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MAGD Credit
Approval does not imply acceptance by a
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1/1/2013 to 12/31/2015
Provider ID#304396

Simplifying
the Denture Process with by John Nosti, DMD, FAGD, FACE, FICOI

GOTHIC ARCH TRACERS

This print or PDF course is a written self-instructional article with adjunct images and is designated for
AGD
Code: 1.5 hours of CE credit by Farran Media. Participants will receive verification shortly after Farran Media
671 receives the completed post-test. See instructions on page 106.

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“ These days, many dentists avoid treating edentulous

patients, despite the growing need for denture treatments.
By following the step-by-step Gothic arch tracer process
described, dentists can now adhere to a successful protocol
for creating accurate and well-fitting dentures.”

Abstract
Dentures can present as a frustrating treatment for both patient and dentist. H ow-
ever, with the prevalence of edentulous patients in the United States alone, they remain a
necessary part of dentistry. Utilizing the Gothic arch tracer for designing dentures, along
with superior materials and a specific smile design protocol, removes the guesswork from
fabricating dentures. B y addressing the patient’s occlusion during initial visits, as well as
determining the precise centric relation, dentists can provide the laboratory with specific
and detailed information about the patient’s most repeatable bite and denture design,
improving the accuracy of fit and comfort.

Educational Objectives
After reading this article, the reader should be able to:
1. Describe complications associated with ill-fitting dentures
2. Identify products that are available to help resolve problems associated with dentures
3. Explain how the Gothic arch tracer works and why it’s valuable for removable dentures
4. Describe the process for using a Gothic arch tracer

Introduction
Although more than 6 0 million people in the United States alone have dentures,1
both dentists and patients frequently report complications and frustrations with ill-fitting
removable prosthetics. An independent survey of edentulous patients recently determined
that of those surveyed, 48 percent were unhappy with their current denture(s) and only five
percent claimed to be completely satisfied with their current dentures.2 Additionally, of the
48 percent of people that were unhappy with their current denture, 7 7 percent of those sur-
veyed wanted improvements in the comfort of their dentures, and 49 percent indicated that
they desired improvements in their denture appearance.2 W ith the prevalence of patients
requiring denture treatments, dentists and laboratories are now tasked with creating better
fitting dentures with a more natural aesthetic appearance.
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Although dentures are an established facet of dentistry, many professionals avoid this treat-
ment given the likelihood for inconsistent denture fit, marginal aesthetics, and amount of post-
operative adjustments required.3 Adjustment appointments require extra chair and clinical time,
while also leading to patient dissatisfaction and reduced patient trust. Although dentures can
help to improve some of the emotional effects caused by edentulism, they still can result in pain,
discomfort and articulation difficulties.4 W hile many dentists avoid treating edentulous patients,
there are more than 23 million people in the United States who are fully edentulous, and that
number continues to grow.5
Edentulism and poor fitting dentures can be life altering emotionally and physically, altering
self-image, reducing self-esteem and causing embarrassment. 6 Physical changes include decreased
oral facial support because of hard and soft tissue loss, as well as chronic pain.7 C hanges in the
facial region caused by bone resorption and decreased lip support and facial height can create the
look of premature aging.3 The physical changes contribute to the emotional and psychological
impact of edentulism, and poor fitting dentures. This can also lead to emotional insecurity, inhib-
iting sociability and relationships.6
C onversely, well-fitting and functional dentures have been shown to improve appearance,
psychological and social behavior of patients. 8 There are procedures and techniques now available
to resolve these issues, ranging from denture base materials and processing systems to anatomi-
cally diverse and occlusally based tooth choices, the combination of which contributes to a more
natural and better functioning denture.
Since its introduction in 1937 , polymethyl methacrylate (PMMA) material has been used
as the primary denture base material.9,10 Its ideal aesthetics, low water sorption and solubility,
minimal toxicity, repair ability, and simple processing technique contribute to the heat-polym-
erized PMMA resin’s longevity as a primary denture base material.11 The conventional method
for curing resin was the pack and press technique.11,12 H owever, this technique is susceptible to
dimensional changes and inaccuracies in the fit of the denture base.13
Further, despite excellent impression techniques, denture processing can result in an ill-fitting
prosthetic, which can be frustrating for patients and dentists alike.4 Traditional denture process-
ing methods have been time-consuming and labor-intensive, requiring laboratory technicians to
master various steps that must be completed consistently and to precise specifications.14,15 They
also require technicians to compensate for shrinkage, avoid mixing or dosage errors, and prevent
any increase in vertical dimension.15
Processing techniques utilizing injection methods result in less increase in vertical dimen-
sion of occlusion compared to traditional techniques.16 Utilizing an injection processing method
minimizes the possibilities for changes and reduces the chances for fabrication error.17
Introduced 30 years ago as an alternative to the conventional method, and setting the stan-
dard for injection processing systems the continuous injection processing system (Ivocap, Ivoclar
V ivadent, Amherst, NY ) allows for the fabrication of highly accurate methyl methacrylate-based
dentures.18 Typically mixed in the capsule, the material is injected into the closed flask under
pressure.17 C onstant pressure is then applied during polymerization and, because the denture base
material flows consistently, the likelihood for material shrinkage is optimally compensated. This
leads to no or minimal increase in vertical dimension and a homogeneous denture base.17
Research has indicated that this injection system imparts increased flexural strength values
compared to other processing techniques.19 This increase may result from the reduction in the
residual monomer level, which may occur because of the higher degree of conversion.20 Additional
research has indicated that this system exhibits the least amount of wear when compared to five
other commonly used orthotic appliance materials.21
A more recent development in processing includes a fully automated, controlled continuous
injection and polymerization procedure of special PMMA resins (IvoB ase, Ivoclar V ivadent, Amherst,
NY ). This system combines the benefits of heat-curing and self-curing polymers.22 Research has indi-

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cated that using the improved injection molding technology, these denture base resins (IvoB ase
H ybrid, IvoB ase H igh Impact, Ivoclar V ivadent) demonstrate superior dimensional precision,23
likely because the process avoids any fluctuation during fabrication. This reduces the chances of
providing patients with poor-fitting dentures. Research has also found that this system achieves
exceptionally low initial contents in residual monomer for auto-curing acrylic system, reducing
the potential sensitization risk for patients to a very low level.24
H owever, advances in material and processing techniques are voided if steps aren’t
taken to achieve a proper fit by first establishing correct centric relation. B y determining
a precise and reproducible centric relation and occlusal vertical dimension, edentulous
patients in need of prosthetic treatments will have a harmonious, functional, and com-
fortable occlusion.25 An accurate occlusion is also essential to fabricating comfortable and
well-fitting dentures.25
Among the previous tools used to create correct centric relation, proper occlusion, and
precise-fitting dentures have been wax bite rims. H owever, recording the vertical dimension
and centric relation can be challenging given the influence of the patient’s proprioceptive
nervous system and its ability to impact mandibular movements and the condylar position,
which reduce the recording’s accuracy.26
In 1910, Alfred Gysi determined that accurate alignment of the maxillary and mandib-
ular anterior dentitions would result in improvement in phonetics, function and aesthetics
in the construction of dental prostheses.27 Introduced to eliminate occlusal discrepancies
and determine the optimal centric relation and occlusal vertical dimension of their patients,
pioneers in their field, H arper, Schiffman, Ellinger and Gysi utilized Gothic arch tracers
to determine proper centric relation and then treated their patients with selective occlusal
grinding and rehabilitation to achieve centric relation and vertical dimension of occlusion.28
This article demonstrates how to achieve an improved fit and reduce postoperative chairside
adjustments with dentures by using the Gothic arch tracer when planning dentures.

The Gothic Arch Tracer

The Gothic arch tracer has been a staple in restorative dentistry for nearly a century.25
It captures occlusal vertical dimension and centric relation, and has been developed over
the last century to minimize technique sensitivity and reduce other complications associ-
ated with traditional Gothic arch tracers.25 Derived from Gothic architecture, the Gothic
arch removed the traditional wax-bite rim and restricted masticatory forces to the central
bearing point in the mouth, in order to create a fulcrum of support for the mandible. This
allows the muscles of mastication freedom to return to their correct physiological position.26
Additionally, the path of the central bearing was recorded through protrusive and excursive
movements, and then the points at which these movements intersected would be recorded
as the patient’s centric relation position.26
Ultimately, Gothic arch tracers remain a largely underutilized tool because the early
versions were considered technique sensitive and difficult to assemble, although they
have demonstrated a proven advantage for recording the precise relationship of the ante-
rior teeth in centric relation.25 Gothic arch tracing utilizes tracing plates to capture and
record the lateral movements of the mandible and maxilla. It is a preferred method for
obtaining consistent and accurate positions of the mandible at a comfortable vertical
dimension of occlusion.29 Although not essential for denture fabrication, Gothic arch
tracing and determining ideal centric relation help ensure the ideal fit, aesthetics and
functions prior to denture processing.29 This technique has a short learning curve that,
once mastered, enables consistent, repeatable and accurate occlusal vertical dimension
and centric relation, ensuring occlusal harmony in any type of prosthesis construction—
including dentures.25
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Setting Up the Gothic Arch Tracer

Utilizing a Gothic arch tracer should only take about 10 minutes, but can save
considerable time in postoperative adjustments.
1. The first step in setting up the Gothic arch tracer is recording an arbitrary bite
relationship during the first appointment with the centric tray (Fig. 1). This
will be sent to the laboratory for mounting the patient’s maxillary and man-
dibular arches parallel to one another so, in return, the laboratory can mount
the Gothic arch tracer components perpendicular to one another. The centric
tray is lined with gauze to facilitate removal of the putty once the laboratory
has mounted the study models (Fig. 2).
2. The putty is then hand-mixed and placed inside the maxillary and mandibu-
lar components of the tray.
3. The tray is then placed in the patient’s mouth, while the patient is asked to
close to a reasonable proximity of the existing denture vertical dimension of
occlusion (Fig. 3).
4. The impression is removed once the putty is set and sent to the laboratory, along
with the rest of the smile design information. Ask the laboratory to fabricate a sec-
ond set of base plates with recorder mounted on it without the wax rims (Fig. 4).

Recording Centric Relation with the Gothic Arch Tracer

After the impression technique, recording the centric relation position is proba-
bly the single-most important step in denture construction.4 The wax rims are uti-

1> 2>

3> 4>

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lized to determine the aesthetic and phonetic position of the teeth. The second set 5>
of baseplates are returned from the laboratory, with the Gothic arch tracer mounted
to record the centric relation position and vertical dimension. Adjustment of the
vertical component of the recorder to match the patient’s desired vertical dimension
of occlusion occurs first.
1. According to the manufacturer’s instructions, the strike plate is then
painted with magic marker or articulating paper is used to mark the strike
plate (Fig. 5. Image courtesy of Brian Carson).
2. After the plate is properly marked, the patient should be instructed to slide
6>
the mandible forward, backward, and into left and right lateral excursions.
The marks made from these actions should resemble an arrow, and the tip
of the arrow is determined as the patient’s centric relation position (Fig. 6).
3. Placement of the center of the centric pin receiver over the point of the
arrow occurs, and adhesive is used to bind it to the strike plate (Fig. 7).
4. Once the base plate is placed back in the patient’s mouth, the patient is
guided until the pin goes into the hole in the centric receiver (Figs. 8a-b).
5. The baseplates should then be secured together using a hard bite registra-
tion material (Figs. 9a-b). 7>

Equilibrating Dentures Post-fabrication

In addition to recording centric relation, Gothic arch tracers can also be used
after denture fabrication to equilibrate the dentures. With proper mounting on the
continued on page 104

8a> 8b>

9a> 9b>

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finished upper and lower dentures, the intraoral tracer can be used as a central bearing device
for attaining balanced denture occlusion.25 Once the dentures are fabricated in the laboratory,
the technician mounts the maxillary cast and uses a facebow record, while the mandibular cast
can be mounted to the maxillary cast using the arch tracings.26 The centric relation and vertical
dimension of occlusion can then be confirmed and any adjustments made prior to the patient’s
fitting. This ensures that the laboratory-fabricated dentures are precise and accurate replications
of the patient’s impressions and denture design determined in the office.

Conclusion
These days, many dentists avoid treating edentulous patients, despite the growing need for
denture treatments. B y following the step-by-step Gothic arch tracer process described, dentists
can now adhere to a successful protocol for creating accurate and well-fitting dentures. Although
Gothic arch tracers have been known for their technique sensitivity in the past, it is a valuable tool
to avoid chronic adjustments after denture fabrication. Typically completed in less than 15 min-
utes, Gothic arch tracer processes can save valuable chair and clinician time. Additionally, Gothic
arch tracers help avoid patient discomfort and dissatisfaction by outlining the ideal denture occlu-
sion for the laboratory prior to fabrication. These simple steps— combined with updated materials
and techniques— enable better laboratory communication, ensure that the impression and design
requested is the same delivered to the patient, and instill confidence that aesthetic, precise and
comfortable removable prostheses are being delivered.

References:
1. Shuman I. Dentures: the ugly duckling. Dental Economics. 2002;92(10). 16. Keenan PL, Radford DR, Clark RK. Dimensional change in complete dentures fabricated by injection
2. Cornerstone Research & Marketing, Inc. Denture Usage/Perceptual Study. August 2014. Buffalo, NY. molding and microwave processing. J Prosthet Dent 2003;89(1):37-44.
3. Nosti J. I (hate) love dentures. Dentaltown. March 2014:63-9. 17. Garfunkel E. Evaluation of dimensional changes in complete dentures processed by injection-pressing
4. Little DA, Buckley SB, Saunders R. Providing stable and esthetic screw-retained implant dentures and the pack-and-press technique. J Prosthet Dent. 1983;50(6):757-61.
with minimal patient visits. Inside Dent Technology. 2012;3(Special Issue 1):1-5. 18. SR Ivocap Injection System. Ivoclar Vivadent AG. Retrieved from [Link]
5. Summary Health Statistics for U.S. Adults: National Health Interview Survey. 2009, tables 11, 12. productcategories/sr-ivocap-injection-equipment. Accessed 8, October 2014.
U.S. Department of Health and Human Services. 19. Konchada J, Kathigeyan S, Ali SA, et al. Effect of simulated microwave disinfection on the mechanical
6. Fiske J, Davis DM, Frances C, et al. The emotional effects of tooth loss in edentulous people. Br Dent properties of three different types of denture base resins. J Clin Diagn Res. 2013;7(12):3051-3.
J. 1998;184(2):90-3; discussion 79. 20. Blagojevic V, Murphy VM. Microwave polymerization of denture base materials. A comparative
7. Vogel RC. Implant overdentures: a new standard of care for edentulous patients current concepts and study. J Oral Rehabil. 1999;26(10):804-8.
techniques. Compend Contin Educ Dent. 2008;29(5):270-6; quiz 277-8. 21. Issar-Grill N, Roberst HW, Wright EF, et al. Volumetric wear of various orthotic appliance materials.
8. Dosunmu OO, Ogunrinde TJ. Selective impression technique for conventional denture rehabilitation Cranio. 2013;31(4):270-5.
in ectodermal dysplasia patient: a case report. West Afr J Med. 2008;27(3):171-4. 22. Ivobase System: a systematic process for the fabrication of high-quality denture bases. Ivoclar Vivadent
9. Huggett R, John G, Jagger RG, et al. Strength of the acrylic denture base tooth bond. Br Dent J. AG. May 2012. Retrieved from [Link]
1982;153(5):187-90. 23. El Bahra S, Ludwig K, Samran A, et al. Linear and volumetric dimensional changes of injec-
10. Takahashi Y, Chai J, Takahashi T, et al. Bond strength of denture teeth to denture base resins. Int J tion-molded PMMA denture base resins. Dent Mater. 2013;29(11):1091-7.
Prosthodont. 2000;13(1):59-65. 24. Wachter W, Voelkel T, Laubersheimer J, et al. New denture processing system reduces residual mono-
11. Memon MS, Yunus N, Razak AA. Some mechanical properties of a highly cross-linked, microwave-po- mer. J Dent Res. 2012;91(Special Issue B):2731.
lymerized, injection-molded denture base polymer. Int J Prosthodont. 2001;14(3):214-8. 25. Wojdyla Sm, Wiederhold DM. Using intraoral Gothic arch tracing to balance full dentures and
12. Salim S, Sadamori S, Hamada T. The dimensional accuracy of rectangular acrylic resin specimens determine centric relation and occlusal vertical dimension. Dent Today. 2005;24(12):74-7.
cured by three denture base processing methods. J Prosthet Dent 1992;67(6):879-81. 26. Deutsch A, Canaday P. Gothic arch tracing. Dental Lab Products. 2010. Retrieved from [Link]
13. Bahrani F, Khaledi AA. Effect of surface treatments on shear bond strength of denture teeth to denture [Link]/lab/article/gothic-arch-tracing.
base resins. Dent Res J (Isfahan). 2014;11(1):114-8. 27. Gysi A. The problem of articulation. The Dental Cosmos. 1910;52:1-19.
14. Kurtzman GM, Melton AB. Improving accuracy and simplifying treatment with full arch removable 28. el-Gheriani AS, Winstanley RB. The value of the Gothic arch tracing in the positioning of denture
prosthetics: a case report. Dent Today. 2004;23(7):82-7. teeth. J Oral Rehabil. 1988;15(4):367-71.
15. Kibler E. Trouble-free denture fabrication: a systematic approach for fabricating precision-pressed 29. Rubel B, Hill EE. Intraoral gothic arch tracing. N Y State Dent J. 2011;77(5):40-3.
denture bases. Inside Dent Technology. 2013;4(5):98-9.

Author’s Bio
Dr. John Nosti practices full-time in Mays Landing/Somers Point, New Jersey, as well as Manhattan, New York, with an emphasis on functional cosmetics,
full mouth rehabilitations and TMJ dysfunction. Dr. Nosti is the Clinical Director for The Clinical Mastery Series, a continuum geared towards advancing
the cosmetic and functional practices of dentists worldwide. He is a member of the American Dental Association, American Academy of Cosmetic Den-
tistry, American Academy of Craniofacial Pain, American Academy of Dental Sleep Medicine and the Crown Council. Dr. Nosti also holds fellowships in the
Academy of General Dentistry, the Academy of Comprehensive Esthetics, and the International Congress of Oral Implantologists.

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1. Dentist are apprehensive about dentures because: 6. The first step in setting up the Gothic arch tracer is:
a. They don’t enjoy the smile design process. a. Recording an arbitrary bite relationship.
b. They don’t have a set protocol. b. Utilizing the wax rims.
c. They have to perform too many adjustments after placement. c. Identifying the centric relation.
d. All of the above d. Mounting the casts.

7. True or False: A centric relation recording is necessary for the fabrica-

2. According to the 2009 National Health Interview Survey, how many
tion of dentures.
edentulous patients are there in the United States?
a. True
a. 12 million
b. False
b. 18 million
c. 23 million 8. The Gothic arch tracer uses the mandible and maxillary positions to
d. 29 million create this shape:
a. Circle
3. The traditional processing technique for dentures utilizes: b. Square
a. A pack and press technique. c. Arrow
b. Auto curing pour processing. d. Triangle
c. An injection technique.
d. None of the above 9. Gothic arch tracers can be used to ensure proper:
a. Centric relation.
4. True or False: Traditional processing has been shown to increase den- b. Vertical dimension of occlusion.
tures’ vertical dimension. c. Tooth position.
d. Both a and b
a. True
b. False
10. Done properly, a Gothic arch tracer will:
a. Increase time spent during the denture fabrication process with
5. Dentists have avoided using a Gothic arch tracer because it: little result.
a. Determines centric relation. b. Decrease post-op adjustments caused by a poor occlusion, but typi-
b. Is considered technique sensitive. cally blamed on an ill-fitting prosthesis or the processing technique.
c. Can be difficult to set up. c. Help establish the correct incisal plane.
d. Both b and c d. Help the lab choose the appropriate posterior occlusal anatomy.

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