wedging effect at first
contact, which in varying degrees, may interfere with the normal pattern of postural
jaw closure.
The length of the ‘long centric’ or ‘free centric’ occlusion is determined by the
distance from terminal hinge axis relation and the normal freedom of movement in the
envelope of function. This will vary greatly with individual patients. For example, the
occlusion of patients with steep incisal and condylar guidance and with the Spee’s
curves of short radii will be ‘locked in’ and will have little ‘free centric’ occlusion and
a small envelope of motion in function. Patients with an edge-to-edge occlusion of the
anterior teeth may have freedom, much greater ‘long centric’ occlusion and a larger
envelope of motion in function because their occlusions are not ‘locked in’. They
possess flatter condylar and incisal guidances and Spee’s curves with long radii.
Obviously, the occlusal tooth forms must harmonize with these factors. We would
expect higher cusps and deeper fossa in the teeth of patients with deep vertical
overlaps and the reverse in the teeth of those with edge-to-edge relationship.
To develop this long centric, the condylar spheres (in the condylar guidance of
the articulator) are set in a protrusive relation either by placing metal strips in front of
them or by using protrusive-retrusive adjustment on the semi-adjustable articulators.
Then, the cuspid wax pattern is carved to accommodate this relation in maximum
intercuspation and the incisal guidance in occlusal rehabilitation of patients. After this
is done, the condylar adjustments are reset to the hinge axis centric relation and the
pattern carvings are extended to contact in this position.
The amount of long centric needed is equal to the difference between centric
relation closure versus postural closure.
Thus, the provision of long centric simply moves the lingual incline forward
so that the jaw is free to close without restriction either in centric relation or in the
slightly protruded relationship that occurs at various postural positions of the head.

FACTORS INFLUENCING CENTRIC RELATION RECORDS IN

EDENTULOUS MOUTHS

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 Centric relation: Controversies surrounding it
Numerous methods of registering centric relation have been described in the
literature. They can be classified as:
1) Static
2) Graphic
3) Physiologic or functional
4) Cephalometric

MECHANISTIC V/S PHYSIOLOGIC CONCEPT:

Niswonger stated that, during the act of swallowing the mandible travels from
the rest position to centric relation and back to the rest position. Swenson wrote that,
swallowing usually brings the mandible to a retruded position and is an aid in
securing this relation. Boucher agreed that, the mandible does tend to move to the
position of centric relation and to the level of occlusion when swallowing occurs. On
the other hand, Posselt claimed the mandible never moves to the hinge position during
swallowing. Other investigators have demonstrated a close association between
swallowing and centric relation by use of motion pictures, serial roentgenography,
cephalometry, cinefluorography and electromyography. Some dentists have used the
act of swallowing to locate centric relation for the construction of dentures.
Unfortunately, all who agree that swallowing has a correlation with centric
relation do not agree on the exact location of the mandible in centric relation. These
writers have been divided loosely into two schools of thought. One group
describes its concepts as “physiologic” and refers to other group as “mechanistic”.
Mechanistic group implies the use of mechanics to the exclusion of the physiologic
factors involved. It is more correct to say that one group places greater emphasis on
certain factors controlling mandibular positions and movements than the other.
Members of the mechanistic group believe that the retruded relation of the
mandible is an essential part of the envelope of jaw movement involved in a
functioning occlusion. They maintain that the most retruded relation of the mandible
to the maxillae must be recorded after the vertical relation of occlusion is established.
They call this retruded position of mandible as centric relation. They say that centric
relation is a border position at which a posterior terminal hinge axis through the
condyles controls the arc of mandibular closure to centric occlusion.

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 Centric relation: Controversies surrounding it
They propose many methods for locating centric relation. All methods have
both, merits and demerits. However, the graphic or needle point, method is probably
the one used most.
Some authors like Granger and Lauritzen in the mechanistic school define
centric relation in terms of terminal hinge axis and believe an attempt to locate it
without finding the hinge axis or rotational center of the mandible is unscientific. It
seems unreasonable to define centric relation by a selected, specific method for
recording it. The method of location is less important than the fact of its location.
Many of these dentists recognize that the mandible is some patients may
assume a habitual position which is not the most retruded position. They provide for
this habitual position in their occlusal plans.
The advocates of the ‘physiologic’ concept like Shanahan believe the
neuromusculature is the dominating factor in mandibular movements and positions.
They contend that centric relation is determined by reflexes learned in infancy and
retained after the teeth are lost. They maintain that centric relation is not the most
retruded relation of the mandible to the maxillae, but an intermediate relation in which
the joints, muscles, teeth and supporting structures are in equilibrium. They believe
this intermediate position to be the optimal starting point from which the occlusal
pattern should be established. They contend that the most retruded position is a
strained position and that it should be ignored in building occlusions. They question
the mechanistic concept of some that a precise axis through the condyles controls
mandibular movements. They cite the excellent function which continues after
surgical removal of the condyles.

Methods for assisting the patient to retrude the mandible:

1. Instruct the patient, “Let your jaw relax, pull it back and close slowly and
easily on your back teeth”.
2. Instruct the patient, “Get the feeling of pushing your upper jaw out and
closing your back teeth together”.
3. Instruct the patient to protrude and retrude the mandible repeatedly while
he holds his fingers lightly against his chin.
4. Instruct the patient to turn the tongue backward toward the posterior
border of the upper denture.

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 Centric relation: Controversies surrounding it
5. Instruct the patient to tap the occlusion rims or back teeth together
repeatedly.
6. Tilt the patient’s head back while the various exercises just listed are
carried out.
7. Palpate the temporal and masseter muscles to relax them.
8. Have the patient swallow.

According to Sharry, it is probably poor practice to force the patient’s chin

backward because, this may result in a protective contraction of the external pterygoid
muscle (external pterygoid response).

A classification of different methods of recording centric relation has been

proposed. There are mainly four methods of recording centric relation i.e.,
1. Direct recording or wax closure or check bite method.
2. Graphic method.
3. Functional recording.
4. Cephalometrics.
Direct recording is divided into two, one with teeth and occlusion as
predominant factor and in other supporting tissue as predominant factor. Both can be
recorded with wax, compound or plaster as inter occlusal recording material.
Graphic recording can be divided into extra oral graphic recording or intraoral
recording method.
Functional recording is divided into three as mandibulographing (after
Shanahan), Relator (after Hosper) and Phonetic (after Silverman).

GRAPHIC RECORDING:
The earliest graphic recordings were based on the studies of mandibular
movements by Balkwill in 1866. The intersection of the arcs produced by right and
left condyles formed the apex of what is known as the Gothic arch tracing. The first
known ‘needle point tracing’ was by Hesse in 1897 and this technique was improved
and popularized by Gysi around 1910.
The apex of tracing made indicates the most retruded relationship of the
mandible to maxilla and from the retruded relationship, lateral movements can take
place. These methods may be accomplished either intraorally or extraorally,
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 Centric relation: Controversies surrounding it
depending on where the recording device is placed. Extraoral tracings are also
referred to by 2 other names; gothic arch tracings and arrow point tracings. These
tracings are larger than intraoral tracings; therefore the apex is more easily seen.
The tracer made by Gysi was an extraoral incisal tracer. The tracing plate,
coated with wax was attached to the mandibular rim. A spring loaded point or marker
was mounted on the maxillary rim. The rims were made of modeling compound to
maintain the vertical dimension of occlusion. When a good tracing was recorded, the
patient held the rims in the apex of the tracing while notches were scored in the rims
for orientation. Clapp described the use of Gysi tracer which was attached directly to
the impression trays. Sears used lubricated rims for easier movement. He placed the
needle point tracing on the mandibular rim and the plate on the maxillary rim. He
believed this made the angle of the tracing more acute and more easily discernible. He
would then cement the rims together for removal.
Phillips (1922) recognized that any lateral movement of the jaw would cause
interference of the rims which would result in a distorted record. He developed a plate
for the upper rim and a tripoded ball bearing mounted on a jack screw for the lower
rim. This assembly was known as ‘central bearing point’. This supposedly produced
equalization of pressure on the edentulous ridges.
Later, graphic recording methods used the central bearing point to produce the
Gothic arch tracing. Hardy and Pleasure described the use of the Coble Balancer and
Hardy later described a modified intraoral tracer similar to Coble.
Hardy and Porter made a depression with a round bur at the apex of tracing.
The patient would hold the bearing point in the depression while plaster was injected
for the centric record.
The Sears ‘Recording Trivet’ had an intraoral central bearing point and two
extraoral tracing plates. The maxillary and mandibular tracing arms were locked into
centric relation with two lumps of plaster.
Robinstein designed the ‘Equilibrator’ a tracing device with a hydraulic
system and four bearing pistons, one each in bicuspid and molar region. It produced a
functional record of centric relation with a uniform distribution of stress over the
basal seat.
Silverman, used an intraoral Gothic arch tracer to locate the ‘Biting Point’ of a
patient. The patient was told to bite hard on the tracing plate. This developed the
functional resultant of the closing muscles which would retrude the mandible. The
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 Centric relation: Controversies surrounding it
indentation made by the patient would be used for the centric record whether or not it
corresponded to the Gothic arch apex.
Yoshiyuki Watanabe in 2004, described a method for determining the
mandibular position using a digital gothic arch tracing.
The graphic recording like the ‘check bite’ recording received much praise
and criticism. In 1927, Hanau conceded that, the Gysi tracing was satisfactory to
check records, but that universal usage was not good. Gysi concluded that his tracings
had only 5º error, whereas wax and compound bites had a 25º error.
When completing a graphic recording, it is important that 12 factors are
considered.
1. The record bases may become displaced, if the central bearing point
becomes ‘off-center’ in excursive movements.
2. If a central bearing device is not used, more resistance to horizontal
movements occurs with the occlusal rims.
3. It is difficult to locate the center of the arches, so that the forces may be
centralized.
4. When a patient’s tissues are easily displaced, it is difficult to achieve a
stabilized record base.
5. Ridges that have no vertical height also cause difficulty in stabilization of
record base.
6. Large tongues result in difficulties in record base stabilization.
7. Recording devices may not be compatible with normal physiologic
mandibular movements.
8. Tracing is considered unacceptable with a blunted apex, only sharp or
pointed apexes are considered acceptable.
9. If double tracing occurs, this usually indicates that the movements were
not coordinated or recordings were made at a different vertical dimensions of jaw
separation (if double tracing occurs, then it is necessary to make additional tracings).
10. It is necessary to perform the graphic tracing at the predetermined vertical
dimension of occlusion.
11. Graphic methods record eccentric relations
12. Such graphic methods of recording are thought to be the most accurate
visual means of recording centric relations with a mechanical instrument.

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 Centric relation: Controversies surrounding it
According to proponents of graphic method following are the advantages
of central bearing points:
Central bearing point devised by Phillips and its modified version is being
used by all clinicians who are recording centric relation through graphic method. The
advantages are –
1. The primary function of central bearing point is equalization of pressure.
2. Maintains intermaxillary space.
3. Keeps the bases seated against the ridges.
4. Provides smooth motion of mandible with the least friction.
However, Trapozzano stated that, ‘the use of the central bearing point is based
on the fallacious assumption that the central bearing point will produce equalization
of forces. Equalization of pressure with a central bearing point will produce result
only if two conditions are present,
1. If normal ridge relation exists and the central point of bearing can be
placed in the center of the maxillary and mandibular foundation bases.
2. If mucosal resiliency is extremely slight.

DISADVANTAGES OF CENTRAL BEARING POINT

1. According to Kingery, central bearing point did not allow for control over
the amount of closing pressure that the patient could apply during the registrations.
2. Payne has called attention to the fact that the introduction of any apparatus
into the mouth may lead to discrepancy.
3. Central bearing device encroach upon the tongue space and may cause
errors.
4. For pressures to be centralized, the position of the plate and point and the
inclination and parallelism should be precise, failing which leads to discrepancies.
5. Patient’s presenting extreme protrusion or retrusion of the mandible make
proper placement of central bearing point extremely difficult, if not impossible.
6. Excessive mucosal resiliency
7. Poor foundation cases.

LIMITATION OR CRITICISM OF GOTHIC ARCH TRACING METHODS

Gothic arch tracing method, though most commonly recommended method of
recording centric relation is also criticized by several prosthodontists indulging in
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 Centric relation: Controversies surrounding it
some other way of recording the relation. Hanau recommended the use of the Gothic
arch tracing but warned that it was a means of checking mandibular position and
should be neither overrated nor underrated. Granger, insists that needle point tracing
is not a reliable means of determining centric relation, since it is recorded in a
horizontal plane only. He believed that centric relation should be considered as a
vertical rotational relationship related to the hinge axis. According to some, gothic
arch tracings give the strained position. Its limitations are as under:
1. Centric relation is a vertical rotational relationship where as gothic arch is
merely a position on a horizontal plane.
2. Centric relation is an extremely precise position, but so called apex of
gothic arch usually does not exist. It is most of the time rounded instead of a sharp
point of junction. It is difficult because of the movement of mandible which is
rotational as well as sliding laterally (Bennett Shift).
3. This method is indicated only with good arches and good ridge relation of
maxillary and mandibular ridges.
4. Not indicated for poor foundations, severely resorbed, knife-edge or flabby
ridges.
5. Introduction of central bearing points or intraoral tracers may lead to error,
as they will occupy tongue space.
6. Difficult to use in cases where interarch distance is less.
7. Patient suffering from TMJ problems like arthropathy, will give inaccurate
records.
8. Users of this method would do well to caution their patient regarding the
amount of pressure used, in holding the bearing point in contact. Extreme biting
pressures frequently encourage tilting of occlusion rims, a practice which results in
error.
9. All the limitations applicable in central bearing point are limitations for
this method of recording centric relation.

Classification of arrow point tracing:

1. Typical: Seen as a well defined apex with a symmetrical left and right
lateral component. The mean gothic arch angle is about 120 degrees. It reflects a
healthy TMJ without interferences in condylar path and balanced muscle guidance.

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 Centric relation: Controversies surrounding it
The symmetrical form indicates an undistributed movement of the condyle in fossa
and distal slope of eminence with symmetrically balanced muscle guidance.
2. Flat form: It is similar to typical arrow point except that it has more obtuse
left and right lateral tracings. This type of arrow point signifies a marked lateral
movement of condyle in the fossa. The gothic arch angle is more than 120º.
3. Asymmetrical form:
a. The left and right lateral tracings meet in an arrow point; however their
inclination to the protrusive path is not symmetrical.
b. One of the lateral tracing is shorter; this form of tracing indicates an
inhibition of the forward movement, either in the left or right joint.
4. Apex absent/round form: Instead of a sharp arrow point, the tracing is
rather round. It shows a weak retrusive movement. Tracing should be repeated till a
definite arrow point is obtained. Patient training is necessary.
5. Miniature arrow point: Similar to the typical arrow point, however the
extension of tracing is very limited. This can be due to restricted mandibular
movements, improper seating of record bases, and painfully fitting record bases
during registration. It is also an indication of a long period of edentulism with an
inhibition in condylar movements.
6. Double arrow point: It is a record of habitual and retruded centric relation.
Allow patient training and repeat till a single gothic arch is obtained. It is also seen
when vertical dimension is altered during registration.
7. Dorsally extended arrow point: The protrusive path extends beyond the
apex of the gothic arch. This signifies a forced strained retrusive movement of the
lower jaw either by the patient or by the operator. During registration procedure,
lower jaw is either forcibly retruded by patient (active retrusion) or forcibly retruded
manually by the operator (passive retrusion). It is also sometimes an artifact caused by
the forward displacement of upper occlusal rim or backward dislodgement of lower
occlusal rim while removing them from the mouth. The arrow point tracing is correct,
but at a particular stage there was sliding of upper occlusal rim forward and lower
occlusal rim backward. It can also occur when the head of the patient is tilted too far
posteriorly. The registration should be repeated after correct head positioning. Gerber
felt that occasionally the distal extension is correct, but the tracing was obtained with
the mandible in protruded position.

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 Centric relation: Controversies surrounding it
8. Interrupted gothic arch: Break or loss of continuity of lateral incisal path
of gothic arch. This happens due to posterior interference at the heels of occlusal rims
during lateral movements. Check for posterior clearance before recording.
9. Atypical form: Protrusive component does not meet at apex but on one of
the lateral path. This may happen in dentulous because of a faulty muscular pattern
due to parafunctional habits like bruxism. It is also seen in very old edentulous
patients, who are using complete dentures with incorrect centric relation.

FUNCTIONAL RECORDING METHOD

Functional or ‘chew in’ records were another method described to record
centric relation. These were first discussed in dental literature around 1910.

Requirements for functional recording methods are:

1. Stable record bases.
2. Good neuromuscular coordination.
3. Patient must be capable of following instructions.
Needles mounted studs on maxillary occlusal rims and these studs engraved
arrow tracings into compound rims on the mandibular arch. After the rims were
removed from the oral cavity, they were reassembled with the functional grooves in
place.
Patterson was also known for promoting the use of functional records.
Patterson prepared a trough in the maxillary and mandibular occlusal rims and these
troughs were filled with a carborundum and plaster mixture. Again the patient was
asked to move his mandible and continue the motion until the appropriate curvature
had been formed on the rims. This was said to equalize pressure and provide uniform
contacts in all excursive movements
Meyer also developed a functional technique in which soft wax occlusion rims
were used and wax paths were formed in these rims during functional movements.
Then a plaster index was made of this wax path and the teeth were set opposing these
generated plaster index.
House described, in 1930, a technique of recording mandibular movement and
registering the centric relation position using an engraving method. To complete the
functional registration using the House technique, shellac trial denture bases with
attached wax occlusal rims were made. A preliminary jaw relation record was
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 Centric relation: Controversies surrounding it
obtained and the maxillary cast and occlusal rim was mounted on the House
articulator. Wax was then placed in the premolar and molar regions bilaterally on the
mandibular occlusion rim. It was then replaced by a block of impression compound.
These compound blocks had an occlusal surface simulating an average curve of Spee
and curve of Wilson. Four triangular shaped studs with cutting edges were then placed
in the maxillary wax occlusion rims opposite these blocks. The new occlusion rims
were then placed intraorally and the patients carried out mandibular movement.
During these movements, the studs engraved four separate needle point gothic arch
recordings into the blocks of compound. This was called a ‘functional chew in’
recording. One of the casts was then remounted. According to the new gothic arch
recording, the condylar elements of the articulator were adjusted.
LIMITATIONS OF FUNCTIONAL RECORDING METHOD
1. Inspite of the fact that, their advocates claim the patient makes his own
recordings, it is believed that the operator must possess a clear concept of what he
seeks to accomplish. The ability of the operator to determine when the record has
been carried to a successful completion is extremely important. The danger of
perpetuating a habit is present in some cases.
2. The record is dependent upon the accuracy of the bases upon which it is
made.
3. The method necessitates patient co-operation.
4. The record is developed under some pressure; hence in patient with
displaceable supporting tissue, the correctness of the method must be closely attached
and verified by the operator.

CEPHALOMETRIC RECORDINGS
The use of cephalometrics to record centric relation was described by Pyott
and Schoeffer. The proper centric relation and vertical dimension of occlusion were
determined by cephalometric radiographs. This method however was somewhat
impractical and never gained widespread usage.
It is apparent from the dental literature that there are many opinions and much
confusion concerning centric relation records. A certain technique might be required
for an unusual situation or a problem patient. In the final analysis, the skill of the
dentist and the cooperation of the patient are probably the most important factors in
securing an accurate centric relation record.
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 Centric relation: Controversies surrounding it

RECORDING CENTRIC RELATION IN DENTULOUS SUBJECTS

Mandible can be guided to centric relation in dentulous situation by manual
guidance or using an anterior deprogrammer.

MANUAL GUIDANCE
Bilateral relaxation of external pterygoid muscle is essential to obtain true
centric.
Manual guidance is the use of external guidance by the operator to assist the
subject’s musculature to seat the condyles and mandible in centric position.
The most common methods are Chin Point Guidance by Guichet (1970), Bimanual
Method by Dawson (1974) and Three-finger method by Peter Thomas (1980).

Chin Point Guidance (Guichet, 1970)

Successfully used by many occlusal therapists. This is one handed
manipulation which relies on downward pressure applied at the symphysis with the
teeth separated, so that contraction of the elevator muscles against the chin point
could seat the condyle up.

Bilateral manipulation method (Bimanual method)(Dawson, 1974)

In this method proper hand position for bilateral manipulation uses downward
pressure from the thumbs to keep the teeth separated whereas upward, slightly
forward pressure from the finger loads the condyles against the posterior wall of
eminentiae.
Correct manipulation requires delicacy first, to encourage neuromuscular
release and then firmness, to verify the position and hold the condyle disc assembly in
hinge axis position while the relation is being recorded.

ANTERIOR DEPROGRAMMER
An anterior deprogrammer provides anterior stop to eliminate posterior tooth
contacts during closure of jaws, thereby eliminating proprioceptive influence from the
teeth. This allows subject’s neuromusculature to seat the condyles in its centric
position without the influence of periodontal proprioception or engram.

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 Centric relation: Controversies surrounding it
The concept of anterior deprogrammer was introduced by Stuart when he
placed a wooden tongue blade between upper and lower teeth while closing the jaws.
Hart Long gave a scientific approach to it by inventing the ‘Leaf Gauge’. Lucia
obtained a similar effect with an anterior jig. Woelfel introduced his OSU leaf wafer
technique to obtain centric interocclusal record.

1. ANTERIOR JIG (LUCIA, 1983)

The anterior jig is a covering on the upper incisors fabricated in acrylic resin
having an occlusal platform against which the lower anterior teeth will close. It acts as
a third leg of tripod, the other two legs being the condyles. The leg acts as an anterior
resistance and stops mandibular closure, without any deviation. The jig is a useful tool
for obtaining centric interocclusal records free from deflective contacts and therefore
eliminates the influence of engram, during centric registration.

2.LEAF GAUGE PRINCIPLE (LONG, 1973; WILLIAMSON, 1980)

LEAF GAUGE:
Leaf gauge guides the mandible to obtain optimum superior-anterior braced
position of condyles against the discs. McHorris felt that leaf gauge helps to tripodize
the mandible and brace the condyles in anterior-superior position against the posterior
slope of articular eminence. Long found that, leaf gauge is a reliable method for
consistently placing the condyles in centric position.
CONSTRUCTION:
Leaf gauge consists of 10 leaves of acetate or other plastic; 0.010 inch thick,
0.5 inch wide and 2 inch long. A hole is punched in one end of the leaf and 10 leaves
are riveted together.

USE IN LOCATING CENTRIC RELATION:

Leaf gauge is place between the anterior teeth and number of leaves is
decreased until first contact is observed in posterior teeth. Number of leaves is
increased by one or two so that teeth are just out of contact. Warm wax or other
plastic recording material is placed between the posterior teeth, the gauge is replaced
in anterior part of mouth and the mandible is retruded and held with biting pressure
until the recording medium is hard or set. By increasing vertical dimension of

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 Centric relation: Controversies surrounding it
occlusion, a small or minimal error is assured when the casts are mounted on an
articulator and closed to first contact.
Leaf gauge is also useful to detect centric prematurities in dentulous subjects.
On first posterior contact, leaf gauge is removed. The teeth are reshaped to perfect the
contact. Process is repeated in the same way and teeth are marked and reshaped until
the occlusion is adjusted and perfected in centric relation.

CENTRAL BEARING POINT

Central Bearing Point, as used in pantographic stereographic techniques, is an
excellent muscle deprogramming device that allows the elevator muscles to seat the
condyles in the proper direction. It also prevents any chance of mandibular
displacement from occlusal contacts.

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