Reproducibility and condylar position of a physiologic maxillomandibular centric relation in upright and supine body...

Better understanding of the physiologic features of the masticatory system has led to the evolution of the concept of maxillomandibular centric relation from the mechanical to physiological bases. However, the reproducibility of physiologic methods for centric relation determination has been criticized. In this clinical study the swallowing technique was modified to establish a physiologic centric relation in a reproducible manner. Condylar and disk positioning and reproducibility of the proposed modified swallowing technique (MST) were compared with the same parameters of a traditional technique, namely, the chin point guidance technique (CGT). Both techniques were studied with the patient in the upright and supine positions. Three interocclusal records were obtained for each technique-position combination for each of the 30 patients. The recorded maxillomandibular relations were analyzed on the three-dimensional analyzer. MST positioned the condyles in a more superoanterior position than did CGT, which was interpreted as a better seating of the condyles and disk in the articular fossae. There was no significant difference in reproducibility between MST and CGT on x, y, or z axes (p > 0.05), indicating that it is possible to establish a physiologic centric relation in a reproducible manner. The term "functional centric area" was proposed in this study to define a neuromuscularly determined centric occlusal scheme.