figure I

A = Superiormost Fosilion
B = Reormost Position

"The Internotianal Joumol ol Periodortics ond Reslorotive Dentistry" 2/1982

Centric Relation - The Anterior

Biting Jig for Recording
the Clenching Position

Edward Levinso
Honarary Profe.

Department of Endodontics
ond Rehabilitation,
University of Pretoria

In restoring an acclusion, it is desirable ta use a maxillomandibular relatianship that is physiolagically acceptable to the patient and reliably
reproducible far the dentist. Centric
relation (RC) has been used for many
years and has been found fo satisfy
both requirements.
It has thus evalved as a clinical cancept rather than a biologic entity [Silverman, 1975) and its definition has
undergone change from time to time.
In that period of its history, when
prosthetic dentistry was primarily
concerned with the provision af full
dentures, a position of the mandible
relative ta the cranium was saught,
where maximum intercuspation (IC)
of the artificial teeth cauld be established. The act of swallowing is normally accompanied by retrusian af
the mandible, and its stabilisation
against the cranium by tooth contact
in this retruded pasition. It is understandable, then, that the IC which
was found clinically to be most camfortable for the patient was at, ar
near, this distalised pasition, and the
fact that this could be duplicated
within acceptable limits was expedient
far the prosthadontist. Stated differently, IC was ta be established close
to the most retruded position of the
mandible |RC}.
Thompson (194) pointed aut the
need far an adequafe interocclusal
clearance (freeway space) between
the opposing teeth in fhe rest position
of the mandible, hie faund this to
average 2-3 mm in the narmal dentition- This implies that, in addition fo
its determination in a harizanfal
plane, there is a vertical component
to the RC/IC positian.
When dentistry entered an era af
fixed prosthetic resfaratlon, fhe concept af establishing the occlusion at

the retruded positian of the mandible

was developed still further. Whereas
the full denture was supparted by a
resilient tissue {Hanau, 1926), which
enhanced the adaptive capacity of
the mechanism, the fixed restoration
had ta be constructed ia finer tolerances. In addition, the presence of
natural teeth, with their periadantal
ligaments richly endowed with proprioceptors, provided an input which
was capable oi triggering the neuromuscular mechanism nta parafunctianol activity.
At that time, the definition of centric
relation was based on fhe concept
that in this pasition fhecondyles occupied their mast posterior pasition in
the fassa [Clossory of Prostfiodontic
Terms, 1977). In the clinical recording af centric relatian position, techniques were adopted which concentrated on placing candyles in their
rearmost pasitian. These included
chin-paint guidance, placing the tip
af the tongue far back in the palate,
swallowing, etc. Several authors
painted out, hawever, that in this rearmost position the condyies would nat
necessarily be in their uppermost positian (Fig. 1). Kaplan (193) painted
out the possibility of recording an inferior "sagged" positian af the candyles. Lang (1973] emphasized
the necessity far getting the condyies
into a superior rather than a posteriar
positian. Dowson (1974) stated that
chin guidance with ane-handed techniques pushing backwards on the
symphysis would tend fo record an inferior pasitian af the condyies. This is
borne aut by the work o\Rees (1954)
who showed that the configurafion of the temporamandibular ligament is such as ta limit distal positianing af the condyle, but permit an
inferiar placement at the same time.

ilemorional Journal of PerLodonrics ond Reslororive Dentistry" 2/1982

10

The definition of centric relatian has

subsequently been chonged to encompass the concept of the eondyle
being in its superiarmost, onteriormost position, where it is braced by
ligament ond bone.
The vorious methods that hove been
used to determine RC position include gathic arch trocings, guided and
free unguided closure, bilateral manipulation, chin-point guidonce ond
swallowing. Such is the adoptobility
of the masticatory mechanism with its
delicote neuromuscular control thot
all these vorious methods have met
with success. It is likely thot care, patient selection ond attention to detail
were more important thon the choice
of technique.

Funclion and Parafuncflon

Telemetric studies [Jankekon, 1953)
show that teeth make but fleeting
contact in function. The impartonce,
then, of the RC/IC position wos not in
relation to function, where light forces, fovourable in direction, distributian ond duration, ore employed. In
porafunctian, on the other hand,
heovy forces, sustoined ond unfavourable in direction ond distribution,
ore placed an the teeth. In clenching,
the concomitant activity of the dosing muscles tends to seat the con"Ttie hternolional Journol af Periodontics and Restorative Dentistry" 2/1982

dyles in their superiormost, onteriormost position [Rabetis, 1974) (Fig. 2).

This could well be described as the
physiologic denchtng positioti of the
condyles (CP), where they are
braced by ligoment and bane, and
can maintain their position without
activity af externol pterygoid muscle
{Dawson, 1974) (Fig. 3].
In providing o new occlusion, its
component parts should be most in
hormony when the condyles are in
CP, where they are best able to withstand heovy parafunctional forces.
This is especiolly important as porofunction is often initiated by alterations
to the occlusion. The bilateral mandibular manipulotion of Dawson is
intended to guide the condyles to
their CP. The technique to be described utilizes the activity of the
clenching muscles to ochieve this
purpose.

Description of Tecfinique
Lucia (1964) advocated the registration of RC with an onterior bite ig, to
record the most posterior position of
the condyles. A madificotion of this,
anterior biting jig (ABJ), is canstructed, either of self-curing acrylic
or compound, in order to record fhe
uppermost, anteriormost eondylar
position (Fig. 4),

loccording ta Rabertsl
Fig. 2 Muscle force
t = temporatis
m = mosseter
bf resultant ol elevator musdes

Fig. 3 Clenching position of the candyle (

RP = Rest Position

Fig. 4 Construction af anterior biting

1 Indexing incisor teeth
2 Trimming of index
3 Jig ready to receive linal index

The International Jaurral of Peiiadontics and Reslorotive Denlistry" 2/1982

12

Stepl

The Centrol Incisor Index

The mandible is guided in a terminal
hinge movement and an index of the
incisol tips of the opposing central incisors is made against compound
fused fo the ig (Fig. 5j.
If the CP record is being made for a
reconstruction of the occlusion, the
index is mode of the vertical dimension fo which it is proposed to rebuild
the occlusion Fig. 6]. If the CP is
being recorded for functional analysis
of the natural dentition, the index is
made with the vertical dimension increased minimally, so that the posterior teeth are only usf held out of occlusion (Fig. 7].
Fig. 5 Anleriar biting {ig for CP registrotian ior reconslruclian, mth compound inde.

Fig 6 CP registrotian for reconstruction

brp = bile registrotion moterial

Jigs may be used in either one or

both aws, depending on skeletal and
faoth relationships and the presence
of missing teeth (Fig. 8].
The CP record should be made in the
absence of abnormal tonus of the
masticatory musculature. If a Hawley
bite plane has been used ta achieve
this, it can serve well as a biting
;igIt is imperative that the anferiar contact does nof praduce o vector of
force at an inclination to the closing
path of the lower anteriors. This
would tend to displace the condyles
either mechanically or by proprioceptively induced muscle octivity.
This situation applies porticularly in
the case of a posterior reconstruction, where the anterior maxillary and
mandibular teefh are often used,
after equilibration, ta serve the purpose of the anterior jig (Fig. 9]. In an
edge-to-edge situotion (Fig. 10] or
with prominent cingula (developmental, or following attrition), no
problem arises. FHowever, where the
anterior guidance could tend to dis-

'The Interrotionoi Jourrol of Periadortccs ond Restorotive Dentisln^" 2/1982

13

Fig. 7 CP registration for functional anolysis

o = acrylic jig
c = coTipound
brp = bite regi^lrotion material

Fig 8 Inde' mode on tower incisor leeth for CP registrolion in Closs III situation.
1 lormmg inde>
2 trimming inde^
3 indei reody lo receive compound

"The International Jaurnol of Periodortics ord Restoralive Dentistry" 2/1982

14

Fig. 9

In the absence af posterior Iooth contact, a biting force cauld couse o distol vector of (orce (orrowl

Fig. 10 I, 2 Edge to edge, ar cingulum siluolions do not require compound reinforcement.

3 Anteriar guidance requiring compaund reinforcement

"The Inrernatronol Journal of Periodonrics ond Restorotive Dentisrry" 2/1982

15

ploce the eandyles os described

above, a thermoplastic material'
that adheres to the teeth is used to
prevent this (Fig. 11).
Step II

Conditioning be Patient

Fig. 1}

The patient is conditioned to bite with

moderote force, by instructing him to
close his teeth an the operator's finger held in the mid-sagittal plane,
until discomfort is felt (by the operatarl). The amount of biting force is
not criticol, as increased farce does
not alter condyiar position within
clinically measurable parameters
[Levinson, 1980).

Compound reinfarcement lc la pn

Because the fulcrum at the central incisar biting point is situoted on a

lower plane than the candyle, the action of the closing muscles is to direct
the condyles upwards and forwords,
complementing their action as described by Raberts above (Fig. 12).
Fig. 12 Condyle being directed upwards and forwords by resultoni bile torco vector ofclastng
abj = anterior biting ig

Step III

The onteriar teeth ore then guided to

the previously made indentations in
the ig, and the patient is instructed to
mointain the moderate biting farce
while a saft recording medium is allowed to set between the posterior
teeth (Figs. 13 and 14]. Where mast af
the posteriors are present, bite registration paste is preferred, its consistency being such as to minimise stimulation af the periodontal propriaceptors of the posterior teeth. It must
be emphasised that this is a "handoff" procedure once the correct onterior contact is made.
Where there ore missing posteriors,
or where the intra-occlusal space

* Kerr's greenstick.
The Internotional Jaumol of Periodartics and Restorolive Dentislrv' 2/1982

16

is lorge, a platform of self-curing

ocrylic carrying c soft mix of the
same material is used (Fig. 15),
Investigation of Reproducibility
Previous studies comparing the dispersion patterns of condylar reproducibility with different techniques
have been reported (Celenza, 1973;
Kantor et al., 1973], From all these
studies, it emerged thot the technique of bilaterol manipulation of the
mandible {Dawson, 1974) was the
most reproducible. With this in mind,
it was decided to compare the anterior biting jig method with the bilaterol manipulation technique.

Fig 3

Ar h

ng ;ig of compound, with index of single inosor tooth

Method
The spatial patterning of the condyle
position as recorded by the two
techniques was determined by the
method ta be described.

Fig. 14 Bite registrofoti poste recording C'P while notier.i maintains biting fo

From a group of dentol students, four

subjects were selected with
1, unmutilated dentitions (except for
absence of lower third molars) with
only minor restorotive dentistry,
2, absence of tooth mobility at a
clinical level,
3, no subjective symptoms of dysfunction of the masticatory mechanism.
Maxillary and mandibular arch impressions were taken with irreversible hydrocolloid and poured without
delay in vacuumed dental stone. Ten
'The Internalional Journai ot PeriodonticB ard Restorative Dentistry" 2/1982

17

registrations of centric relation were

made for each patient, five using the
bilateral manipulation technique,
ond five by the onterior biting ig method. The registrations with bilateral
manipulation were made by an operator well versed in this technique,
and those with the anterior biting jig
by the author.

Fig. 15 CP registration formed by acrylic platform corrying o soft mix of elf-curing ocrylic. Resincap
ainglar Duralay Relioncel

Fig. I Denar Voricheclr inilrumenl. Styli recording position af a regrilralion.

The mandibular cast was fixed ta the

lower member of the Denar Varicheck instrument with dental stone
(Fig. 16]. The maxillary cast was then
related to the mandibular cast using
each of the five records of one technique in turn, and indentatians were
made by pressing the styli of the upper member inta millimetre-ruled
graph paper held vertically and horizontally by fhe lower member
(Fig-16].
The graph recarding papers were
then photographed and replaced.
Transparencies of the groupings
were projected on a screen so that
each millimetre graduotion was enlarged ta one cm., thus giving lOOx
magnification. The diameter af the
smallest circle which covered the five
indentatians was measured with vernier calipers to 0.1 mm. This figure divided by ten was recorded, giving the
acfual dimension (Fig. 17].
The position of the indentations relative to X (vertical], Y (horizontal, sagittal] and Z (horizontal, frantal) axes
was also recorded. X, Y and Z axes
were farmed by the boundaries of
the surfaces holding fhe recording
graph paper.

Tfie International Jouriral of Periodoiilic5 ond Restorotive Dentistry' 2/1982

18

Results

1. The spatiol pafterning, as evidenced by the diameter af the smallest circle, was significantly more
constricted for the ABJ recordings.
Recordings made by the ABJ are
thus more reproducible fhon those
made wifh biloteral mandibular manipulotion.
1. On investigoting the indentotions with reference to the X. Y and Z
axes, the ABJ method consistently recorded o more superior ond onterior
position.

Investigaffon of Physiologic
Acceptance

This is assessed subjectively by investigating the potient far camfart and

freedom from symptoms of dysfunction, and objectively by the reoction
of the periodontium. The latter can
anIy be determined from clinicol examination of pafienfs with proven
susceptibility to periodontai diseose
[Levinson. 1981).
Reaction of the Periodontium

Fig, 7

Grouping of live registrotions recorded on groph paper on Oenor Vanctieck inslrun

Seventy-four patients who hod been

treated for odvanced periodontai
disease were examined. An integral
part of the treotment had been the
provision of periodontol prostheses,
which were constructed to centric relation records obtoined by the ABJ
method described above. Exomination consisted of determination of
bleeding from the sulcus on genfle
probing, and quantifotive ossessment of residuol alvealar bone from
rodiogrophs.
Post-operotive periods ronged from
fhree to twelve years with a mean of 5.2
years. In every instance, the dentition
as o whole was surviving with improved periodonfal stotus (Fig. 18). A
"Tfie Internotional Journal af Periodontics and Restarattve Dentistr/" 2/1982

Figs. I8o ond b Betre (o) and alle: (b) tracings ol radiographs
oi poliGnl
shownQ
p
Q n'iciinfenoncG of osseous levels
d
potfnt withh pGriooonlQi d'S

Tfie hrernationol Journal ol Perjodontics ond Resrorative Denrislry- 2/1982

20

200

160

SYMPTOMS

ELIMINATED
IMPROVED

H l
j

UNCHANGED |B<J

120

80

1
1

40

PAIN
(208)

ZI

d]
IMITATION
(32)

CLICKING
(122)

OCCLUSAL
AWARENESS
(47)

MPDS - REGRESSION OF SYMPTOMS - RECONSTRUCTED OCCLUSIONS

Fig. 19 Bar graph showing resolution of
symptoms in investigation of 208 patients with
myofoscia! pain dysfunction syndrotne.

Fiq. 20 Showing initoi contact posteriorly on

clenching when RC registration is mode with co
dyte n a "sagged" position.

The InlematiOfiol Journal oi Periodonlics and Re&torofiv

21

total of l,145teeth were involved in this

survey ond of these only eighteen units
had been lost. Most of these were
roots of molar teeth which had been
treoted for Grade 111 furcation problems [Rosenberg, 1979), and were
breaking down due to a combination of periodontal and endodontal
factors.
Patient Acceptance
Extending the principle underlying
the periodontal assessment, only
patients with a history of myofascial
pain dysfunction syndrome (MPDS)
were included in this investigation
[Levinson, 1976), The symptoms of
MPDS recorded were poin, limitation
of movement, clicking and ocdusol
awareness. Two hundred eight potients who had been provided with a
new occlusion treatment of their overall dental condition were exomined
after o follow-up period varying from
six months to twelve yeors with a
mean of 4,2 years. The results are
shown in the bar graph (Fig, 19),
Whereas it is conceded that the high
success rate was influenced by other
than acdusal foctors, at least it may
be said that the occlusion provided
wos acceptable to a significant number of patients with proven susceptibility to problems of dysfunction of the
masticatory mechanism.

employed in fabricating the restorotions could have been made with the
condyles in a "sogged" position
(Fig. 20), The object of the bilateral
manipulation technique is to record
the mandibular positian with condyles seated superiorly ond onteriorly,
i.e,, where the elevator muscles would
take them in o terminal hinge closure.
It seems logical to direct the closing
muscles to achieve this seating while
moking the recard. This investigation
shows this to be a more reproducible
method.
In considering the spatial patterning
as recorded on the Varicheck instrument, a pontographic effect results
from the styli being remote from the
zone of registration. The cusp tips
undergo less deviation than that
shown, by o factor of approximately
four. At best, however, it is evident
that the occlusal morphology thot is
provided when the posterior occlusion is restored should have a built-in
tolerance, rather than a precise point
relationship. This aspect is the subject of a subsequent article.

Conclusion
The object of the bimanual manipulation technique is to record the mandibular position with the condyles
positioned where the elevotor musdes would seat them in a terminal
hinge dosure,

Discussion
Potients who experience sensitivity,
and or symptoms of dysfunction of
the masticatory mechanism following
occlusal reconstruction, are often
found to hove occlusal interferences
relating to the terminal molars, when
examined by the method advocated
by Lang (1973), This would indicate
that the inter-occlusal registrations

Reprints
Dr. Edward Levinson
UHorcourt House
19a Cavendish Squore
LondonW, I.England

Refe
Celenza, F. V.:
The Centnc Position: Replacement and
Chorader, J. Prosthet, Dent, 30:591-598,
1973.
Dowson, P E
Evaluation, Diognosis, and Treatment of
Ocdusal Problems, St, Louis: C, V Mosby
C o , 1974.
Glossory of Prosthodontic Terms 11977)
J. Prosthet. Dent., 3874-75,
Honau.
Dentol Engineering, Val. I. Buffalo: Hanau
Engineering Co., I92
Jankelson, B., Hoffmann, G., and Henderson, J. A.:
The Physiology of the Slomotagnathic System. J.A.D.A., 46:375-330, 1953.
Kontor, M E., Silvermon, S, 1., ond Garfmi<el,
L..
Centric Relotion Recording Tecinniques, o
Comparative Invesligotion J. Prosthet,
Dent.,28:593-600, 1972.
Kaplan, R. L:
Concepts ol Ocdusion 8, Gnothology.
Dent d i n . N, Amer., 1:577, 1963.
Levinson, E.'
Ocdusol Factors in Treatment of MPDS,
Post-Grad Date Seminar on MPDS, University of Pretoria, 197.
Levinson, E,:
Investigation of Condyle Position with
Elevator Muscle Activity Using Anterior Biting Jig. Awaiting publication, 1980,
Levinson, E.'
Periodontal Postulotes for ihe Prosthodontist, 1981.
Long,J, H.,Jr.:
Ocdusol Adjustment. J. Prosthet, Dent.,
30:706-714,1973.
Lucia, V.:
A Tecfiniquefor Recording Centric Relation,
J. Prosthet, Dent,, 14:492-505,1964.
Rees, L,A.:
The SIructure and Function afthe Mondibulor Joint. Brit. Detit,J,,96.125-133,1954.
Roberts, D,;
Tine Etiology of the Temporomandibulor
Jaint Dysfunction Syndrome, Am J. Orthod.,
66:514,1974,
Rosenberg, M :
Management ot Osseous Defects, Furcation
Involvements and Periodontal Pulpal Lesions. Clinicai Dent. Vol. 3 New Yori<:
Harper & Row, 1979.
Silverman, S. I,:
Centric Relotion. J, Dent. Assoc, S. Afs
30:167,1975.
Thompson, J. R.:
The Rest Position of the Mandible and Its
Significcinca to Dental Science, J,A,D.A.,
33:151-180,1946,

"Tfie irlemofionol Journal of Perbdonlics ond Reslorolive Dentistry' 2/1982