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USE OF TONGUE FOR RECORDING CENTRIC RELATION FOR EDENTULOUS PATIENTS Magid Bissasu JPD 1999,VOL 82 : 369-70

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INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com

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INTRODUCTION

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Centric relation record DEFINITION [according to GPT-7]:Centric relation record is a registration of the relationship of the maxilla to the mandible when the mandible is in centric relation. The registration may be obtained either intraorally or extra orally.

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DEFINITION: THE MAXILLO MANDIBULAR

RELATIONSHIP IN WHICH CONDYLES ARTICULATE WITH THE THINNEST AVASCULAR PORTION OF THEIR RESPECTIVE DISCS WITH THE COMPLEX IN THE ANTERO-SUPERIOR POSITION AGIANST THE SLOPES OF ARTICULAR EMINENCES.THIS POSITION IS INDEPENDENT OF TOOTH CONTACT.THIS POSITION IS CLINICALLY DESCERNABLE WHEN MANDIBLE IS DIRECTED SUPERIORLY AND ANTERIORLY.IT IS RESTRICTED TO PURELY ROTATORY MOVEMENT ABOUT THE TRANSVERSE HORIZONTAL AXIS. www.indiandentalacademy.com


METHODS OF RECORDING: METHODS OF RECORDING CENTRIC RELATION DEPEND ON THE CHOICE OF THE OPERATOR,DEGREE OF CO-OPERATION OF THE PATIENT AND EXPERIENCE OF OPERATOR. THEY ARE BROADLY CLASSIFIED INTO 4 CATEGORIES, NAMELY : DIRECT CHEEK BITE RECORDINGS GRAPHIC RECORDINGS FUNCTIONAL RECORDINGS CEPHELOMETRICS www.indiandentalacademy.com


DIRECT CHECK BITE RECORDINGS: DIFFERENT ACADEMICS ADVOCATED DIFFERENT TECHNIQUES TO RECORD CENTRIC RELATION.BASICALLY THERE ARE TWO MAIN CONCEPTS,NAMELY : ZERO PRESSURE PHILOSOPHY ADVOCATED BY HANAU,WRIGHT AND OTHERS.

MINIMUM PRESSURE PHILOSOPHY BY PAYNE , TROPPOZONO, SCHYLER AND OTHERS

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Techniques for centric relation record. ► Active

centric relation record

► Passive

centric relation record 1.Chin point technique. 2.Dawson’s bimanual manipulation. 3.Tongue to palate technique. www.indiandentalacademy.com


Chin point guidance [one handed technique] â–ş By

Anderson and Tanner â–ş Posteriorly directed force is gently directed against the chin.

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Dawson's ‘Bimanual manipulation’

► Patient

position www.indiandentalacademy.com


Operator position and finger position

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Tongue to palate technique.

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GRAPHIC RECORDINGS: THESE INCLUDE : INTRA ORAL TRACING EXTRA ORAL TRACING

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FUNCTIONAL RECORDINGS

THESE TECHNIQUES UTILIZE THE FUNCTIONALLY GENERATED PATHWAYS TO RECORD THE CENTRIC RELATION IN PATIENTS. NEEDLES , PATTERSON AND MAYERS MAINLY ADVOCATED THIS METHOD . BOOS (1959) USED GNATHODYNAMOMETERTO REGISTER THE MAXIMUM INTERCUSPATION POSITION.

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Problems encountered BASICALLY THERE ARE 3 TYPES OF DIFFICULTIES IN RECORDING CENTRIC RELATION.

BIOLOGIC DIFFICULTIES PSYCHOLOGIC DIFFICULTIES MECHANICAL DIFFICULTIES

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METHOD:

THIS ARTICLE DESCRIBES A SIMPLE PROCEDURE THAT HELPS PATIENTS TO PUT THE TIP OF THE TONGUE IN MOST POSTERIOR POSITION IN MOUTH TO RETRUDE THE MANDIBLE TO ITS CENTRIC RELATION POSITION.

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PROCEDURE:

1. A STRIP OF RECTANGULAR SHAPED BASEPLATE WAX( 50 mm LENGTH AND 70mm WIDTH) IS ADAPTED TO THE PALATAL SURFACE OF MAXILLARY RECORD BASE AT THE MID LINE. 2. FOUR CIRCULAR HOLES ARE MADE ALONG THE WAX STRIP MITH THE DIAMETER OF 10 mm. 3. PATIENT IS SHOWN HOW TO PLACE TONGUE www.indiandentalacademy.com INTO HOLES.


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1. AFTER RECORD BASE IS PLACED AND STABILISED PATIENT IS ASKE TO PRACTICE THE POSITIONING OF TONGUE. 2. PATIENT IS ASKED TO KEEP HIS TONGUE AS POSTERIOR AS POSSIBLE. 3. TO ASSIST THE PATIENT TO PUT THE TIP OF THE TONGUE IN DESIRE POSITION, PATIENT IS INSTRUCTED TO KEEP TONGUE FIRST INTO ANTERIOR HOLE, THEN SECOND AND GO ON TILL IT REACHES DESIRED POSITION. 4. WHEN PATIENT IS ABLE TO REPEAT THE POSITION CENTRIC RELATION RECORD IS MADE

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CONCLUSION

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REFERENCES:

1. RAHN AO,HEARTWELL CM. TEXT BOOK OF COMPLETE DENTURES. 2. HICKEY,ZARB,BOULENDER. BOUCHERS PROSTHODONTIC TREATMENT FOR COMPLETE DENTURES. 3. WINKLER S. ESSENTIALS OF COMPLETE DENTURE PROSTHODONTICS. 4. CENTRIC RELATION RECORDS, HISTORICAL REVIEW. JPD 1982; 47: 141-5. 5. FACTORS INFLUENCING CENTRIC RELATION RECORDS IN EDENTULOUS PATIENTS. JPD 1964;14: 1054-65. 6. AN EVALUATION OF CENTRIC RELATION RECORDS OBTAINED BY VARIOUS TECHNIQUES. www.indiandentalacademy.com JPD 1957; 7:770-86 .


THANK YOU

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