Taking a centric relation record with a Pankey Bite Stop can be simple and straightforward. Gather your tools and use these five steps to achieve success:

Five Steps of Taking a Centric Relation Record

1. Try-In: Evaluate the patient’s lower incisal plane for evenness. Try the Pankey Bite Stop on the upper teeth and have the patient close. Move the stop left or right to get an even contact between the most level area of the lower incisal edges.  

2. Preparing the Bite Stop: Squirt Futar-D Polyvinylsiloxane bite registration (regular set) into the underside of the Pankey Bite Stop. Reposition it onto the maxillary anterior teeth as done in step 1. Again, the goal is to position it in such a way as to capture two lower incisal edges that are as level as possible. They should also touch the upper occlusal surface of the record as parallel to each other as possible.   

Have the patient close to touch the bite stop and hold it until the Futar-D registration material is set firm (at least 45 seconds). As it is setting, you can have the patient quickly open once to wipe any excess registration material that has come out around the sides. This is so it does NOT go down past the incisal plane of the bite stop or catch any incisor on a protrusive movement. Have the patient close back down on the record lightly and hold until the registration material sets up.

3. Full Record: Now that the anterior Pankey Bite Stop is stable, in a very calm tone instruct the patient to slide their lower jaw forward, backward, and squeeze. Every 15 seconds, repeat this process. I will often go check on a hygiene patient and leave them to continue this movement as we are deprogramming muscles. 

Next, insert accufilm articulation paper (red side up) and have the patient slide forward and backward. Flip the articulation paper over and instruct the patient to bite in the very back position with the black side up. These posterior occlusal marks will be your reference points to check as you verify your record in the mouth.   

Dry the maxillary teeth with a 2×2 gauze. Squirt new Futar-D regular set polyvinylsiloxane material starting with the posterior teeth on both sides. The goal is to cover both the lingual and buccal cusps. This registers the lower buccal and lingual cusps for an accurate, stable record.

4. Trimming the Record: Beforehand, go to Home Depot/Lowes. Get a 1.5 inch drum sander and some fine sandpaper that fits on the drum. The sander will fit in your quick change lathe for gross trimming of the record. After gross trimming, go back with your E cutter lab carbide burs and fine-tune trim the record so only flat planes are left. There should be no grooves or sharp areas. 

5. Mounting Your Models: Once the record is properly trimmed and your accurate diagnostic models are properly groomed, place the records on the models. The records should sit passively and not lift off. If they do lift off the stone, go back and look for discrepancies in the record and the models. You are now ready to mount the models on a semi-adjustable articulator.

Pankey Bite Stops are available at the L.D.Pankey Resource center. Call 1-800-4-Pankey and ask for Mark Collis.

Clarifying and fine-tuning a new patient system can be more challenging than you might think.

Five years ago, my partner Charlie and I bought a ‘Pankey practice.’ Soon after the transition, we started to recognize that our new patient system would need a little adjusting. The prior owners, who happened to also be my parents, had almost every new patient go through the same protocol.

Charlie and I noticed that the young adult patients who were drawn to our practice had two things in common. (1) They wanted cleanings at the first appointment and (2) they often had less dental needs. We concluded they may not need all the diagnostic records that someone with a lot of restorative needs would have to have.

Defining an Efficient Patient System

I am very systems oriented, and having worked with my parents for a few years, it wasn’t easy for me at first to switch up the new patient system. I liked having all patients funnel through the same protocol, but I began to realize that to get the younger generation into our practice we needed to cater to their desires and gain their trust.

When a patient calls our office, we have a great team that asks questions to understand what the patients’ needs are. I would say that because our referral is mostly word of mouth, we still have many new patients looking for comprehensive treatment. This means we have the traditional new patient appointment, which includes the new patient interview comprehensive exam and full diagnostic records.

But if a patient calls and says they want a cleaning and that there are no concerns, we flex and allow them to meet with the doctor first for a new patient interview, then they have their comprehensive exam and we finish with a cleaning with the hygienist.

If I find that diagnostic records are necessary, I will then have them come back for the records. Sometimes if I really think it would be in the patient’s best interest to not have the cleaning the same day, I will try and talk to the patient to help them understand why I think diagnostic records would be a better option that same day. Most times, if the patient understands the benefits, they are comfortable coming back for the cleaning with the hygienist on another day.

No matter whether the patient has the full new patient exam and diagnostic workup or has the exam and cleaning, the most important part to me is the first 30 minutes where I sit down with the patient and get to know them. I love this time because it allows me to learn about my patient. It also allows the patient to learn about me and my practice and ask any questions.

I believe those first minutes with my patients set our practice apart. It is the beginning of building trust so that whether they have a healthy mouth or need extensive treatment, they are confident that my practice will work with them to maintain optimal oral health.