Centric Relation in Dentistry

Kushal GadhiaBDS, MFDS (RCS Eng.), MSc (Cons), FDS (Rest. Dent)

Consultant in Restorative Dentistry, Eastman Dental HospitalClinical Director at Centre Of Dental Excellence

Clinical Director at Royston Dental careDirector at Advanced Centre of Excellence (ACE)

Specialist in Periodontology, Endodontics, ProsthodonticsSpecial Interest in Implant Surgery

Study Club Director Dentinal Tubules (North London)

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V1 – impressions –> study casts

V2 – record the CR -> lucia jig, facebow, bite records

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Step 1: Examine the occlusion of the subject

Step 2: Cotton wool between the anterior teeth for 10 minutesAssess the amount of separation at the most posterior teethIdeally you want 2 – 2.5mm separation (for michigan splint)

Step 3: Vaseline the anterior teethLet the patient know to inform you if the teeth feel hot

Step 4: Mix the Duralay (pattern resin)Ensure the cotton woll roll is always in place and the teeth don’t contact

Step 5: Construct the duralay jig and let is setTake it in and out as the consistency hardensDon’t lock it in between the teethDon’t let it get too hot - Very important

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Step 6: Once set, assess there is no rocking of the Jig when fully seated

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Step 7: Check that the separation between the 7’s is at least 2mm

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Step 8: With the jig in place, ask the patient to slide mandible in protrusion and backwards multiple time, OBSERVE THE OCCLUSION CAREFULLY FALL INTO CR

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Step 9: Check which anterior teeth contact with a BLUE / BLACK articulating paper

Step 10: Record Protrusive marks

Step 11: VISUALISE WHAT HAPPENS IN LATERAL EXCURSIONS AND PICK A TOOTH

Step 12: WITH A TOOTH OF YOUR CHOICE, AS PATIENT TO MAKE THE FOLLOWING MOVEMENTS

PROTRUSION

RIGHT LATERAL EXCURSION

PROTRUSION

LEFT LATERAL EXCURSION

PROTRUSIONwww.ace-courses.co.uk

Step 12: PROTRUSION AND RIGHT LATERAL MOVEMENTS ONLY. ELIMINATE THE UNWANTED LINES

Step 12: PROTRUSION AND RIGHT LATERAL MOVEMENTS ONLY. ELIMINATE THE UNWANTED LINES

Step 13: WITH A TOOTH OF YOUR CHOICE, AS PATIENT TO MAKE THE FOLLOWING MOVEMENTS

PROTRUSION

RIGHT LATERAL EXCURSION

PROTRUSION

LEFT LATERAL EXCURSION

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Step 13: VISUALISE AND MARK WHAT HAPPENS IN LEFT LATERAL EXCURSIONS

Step 13: ELIMINATE THE LINES YOU DON’T WANT

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MIP

LLERLE

CR

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Step 14: RECORD THE CENTRIC RELATION

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Step 14: RECORD THE CENTRIC RELATION

Take Moyco beauty waxRun it under Hot WaterFold it in 3Trim the wax to fit the dentitionAsk the patient to bite into the beauty wax and let it set

You want light indentationsYou can reline it later with temp bond to get accurate indentation

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Step 14: VERIFY THE BITE REG ON YOUR DIRECTORS STUDY CASTS

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