J Korean Acad Prosthodont.  2015 Oct;53(4):366-376. 10.4047/jkap.2015.53.4.366.

Full mouth rehabilitation of a patient with difficulties in guiding centric relation: A case report

• Jun D
• Vang M
• Yang H
• Park S
• Lim H
• Yun K

• KMID: 2118810
• DOI: http://doi.org/10.4047/jkap.2015.53.4.366

Abstract

The Gothic arch tracing method using a Gothic arch tracer which is one of the centric relation recording methods can reproduce mandibular movement more accurately by describing the path of mandibular curvilinear motion. This case reports that we have satisfactory results by recording reproducible centric relation using a gothic arch tracing method in a patient who has difficulty to induce centric relation by operator due to parafunctional movement.

Keyword

Gothic arch tracer; Gothic arch tracing; Centric relation

MeSH Terms

Centric Relation*
Humans
Mouth Rehabilitation*
Mouth*

Figure

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  Fig. 1. Initial intraoral photographs. Severe attrition observed on occlusal surface. (A) Right side view, (B) Frontal view, (C) Left side view, (D) Maxillary occlusal view,(E) Mandibular occlusal view.

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  Fig. 2. Initial panoramic radiograph.

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  Fig. 3. Initial transcranial view of both TMJ. (A) Left TMJ. The arrow indicates retrude position of condyle. Internal derangement with reduction on the left TMJ, (B) Right TMJ.

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  Fig. 4. Evaluation with ARCUS® digma II. (A) EPA test. ① indicates MICP. Others indicates unstable centric relation, (B) Gothic arch tracing. There is no reproducibility due to parafunctional habitual movement.

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  Fig. 5. Intraoral photographs after first provisional restoration placement. (A) Right side view, (B) Frontal view, (C) Left side view, (D) Maxillary occlusal view, (E) Mandibular occlusal view. Monoplane occlusion applied for treatment denture.

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  Fig. 6. Jaw relation taking with Gothic arch tracer. (A) Gothic arch tracer applied into patient mouth, (B) Repeat until taking stable and reproducible graph, (C) Confirm the ideal graph.

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  Fig. 7. CAD/CAM for second provisional restoration. (A) Model scan, (B) Wax up scan, (C) second provisional restoration.

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  Fig. 8. Intraoral and extraoral photographs after second provisional restoration placement. (A) Right side view, (B) Frontal view, (C) Left side view, (D) Maxillary occlusal view, (E) Mandibular occlusal view, (F) Extraoral photograph.

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  Fig. 9. Transcranial view of both TMJ after second provisional restoration placement. WNL on both TMJ. (A) Left TMJ, (B) Right TMJ.

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  Fig. 10. Evaluation with ARCUS® digma II. (A) EPA test. ① indicates MICP. Others indicates stable centric relation, (B) Gothic arch tracing. There is reproducibility due to stable centric relation.

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  Fig. 11. CAD/CAM for surveyed PFM crowns. (A) Superimposition of wax up and die model, (B) CAD for surveyed PFM crowns, (C) Cutback on CAD for metal coping fabrication.

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  Fig. 12. CAD/CAM for metal coping of surveyed PFM crowns. (A, D) Design of surveyed PFM crowns, (B, E) 1.2 mm uniformly cutback on CAD for porcelain veneering, (C, F) metal coping fabrication with Co-Cr block.

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  Fig. 13. Metal coping try-in and surveyed PFM crowns placement. (A) Metal coping try-in, (B) Porcelain veneering on metal coping, (C) Surveyed PFM crown placement.

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  Fig. 14. Definitive denture placement and check the bite. (A) Definitive denture placement, (B) Check the bite on maxilla, (C) Check the bite on mandible.

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  Fig. 15. Transcranial view of both TMJ after definitive denture placement. WNL on both TMJ. (A) Left TMJ, (B) Right TMJ.

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  Fig. 16. Evaluation with ARCUS® digma II. (A) EPA test. ① indicates MICP. Others indicates stable centric relation. MICP synchronize with centric relation, (B) Gothic arch tracing. There is reproducibility due to stable centric relation.

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  Fig. 17. Patient’ s profile. (A) Profile of first visit, (B) Profile of after definitive prosthesis placement.

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