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OsseoNews: What is your procedure of choice in making a centric relation record?
Dr. Jameson: In my hands, an intra-oral needlepoint tracing made with stable recording bases at the central bearing area of the mandibular arch is by far the most accurate. While standing, the patient is instructed to move the mandible forward and backward to achieve the most retruded position. To give the patient a point of reference as to when this is accomplished, the patient is instructed to place the little finger in the ear canal on either side, fingernail to the rear. The patient can then feel the head of the condyle bump the fingers when the mandible is retruded forcefully (Figure 3, 4). From this position, the patient is then instructed to move the mandible from side to side drawing the classic arrow point tracing (Figure 5). It is important this procedure be accomplished without any physical contact between the patient and clinician. The recording bases are then luted together at this point with quick set impression plaster (Bosworth Plastogum).
Dr. Jameson is a board certified Prosthodontist who has done considerable work in disseminating information concerning the concept of linear non-interceptive occlusion. He was a consultant in Prosthodontics to the Surgeon General, USAF prior to his retirement from active duty and has been a consultant to the Department of Veterans Affairs.
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7 Responses to “ Centric Relation Record ”
gothic arch tracer is a wonderful way to fine cr but the plate must be parallel to the hamular notch and incisive papilla. What is so interesting that if you open the patient very wide the border movement are reduced and when you find the correct vertical the border movements are the greatest…..how interesting.
Yes, the repetiteve contracted length of the muscle sarcomeres. And in a more relaxed state (emg). Good point Dr Hoos!
Centric relation is a good treatment position for rehabilation. I do not think it is a stable position since patients in time adapt into a more downward and forward position of MI. Therefor, one could say it is not the most physiologic position. It is a more a convenience position for treatment , not function. SO?
In majority of individuals CR is a stable position. If dentures are made at any other acquired position, the patient will have trouble at a later stage when we have to re do the denture. Dentists should not hesitate to redo. Check bit method is done first and later try to verify it by graphic tracings.
CR is not a most stable relationship of the condyle to disc to fossa. It is not the most physiologic position for mandibular function. What defines the position of CR is also not clear from a clinical perspective either. We are the only profession to have 7 definitions from where our joint belongs. Just look in the glossery of prosthetic terminology. All CR is and for what it is most needed for is a starting position that is repeatable for therapy. A place where the brain can find its teeth since the MI position may not be functional. Thats it!
gothic arch tracer is very convenient for use in patients with good neuromuscular control. what about patients with poor neuromuscular control ?.is there any other way to deal this other than the selection of posterior teeth?.because most of the complete denture patients fall into this category.if the patient is trained to do the mandibular movements from the first visit, may be it will help to record the tracings better
CR is a position which is considered stable because of the manifested characteristics - repeatability is the best of its kind. In the clinic how does a dentist know that the condyle has gone to CR position? Confirming on repeatability. True muscles must be having some influence for that reason more emphasis need not be given on training. The patient system is upset by the occlusion rims which has increased vertical height. If a stable starting point is not used, finally dentists will land up in grinding all the posterior teeth. For a master adjustments will be easier but to become a master CR should be understood without ambiguity.
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