Centric relation: A matter of form and substance

Area of Science:

• Dentistry
• Orthodontics
• Temporomandibular Joint (TMJ) Disorders

Background:

• A recent review questioned the clinical implications of centric relation in orthodontics.
• It suggested orthodontists can disregard condylar position, relying on tissue plasticity and occlusal outcomes.
• This perspective overlooks potential pathological variations and the impact of occlusion on condylar positioning.

Purpose of the Study:

• To critically evaluate the assertion that condylar position is largely irrelevant in orthodontic treatment.
• To highlight the importance of monitoring condylar position and mandibular function during occlusal alterations.
• To challenge the reliance on maximum intercuspation and TMJ resilience without considering condylar health.

Main Methods:

• Critical analysis of existing literature and clinical perspectives on centric relation and orthodontic treatment.
• Discussion of the relationship between dental occlusion and the condyle-to-glenoid-fossa position.
• Examination of the potential for iatrogenic effects from occlusal changes without condylar assessment.

Main Results:

• The authors disagree with the conclusion that orthodontists can disregard condylar position.
• Changes in occlusion are likely to alter the natural condyle-to-glenoid-fossa relationship.
• Biological variations in stomatognathic structures can be pathological.

Conclusions:

• Clinicians must carefully monitor condyle position and mandibular function when altering occlusal relationships.
• Relying solely on occlusal outcomes and TMJ plasticity may lead to iatrogenic consequences.
• Further clarification is needed on definitions of 'average patient,' 'biologically acceptable condylar relationship,' and alternatives to centric relation.