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 Table of Contents  
CLINICAL INNOVATION
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 53-54

A Novel Technique to Guide the Mandible to Centric Relation


1 Professor, Department of Prosthodontics, School of Dental Sciences, Krishna Institute of Medical Sciences and Deemed University, Karad, Maharashtra, India
2 Professor, Department of Physiology, Krishna Institute of Medical Sciences and Deemed University, Karad, Maharashtra, India
3 Professor and Head, Department of Prosthodontics, School of Dental Sciences, Krishna Institute of Medical Sciences and Deemed University, Karad, Maharashtra, India

Date of Submission21-Jul-2021
Date of Decision20-Aug-2021
Date of Acceptance31-Aug-2021
Date of Web Publication22-Sep-2021

Correspondence Address:
Dr. Anand G Joshi
Department of Physiology, Krishna Institute of Medical Sciences and Deemed University, Karad, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmo.ijmo_15_21

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  Abstract 


Background: A new and innovative technique to guide the mandible to centric relation. Aim: To design an innovative technique to guide the mandible into centric relation. Objective: To achieve the centric relation in an easy way. Materials and Methods: With some modification on the denture base the tongue is assisted to the posterior part of the palate thus guiding the mandible to centric relation. Results: This technique guides the mandible to centric relation. Conclusion: The Mandible is guided to the centric relation by this technique.

Keywords: Centric relation, condyle, electromyography, magnetic resonance imaging, masseter, temporalis


How to cite this article:
Sushma R, Joshi AG, Sanyal PK. A Novel Technique to Guide the Mandible to Centric Relation. Int J Med Oral Res 2021;6:53-4

How to cite this URL:
Sushma R, Joshi AG, Sanyal PK. A Novel Technique to Guide the Mandible to Centric Relation. Int J Med Oral Res [serial online] 2021 [cited 2022 Jan 19];6:53-4. Available from: http://www.ijmorweb.com/text.asp?2021/6/2/53/326367




  Introduction Top


Centric relation (CR) is at the heart of dentistry and prosthodontics in particular. A sound understanding of CR becomes an integral part of a restorative treatment and a missed recording could lead to failure of a treatment. Techniques to achieve CR are surrounded by open-ended controversies regarding their comparative reproducibility and accuracy.[1],[2],[3],[4] Kapur and Yurkstas[5] summarized the various CR recording techniques given by various authors[6],[7],[8] however; there is no “gold standard” method of recording patient's CR position. It is also an established fact that recording CR can be cumbersome.[9] The difficulties in recording CR escalate especially in certain categories of patients like edentulous patients who have not been using dentures for a long period of time; dentures wherein centric occlusion does not coincide with CR; dentures with excessively low or high vertical dimension of occlusion and in who have less muscular coordination.[10] These patients usually develop a habitual pattern of eccentric closure. Unless, these patients are preconditioned, the new dentures may be unsuccessful, furthermore when new dentures are constructed; they may show disharmony between centric occlusion and centric jaw relation.[11],[12] Literature[6],[7],[8],[9] describes the use of tongue to record the CR. The purpose of this article is to present a new copyrighted technique (Wax ball technique, L-77997/2018) and design (Denture base design for the wax ball technique, L-78006/2018) for recording the CR with the assistance of the tongue.


  Technique Top


All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. The study proposal was submitted for approval and clearance was obtained from the ethical committee of our institution. A written informed consent was obtained from each participant.

  1. To record the CR after establishing the vertical jaw relation, place three orientation balls made of modeling wax, 1 cm in diameter and 2 mm thickness, to the upper record base along the midline; first ball behind the incisive papilla, the second at the center of the palate and the third immediately anterior to the Posterior Palatal Seal region [Figure 1]
  2. Show the record bases to the patients and give instructions pertaining the sequence and position where they must place their tongue on instructions by the operator during the procedure
  3. Insert record bases into the mouth and instruct the patient to relax
  4. Ask the patient to open the mouth to 20–25 mm and instruct the patient to touch the tip of the tongue onto the first (anterior most) orientation ball, then move it into the second, and finally to the third orientation ball
  5. Instruct the patient to hold the tongue on the third orientation ball, and to close onto the lower occlusion rims slowly and gently
  6. When the patient gives the same position repeatedly seal the rims using the Nick and Notch method.
Figure 1: Record base modification and Wax Ball orientation technique (a) Denture base design on the cast, (b) Placing the tongue on the first wax orientation ball, (c) Placing the tongue on the second wax orientation ball, (d)modified denture base in mouth, (e) Placing the tongue on the third wax orientation ball, (f) Mandible in centric relation position

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  Discussion Top


A new method of recording, the CR is described. With an elaborate literature[5],[6],[7],[8] where clinicians, researchers have compared various materials and methods to register an accurate CR, the most conclusive statement turns out to be that irrespective of the methods used, patient's compliance and practitioner's knowledge and expertise are the 2 most important factors to achieve the CR position. The advantages of this technique are that, it is easy for the patients to understand and replicate the tongue movements on the orientation wax balls thus retruding the mandible posteriorly; The wax orientation balls give an exact and repeatable position where in the patient can move their tongue; The technique is cost effective and saves time for the clinicians and patients.


  Conclusion Top


This technique describes an easy, repeatable method of recording the CR with the tongue assisting the mandible to CR position.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Swenson AL, Oesterle LJ, Shellhart WC, Newman SM, Minick G. Condylar positions generated by five centric relation recording techniques. Oral Biol Dent 2014;2:8.  Back to cited text no. 1
    
2.
Braun S, Marcotte MR, Freudenthaler JW, Hönigle K. An evaluation of condyle position in centric relation obtained by manipulation of the mandible with and without leaf gauge deprogramming. Am J Orthod Dentofacial Orthop 1997;111:34-7.  Back to cited text no. 2
    
3.
Wood DP, Elliott RW. Reproducibility of the centric relation bite registration technique. Angle Orthod 1994;64:211-20.  Back to cited text no. 3
    
4.
Michman J, Langer A. Comparison of three methods of registering centric relation for edentulous patients. J Prosthet Dent 1963;13:248-54.  Back to cited text no. 4
    
5.
Kapur KK, Yurktas AA. An evaluation of centric relation records obtained by various techniques. J Prosthet Dent 1957;7:770-86.  Back to cited text no. 5
    
6.
Zarb GA, Eckert JA, Jacob R. Prosthodontic Treatment for Edentulous Patients: Complete Denture and Implant- Supported Prosthesis. 13th ed. St Louis: CV Mosby; 2013. p. 192-4.  Back to cited text no. 6
    
7.
Fenn HR, Liddelow KP, Grimson AP. Clinical Dental Prosthetics. 2nd ed. London: Staples Printers Limited; 1961. p. 172-222.  Back to cited text no. 7
    
8.
Winkler S. Essentials of Complete Denture Prosthodontics. 2nd ed. India: AITS; 2015. p. 249-52.  Back to cited text no. 8
    
9.
Bissasu M. Use of the tongue for recording centric relation for edentulous patients. J Prosthet Dent 1999;82:369-70.  Back to cited text no. 9
    
10.
Stuart CE. Articulations of the human teeth. Dent Items Interest 1939;61:1029.  Back to cited text no. 10
    
11.
Pound E. Conditioning of denture patients. J Am Dent Assoc 1962;64:461-8.  Back to cited text no. 11
    
12.
Nasr MF, Griffiths NH. Exercise therapy for accurate recording of centric relation. J Prosthet Dent 1973;29:5-9.  Back to cited text no. 12
    


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