How a Discrepancy Between Centric Relation and Maximum Intercuspation Alters Cephalometric and Condylar Measurements

The authors' objective was to determine, by means of cone-beam computed tomography (CBCT), if there is a significant difference between the cephalometric and condylar measurements obtained in maximum intercuspation (MIP) and those obtained in centric relation (CR), which would interfere in orthodontic diagnosis and planning.

The sample consisted of 30 randomly selected patients (15 men and 15 women, mean age 14 years, CR ≠ MIP between 1 mm and 2 mm) who had undergone orthodontic treatment. This retrospective study used CBCT scans, one in MIP and the other in CR. Cephalometric measurements and sagittal, axial, and vertical condylar variations between the CR and MIP positions were analyzed in a tridimensional (3D) imaging software.

Patients with a small CR-MIP discrepancy (<2 mm) presented significant differences in the cephalometric analysis carried out in CR and MIP, although these differences might be of low clinical significance. The condyle-fossa relationships in sagittal, coronal, and axial planes did not seem to be relevant, because only one measurement presented significant change between CR and MIP positions.

Class II malocclusion in patients with a large CR-MIP discrepancy may be exacerbated in the CR position, which may in turn increase treatment difficulty. In these cases, not only must cephalometrics be registered in CR, but dental casts and photographs of the patient are needed to permit orthodontists to plan an appropriate treatment.