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CLINICAL PRACTICE PRACTICAL SCIENCE
Centric relation
A historical and contemporary orthodontic perspective
Donald J. Rinchuse, DMD, MS, MDS, PhD;
Sanjivan Kandasamy, BDSc, BScDent, DocClinDen, MOrthRCS
DEFINITIONS OF CENTRIC RELATION tions. A previously used term that all editions of
AND CENTRIC OCCLUSION the GPT considered obsolete and referenced along
with CO is “centric relation occlusion” (CRO).
Dentistry has not arrived at a consensus defini- Decades ago, CRO was used by gnathologists to
tion and concept of CR. In 2004, Christensen1 said describe the interocclusal position of the teeth
that he and most practitioners “accept the concept when the condyles were located in retruded CR.4,5
that CR is the most comfortable posterior location Past usage of the term “centric relation
of the mandible when it is bilaterally manipu- occlusion–centric occlusion” discrepancies, or
lated gently backward and upward into a retru- slides, was semantically appropriate. To avoid
sive position.” However, CR has not been recog- some of the confusion about the term “CR-CO,”
nized as a posterior, retruded condyle position for one publication appropriately used the term “CO
almost 20 years.2 In 2000, Jasinevicius and col- condyles” compared with CR.8 Recently, CO-CR
3
leagues found that faculty and students at seven (or CR-CO) and MI-CR (or CR-MI) in which MI is
dental schools could not agree on a unified defini- synonymous with CO, have been use interchange-
tion of CR. ably. Other “centric” terms found in the literature
The definition of CR has evolved over the past are intercuspal position (ICP), which is used syn-
CRO contacts were found to occur during swal- degree, this has proven to be true. Orthodontic
lowing, most swallowing and all chewing contacts gnathologists recently have found only minor MI-
occurred in CO.55-58 Furthermore, lateral func- CR discrepancies for the vertical dimension, but
tional occlusal contacts originate from CO and not the horizontal and transverse dimensions.86
55-58
not from CRO. As we previously mentioned, The magnitude of the vertical MI-CR discrepancy
telemetry research has indicated that even when is approximately 1 mm. When the errors in
patients’ entire dentitions were reconstructed in method, recording and instrumentation are calcu-
retruded CR, they still persisted in using CO.58 In lated against this 1 mm figure, the importance of
addition, retruded CR was not believed to be a these findings can be insignificant.81 Nonetheless,
natural and physiological condyle position, but orthodontic gnathologists argue that considera-
rather an extreme border position.67-71 Interest- tion and measurements of MI-CR slides or dis-
ingly, Jankelson and colleagues72 supported the crepancies are still valid.21-25,86-92
view that neither CRO nor CO was physiological Using a Roth “power centric bite registration”
and, therefore, advocated what they and articulator-mounted models,
termed the “myocentric” position or Utt and colleagues90 found that CO
muscle (masticatory) -generated Many prosthodontists condyles were located on average
dental casts, Klar and colleagues89 found a statis- CR recordings do not place condyles in the posi-
tically, but perhaps not clinically, significant tions stated by their advocates. Alexander and
change in the pre– versus post–MI-CR recordings colleagues8 provided TMJ MRI documentation
(differences of no more than 0.39 mm in any of that condyles are not located in the assumed
the three spatial planes) among 200 consecutively positions as advocated and provided by several
gnathologically treated orthodontic patients. gnathologic centric bite registrations. Centric bite
Lastly, gnathologically oriented orthodontists registrations attempting to locate retruded
advocate the use of the terminal hinge axis posi- (posterior-superior) CR and contemporary ante-
tion, the need for pretreatment CR-MI–converted rior-superior CR do not correspond to the condyle
lateral cephalograms and the placement of positions of people with asymptomatic TMD.
gnathologic positioners immediately after ortho- CR gnathologic recording techniques such as
dontic appliances are removed.92 Roth power centric bite registration and articu-
On the other hand, nongnathologic orthodon- lator mounting instrumentation have been
tists tend to use hand-held models and demonstrated to be somewhat reliable (repeata-
noninstrument-oriented CR techniques. They bility and consistency of the records or tech-
favor more general treatment goals that include niques).91,92 We, however, question the validity of
ferent people. Because articulators do not incorpo- tric registration when a deprogrammer was used;
rate any initial translatory movement of the the difference may not be clinically significant.
condyles during jaw opening, Lindauer and col- Conversely, Kulbersh and colleagues87 did not
leagues95 concluded that the use of articulators to find a difference in MI-CR measurements
simulate “jaw movements to identify occlusal between orthodontic patients who wore full-
interferences cannot be expected to replicate the coverage deprogrammers for three weeks for 24
patient’s mandibular movement precisely.” They hours a day and those who did not.
further argue that “the uncertainty of predicting There are many unanswered questions con-
mandibular rotation for a given patient should be cerning deprogramming splints.
considered when planning surgical treatment and dIs there a difference in findings between ante-
fabrication of orthodontic appliances.”95 rior and full-coverage deprogrammers?
dWould a longer period of wearing a deprogram-
DEPROGRAMMING ming splint yield larger differences?
The need to “deprogram” patients from their pre- dAre the fractions-of-a-millimeter differences in
existing occlusions with occlusal centric registrations produced by
splints before taking CR recordings is deprogramming splints clinically
patients. The use of deprogramming splints is 32. Gianelly AA, Anderson CK, Boffa J. Longitudinal evaluation of
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equivocal, with the best approximation leaning Orthod Dentofacial Orthop 1991;100;416-20.
toward the view that their use is not EB. ■ 33. O’Reilly MT, Rinchuse DJ, Close J. Class II elastics and extrac-
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