Robert W.

Loney
Maxillo-Mandibular Relationships
Centric and Protrusive Records
Robert W. Loney
Problems Establishing Edentulous
Maxillo-mandibular Relationships
Edentulous patients have more
difficulty determining where their
denture teeth should contact
No periodontal membrane
Old dentures wont fit on casts
Record base fit and wax rim changes
confuse some patients

Robert W. Loney
Centric Position
Acceptable position should be:
Conducive to health
Relatively repeatable
position can be checked before dentures
completed
Robert W. Loney
Conducive to Health
Relatively Symmetrical Position
Not absolute symmetry
Less chance of muscle strain which
might occur in non-centered positions
Robert W. Loney
Hinge Position is Repeatable
relatively centered
patient can find stable
occlusal contacts
relatively easily
allows change in
vertical dimension
Robert W. Loney
Centric Relation (CR)
Centric position of mandible in
relation to the maxilla
Defined by the position of the
condyles, rather than the teeth
Hinge position
Robert W. Loney
Centric Relation
Treatment position
Not necessarily ideal or
normal
Robert W. Loney
Centric Occlusion (CO)
Maxillo-mandibular position
determined by teeth
Sometimes considered coincident with
maximum intercuspation or habitual
closure
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CR and CO have been defined
differently by various
investigators, and differently over
different time periods
Robert W. Loney
Where is Centric Relation?
Glossary of Prosthodontic Terms:
Independent of
tooth contact
Clinically
discernible when
the mandible is
directed
superiorly and
anteriorly
Robert W. Loney
Where is Centric Relation?
Glossary of Prosthodontic Terms:

Condyles articulate with thinnest, avascular
portion disks
Anterior-superior position against slope of the
articular eminence
Robert W. Loney
Where is Centric Relation?
Glossary of Prosthodontic Terms:
Purely rotary
movement
about the
transverse
horizontal axis
Robert W. Loney
For the purpose of fabricating
complete dentures, the superior-
anterior position of Centric Relation
will be used
Robert W. Loney
Clinically the dentist cannot
determine the actual position of the
condyles at the time jaw relations
records are made
Robert W. Loney
When to Use Centric Relation
When entire occlusion being restored
No remaining posterior centric stops
When complete, fixed, or removable
partial dentures involve the entire
occlusion
Robert W. Loney
When to Not to Use Centric
Relation
Stable occlusion
No pathology
Posterior centric stops
present
No valid reason to change
Use maximum intercuspation
Robert W. Loney
Registering Centric Relation
Bimanual manipulation
Patient in a slightly
supine position
Robert W. Loney
Registering Centric Relation
Bimanual manipulation
Occlusion rim notched
to aid stabilizing the
record bases
Robert W. Loney
Registering Centric Relation
Bimanual manipulation
Index fingers on the rim,
thumbs under symphysis
Robert W. Loney
Registering Centric Relation
Jiggle the mandible
Mandible should freely arc
Allow the patient to close into contact
Robert W. Loney
Registering Centric Relation
Do NOT push the mandible or
dislodge the record base
Medium must be dead soft
(Yurkstas and Kapur)
Robert W. Loney
Registering Centric Relation
Minimal closing pressure
(Yurkstas and Kapur)
Robert W. Loney
Recording Centric Position
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Preparing Occlusion Rims
Place 3 widely separated lines between
the rims in the centric position
CRITICAL! Check that record base
heels/rims do not touch
Robert W. Loney
Line up Marks
Eliminate contact with record
bases
Robert W. Loney
Registering Centric Relation
Max & Mand Occusion Rims
Two sharp V-shaped
notches in the
molar/premolar area of
each sided wax
Depth 1-2 mm
1-2
mm
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Ensure Adequate Notch Depth
Too Shallow
- no undercuts
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Registering Centric Relation
Rehearse making the record without
recording medium
Place occlusion rims intraorally
PVS registration material (Memoreg) over
entire occlusal rim

Robert W. Loney
Thin Layer of Material
Too Thick
Good
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Thin Layer
Want flat record, no
excess on sides of rims
Excess material recording
of the sides of the rim can
cause deflection when
checking record
Robert W. Loney
Making the Record
Have patient close into record
Ensure smooth arc of closure, no
horizontal deviations
Use index fingers to stabilize lower
record base

Robert W. Loney
Registering Centric Relation
Patient opens, relaxes,
and slowly closes
Robert W. Loney
Registering Centric Relation
Gently arc the mandible in
a hinge-like motion
There should be:
No translation
No splinting
Robert W. Loney
Registering Centric Relation
Patient slowly closes
Operator uses tactile senses to
ensure the mandible does not
translate
Robert W. Loney
Registering Centric Relation
Patient closes until rims are almost
touching (1 mm separation)
Ask patient to stop as soon as this
position has been reached
Some may not be able to tell when
they contact
Robert W. Loney
Registering Centric Relation
Never instruct the patient to bite
firmly
Causes translation or inaccuracy
in the record
Robert W. Loney
Registering Centric Relation
Hold position until
set 1-2 min
Remove both rims
together
Separate
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Registration Should be Sharp,
Not Rounded
Robert W. Loney
Registering Centric Relation
Mounting the Mandibular Cast
Ensure record is repeatable
Increase the height of incisal
pin 1 mm, invert articulator
Place wax rims together, lute
with sticky wax - 4 spots
Robert W. Loney
Registering Centric Relation
Mount the mandibular cast with
mounting plaster
After mounting, remove the record &
adjust the incisal pin to allow contact
between rims
Occlusion rims should be touching
evenly, over the entire occlusal surface
Robert W. Loney
Registering Centric Relation
Do not alter incisal pin after
rims are contacting
Otherwise, height of correct
vertical dimension can be lost
Robert W. Loney
Check CR Record
Take new record, place on
articulator
Release articulator centric locks
Should arc into record without any
translation
If doesnt take 3rd record to see
which one is reproducible
Robert W. Loney
Protrusive Records
Used to set
condylar guidance
Helps setting teeth
for best occlusal
contacts
Robert W. Loney
Protrusive Records
Protrude a minimum of 5-6 mm
Ease of determination
Protrude less than 12 mm
Maximum travel of the condylar element
on most articulators
Robert W. Loney
Protrusive Records
Registration material over entire
rim
Patient closes with mandible
positioned anteriorly
Robert W. Loney
Protrusive Records
Material must interdigitate with the
opposing V-shaped notches
Record should cover entire rim surface
Robert W. Loney
Protrusive Records
Condylar elements are released from
hinge position
Instrument protruded, and the rims
closed into record
Robert W. Loney
Adjust Protrusive Guide for
Maximal Interdigitation
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Setting Condylar Angle
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Protrusive Records
The lateral
component of
condylar guidance
(Bennett Angle)
can be set
arbitrarily at 15
Robert W. Loney
Maxillomandibular Records
for Complete Dentures
Centric Relation
Treatment position
Operator assists to ensure a hinge position
Patient stops closure at initial contact
Protrusive
Programs articulator to optimize occlusion