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JAW RELATIONS RECORD
Prof. Dr. Abdel-Basit Mahmoud 1

CHAPTER IV

RECORDING JAW RELATIONS

It is essential that the retention and the stability of the record blocks are good if
accurate results are to be obtained and both must be checked before starting to trim the
rims.

Fig. 4; 1: Armamentarium, the following items are needed:
Maxillary cast with record base (without rim), Mandibular cast with wax occlusion
rim, Occlusal plane indicator, Rim former, Bunsen burner, Ruler, Wax spatula,
Baseplate wax, Sticky wax, Laboratory knife, Indelible pencil and Petroleum jelly.

I. Adjustment of the Upper Record Block

A. Labial fullness:
The labial surface must be adjusted until a natural and pleasing position
of the upper lips is obtained (fig.4: 2).

Fig. 4; 2: Adjusting the upper rim until a natural position
of the upper lips is obtained.


Fig. 4; 3: The right cheek contacts the wax rim correctly. The left side of the
wax rim extends too far to-wards the palate on the residual ridge.

Fig. 4; 4: Correcting the wax rim, it has good contact with the left cheek & remove
the wax from the palatal aspect to the dotted line.

B. The height of the rim:
The average adult shows approximately 2 mm. of the upper central
incisors when the lips are just parted and the same should be applied to
the occlusion rims (fig.4: 5).

A greater length of teeth than normal will be shown with:
(a) A short upper lip.
(b) Superior protrusion.

Less lemgth will be shown with:
With a long upper lip.
In most old people, owing to the attrition of the natural teeth and
some loss of tone of the orbicularis muscle.

An aid in establishing the anterior length is by a phonetic test. Ask the patient
to pronounce the letters F or V, on pronouncing those letters the edge of the upper rim
(representing the incisal edge of anterior teeth) should be in light contact with the
lower lip.

C. The anterior plane:
Generally, the anterior plane of the rim, must be
trimmed to be parallel to an imaginary line joining
the pupils of the eyes (inter-pupillary line)

Fig. 4; 6: The anterior plane is adjusted with the aid of the Fox plane to
be parallel to the inter-pupillary line.

D. The anteroposterior plane:
The rim is trimmed parallel to the naso-auricular
line (ala-tragus or Camper's line).
It is an imaginary line running from the superior
border of the tragus of the ear to the inferior
border of the ala of the nose.
It must be remembered that the posterior teeth are set to a slight
anteroposterior curve whilst the naso-auricular line is straight, and is used as
an aid to the technician rather than a fixed position.
It is advisable to use an occlusal plane indicator (Fox plane) for obtaining
the correct anterior and anteroposterior planes (Fig. 4: 7 - 10).

Fig. 4; 8: Initial situation with the new record bases
Fig. 4; 9: The wax occlusion rims adjusted parallel to the
in situ. The wax occlusion rims made in the laboratory reference planes.
do not correspond optimally to the reference planes.

Fig. 4; 10: Completed record bases and occlusion rims in the mouth
(the rims contact each other uniformly)

E. The position of the posterior palatal border (post-damming):
Site: The post dam should be placed in the region of compressible tissue just
distal to the hard palate, but it must be anterior to the vibrating line.
Determination:
The operator first determines the position of the vibrating line by asking
the patient to say a prolonged "ah" with the mouth widely opened, and
noting the line from which the soft palate moves. For future reference it
is useful to mark this line on the palate with an indelible pencil. The
tissue in front of this line is exposed with a blunt instrument and the area
of soft compressible tissue noted.
The posterior border can be located with great accuracy if it is possible to
see the two small pits (fovea palatinae) one on either side of the midline
on the anterior part of the soft palate. The fovea is usually, though not
invariably, present, and are situated just anterior to the vibrating line, thus
marking the posterior limit of the denture. The posterior border of the
record block is adjusted by trimming or by adding wax to coincide with
the position, which has been selected for post-damming (Fig. 4: 11).

Fig. 4; 11: Locating the position of the post dam.
Function of posterior palatal seal:
1- It increases retention of the denture by atmospheric pressure.
2- It prevents air and food from getting under the denture.
3- It reduces reflex irritation and gag by reducing patient awareness of this area,
since there should be no separation of the denture base and soft palate.
4- Making the thickness of the base less conspicuous to the tongue, as, the posterior
denture border will approximate the soft tissues.
5- It compensates for dimensional changes that are inherent in the laboratory
procedures.

F. Guide lines:
The central line (midline). The high lip line. The corner lines (canine lines).

1- The central line (midline):
A vertical line is scored on the labial surface of the upper rim (fig. 4: 12):
Immediately below the incisive papilla or labial frenum.
Immediately below the center of the philtrum.
At the bisection of the line from corner to corner of the mouth when the
lips are relaxed.

2- The high lip line:
This is a line just in contact with the lower border of the upper lip when
it is raised as high as possible unaided, as in smiling or laughing.
it is marked on the labial surface of the rim and indicates the amount of
the denture, which may be seen under normal conditions, and thus
assisting in determining the length of tooth needed.

3- The corner (canine) lines:
These mark the corners of the mouth when the lips are relaxed and are
supposed to coincide with the tips of the upper canine teeth.
These lines give some indications of the width of six anterior teeth from
tip to tip of the canines.

Fig. 4; 12: Guide lines (Left, midline & Right, canine lines )

II. DETERMINING OCCLUSAL
VERTICAL DIMENSION (OVD)

Vertical dimension is a vertical measurement of the face between any two
arbitrary selected points that are conveniently located one above and one below the
mouth, usually in the midline.

There are two types of vertical dimension:
o Vertical dimension of rest position: This is "the vertical dimension of
the face when the jaws are in rest relation (position)". This is the position
of the jaws when all the muscles are relaxed i.e. in a state of equilibrium.

o Occlusal vertical dimension (vertical dimension of centric occlusion):
which is "the vertical dimension of the face when the teeth or occlusion
rims are in contact in centric relation".

*Techniques of establishing the Vertical Dimension:

A. Rest position (free way space) measurement:
Make a thin horizontal line or pin-head-sized mark on the tip of the patient's
nose and another on the point of his chin.

The patient must be comfortably seated in the chair and asked to relax his whole
body as comfortable as possible and allow his jaw to rest in a comfortable
position with the lips closed or slightly parted.
Measure the distance between the marks either with a pair of dividers, a
millimeter ruler or a bite gauge (Fig. 4 : 13 a, b & c).

a b c
Fig. 4; 13: Two arbitrary selected points located one above and one below the mouth, usually in the
midline using: a) millimeter ruler, b) bite gauge, c) or divider.

For obtaining a relaxed position
Ask the patient to moisten his lips and then close them to a comfortable
position. Check the measurement previously obtained.
Ask the patient to swallow and relax without separating the lips. Again check
the measurement.
Ask the patient to repeat the letter "M" several times, finishing in the middle
of the last M; that is not completing the sound by separating the lips.

Insert the record blocks and trim the occlusal surface of the lower until it
occludes evenly with that of the upper (Fig. 4 : 14),

Produce a free way space by removing a further 2 or 3 mm. from the lower
record rim (Fig. 4 : 15-a).

Check the existence of this free way space by asking the patient to relax with the
record blocks in his mouth and with the lips closed. Then ask the patient to close
the blocks together, slight but definite movement of the chin will take place, if
there is an adequate free way space (Fig. 4 : 15-b).

a b
Fig. 4; 14 : Trim the occlusal surface of the lower (Left) until it occludes evenly
with that of the upper (Right)

a b
Fig. 4; 15 : Left, adequate free way space (2-3 mm.).
Right, check the existence of this free way space.

B. Willis measurement:
The distance from the base of the nose to the lower edge of the mandible should
be equal to the distance from the outer canthus of the eye to the parting line of the lips
when the mandible is in rest position (Fig. 4 : 16).

Fig. 4; 16: The diagram shows the equal proportions of the forehead, the midline
of the face and the lower face.
C. Facial expression:
o A protruded mandible seen in profile may indicate excessive
interocclusal space. If the chin looks too close to the nose in full view,
there may be excessive interocclusal space.
o Compressed lips, without strain, indicate overclosure. If the smooth mucosa
is overly exposed or if the chin is strained to allow lip contact, the jaws are
being kept too far apart (high vertical dimension).

o The mento-labial sulcus is obliterated when the jaws are too far apart and
deeply furrowed when they are too close together.
o The naso-labial sulcus curves backwards excessively in overclosure and
is made excessively straight in over opening.

E. Pre-extraction records:
a) Facial measurements:
The Willis device can be used to measure the distance from the base of the nose
to the lower border of the chin.

b) Contour wire (profile tracing):
A soft lead wire is used to outline the contour of the face before extraction of
the teeth. This contoured wire is outlined on a piece of cardboard and cut to be refitted
to the patient's face at the time of recording the vertical dimension.

c) Articulated models:
These will indicate the amount of overbite as well as assisting in the selection
of size, shape and position of the teeth to be used for the dentures.

d) Acrylic resin facemask:
Hydrocolloid or plaster of Paris is used as facial impression materials. A
transparent acrylic resin face form is then constructed on the stone cast. This method
was found to be impractical.

e) Profile radiographs or photographs:
Some authors suggest them but they are not accurate enough to replace the
other measurements.

E. Other measurements:

1) Paralleling posterior ridges:
The paralleling of the maxillary and mandibular ridges, plus a 5-degree
opening, in the posterior region, as suggested by Sears, often gives a clue to the
correct amount of opening.
Parallelism between ridges is important because in this way biting forces are
vertical on the ridges and there is no tendency for horizontal displacement of
the dentures.
2) Phonetics:
o Phonetics has been used by some to aid in obtaining the correct vertical
dimension, by having the patient use words with the letters S and Ch
(closest speaking space).

3) The power point (Boos Bimeter):
The theory is that the patient registers the maximum amount of biting force
when the teeth first contact in centric occlusion. This registration is done by
means, of an instrument called Bimeter.
The Bimeter is attached to the lower rim and a plate is attached to the upper.
The patient is asked to close with maximum biting force and the device is
locked. This technique was found to be clinically unreliable.

*Effects of excessively increasing the vertical dimension:

1. Discomfort: By altering the vertical height the environment in which the
unconscious movements take place has been altered, until a new pattern has been
established considerable discomfort will be caused.
2. Trauma: The premature striking of the teeth causes constant trauma on the
tissues.
3. Clicking of teeth: Premature contact of the teeth during speech or eating will
produce embarrassing clicking or clattering sound. During eating the clicking sound
is less obvious because it is muffled by the food.
4. Appearance: Over-opening may result in an elongation of the face, but if it is
only slight it will usually pass unnoticed.

*Effects of excessively reducing the vertical dimension:

1. Inefficiency: Reduced inter-arch distance reduces biting force because the
muscles of mastication are acting from attachments, which have been brought closer
together.
2. Cheek biting: In some cases where there is a loss of muscular tone, as well as a
reduced vertical height, the flabby cheeks tend to become trapped between the teeth
and bitten during mastication.
3. Appearance: The general effect of overclosure on facial appearance is of
increased age; there is closer approximation of the nose to chin, the soft tissues sag
and fall in, and the lines on the face are deepened. The greater the degree of
overclosure the more exaggerated is these effects.
4. Soreness at the corners of the mouth: (Angular cheilitis):
Overclosure of the vertical height sometimes results in a falling of the corners
of the mouth beyond the vermilion border and the deep fold thus formed becomes
bathed in saliva: this area may become infected and sore and then difficult to cure
whilst it remains moist. Opening the vertical height restores the corners of the mouth
to their normal position, sometimes producing a marked improvement or cure.

5. Troubles in tempromandibular joint:
Troubles in the T.M.J are often attributed to reduced vertical dimension.
Obscure pains and discomfort, clicking sounds, and headaches and neuralgia often
manifest the symptoms of the joint involvement.

III. THE HORIZONTAL RELATION
(CENTRIC RELATION)

The significance of centric relation:
The irregular loss of teeth has often shunted the mandible into a slight
protrusive or lateral position, or both. It is known that the most favorable position of
the mandible for complete dentures is an exact centric relation. The muscles, the
bones, the ligaments, the teeth, and all structures grow into what might be termed a
muscle center. To change haphazardly, this muscle center is to endanger the stability
and efficiency of the dentures and the comfort of the patients.

Difficulties of retruding the mandible:
Many individuals, who have been without teeth for some considerable time,
have a tendency to protrude the mandible when asked to close the jaws together.

Such patients cause difficulty for the operator when trying to obtain centric
relation. Also, many patients manage for a number of years with only the natural
anterior teeth standing without wearing dentures to replace the missing posterior teeth
and once again an unconscious provision of the mandible results.
Aids to retruded the mandible:
a. Tongue retrusion:
Ask the patient to place the tip of the tongue as far back on the palate as
possible, to keep it there and close the record blocks together until they meet
(Fig. 4 : 17). Some patients have a tendency to let the tongue move forward and
it is often helpful to put a small piece of composition near the posterior border
of the upper record block. The patient is requested to place the tip of the tongue
in contact with the composition and keep it there whilst he closes.
The reason behind this suggestion is that the tongue, when in position, will
exert a muscular pull on the mandible, in a backward direction.

b. Relaxation:
If the patient relaxes the muscles of the jaw it will automatically assume
the retruded position and this will be greatly assisted by general bodily
relaxation.

c. Swallowing:
Ask the patient to swallow and conclude the act with the blocks in
contact.
This is based on the fact that with a natural dentition the teeth are brought
into centric occlusion during swallowing.

d. Fatigue:
Ask the patient to protrude and retrude the mandible continuously for
as long as possible and to finish in a retrusive position with the blocks in
contact.
The objective is to tire the lateral pterygoid muscles so that they will
relax when the movement ceases, and so allow the condylar heads to be
retruded.

e. Head position:
Ask the patient to bend the head backward as possible. This will
produce some backward pull on the mandible.

f. The temporalis muscle:
The anterior fibers of the temporalis muscle only contract on closure
of the mandible if it is retruded.
Thus, if the fingers are placed on the temporalis and the patient closes the
rims firmly the contraction or not of the anterior fibers of the temporalis
may be used as an assessment of mandibular retrusion.

As soon as it is considered that the rims are in retrusive occlusion, two,
approximately vertical lines (Buccal lines) should be scored on their buccal aspects
one on either side in the premolar region. These lines should extent across both rims
and are used for checking the retrusion of the mandible.

- If the mandible is correctly retruded; the lines on the lower block will
always coincide with those on the upper when the jaws are closed.
- If any alteration in the maxillo-mandibular relation occurs, the lines on
the lower block will no longer coincide with those on the upper; and this will indicate
an altered relationship.

Methods of centric relation registration

I. The interocclusal registration method (check bite).
II. The central bearing point (Gothic arch tracing method).
III- Terminal hinge axis method
IV - Chew-in or the functional method

A- Interocclusal registration of centric relation:

Always ask the patient to close never ask him to bite. Bite conveys the
impression of incising, and to incise requires some protrusion of the jaw, which is
reverse of what is required.

Check bite method (Fig. 4: 18):
o Two V-shaped notches are cut in the occlusal surface of the upper rim.
o Two millimeters of wax is removed from the mandibular occlusion rim to
accommodate the recording material.
o Softened wax is shaped into a roll approximately two-thirds the diameter of a
lead pencil and attached to the occlusal surface of the mandibular rim, replacing
the removed wax.
o The soft wax is shaped triangular with the base adjacent to the hard wax. The
added wax should be about 4mm. in height.
o The blocks are placed in the mouth while the added wax is soft and the patient
is guided to close in centric relation using any of the previously mentioned
techniques till the required vertical dimension is obtained (vertical dimension of
occlusion).
o The blocks are then removed from the mouth and chilled. After the wax has
been chilled, the excess that oozed out is trimmed away;
o The centric relation is, then, re-checked as described before. Some authors
recommend the removal of wax only from the posterior portion of the
mandibular rim leaving the anterior portion to maintain the predetermined
vertical dimension.

B. Gothic arch tracing method:
Gothic arch tracing can be used either to record centric relation or to re-check
a previously mounted centric relation record.
This may be obtained either by intra-oral or extra-oral tracing methods.
Gothic arch tracer in the form of a tracing, made by a pointed attachment
(stylus) fitted to one block and a recording plate fitted to the other.

The lateral movements of the mandible starting from the retruded
position and traces a line or arc starting from a point, which is the most
retruded position of the rotating condyle.
When the opposite condyle is caused to move on its path, it starts from
the same point
the to lines intersect to form an angular tracing called gothic arch
tracing.
Therefore, when both condyles are resting in their most retruded positions,
the needle point of the tracer will be resting on the apex of the Gothic arch
thus created.

1. Intra-oral tracing:
The intra-oral device consists of a tracing plate, a locking disc and a
carrier through the center of which is a threaded a pointed stylus (tracing
point) controlled by a locking nut (Fig. 4: 19).

Fig. 4; 19: Intra oral tracer, showing tracing stylus attached to the upper block (Left), tracing plate
attached to the lower block (Middle) and registration device in the patient's mouth (Right).

After the correct vertical height has been obtained, the carrier is fitted to
the lower rim
The tracing plate is inserted parallel to and just below, the occlusal
surface of the upper rim.
Place the blocks in the mouth with the stylus adjusted to hold the rims
slightly apart.
The patient now performs lateral jaw movements, keeping the tracing
point in contact with the plate the whole time.
When the operator is satisfied that the patient can perform these
movements correctly, the upper blocks is removed and after the
tracing plate has been filmed with blue inlay wax the blocks are
replaced in the mouth.

Lateral and protrusive movements are made (Fig. 4: 20), the tracings
examined, and if a clearly defined arrow has been recorded the retruded
position has been obtained.
The locking disc is a transparent plastic disc having a hole in the center
and which can be secured to the tracing plate in any desired position.
The disc is placed over the tracing plate and its hole is adjusted to the
apex of the Gothic arch. The disc is then secured to the underlying plate.
The tracing point is then readjusted just to make the rims
in contact.
Fig. 4; 20: Tracing the ability of the patient's to move the mandible
horizontally.

The blocks are returned to the mouth and the patient is
asked to move the mandible until the stylus slips into the hole of the disc.
The blocks should now be in even contact and no longer held apart by the
screw the blocks are united in the mouth with a mix of plaster (Fig. 4: 21).

If the recorded centric relation is found to be different from that recorded by
interocclusal registration the lower model will be remounted according to the Gothic
arch tracing.

2. Extra-oral tracing (Fig. 4: 22 a & b):
The extra-oral tracing apparatus is similar to the intra-oral except that the
stylus and tracing plate are outside the mouth, being attached to the record
blocks by rods, which pass between the lips.
The tracing plate is attached to the lower rim. The technique is dependent on
well-fitting, stable bases and those of acrylic undoubtly give the most
successful results.

Tracings inside the mouth are often so small that it is difficult to obtain a sharp
apex.
No locking discs or holes in the plate are required to ensure that the mandible is
in the most retruded position; this can be known from the tracer outside the
mouth.
The extra-oral tracings are sometimes used in combination with a central
bearing point, which is mounted intra-orally.

Disadvantages of extra-oral tracings without using a central bearing point are the
following:
It is extremely difficult to get an equalized pressure on blocks of wax or
compound during tracing.
The weight of the extra-oral tracer may displace the record blocks.

C. Terminal hinge axis method:
The fork of the mandibular face bow is attached to the lower rim. The
patient is asked to open and close until the condylar rods do not move in
an arc but rotate in a point.
Wax or plaster mix is interposed between maxillary and mandibular rims
and the relation can be transferred to the articulator.

D. Chew-in or the functional method:
In this method the patient records centric and eccentric (lateral and
protrusive) movements.
A suitable material is placed in between the upper and lower blocks and
the patient is asked to perform lateral (right and left) and protrusive
movements, alternating these movements until paths are curved into the
material.

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JAW RELATIONS RECORD

Prof. Dr. Abdel-Basit Mahmoud 1

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