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Intraoral Gothic ñrch Tracing
SimpI® Technique Por Determining VDO and Recording Centric
Relation Position For Complete Dentures
Barry Rubel, D.M.D.; Edward E. Hill, D.D.S., M.S.
Abstract
In order to oréate optimum esthetios, funotion and phonet-
ios in oomplete denture fabrioation, it is neoessary to record
aoourate maxillo-mandibuiar determinants of occlusion.
This requires clinical skill to establish an accurate, verifiable
and reproducible vertical dimension of occlusion (VDO)
and centric relation (CR). Correct vertical relation depends
upon a consideration of several factors, including muscle
tone, inter-dental arch space and parallelism of the ridges.
Any errors made while taking maxillo-mandibuiar jaw rela-
tion records will result in dentures that are uncomfortable
and, possibly, unwearable.
The application of a tracing mechanism such as the
Gothic arch tracer (a central bearing device) is a demon-
strable method of determining centric relation. Intraoral
Gothic arch tracers provide the advantage of capturing
VDO and CR in an easy-to-use technique for practitioners.
Intraoral tracing (Gothic arch tracing) is a preferred method
of obtaining consistent positions of the mandible in motion
(retrusive, protrusive and lateral) at a comfortable VDO.
RESTORATIVE DENTISTS want to be able to provide their com-
plete denture patients with prostheses that look natural, are
esthetically pleasing and provide optimum function within bio-
medical and acceptable dental parameters. In order to create den-
40 NYSDJ • AUGUST/SEPTEMBER 2011
ture occlusion that is functional, comfortable and balanced, it is
necessary to both determine a vertical dimension of occlusion that
is in harmony with the patient's musculature and to record a rela-
tively repeatable jaw relation position.' Both tasks require a degree
of accuracy that may challenge the knowledge and skill of the aver-
age general dentist. The purpose of this paper is to review and
illustrate a very simple and efficient technique for accomplishing
these two important steps in complete denture fabrication.
Background
An acceptable vertical dimension of occlusion (VDO—the distance
between the jaws when the teeth are in maximum intercuspation)
for a denture patient depends upon many factors. Muscle tone,
inter-arch space and parallelism of the ridges all play a role. An
excessive VDO may cause the patient to gag, clench or have chronic
soreness of the edentulous ridges, whereas an inadequate VDO will
reduce the patient's face height and make him or her look older. It
could also reduce chewing ability.
Numerous techniques have been offered in the dental literature to
establish a VDO for the denture patient (biting force,' facial measure-
ments,' phonetics,^ swallowing,' etc.). All of these rely upon the profes-
sional judgment of the dentist, which continues to develop with
increasing clinical experience in fabricating complete dentures. Robert
Lytle (1964) advocated using an adjustable central bearing device (a
flat metal plate attached to the upper record base and a flat metal plate
with an adjustable screw attached to the lower record base) for VDO
determination, assisted by patient feedback based upon the patient's
neuromuscular perception of what amount of jaw separation felt cor-
rect. He emphasized that the inexperienced dentist who uses the rest
position as a starting point to establish VDO is greatly handicapped,
because denture patients vary considerably in their interocdusal rest
 Dentai
Practice
B Brokerage
frem Sea te
Figure 1 . Gothic arch tracing. Shining Sea.
The Snyder Group is now a division of Henry
distance requirements and because "most patients have the ability to Scfiein Professional Practice Transitions, effec-
recognize an improved or proper vertical relation of occlusion."''
tively creating one of the largest dental transi-
The adjustable central stylus (screw) for an intraoral Gothic arch
tion firms in North America.
tracing device allows patient involvement in the VDO determination
process as recommended by Lytle. As for any technique used to estab-
With hundreds of practices available through-
lish VDO, it should be re-evaluated after teeth are set to insure that
out the U.S., we offer unparalleled opportuni-
phonetic, esthetic and physiological requirements are met.
Centric relation (CR) position (a mandibular position where the ties for buying, selling or nnerging your
condyles are superior and medially braced) is thought to be a relatively practice. We match buyers and sellers nation-
repeatable jaw position from which all opening and lateral mandibular wide, which means your pending or future sale
movements begin.' As such, recording centric relation position at an has even greater potential.
acceptable VDO is a critical step in the fabrication of complete dentures.
The dental literature cites many philosophies and methodologies on Our hands-on, comprehensive approach hasn't
how to attain centric relation. Bimanual manipulation of the mandible, changed. We still provide expert guidance at
chin point guidance and the use of an anterior jig have all been advo- every turn — from practice valuation and
cated for dentate patients; each has pros and cons.
financing through contracts and settlement.
For the edentulous patient, soft-tissue-supported record bases
must remain stable during jaw positioning. Not holding the record To learn more about improving your opportuni-
bases while the patient's mandible is manipulated, having the patient ties for success, call 1 -800-988-5674 or visit
curl the tongue to the top of the mouth, or the dentist securing the
www.snydergroup.net today to view prac-
lower record base with his or her fingers while manipulating the
mandible all may influence the patient or allow shifting of the record tices for sale nationwide.
bases and lead to an incorrect CR record. The use of a central bearing
device helps hold both record bases in place while the patient's mus-
cles place the condyles in a retruded position that is most physiologi- THE
cally favorable for that particular patient without external influence. SNYDER QHENRY SCHEIN*
Early extraoral graphic recordings by Balkwill produced an GROUP PROFESSIONAL PRACTICE TRANSITIONS
A DrvisoN OF a HENRY SCHEIN*
intersection of arcs caused by lateral translation of the right and left
condyles, which form an apex of what is known as the Gothic arch
tracing (Figure I).' Hardy designed an intraoral tracer and made a 100 Centre Blvd., Suite A Marlton, NJ 08053
depression with a round bur at the apex of the tracing to help him

NYSDJ • AUGUST/SEPTEMBER 2011 41

 1 repeatedly place the mandible in its most retruded position. The
Figure 2. Components ot intraoral tracer: recording plate: stylus and holding
plate: locking nut tor stylus (Y& M Maxillomandibular Recorder, Edmonds Dental
Prosthetics. Inc., Springfield MO).
Figure 3. Looking nut tightened on stylus positioned on maxillary occlusion rim.
Figure 4. Gothic arch tracing on aluminum plate positioned on mandibular
occlusion rim.
Figure 5. Divot or hole is placed at apex ot tracing to mark centric position.
42 NYSDJ • AUGUST/SEPTEMBER 2011
central bearing point was kept in the depression while plaster was
injected to form a static record." Other dental pioneers, such as
Harper, Schiffman, Ellinger and Gysi, all utilized Cothic arch tracers
to help determine optimal jaw position and eliminate occlusal dis-
crepancies for their patients."
Phillips (1927) stated that the apex of a Gothic arch tracing
visibly indicates the correct centric position.'' Kapur and Yurkstas
(1957) concluded that an intraoral tracing procedure was more
consistent for recording centric relation in complete denture pros-
thetics than extraoral tracing or wax registration procedures." A
study by Myers ( 1980) found no evidence to support the contention
that a dentist-assisted jaw relation is more reproducible than the
relation indicated by a Gothic arch apex.'"
Technique
Intraoral Gothic arch tracers provide all the advantages of their
early extraoral counterparts, but do so with far greater simplicity.
The technique for using both old style and newer Gothic arch trac-
ers is the same and utilizes four very basic parts (Figure 2). First,
the maxillary occlusion rim is contoured for: a. facial; b. incisai
length; and c. occlusal plane. A metal plate holding an adjustable
stylus is then secured to the maxillary wax occlusion rim and
record base and a flat metal plate is attached to the mandibular
occlusion rim and record base. The point of the tracing stylus
should be at the intersection of the maxillary midline and an
imaginary line passing through the distal surface of the first bicus-
pids. The aluminum tracing plate is attached to the mandibular
record base and wax rim, so that it is parallel to the maxillary plate
and perpendicular to the tracing stylus.
The record bases are returned to the mouth and the stylus is
adjusted to allow a VDO position that feels comfortable to the
patient and appears esthetically and physiologically correct to the
dentist. A locking nut is used to secure the height of the stylus when
the VDO is acceptable (Figure 3). The patient is instructed to
retrude the jaw and then advance the mandible into a protrusive
position. These paths of retrusion and protrusion are repeated sev-
eral times to ensure they are marked on the lower tracing plate
(Figure 4). Air abrasion of the tracing plate to give a matte finish or
coating with wax may make the tracing marks easier to see. The
patient is then instructed to carry his or her mandible into its most
lateral movements; these movements are similarly marked on the
lower tracing plate.
After a discernable Gothic arch tracing has been marked on
the aluminum plate, a small hole or divot is made with a #6 round
burr at the apex, which is used to position the patient for a static
record (Figure 5). The record bases are returned to the mouth and
the patient is asked to close his or her mouth and move to a
retruded mandibular position so that the stylus falls into the divot
or hole. Quick-setting plaster, or any other rigid material, may be
injected between the rims or placed on the rims to produce a
static record of centric relation position at the predetermined
VDO for the patient (Figure 6). After mounting casts on a suitable
articulator and setting the teeth, the wax trial dentures should be
evaluated for correctness of the chosen VDO and centric relation
occlusion (Figure 7).

Conclusion
The use of an intraoral Gothic arch tracing device is a simple, effi- Figure 6. Quick-set plaster used to secure plates in centric relation position.
cient and relatively consistent technique to determine both VDO
and record a repeatable retruded jaw relationship when fabricating
complete dentures.'"' It is a tried and tested technique that is not
new to dentistry, but may be especially useful for the younger den-
tal practitioner or dentist with limited experience in treating com-
pletely edentulous patients. •

Queries about this article can be sent to Dr. Rubel at brubel&umc.edu.

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