Horizontal jaw relation final/ cosmetic dentistry training


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  • JAW RELATION-Any spatial relationship of the maxilla to the mandible.
  • Thus an occlusion that is physiologically acceptable or desirable may not be applicable for the complete dentures.
  • First and the second registration material should be the same.
  • Path of the condyle in eccentric movmnts is not a straight line.
    Shape of the mandibular fossa is an OGEE curve viewed in sagital plane
    This double curve will cause the apparent path of the condyle to be different with varying amounts of protrusion.
    Ideal amount of protrusion is amount to bring anterior teeth end to end.
    Mechanical limitation of articulators require a minimum of 6mm to adjust condylar guidance.
  • Lateral tracing if done, should be recorded 6 mm on the tracing because its moves 3mm at the molar region. Because its appx middle between the tracing & working side condyle
  • Horizontal jaw relation final/ cosmetic dentistry training

    1. 1. Horizontal Jaw RelationHorizontal Jaw Relation INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    2. 2. CONTENTS: Introduction Definition Significance of centric relation Retruding the mandible to centric relation Methods of recording centric relation Factors influencing centric relation record www.indiandentalacademy.com
    3. 3. Eccentric relation records Recording of eccentric jaw relations Review of Articles. Conclusion Bibliography. www.indiandentalacademy.com
    4. 4. INTRODUCTION Horizontal relation are those that are established anterio posteriorly & mediolaterally, Its classified as 1, Centric relation 2, Eccentric relation- which includes -Protrusive -Left & Right lateral movements www.indiandentalacademy.com
    5. 5.  The principles of good occlusion apply to both dentulous & edentulous patients.  Different requirements are necessary in the occlusion for the complete dentures because artificial teeth are not attached to the bone as in natural teeth. www.indiandentalacademy.com
    6. 6.  To maintain stability of complete dentures,the opposing teeth must meet evenly on both sides of the dental arch when the teeth contact anywhere within the normal functional range of mandibular movements. www.indiandentalacademy.com
    7. 7.  An occlusion for complete dentures that provides these even contacts can only be developed with centric occlusion in harmony with centric relation & smooth gliding contact from this position to any eccentric position with in the normal range of mandibular movements. www.indiandentalacademy.com
    8. 8. www.indiandentalacademy.com
    9. 9. DEFINITION : 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 independent of tooth contact and is clinically discernible when the mandible is directed superiorly and anteriorly. It is restricted to a purely rotary movement about the transverse horizontal axis - GPT 8 www.indiandentalacademy.com
    10. 10. Significance of Centric Relation: It is a definite learned position which is independent of the presence or absence of teeth. It is reproducible ,repeatable and recordable position. www.indiandentalacademy.com
    11. 11. When the centric relation & centric occlusion of natural teeth do not coincide, the periodontal structures around the natural teeth are endangered  If the occlusion of artificial teeth do not coincide, there is instability of the dentures leading to pain & discomfort www.indiandentalacademy.com
    12. 12. Errors in mounting of the cast can be detected when used as a horizontal reference point An accurate record properly orients the mandibular cast to the opening axis of the articulator. www.indiandentalacademy.com
    13. 13. RELATING CENTRIC RELATION TO THE HINGE AXIS . During mandibular opening movement,the condyles rotate initially in a hinge and later in a translatory motion.A pure hinge movement of the condyle occurs only when the condyle is in its centric position. www.indiandentalacademy.com
    14. 14. • Combinations of translation and hinge movement take place when the condyle moves anterior to centric relation. • Hence ,centric relation is known as the Terminal hinge relation. • Terminal hinge axis is the horizontal axis of condyles, when the condyles are in centric relation. www.indiandentalacademy.com
    15. 15. CHARACTER OF OCCLUSION IN CENTRIC RELATION: There are two concepts: Point centric : 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. www.indiandentalacademy.com
    16. 16. Long centric/ Freedom in centric / Area centric: 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 and change in vertical dimension of occlusion. www.indiandentalacademy.com
    17. 17. 1) Minimal Closing Pressure :  Minimal displacement of the tissue  Opposing teeth to touch uniformly and simultaneously at their first contact. CONCEPTS AND OBJECTIVES IN RECORDING CENTRIC RELATION: www.indiandentalacademy.com
    18. 18. ADVANTAGES  Uniform contact will not simulate the patient to clench the teeth  Relaxes the closing muscles. www.indiandentalacademy.com
    19. 19. 2) Heavy Closing Pressure:  Tissues under bases is displaced while the record is made  Produce same displacement of the soft tissues as would exist when heavy closing pressure are applied on the dentures. www.indiandentalacademy.com
    20. 20. DISADVANTAGES  Uneven contacts which tends to clench the teeth  Thus causing soreness under the denture bases & changes in the residual ridges www.indiandentalacademy.com
    21. 21. RELATING CENTRIC RELATION TO CENTRIC OCCLUSION:  Centric relation is a bone to bone relation  Centric occlusion is a relationship of upper and lower teeth to each other.  Centric relation must be accurately recorded so that centric occlusion can be built to coincide with it. www.indiandentalacademy.com
    22. 22. When natural teeth are removed,many receptors that initiate impulses resulting in positioning of mandible away from deflective occlusal contacts into centric occlusion are lost or destroyed. Therefore edentulous patients cannot control mandibular movements or avoid deflective occlusal contacts in centric relation as in dentulous patients. www.indiandentalacademy.com
    23. 23. These deflective occlusal contacts in centric relation causes movement of the denture bases or direct the mandible away from the centric relation. Thus centric relation must be recorded for edentulous patients so that centric occlusion can be established in harmony with this position. www.indiandentalacademy.com
    24. 24. Retruding the mandible to centric relation: Difficulties seen are Biological Psychological Mechanical www.indiandentalacademy.com
    25. 25. Methods of assisting the patient to retrude the mandible: Instructing the patient to: Relax the jaw ,pull it back and close slowly and easily on your back teeth. [ never ask the patient to bite] Get the feeling of pushing your upper jaw out and close your back teeth together. www.indiandentalacademy.com
    26. 26. Protrude and retrude the mandible repeatedly as the patient holds the fingers lightly against the chin. Turn the tongue backwards towards the posterior border of the upper denture. Ask the patient to swallow & conclude the act with the blocks in contact. www.indiandentalacademy.com
    27. 27. Tap the occlusal rims or the back teeth rapidly & repeatedly. Tilting the head back while all the exercise is carried out. Assist the patient to retrude the mandible by placing the index fingers on the buccal flanges on the premolar regions with the thumbs under the patients chin. www.indiandentalacademy.com
    28. 28. www.indiandentalacademy.com
    29. 29. Verification of Centric Relation Palpating the temporais and the masseter muscles. Use of guide lines on the occlusion rims www.indiandentalacademy.com
    30. 30. www.indiandentalacademy.com
    31. 31. Factors Influencing Centric Relation Records  The resiliency of the supporting tissue.  The stability of the recording bases.  The TMJ and its associated neuromuscular mechanism.  The nature of pressure applied in making the recording.www.indiandentalacademy.com
    32. 32.  The technique in making the recording & the associated recording devices used  The skill of the dentist.  The health & the co-operation of the patient.  The maxillomandibular relationship www.indiandentalacademy.com
    33. 33.  The posture of the patient.  The character or size of the residual arch.  The size & position of the tongue. www.indiandentalacademy.com
    34. 34. Requirements for Making Centric Relation Records  To record the correct horizontal relationship of the mandible to the maxilla.  To exert equalized vertical pressure.  To retain the record in an undistorted condition until the cast has been accurately mounted on the articulator. www.indiandentalacademy.com
    35. 35. Methods Of Recording Centric Relation:  Physiological / tactile / interocclusal check record method.  Functional/ chew in method. -Patterson technique -Needle house technique  Graphic method. -Intra oral tracing -Extra oral tracingwww.indiandentalacademy.com
    36. 36. OTHER METHODS-  Strips of celluloid placed between the rims  Heating the surface of one of the rims  Deep heating or pooling method  Softened wax placed over the occlusal surface of the mandibular posterior teeth  Soft cones of wax placed on the lower denturel bases www.indiandentalacademy.com
    37. 37. Physiological / tactile / interocclusal check record method: History In 1756,Philip pfaff, the dentist of Frederick the great of Germany, was the first to describe this technique. The direct interocclusal record during that period was a non-precision jaw record obtained with a thermoplastic material, usually wax or compound. www.indiandentalacademy.com
    38. 38. This was known as “mush” “biscuit” or “squash bite.  Christensen[1905] was one of the early authors to use impression wax for bite records. Brown [1954] recommended repeated closures into softened wax rims. www.indiandentalacademy.com
    39. 39. Greene had his patients hold their jaw apart for 10 sec to fatigue the muscles and then had them snap the rims together.  Wax, compound, plaster & zinc oxide eugenol paste were used as registration material for the records www.indiandentalacademy.com
    40. 40.  Schuyler[1932] preferred modelling compound to wax for the occlusal records  Trappzzano[1955] stated that wax check bite method was the technique of preference www.indiandentalacademy.com
    41. 41.  Payne[1955] & Hickey[1964] stated a preference for plaster  Boos[1959] stated that it was important to avoid torsion when recording centric relation & felt that plaster & zinc oxide eugenol paste was more accurate www.indiandentalacademy.com
    42. 42.  Hanau[1929] was the first individual to be concerned about equalization of pressure when recording the bite. He coined the word “realeff” which is formed by the beginning letters of the words “resilient and like effect”.  This became a major factor in “check bite” techniques. www.indiandentalacademy.com
    43. 43.  Wright (1939) described the four factors which affected the accuracy of records- 1. Resiliency of tissues. 2. Saliva film, 3. Fit of bases 4. Pressure applied www.indiandentalacademy.com
    44. 44.  Scyhyler, Payne and Trapozzano advocated the use of light pressure  The problem of pressure in any record was recognized by Boucher (1960) who wrote, “In addition to technical errors are the errors which occur as a result of failure to control jaw activities and pressure at the time of registration”. www.indiandentalacademy.com
    45. 45.  The importance of verifying the interocclusal records has been stressed by Greene (1910), Schyuler (1932), Trapozzano (1950, Beck (1960)  Most of the criticisms for using “check bites” for centric relation record were from individuals who favored some type of graphic recording.  Gradually these procedures evolved into interocclusal records as they are usually done today. www.indiandentalacademy.com
    46. 46. Physiological / Tactile / Interocclusal Check Record Method: It is particularly indicated in situation of Abnormally related jaws Supporting tissues that are excessively displaceable Large tongue. Uncontrollable or abnormal mandibular movements To check the occlusion of the teeth in try-in dentures www.indiandentalacademy.com
    47. 47. The technique for this record is divided into two steps- 1. Tentative records using occlusion rims attached to accurate stable bases. 2. Inter occlusal check records with teeth arranged for try-in. www.indiandentalacademy.com
    48. 48.  In this method the vertical dimension is established first . A tentative centric relation is recorded, occlusal rims are articulated using tentative records and artificial teeth are arranged. Now the try-in dentures are ready for making the inter-occlusal check record. www.indiandentalacademy.com
    49. 49. The try-in dentures are inserted into patient mouth ,recording material is loaded onto the occlusal surface of posterior teeth in the mandibular occlusal rim and patient is asked to slowly retrude the mandible and close, make sure there’s no tooth to tooth contact. The horizontal Condylar guide locks in the articulator are unlocked and the try- in dentures are placed on their articulated casts.www.indiandentalacademy.com
    50. 50. Recording material on the buccal aspect of mandibular teeth is scraped off and the articulated casts are adjusted to fit into the check record. If the tentative record is accurate and is same as the check record then both Condylar elements will contact against the centric stops. www.indiandentalacademy.com
    51. 51.  If any one of the Condylar elements are not touching ,then one or the other record is inaccurate. www.indiandentalacademy.com
    52. 52. Functional/chew in Method :: HISTORY  Functional recordings were described as early as 1910. by Greene where he used a pumices and plaster mixture in one of the rims and instructed the patient to grind the rims together. The teeth were set to the generated paths. www.indiandentalacademy.com
    53. 53.  Needles(1923) mounted studs on the maxillary rims which cut tracing into the mandibular rims  Petterson(1923) used a carborundum and plaster mixture which were filled in a trough cut in the upper and lower rims  Meyers(1934)used soft wax occlusion rims. www.indiandentalacademy.com
    54. 54.  Boos (1959) felt that it was essential that all registrations be made under the biting force so that the displacement of the soft tissues which occur in function would occur during bite registration www.indiandentalacademy.com
    55. 55. Functional/chew in Method :: Needles-house technique: Compound occlusal rims with 4 metal styli placed in the maxillary rim. When the mandible moves with the styli contacting the mandibular rim, the styli cuts 4 diamond shaped tracings. www.indiandentalacademy.com
    56. 56. The pathways cut into the modeling compound indicating both the centric position and the eccentric mandibular excursions. The records are placed on a suitable articulator to receive and duplicate the records. www.indiandentalacademy.com
    57. 57. www.indiandentalacademy.com
    58. 58. The Patterson method: Uses wax occlusal rims. A trench is made in the mandibular rim and a mixture of half plaster and half carborundum or pumice paste is placed in the trench. www.indiandentalacademy.com
    59. 59. When the plaster & pumice are reduced to the pre determined height the patient is asked to retrude the mandible and the occlusion rims are joined with metal staple pins.` www.indiandentalacademy.com
    60. 60.  Plaster pumice rims tends to be rather messy an alternative is modelling wax mixed with a little carding wax to render it displaceable, the rims are covered with the tin foil to prevent them sticking together while the patient squeezes them into his own individual occlusal curves. www.indiandentalacademy.com
    61. 61. www.indiandentalacademy.com
    62. 62. Disadvantages 1. The displaceable basal tissues, the resistance of the recording medium and the lack of control of equalized pressure in the eccentric relation contribute to inaccuracies. 2. Patients should have a good neuromuscular co-ordination and should be capable of following instructions. www.indiandentalacademy.com
    63. 63. NEEDLE POINT TRACING: HISTORY • The earliest graphic recording Were based on mandibular movements by Blackwil in 1866. The intersections of the arcs produced by the 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 the technique was improved and popularized by Gysi around 1910” www.indiandentalacademy.com
    64. 64.  Gysi’s tracer was an Extraoral incisal tracer in which the plate was attached to the mandibular rim & spring loaded pin was mounted on the maxillary rim. www.indiandentalacademy.com
    65. 65.  Phillips(1927) recognized that any lateral movement of the jaw would cause interference of the rims resulting in a distorted record.  He developed a plate for the upper rim under tripoded ball bearing mounted on a jacks screw for the lower rim. The innovation was named the “Central bearing point”, which was supposed to produce the equalization of pressure on the edentulous ridges. www.indiandentalacademy.com
    66. 66.  Stansbery (1929) introduced a technique which incorporated a curved plate corresponding to monson’s curve.  He mounted this on the upper ring and a central bearing screw was attached to a lower plate corresponding to the reverse monsoon curve. After the tracing was made , a biconcave centric registration was obtained using plaster. www.indiandentalacademy.com
    67. 67.  Later gothic recording methods used the central bearing point to produce gothic arch tracing. Various tracing devices were designed by Flight, Phillips, Terrell, Sears, House, Messerman and others www.indiandentalacademy.com
    68. 68.  The graphic recording like the check bites records received much praise and criticism. Critics of Gothic arch tracing stated that equalization of pressure did not occur, prognathic and retrognathic patients could not be used, flabby tissues and large tongues could cause shifting of the bases and finally too much of patient cooperation was needed. www.indiandentalacademy.com
    69. 69. Graphic Methods: Graphic methods are of two types:  Arrow point tracing. - Extra oral tracing. - Intra oral tracing. www.indiandentalacademy.com
    70. 70. Extra Oral Tracing Assembly  It has a central bearing device consisting of a central bearing point & a plate  It has a tracing device consisting of a stylus & a recording plate www.indiandentalacademy.com
    71. 71. Technique for Gothic Arch Tracing:  Make accurate stable maxillary and mandibular record bases. Contour the wax occlusal rims.  Establish the vertical jaw relation  Make a face bow transfer and mount the maxillary cast .www.indiandentalacademy.com
    72. 72.  With soft wax make a tentative centric relation record.  Adjust the articulator with the condylar elements secured against the centric stops. www.indiandentalacademy.com
    73. 73. Relate the maxillary occlusion rims in the soft wax record and attach the mandibular cast to the articulator with plaster.  Reduce the mandibular occlusal rim to provide 2 mm while maintaining the occlusal plane www.indiandentalacademy.com
    74. 74.  Central bearing device is attached to the occlusal rims taking care to centre them laterally & anteroposteriorly.  Mount the tracing device, be sure to attach the devices securely to the occlusion rims.The stylus is attached to the maxillary rim and the recording plate on the mandibular. www.indiandentalacademy.com
    75. 75.  Seat the recording bases with the attached recording devices ,make sure that there is no interference between the occlusion rims when the mandible is moved in any direction.  Retract the stylus and conduct training exercises with the patient. www.indiandentalacademy.com
    76. 76.  When the patient is proficient in executing the mandibular movements prepare the tracing plate to record the tracing by coating with thin coat of precipitated chalk in denatured alcohol.  Develop an acceptable tracing by dropping the stylus to the record plate.www.indiandentalacademy.com
    77. 77.  When a definite arrow point tracing with a sharp apex is made, have the patient retrude the mandible to the centric relation.  Inject quick setting dental plaster between the occlusion rims.  Remove the assembly and mount the mandibular cast with the new record.www.indiandentalacademy.com
    78. 78. ADVANTAGES  Tracing point is much larger because they are made farther from the centers of rotation & the apex is more discernible  Extra oral tracings are visible when the tracings are made, therefore patients can be guided & directed more intelligently www.indiandentalacademy.com
    79. 79.  The stylus can be observed in the apex of the tracing during the process of injecting plaster between the occlusal rims & no hole is required. www.indiandentalacademy.com
    80. 80. Classical, pointed form The symmetry indicates an undisturbed movement sequence in the joints and uniform muscle guidance. Evaluation of Gothic Arch Tracings: Classical flat form Indicates distinct lateral movements of the condyles in the fossa. www.indiandentalacademy.com
    81. 81. Weak Gothic arch tracing Indicates a lax and negligent performance of the movements. The registration must be repeated: Stronger movements must be demanded from the patient. Asymmetrical form The tracing indicates a distinct inhibition of the forward movement in the right joint. www.indiandentalacademy.com
    82. 82. Miniature Gothic arch tracing This tracing points restricted mandibular movements. •Due to badly fitting and pain- causing record bases or •Long standing edentulous state with inhibited movement in the joints. www.indiandentalacademy.com
    83. 83. Intra-oral tracing devices:  It is a combination of a central – bearing point and plate with a needle point tracing made inside the mouth. The bearing point is sharp which makes a tracing on the opposing central bearing plate . www.indiandentalacademy.com
    84. 84. A hole may be drilled at the apex of the tracing to ensure that the patients jaw is in the most retruded position while the registration is being recorded. A plastic piece with a hole in the center can also be placed at the apex. www.indiandentalacademy.com
    85. 85. DISADVANTAGES  Tracings are small, hence its difficult to find the apex.  The tracer must be seated in the hole at the point of the apex to assure accuracy when injecting plaster between the occlusion rims.  If the patient moves the rims before they are secured, the records shift on their basal seat which destroys the accuracy. www.indiandentalacademy.com
    86. 86. Digital Gothic Arch Tracing: Here the stylus is a plastic sphere of 6mm in diameter and is attached to the maxillary rim with auto polymerizing acrylic resin. A resistance film sensor is attached to the conventional tracing device ,that is attached to the mandibular occlusal rim www.indiandentalacademy.com
    87. 87. Digital Gothic Arch Tracing: www.indiandentalacademy.com
    88. 88. Other methods of recording centric relation:  Use of celluloid paper.  Soft cones of wax placed on the lower denture trial bases www.indiandentalacademy.com
    89. 89.  Heating the surface of one of the rims  Deep heating or pooling method  Softened wax placed over the occlusal surface of the mandibular posterior teeth www.indiandentalacademy.com
    90. 90. www.indiandentalacademy.com
    91. 91. Eccentric relation records An eccentric maxillo-mandibular relation is any relationship of the mandible to the maxillae other than the centric relation. It is recorded to adjust the lateral and horizontal condylar inclinations. www.indiandentalacademy.com
    92. 92. The adjustment permits the condylar elements to travel to and from the centric and eccentric positions and make it possible to arrange the teeth for complete dentures in balanced occlusion.  The eccentric positions to be recorded are the protrusive and the right & left lateral. www.indiandentalacademy.com
    93. 93. Tactile or Inter Occlusal Check Record  The preferred time to make the record is during the try-in procedure  The trial dentures are inserted & the patient is instructed to protrude his lower jaw to approximately 5-6 mm  Midline of maxillary & mandibular incisors should coincide www.indiandentalacademy.com
    94. 94.  Once the patient has learned this position, 3 layers of wax is placed over the mandibular teeth, seal the wax on the lingual & buccal surface of the teeth.  The wax is softened over the controlled water bath. www.indiandentalacademy.com
    95. 95. Try-in dentures are re-inserted & the lower jaw is protruded until the upper teeth contact the wax.  The wax is allowed to harden and transferred to the articulator to record the horizontal inclination. www.indiandentalacademy.com
    96. 96.  FUNCTIONAL/ CHEW IN PROCEDURE  After the records are used to mount the mandibular cast, the articulator is adjusted to the eccentric records. www.indiandentalacademy.com
    97. 97. Recording of eccentric jaw relations: Gothic arch tracing : (protrusive relation records) Measure a distance of 5 to 6 mm from the apex of the arrow point tracing on the protrusive tracing and mark this point Instruct the patient to protrude until the point of the stylus rests in the marked point www.indiandentalacademy.com
    98. 98. Inject quick setting dental plaster between the occlusal rims. Free the horizontal condylar adjustment on the articulator. Raise the incisal pin about one half inch from the top of the guide table. Carefully seat the record bases on the cast. www.indiandentalacademy.com
    99. 99. Using the locknuts as handles manipulate one side ,then the other. An accurate seating of both record bases must be secured without forcing so that the protrusive record is not destroyed. Secure the lock nuts. www.indiandentalacademy.com
    100. 100. Lateral relation records :: Gothic arch tracing:  Two records are required – one of right lateral and one of left lateral  The articulator is adjusted as each record is made.  However with complete dentures, it is more difficult to secure accurate & reproducible records. www.indiandentalacademy.com
    101. 101.  Hanau recommended a formula to arrive an acceptable lateral inclination • L =H/8+12 L- Lateral condylar guidance H- Horizontal condylar inclination in degrees as established by the protrusive record  The value of this formula is neither proved or disproved www.indiandentalacademy.com
    102. 102. Review of Articles 1) Millet,Jeannin,Vincent & Malquarti: Concluded that the record of the relationship between the jaws in the swallowing cycle can be used as the VDO but is not favorable when used to obtain centric relation. www.indiandentalacademy.com
    103. 103. 2) Dennis B .Gilboe: summarized that centric relation should be considered as the most superior position of the mandibular condyles with the central bearing area of the disk in contact with the articular surfaces of the mandibular condyles and the articular eminences. www.indiandentalacademy.com
    104. 104. 3) Williamson,Bowley and Randy : Mandibular denture base stability has been reported to be increased by using an central bearing intra oral gothic arch tracing device,as it provides equalization of occlusal pressure. www.indiandentalacademy.com
    105. 105. 4)Albert Yurkstas and krishan k kapur carried out the study to evaluate the effect of various factors on the reliability or duplicability of wax records and the Intraoral tracing procedures for registering centric relation.They concluded that the control wax and central intra oral tracing records show least variations. www.indiandentalacademy.com
    106. 106. Conclusion :Conclusion : The accurate determination,recording & transfer of jaw relation records from the edentulous patient to the articulator is essential for the restoration of function,facial appearance and the maintenance of patient health. www.indiandentalacademy.com
    107. 107. Therefore it is emphasized that irrespective of the method used, subsequent clinical checking and rechecking must be done throughout the entire denture construction phases. The skill of the dentist & the co-operation of the patient being most important factor. www.indiandentalacademy.com
    108. 108. BIBLIOGRAPHY  Prosthodontic treatment for edentulous patients. - Boucher  Syllabus of Complete Denture - Heartwell  Essentials of complete denture - Sheldon Winkler  Occlusion:principles and concepts. - jose’ dos santwww.indiandentalacademy.com
    109. 109.  Evaluation,diagnosis,and Treatment of Occlusal Problems. - Peter E Dawson.  Text book of complete dentures. -Swenson.  Management of –TMJ disorders and occlusion- Okeson  The Glossary of Prosthodontic Terms 8th Edition - The Academy of Prosthodontics www.indiandentalacademy.com
    110. 110.  Report on the determination of occlusal vertical dimension and centric relation using Swallowing in edentulous patients. -J Oral Rehab. 2003 Nov;30(11):1118- 1122  Centric relation records- Historical review. -J Prosthet Dent. 1982 Feb; 47(2):141- 145.  Factors influencing centric relation records in edentulous mouths. - JPD 2005; 93; 305-310.www.indiandentalacademy.com
    111. 111.  Centric relation as the treatment position. - J Prosthet Dent. 1983 Nov; 50(5):685- 689.  Simplified technique of recording edentulous jaw relationship. - J Prosthet Dent. 1993 April; 69(4):448-449  Maximizing Mandibular prosthesis stability utilizing centric recording. - J Prosthet Dent. 2004 March; 13(1): 55 - 61 www.indiandentalacademy.com
    112. 112. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com