Journal of Prosthetic Dentistry

Differences in maxillomandibular relationship recorded at centric relation when using a conventional method, four intraoral scanners, and a jaw tracking system: A clinical study


      Statement of problem

      Digital systems including intraoral scanners (IOSs) and optical jaw tracking systems can be used to acquire the maxillomandibular relationship at the centric relation (CR). However, the discrepancy of the maxillomandibular relationship recorded at the CR position when using digital methods remains uncertain.


      The purpose of this clinical study was to compare the accuracy of the maxillomandibular relationship recorded at the CR position using a conventional procedure, 4 different IOSs, and an optical jaw tracking system.

      Material and methods

      A completely dentate volunteer was selected. A Kois deprogrammer (KD) was fabricated. Six groups were created based on the technique used to obtain diagnostic casts and record the maxillomandibular relationship at the CR position: conventional procedures (CNV group), 4 IOS groups: TRIOS4 (TRIOS4 group), iTero Element 5D (iTero group), i700 wireless (i700 group), Primescan (Primescan group), and a jaw tracking system (Modjaw) (Modjaw group) (n=10). In the CNV group, conventional diagnostic stone casts were obtained. A facebow record was used to mount the maxillary cast on an articulator (Panadent). The KD was used to obtain a CR record for mounting the mandibular cast, and the mounted casts were digitized by using a scanner (T710) to acquire the reference scans. In the TRIOS group, intraoral scans were obtained and duplicated 10 times. The KD was used to obtain a bilateral virtual occlusal record at the CR position. To acquire the specimens of the iTero, i700, and Primescan groups, the procedures in the TRIOS4 group were followed, but with the corresponding IOS. In the Modjaw group, the KD was used to record and export the maxillomandibular relationship at the CR position. Articulated virtual casts of each group were exported. Thirty-six interlandmark linear measurements were computed on both the reference and experimental scans. The distances obtained on the reference scan were used to calculate the discrepancies with the distances obtained on each experimental scan. The data were analyzed by using 1-way ANOVA followed by the pairwise comparison Tukey tests (α=.05).


      The trueness and precision of the maxillomandibular relationship record were significantly affected by the technique used (P<.001). The maxillomandibular relationship trueness values from high to low were iTero (0.14 ±0.09 mm), followed by the Modjaw (0.20 ±0.04 mm) and the TRIOS4 (0.22 ±0.09 mm) groups. However, the iTero, Modjaw, and TRIOS4 groups were not significantly different from each other (P>.05). The i700 group obtained the lowest trueness and precision values (0.40 ±0.22 mm) of all groups tested, followed by the Primescan grop (0.26±0.13 mm); however, the i700 and Primescan groups had significantly lower trueness and precision than only the iTero group (P<.05).


      The trueness and precision of the maxillomandibular relationship recorded at the CR position were influenced by the different digital techniques tested.
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        • Rosenstiel S.F.
        • Land M.F.
        • Fujimoto J.
        Contemporary fixed prosthodontics.
        5th ed. Mosby/Elsevier, St. Louis2015: 92-116
        • Klineberg I.
        • Eckert S.
        Functional occlusion in restorative dentistry and prosthodontics. 1st ed. Elsevier, St Louis, Missouri2015: 105-128
        • Pokorny P.H.
        • Wiens J.P.
        • Litvak H.
        Occlusion for fixed prosthodontics: a historical perspective of the gnathological influence.
        J Prosthet Dent. 2008; 99: 299-313
      1. The glossary of prosthodontic terms: 9th edition.
        J Prosthet Dent. 2017; 117: e1-e105
        • Kois J.C.
        • Phillips K.M.
        Occlusal vertical dimension: alteration concerns.
        Compend Contin Educ Dent. 1997; 18: 1169-1177
        • Myers M.L.
        Centric relation records-historical review.
        J Prosthet Dent. 1982; 47: 141-145
        • Dixon D.L.
        Overview of articulation materials and methods for the prosthodontic patient.
        J Prosthet Dent. 2000; 83: 235-247
        • Zuccari A.
        Anterior deprogramming device fabrication using a thermoplastic material (Land, MF, Pregerina, A. J Prosthet Dent 2003;90:608-10).
        J Prosthet Dent. 2004; 91: 401
        • Lucia V.O.
        A technique for recording centric relation.
        J Prosthet Dent. 1964; 14: 492-505
        • Long J.H.
        Locating centric relation with a leaf gauge.
        J Prosthet Dent. 1973; 29: 608-610
        • Wirth C.G.
        Interocclusal centric relation records for articulator mounted casts.
        Dent Clin North Am. 1971; 15: 627-640
        • Wood D.P.
        • Elliot R.W.
        Reproducibility of the centric relation bite registration technique.
        Angle Orthod. 1994; 64: 211-221
        • Hunter 2nd, B.D.
        • Toth R.W.
        Centric relation registration using an anterior deprogrammer in dentate patients.
        J Prosthodont. 1999; 8: 59-61
        • Solow R.A.
        The anterior acrylic resin platform and centric relation verification: a clinical report.
        J Prosthet Dent. 1999; 81: 255-257
        • Kois D.E.
        • Kois J.C.
        Comprehensive risk-based diagnostically driven treatment planning: developing sequentially generated treatment.
        Dent Clin North Am. 2015; 59: 593-608
        • Revilla-León M.
        • Zeitler J.M.
        • Kois D.E.
        • Kois J.C.
        Utilizing an additively manufactured Kois deprogrammer for recording centric relation: a simplified workflow and delivery technique.
        J Prosthet Dent. 5 August 2022; ([Epub ahead of print])
        • Kantor M.E.
        • Silverman S.I.
        • Garfinkel L.
        Centric relation recording techniques: a comparative investigation.
        J Prosthet Dent. 1973; 30: 604-606
        • Teo C.S.
        • Wise M.D.
        Comparison of retruded axis articular mountings with and without applied muscular force.
        J Oral Rehabil. 1981; 8: 363-376
        • Hobo S.
        • Iwata T.
        Reproducibility of mandibular centricity in three dimensions.
        J Prosthet Dent. 1985; 53: 649-654
        • McKee J.R.
        Comparing condylar position repeatability for standardized versus non-standardized method of achieving centric relation.
        J Prosthet Dent. 1997; 77: 280-284
        • McKee J.R.
        Comparing condylar positions achieved through bimanual manipulation to condylar positions achieved through masticatory muscle contraction against an anterior deprogrammer: a pilot study.
        J Prosthet Dent. 2005; 94: 389-393
        • Tripodakis A.P.
        • Smulow J.B.
        • Mehta N.R.
        • Clark R.E.
        Clinical study of location and reproducibility of three mandibular positions in relation to body posture and muscle function.
        J Prosthet Dent. 1995; 73: 190-198
        • Campos A.A.
        • Nathanson D.
        • Rose L.
        Reproducibility and condylar position of a physiologic maxillomandibular centric relation in upright and supine body position.
        J Prosthet Dent. 1996; 76: 282-287
        • Nakamura K.
        • Minami I.
        • Wada J.
        • Ikawa Y.
        • Wakabayashi N.
        Head position affects the direction of occlusal force during tapping movement.
        J Oral Rehabil. 2018; 45: 363-370
        • Coelho M.F.
        • Cavalcanti B.D.
        • Claro Neves A.C.
        • Jóias R.P.
        • Rode Sde M.
        Influence of dental chair backrest inclination on the registration of the mandibular position.
        J Prosthet Dent. 2015; 114: 693-695
        • Kinderknecht K.E.
        • Wong G.K.
        • Billy E.J.
        • Li S.H.
        The effect of a deprogrammer on the position of the terminal transverse horizontal axis of the mandible.
        J Prosthet Dent. 1992; 68: 123-131
        • Shafagh I.
        • Yoder J.L.
        • Thayer K.E.
        Diurnal variance of centric relation position.
        J Prosthet Dent. 1975; 34: 574-582
        • Latta Jr., G.H.
        Influence of circadian periodicity on reproducibility of centric relation records for edentulous patients.
        J Prosthet Dent. 1992; 68: 780-783
        • Weinberg L.A.
        The role of stress, occlusion, and condyle position in TMJ dysfunction pain.
        J Prosthet Dent. 1983; 49: 532-545
        • Okeson J.P.
        • de Leeuw R.
        Differential diagnosis of temporomandibular dis- orders and other orofacial pain disorders.
        Dent Clin North Am. 2011; 55: 105-120
        • Kraus S.
        Head posture: a case study of the effects on the rest position of the mandible.
        J Orthop Sports Phys Ther. 1984; 5: 179-183
        • Aragón M.L.
        • Pontes L.F.
        • Bichara L.M.
        • Flores-Mir C.
        • Normando D.
        Validity and reliability of intraoral scanners compared to conventional gypsum models measurements: a systematic review.
        Eur J Orthod. 2016; 38: 429-434
        • Tabesh M.
        • Nejatidanesh F.
        • Savabi G.
        • Davoudi A.
        • Savabi O.
        • Mirmohammadi H.
        Marginal adaptation of zirconia complete-coverage fixed dental restorations made from digital scans or conventional impressions: a systematic review and meta-analysis.
        J Prosthet Dent. 2021; 125: 603-610
        • Bandiaky O.N.
        • Le Bars P.
        • Gaudin A.
        • et al.
        Comparative assessment of complete-coverage, fixed tooth-supported prostheses fabricated from digital scans or conventional impressions: a systematic review and meta-analysis.
        J Prosthet Dent. 2022; 127: 71-79
        • Morsy N.
        • El Kateb M.
        • Azer A.
        • Fathalla S.
        Fit of zirconia fixed partial dentures fabricated from conventional impressions and digital scans: a systematic review and meta-analysis.
        J Prosthet Dent. 22 October 2021; ([Epub ahead of print])
        • Delong R.
        • Ko C.C.
        • Anderson G.C.
        • Hodges J.S.
        • Douglas W.H.
        Comparing maximum intercuspal contacts of virtual dental patients and mounted dental casts.
        J Prosthet Dent. 2002; 88: 622-630
        • Maruyama T.
        • Nakamura Y.
        • Hayashi T.
        • Kato K.
        Computer-aided determination of occlusal contact points for dental 3-D CAD.
        Med Biol Eng Comput. 2006; 44: 445-450
        • Jaschouz S.
        • Mehl A.
        Reproducibility of habitual intercuspation in vivo.
        J Dent. 2014; 42: 210-218
        • Solaberrieta E.
        • Arias A.
        • Brizuela A.
        • Garikano X.
        • Pradies G.
        Determining the requirements, section quantity, and dimension of the virtual occlusal record.
        J Prosthet Dent. 2016; 115: 52-56
        • Yee S.H.X.
        • Esguerra R.J.
        • Chew A.A.Q.
        • Wong K.M.
        • Tan K.B.C.
        Three-dimensional static articulation accuracy of virtual models - part I: system trueness and precision.
        J Prosthodont. 2018; 27: 129-136
        • Yee S.H.X.
        • Esguerra R.J.
        • Chew A.A.Q.
        • Wong K.M.
        • Tan K.B.C.
        Three-dimensional static articulation accuracy of virtual models - part II: effect of model scanner-CAD systems and articulation method.
        J Prosthodont. 2018; 27: 137-144
        • Zimmermann M.
        • Ender A.
        • Attin T.
        • Mehl A.
        Accuracy of buccal scan procedures for the registration of habitual intercuspation.
        Oper Dent. 2018; 43: 573-580
        • Edher F.
        • Hannam A.G.
        • Tobias D.L.
        • Wyatt C.C.L.
        The accuracy of virtual interocclusal registration during intraoral scanning.
        J Prosthet Dent. 2018; 120: 904-912
        • Abdulateef S.
        • Edher F.
        • Hannam A.G.
        • Tobias D.L.
        • Wyatt C.C.L.
        Clinical accuracy and reproducibility of virtual interocclusal records.
        J Prosthet Dent. 2020; 124: 667-673
        • Ries J.M.
        • Grünler C.
        • Wichmann M.
        • Matta R.E.
        Three-dimensional analysis of the accuracy of conventional and completely digital interocclusal registration methods.
        J Prosthet Dent. 2022; 128: 994-1000
        • Revilla-León M.
        • Alonso Pérez-Barquero J.
        • Zubizarreta-Macho Á.
        • Barmak A.B.
        • Att W.
        • Kois J.C.
        Influence of the number of teeth and location of the virtual occlusal record on the accuracy of the maxillo-mandibular relationship obtained by using an intraoral scanner.
        J Prosthodont. 21 April 2022; ([Epub ahead of print])
        • Revilla-León M.
        • Kois D.E.
        • Kois J.C.
        A guide for maximizing the accuracy of intraoral digital scans. Part 1: operator factors.
        J Esthet Restor Dent. 7 December 2022; ([Epub ahead of print])
        • Revilla-León M.
        • Gohil A.
        • Barmak A.B.
        • et al.
        Influence of ambient temperature changes on intraoral scanning accuracy.
        J Prosthet Dent. 21 February 2022; ([Epub ahead of print])
        • Revilla-León M.
        • Subramanian S.G.
        • Att W.
        • Krishnamurthy V.R.
        Analysis of different illuminance of the room lighting condition on the accuracy (trueness and precision) of an intraoral scanner.
        J Prosthodont. 2021; 30: 157-162
        • Medina-Sotomayor P.
        • Pascual-Moscardó A.
        • Camps I.
        Relationship between resolution and accuracy of four intraoral scanners in complete-arch impressions.
        J Clin Exp Dent. 2018; 10: e361-e366
        • Renne W.
        • Ludlow M.
        • Fryml J.
        • et al.
        Evaluation of the accuracy of 7 digital scanners: an in vitro analysis based on 3-dimensional comparisons.
        J Prosthet Dent. 2017; 118: 36-42
        • Revilla-León M.
        • Jiang P.
        • Sadeghpour M.
        • et al.
        Intraoral digital scans-part 1: influence of ambient scanning light conditions on the accuracy (trueness and precision) of different intraoral scanners.
        J Prosthet Dent. 2020; 124: 372-378
        • Revilla-León M.
        • Subramanian S.G.
        • Ozcan M.
        • Krishnamurthy V.R.
        Clinical study of the influence of ambient light scanning conditions on the accuracy (trueness and precision) of an intraoral scanner.
        J Prosthodont. 2020; 29: 107-113
        • Revilla-León M.
        • Subramanian S.G.
        • Özcan M.
        • Krishnamurthy V.R.
        Clinical study of the influence of ambient lighting conditions on the mesh quality of an intraoral scanner.
        J Prosthodont. 2020; 29: 651-655
        • Oh K.C.
        • Park J.M.
        • Moon H.S.
        Effects of scanning strategy and scanner type on the accuracy of intraoral scans: a new approach for assessing the accuracy of scanned data.
        J Prosthodont. 2020; 29: 518-523
        • Muller P.
        • Ender A.
        • Joda T.
        • Katsoulis J.
        Impact of digital intraoral scan strategies on the impression accuracy using the TRIOS Pod scanner.
        Quintessence Int. 2016; 47: 343-349
        • Moon Y.G.
        • Lee K.M.
        Comparison of the accuracy of intraoral scans between complete-arch scan and quadrant scan.
        Prog Orthod. 2020; 21: 36
        • Kim M.K.
        • Son K.
        • Yu B.Y.
        • Lee K.B.
        Effect of the volumetric dimensions of a complete arch on the accuracy of scanners.
        J Adv Prosthodont. 2020; 12: 361-368
        • Waldecker M.
        • Rues S.
        • Trebing C.
        • Behnisch R.
        • Rammelsberg P.
        • Bomicke W.
        Effects of training on the execution of complete-arch scans. Part 2: scanning accuracy.
        Int J Prosthodont. 2021; 34: 27-36
        • Kim J.
        • Park J.M.
        • Kim M.
        • et al.
        Comparison of experience curves between two 3-dimensional intraoral scanners.
        J Prosthet Dent. 2016; 116: 221-230
        • Shin S.H.
        • Yu H.S.
        • Cha J.Y.
        • Kwon J.S.
        • Hwang C.J.
        Scanning accuracy of bracket features and slot base angle in different bracket materials by four intraoral scanners: an in vitro study.
        Materials (Basel). 2021; 14: 365
        • Jin-Young Kim R.
        • Benic G.I.
        • Park J.M.
        Trueness of intraoral scanners in digitizing specific locations at the margin and intaglio surfaces of intracoronal preparations.
        J Prosthet Dent. 2021; 126: 779-786
        • Anh J.W.
        • Park J.M.
        • Chun Y.S.
        • Kim M.
        • Kim M.
        A comparison of the precision of three-dimensional images acquired by 2 digital intraoral scanners: effects of tooth irregularity and scanning direction.
        Korean J Orthod. 2016; 46: 3-12
        • Li H.
        • Lyu P.
        • Wang Y.
        • Sun Y.
        Influence of object translucency on the scanning accuracy of a powder-free intraoral scanner: a laboratory study.
        J Prosthet Dent. 2017; 117: 93-101
        • Chen Y.
        • Zhai Z.
        • Li H.
        • et al.
        influence of liquid on the tooth surface on the accuracy of intraoral scanners: an in vitro study.
        J Prosthodont. 2022; 31: 59-64
        • Walker W.E.
        Movements of the mandibular condyles and dental articulation.
        Dent Cosmos. 1896; 38: 573-583
        • Posselt U.
        Studies in the mobility of the human mandible. Thesis.
        Acta Odontol Scand. 1952; 10: 1-160
        • Stuart C.E.
        Diagnosis and treatment of occlusal relations of the teeth.
        Tex Dent J. 1957; 75: 430-435
        • Gibbs C.H.
        • Messerman T.
        • Reswick J.B.
        • Derda H.J.
        Functional movements of the mandible.
        J Prosthet Dent. 1971; 26: 604-620
        • Luce C.E.
        The movements of the lower jaw.
        Boston Med Surg J. 1889; CXXI: 8-11
        • Hildebrand G.Y.
        Studies in the masticatory movements of the human lower jaw.
        Arch Physiol. 1931; 61: 1-90
        • Hedegard B.
        • Lundberg M.
        • Wictorian L.
        Masticatory function –a cineradiographic investigation. I. Position of the bolus in full upper and partial lower denture cases.
        Acta Odontol Scand. 1967; 25: 331-353
        • Sójka A.
        • Huber J.
        • Kaczmarek E.
        • Hędzelek W.
        Evaluation of mandibular movement functions using instrumental ultrasound system.
        J Prosthodont. 2017; 26: 123-128
        • Röhrle O.
        • Waddell J.N.
        • Foster K.D.
        • Saini H.
        • Pullan A.J.
        Using a motion-capture system to record dynamic articulation for application in CAD/CAM software.
        J Prosthodont. 2009; 18: 703-710
        • Bapelle M.
        • Dubromez J.
        • Savoldelli C.
        • Tillier Y.
        • Ehrmann E.
        Modjaw® device: analysis of mandibular kinematics recorded for a group of asymptomatic subjects.
        Cranio. 2021; : 1-7
        • Li W.
        • Li L.
        • Wang Y.
        • Sun Y.
        • Xie Q.
        Accuracy of recording edentulous jaw relations by using an optical jaw tracking system: an in vitro study.
        Int J Prosthodont. 2022; 35: 302-310
        • Revilla-León M.
        • Zeitler J.M.
        • Kois J.C.
        Digital maxillo-mandibular relationship and mandibular motion recording by using an optical jaw tracking system for acquiring a dynamic virtual patient.
        J Prosthet Dent. 16 August 2022; ([Epub ahead of print])
        • Revilla-León M.
        • Zeitler J.M.
        • Gómez-Polo M.
        • Kois J.C.
        Utilizing additively manufactured custom devices for recording mandibular motion using optical jaw tracking systems: a dental technique.
        J Prosthet Dent. 20 May 2022; ([Epub ahead of print])
        • International Organization for Standardization
        ISO 5725-1:1994. Accuracy (trueness and precision) of measurement methods and results - part 1: general principles and definitions.
        (Available at:)
        • International Organization for Standardization
        ISO 20896-1:2019. Dentistry—digital impression devices—part 1: methods for assessing accuracy.
        (Available at:)