Cheek Bite Technique for Recording Jaw Relation in Prosthodontics

Definition and Classification

1. Proprioceptive impulses from the periodontal membrane and muscles of mastication
2. Kinesthetic sense of mandibular movement by the patient
3. Visual acuity and sense of touch of the dentist

Principle

Indications

1. Abnormally related jaws - skeletal Class II or Class III jaw relationships make conventional rim-to-rim recording difficult
2. Displaceable or flabby tissues - the resilient bearing tissues compromise record base stability
3. Large tongue - tongue interference prevents reliable closure on occlusal rims
4. Uncontrollable mandibular movements - neuromuscular problems, tremors, or poor patient cooperation
5. Patients already wearing complete dentures - can use the existing dentures as a guide while placing fresh recording material

Materials Used

Ideal Requirements of a Bite Registration Material

1. Limited resistance before setting - must not displace teeth or mandible during closure
2. Rigid or resilient after setting - maintains the recorded position
3. Minimal dimensional change after setting (dimensional stability)
4. Low viscosity, no adherence to teeth, good plasticity
5. Accurate recording of occlusal and incisal surfaces
6. No adverse biological effects on tissues
7. Adequate working time
8. Low cost

Clinical Procedure (Step-by-Step)

Preliminary Steps

1. Patient positioning - Seat the patient upright to avoid an erroneously high or low vertical dimension of rest (VDR)
2. Occlusal plane orientation - Adjust using a Fox plane:
   • Anterior occlusal plane parallel to the interpupillary line
   • Posterior occlusal plane parallel to the ala-tragus line
3. Establish VDR - Guide the patient to a relaxed rest position and measure the distance between reference points on the nose and chin
4. Determine VDO - Vertical dimension of occlusion should be approximately 2-4 mm less than VDR
5. Mark landmarks on the occlusal rims: midline, canine lines

Core Recording Steps

1. Prepare the lower occlusal rim - Make a "V"-shaped notch at the posterior (molar) region of the lower rim
2. Seat the upper occlusal rim securely; apply denture adhesive powder to the tissue side if retention is inadequate
3. Remove 2-3 mm of wax from the lower rim in the premolar areas; add a fresh roll of baseplate wax (4-5 mm thickness) to the lower rim in the premolar-molar area (the "cheek bite" zone)
4. Soften the wax in a water bath at 130°F (54°C) or with a controlled flame
5. Seat the lower rim in the patient's mouth; confirm stability by placing fingertips bilaterally on the buccal flanges at the second premolar region
6. Guide the patient to retrude the mandible and close slowly on the back teeth until the predetermined VDO is reached (by patient tactile sense and dentist experience); the anterior portions of the upper and lower rims will come into contact
7. Allow the wax to harden, then remove the assembled occlusal rims together from the mouth
8. Mount the casts on the articulator using the centric relation record

Techniques to Aid Centric Closure

• Instruct the patient to turn the tongue backward toward the posterior border of the upper denture and close slowly
• Have the patient protrude and retrude the mandible repeatedly before closure
• Ask the patient to tap the bite rims together repeatedly
• Tilt the head back slightly (gravity assists mandibular retraction)
• Have the patient swallow and close slowly
• Gently guide the mandible backward while the patient relaxes the jaw

Methods Within the Cheek Bite Technique

1. Static (Pressureless) Method

2. Pressure Method

Evaluation of the Record

1. The pyramid locking into the V-notch - the pyramid (on the lower rim) must close directly into the centre of the V-notch without touching the inclines
2. The patient should show no excessive effort during centric closure (no over-retrusion)
3. No unusual effort during swallowing
4. Facial proportions - the face should be divisible into three equal thirds
5. Remeasure VDR to confirm the recorded VDO is approximately 2-4 mm less

Factors Affecting Success of the Interocclusal Record

1. Uniform consistency of the recording material
2. Accurate vertical jaw relation records established beforehand
3. Stability and fit of the record bases
4. Presence of reference points (pins or styli) embedded in the record

Complicating Factors

Advantages of the Cheek Bite (Physiological) Approach

• Patient-guided closure mimics natural muscle function
• Relatively simple equipment requirements
• Low cost (especially with wax)
• Can be used in difficult patients who cannot cooperate with bimanual manipulation
• Usable in patients already wearing dentures

Limitations

• Dependent on patient cooperation and neuromuscular control
• Wax records are prone to distortion from body heat and handling
• Less precise than graphic (pantographic) or bimanual manipulation methods in patients with neuromuscular dysfunction
• The mandible can shift anteriorly from habitual closure patterns if the patient is not properly guided

Context Within Jaw Relation Recording