Clinical decision of centric relation

doi:10.7518/hxkq.2024.2024147

Abstract

Abstract:

Centric relation (CR) was used in the complete dentures for edentulous jaws firstly. Then, CR was gradually applied in the clinical diagnosis and treatment of dentate jaws. Regarding the application of CR in dentate jaws, there are many doubts about its rationality. For instance, should CR be the core of diagnosis and treatment of temporomandibular disorders? Should CR be used as the jaw position of establishing occlusion in occlusal reconstruction? Should CR serve as the target jaw position in orthodontic treatment? Meanwhile, varieties of CR clinical applications are objective. According to the existing evidence, this paper summarizes the applicable conditions of several main clinical situations with little controversy. We preliminarily put forward the decision tree for the clinical application of CR, which can be used as a reference in clinical practice.

Key words: centric relation, maximal intercuspal position, condyle, complete denture, temporomandibular disorder, occlusal reconstruction, orthodontic treatment

CLC Number:

R783

Yu Haiyang, Yan Zhebin, Xie Chenyang, Wu Qin. Clinical decision of centric relation[J]. West China Journal of Stomatology, 2024, 42(5): 558-565.

Figures/Tables 2

References 56

1	The glossary of prosthodontic terms 2023 : tenth edition[J]. J Prosthet Dent, 2023, 130 (4 ): e7-e126.
2	徐军. 口腔修复学常用词汇——歧义名词与定义分析[M]. 北京: 人民卫生出版社, 2022.
	Xu J. Common vocabulary in prosthodontics—Ambiguous nouns and definition analysis[M]. Beijing: People’s Medical Publishing House, 2022.
3	何三纲. 口腔解剖生理学[M]. 8版. 北京: 人民卫生出版社, 2020.
	He SG. Oral anatomy and physiology[M]. 8th ed. Beijing: People’s Medical Publishing House, 2020.
4	张祖燕. 口腔颌面医学影像诊断学[M]. 7版. 北京: 人民卫生出版社, 2020.
	Zhang ZY. Oral and maxillofacial medical imaging diagnostics[M]. 7th ed. Beijing: People’s Medical Publishing House, 2020.
5	Kattadiyil MT, Alzaid AA, Campbell SD. What mate-rials and reproducible techniques may be used in recor-ding centric relation? Best evidence consensus statement[J]. J Prosthodont, 2021, 30(s1): 34-42.
6	Hassall D. Centric relation and increasing the occlusal vertical dimension: concepts and clinical techniques-part one[J]. Br Dent J, 2021, 230(1): 17-22.
7	刘洋. 正中关系的可重复性考察及对其历史和发展的考量[J]. 国际口腔医学杂志, 2019, 46(1): 1-4.
	Liu Y. Repeatability of centric relation registration me-thods and their effect on concept development[J]. Int J Stomatol, 2019, 46(1): 1-4.
8	赵铱民. 口腔修复学[M]. 8版. 北京: 人民卫生出版社, 2020.
	Zhao YM. Prosthodontics[M]. 8th ed. Beijing: People’s Medical Publishing House, 2020.
9	王思谕, 周哲青, 袁泉, 等. 3种口内扫描仪用于咬合关系记录的准确度研究[J]. 华西口腔医学杂志, 2024, 42(2): 227-233.
	Wang SY, Zhou ZQ, Yuan Q, et al. Trueness evaluation of three intraoral scanners for the recording of maximal intercuspal position[J]. West China J Stomatol, 2024, 42(2): 227-233.
10	王静. 伴TMD错患者RP-ICP咬合和颌面特征的差异[D]. 天津: 天津医科大学, 2021.
	Wang J. The difference of occlusal and maxillofacial characteristics in RP-ICP in malocclusion patients with TMD[D]. Tianjin: Tianjin Medical University, 2021.
11	Cordray FE. Articulated dental cast analysis of asymptomatic and symptomatic populations[J]. Int J Oral Sci, 2016, 8(2): 126-132.
12	Kattadiyil MT, Alzaid AA, Campbell SD. The relationship between centric occlusion and the maximal intercuspal position and their use as treatment positions for complete mouth rehabilitation: best evidence consensus sta-tement[J]. J Prosthodont, 2021, 30(s1): 26-33.
13	Ekberg EC, Sabet ME, Petersson A, et al. Occlusal appliance therapy in a short-term perspective in patients with temporomandibular disorders correlated to condyle position[J]. Int J Prosthodont, 1998, 11(3): 263-268.
14	Zhang SH, He KX, Lin CJ, et al. Efficacy of occlusal splints in the treatment of temporomandibular disorders: a systematic review of randomized controlled trials[J]. Acta Odontol Scand, 2020, 78(8): 580-589.
15	Rinchuse DJ, Greene CS. Scoping review of systematic review abstracts about temporomandibular disorders: comparison of search years 2004 and 2017[J]. Am J Orthod Dentofacial Orthop, 2018, 154(1): 35-46.e9.
16	Jiménez-Silva A, Tobar-Reyes J, Vivanco-Coke S, et al. Centric relation-intercuspal position discrepancy and its relationship with temporomandibular disorders. A systematic review[J]. Acta Odontol Scand, 2017, 75(7): 463-474.
17	Kandasamy S, Greene CS, Obrez A. An evidence-based evaluation of the concept of centric relation in the 21st century[J]. Quintessence Int, 2018, 49(9): 755-760.
18	Manfredini D, Ercoli C, Poggio CE, et al. Centric relation—A biological perspective of a technical concept[J]. J Oral Rehabil, 2023, 50(11): 1355-1361.
19	Busse JW, Casassus R, Carrasco-Labra A, et al. Management of chronic pain associated with temporomandi-bular disorders: a clinical practice guideline[J]. BMJ, 2023, 383: e076227.
20	刘洪臣. 我国颞下颌关节病的研究与临床进展[J]. 中华口腔医学杂志, 2014, 49(7): 385-389.
	Liu HC. Research and clinical progress of temporomandibular joint disease in China[J]. Chin J Stomatol, 2014, 49(7): 385-389.
21	Hamata MM, Zuim PR, Garcia AR. Comparative evaluation of the efficacy of occlusal splints fabricated in centric relation or maximum intercuspation in temporomandibular disorders patients[J]. J Appl Oral Sci, 2009, 17(1): 32-38.
22	Greene CS, Menchel HF. The use of oral appliances in the management of temporomandibular disorders[J]. Oral Maxillofac Surg Clin North Am, 2018, 30(3): 265-277.
23	Aldrigue RH, Sánchez-Ayala A, Urban VM, et al. A survey of the management of patients with temporomandibular disorders by general dental practitioners in southern Brazil[J]. J Prosthodont, 2016, 25(1): 33-38.
24	Goldman I. The goal of full mouth rehabilitation[J]. J Prosthet Dent, 1952, 2(2): 246-251.
25	Schweikert EO. Centric relation and occlusion in full mouth reconstruction[J]. Quintessence Dent Technol, 1985, 9(5): 313-316.
26	Goldstein GR. Centric relation: a needed reference position[J]. J Prosthodont, 2023, 32(6): 482-488.
27	Goldstein G, Andrawis M, Choi M, et al. A survey to determine agreement regarding the definition of centric relation[J]. J Prosthet Dent, 2017, 117(3): 426-429.
28	何凯讯, 张思慧, 陈江. 数字化咬合重建的流程管理[J]. 口腔医学, 2021, 41(3): 193-197, 230.
	He KX, Zhang SH, Chen J. The workflow for digital oral rehabilitation[J]. Stomatology, 2021, 41(3): 193-197, 230.
29	李波. 咬合重建修复中的相关学问题[J]. 中国实用口腔科杂志, 2019, 12(1): 6-9.
	Li B. Occlusion-related problems in occlusal reconstruction[J]. Chin J Pract Stomatol, 2019, 12(1): 6-9.
30	Banerji S, Mehta SB, Opdam N, et al. Practical procedures in the management of tooth wear[M]. Hoboken: Wiley-Blackwell, 2019.
31	李全利, 曹颖, 武郭敏, 等. 一种牙齿重度磨耗的全牙列固定修复咬合重建方案[J]. 口腔医学, 2022, 42(12): 1080-1085.
	Li QL, Cao Y, Wu GM, et al. A fixed occlusal rehabilitation protocol for severely worn dentition[J]. Stomatology, 2022, 42(12): 1080-1085.
32	刘小雅, 罗寒, 刘天爽. 重度磨耗微创咬合重建的临床效果分析[J]. 口腔颌面修复学杂志, 2022, 23(4): 272-276.
	Liu XY, Luo H, Liu TS. Clinical evaluation of minimal invasive occlusal reconstruction of patients with severely worn teeth[J]. Chin J Prosthodont, 2022, 23(4): 272-276.
33	Lee WT, Chen YC. Digitally fabricated dentures for full mouth rehabilitation with zirconia, polyetheretherketone and selective laser melted Ti-6Al-4V material[J]. Int J Environ Res Public Health, 2022, 19(5): 3021.
34	Ergun G, Yucel AS. Full-mouth rehabilitation of a patient with severe deep bite: a clinical report[J]. J Prosthodont, 2014, 23(5): 406-411.
35	Muts EJ, van Pelt H, Edelhoff D, et al. Tooth wear: a systematic review of treatment options[J]. J Prosthet Dent, 2014, 112(4): 752-759.
36	梁倩, 孙千月, 罗有成, 等. 牙列重度磨耗的全程数字化咬合重建1例[J]. 口腔医学研究, 2019, 35(12): 1191-1192.
	Liang Q, Sun QY, Luo YC, et al. Occlusal reconstruction treatment of severely worn dentition with CDD/CDM workflow[J]. J Oral Sci Res, 2019, 35(12): 1191-1192.
37	金晓婷, 赵维家, 罗洁, 等. 咬合重建: 科学与艺术的结合[J]. 口腔颌面修复学杂志, 2023, 24(1): 1-6.
	Jin XT, Zhao WJ, Luo J, et al. Full-mouth occlusal reconstruction: science and art[J]. Chin J Prosthodont, 2023, 24(1): 1-6.
38	王美青. 学[M]. 4版. 北京: 人民卫生出版社, 2020.
	Wang MQ. Occlusion[M]. 4th ed. Beijing: People’s Me-dical Publishing House, 2020.
39	Koyano K, Tsukiyama Y, Kuwatsuru R. Rehabilitation of occlusion-science or art[J]. J Oral Rehabil, 2012, 39(7): 513-521.
40	刘洋. 关于咬合重建的几个重要问题[J]. 华西口腔医学杂志, 2020, 38(4): 357-363.
	Liu Y. Several important issues concerning occlusal reconstruction[J]. West China J Stomatol, 2020, 38(4): 357-363.
41	刘洋. 咬合重建病例集: 短面型病例[M]. 北京: 人民卫生出版社, 2022.
	Liu Y. A case series of oral rehabilitation—brachyfacial type[M]. Beijing: People’s Medical Publishing House, 2022.
42	姜婷, 张海. 全口咬合重建[M]. 北京: 人民卫生出版社, 2015.
	Jiang T, Zhang H. Full mouth rehabilitation[M]. Beijing: People’s Medical Publishing House, 2015.
43	Roth RH. Functional occlusion for the orthodontist[J]. J Clin Orthod, 1981, 15(1): 32-40, 44.
44	Roth RH. Temporomandibular pain-dysfunction and occlusal relationships[J]. Angle Orthod, 1973, 43(2): 136-153.
45	Roth RH. Point/counterpoint[J]. Am J Orthod Dentofacial Orthop, 1995, 107(3): 315-318.
46	经典, 申玉, 杨璞, 等. 正中关系与正畸治疗的相关性[J]. 华西口腔医学杂志, 2019, 37(5): 527-532.
	Jing D, Shen Y, Yang P, et al. Research progress on the relationship between centric relation and orthodontic treatment[J]. West China J Stomatol, 2019, 37(5): 527-532.
47	熊晖, 花放, 贺红. 浅谈正畸学动态咬合目标及相关循证医学的争议[J]. 中华口腔医学杂志, 2015, 50(5): 271-274.
	Xiong H, Hua F, He H. Disputes on the dynamic occlusal goal of orthodontics and related evidence-based medicine[J]. Chin J Stomatol, 2015, 50(5): 271-274.
48	陈扬熙. 口腔正畸学——基础、技术与临床[M]. 北京: 人民卫生出版社, 2012.
	Chen YX. Orthodontics—basic, technical and clinical[M]. Beijing: People’s Medical Publishing House, 2012.
49	Zhao M, Wang P, Wang H, et al. Diagnostic and treatment protocol for a patient with temporomandibular disorder using a stabilization splint and temporary anchorage devices[J]. Am J Orthod Dentofacial Orthop, 2021, 159(5): 666-681.e2.
50	Song F, He S, Chen S. Temporomandibular disorders with skeletal open bite treated with stabilization splint and zygomatic miniplate anchorage: a case report[J]. Angle Orthod, 2015, 85(2): 335-347.
51	王美青, 亓坤. 谈正畸治疗中的正中关系[J]. 中华口腔医学杂志, 2015, 50(5): 266-270.
	Wang MQ, Qi K. The centric relation in orthodontic treatment[J]. Chin J Stomatol, 2015, 50(5): 266-270.
52	丁寅. 正畸治疗中咬合、颌位及颞下颌关节相关问题的探讨[J]. 中华口腔医学杂志, 2015, 50(5): 275-277.
	Ding Y. Discussion on occlusal, mandibular position and temporomandibular joint related problems in orthodontic treatment[J]. Chin J Stomatol, 2015, 50(5): 275-277.
53	Kandasamy S, Boeddinghaus R, Kruger E. Condylar position assessed by magnetic resonance imaging after various bite position registrations[J]. Am J Orthod Dentofacial Orthop, 2013, 144(4): 512-517.
54	赵贺剑. 正畸治疗后CR-MI髁突位置变化及影响因素的研究[D]. 西安: 空军军医大学, 2021.
	Zhao HJ. The discrepancy of centric relation-maximumintercuspation and centric premature contact afterorthodontic treatment[D]. Xi’an: Air Force Medical University, 2021.
55	Kandasamy S, Rinchuse DJ, Greene CS, et al. Temporomandibular disorders and orthodontics: what have we learned from 1992-2022[J]. Am J Orthod Dentofacial Orthop, 2022, 161(6): 769-774.
56	Zonnenberg AJJ, Türp JC, Greene CS. Centric relation critically revisited-What are the clinical implications[J]. J Oral Rehabil, 2021, 48(9): 1050-1055.

时间/ 年	词典	收录词条总数	CR的定义要点
1956	GPT-1	716	髁突最后位+下颌最后位
1960	GPT-2	874	髁突最后位+下颌最后位、下颌最后位
1968	GPT-3	940	下颌最后位
1977	GPT-4	1 081	髁突最后位（×2）、下颌最后位
1987	GPT-5	2 346	髁突前上位
1994	GPT-6	2 766	髁突前上位、下颌最后位（×2）、髁突最后位+下颌最后位、髁突最中最上位、髁突最上最后位、髁突前最上位
1999	GPT-7	2 875
2005	GPT-8	3 068
2017	GPT-9	3 210	髁突前上位
2023	GPT-10	3 611	髁突前上位

[1]	Bi Ruiye, Zhu Songsong. Application of temporomandibular joint prosthesis in oral and maxillofacial surgery: strategic thinking and prospects [J]. West China Journal of Stomatology, 2024, 42(5): 551-557.
[2]	Guo Yanling, Li Jiaxin, Liu Xinran, Yue Yuan, Wei Na, Wang Min, Hao Liang. Case of precise full-mouth occlusal reconstruction guided by digital occlusal function analysis [J]. West China Journal of Stomatology, 2024, 42(3): 394-402.
[3]	Wang Siyu, Zhou Zheqing, Yuan Quan, Yue Li, Yang Shengtao. Trueness evaluation of three intraoral scanners for the recording of maximal intercuspal position [J]. West China Journal of Stomatology, 2024, 42(2): 227-233.
[4]	Gong Yanji, Liu Yang, Yin Deqiang. Effect of the application of digital technology-assisted optimization in the process of adjusting jaw position [J]. West China Journal of Stomatology, 2024, 42(2): 268-276.
[5]	Li Yulin, Xu Jingchen, Jiang Xiaoge, Chen Song.. Meta-analysis of condylar changes produced by a Twin-block appliance in Class Ⅱ malocclusion [J]. West China Journal of Stomatology, 2023, 41(4): 463-470.
[6]	Li Huang, Wu Xiuping, Huang Lan, Xu Xiaomei, Kang Na, Han Xianglong, Li Yu, Zhao Ning, Jiang Lingyong, Xie Xianju, Guo Jie, Li Zhihua, Mo Shuixue, Liu Chufeng, Hu Jiangtian, Shi Jiejun, Cao Meng, Hu Wei, Cao Yang, Song Jinlin, Tang Xuna, Bai Ding. External apical root resorption in orthodontic tooth movement: the risk factors and clinical suggestions from experts’ consensus [J]. West China Journal of Stomatology, 2022, 40(6): 629-637.
[7]	Zhang Qiao, Huang Dongzong, Zhai Xiaoting, Li Hongbo, Hu Min, Liu Hongchen, Jiang Hua. Occlusal analysis of patients with chewing side preference and symptoms of temporomandibular disorders [J]. West China Journal of Stomatology, 2022, 40(4): 457-467.
[8]	Sun Xinrong, Feng Yue, Liu Weicai.. Application of visualization technology of multimode data fusion in occlusal rehabilitation [J]. West China Journal of Stomatology, 2022, 40(4): 468-475.
[9]	Yin Yuanyuan, Li Fei, He Shushu, Chen Song. Abnormal static and dynamic brain function in patients with temporomandibular disorders: a resting-state functional magnetic resonance imaging study [J]. West China Journal of Stomatology, 2021, 39(6): 682-689.
[10]	Xiao Mian, Hu Zhihui, Jiang Henghua, Fang Wei, Long Xing. Role of osteoclast differentiation in the occurrence of osteoarthritis of temporomandibular joint [J]. West China Journal of Stomatology, 2021, 39(4): 398-404.
[11]	Teng Haidong, Shu Jingheng, Sun Tinghui, Pan Shiyu, Liu Zhan. Three-dimensional morphological changes in the temporomandibular joints of patients with anterior disc displacement with reduction [J]. West China Journal of Stomatology, 2021, 39(2): 203-208.
[12]	Zhou Yongsheng, Sun Yuchun, Wang Yong. Clinical application and research progress of digital complete denture [J]. West China Journal of Stomatology, 2021, 39(1): 1-8.
[13]	Zhang Xixi, Liu Jianzhang. A review about the application of phonetic methods in deciding the jaws relation of complete denture [J]. West China Journal of Stomatology, 2021, 39(1): 105-107.
[14]	Liu Chao- feng, Xu Yanhua, Liu Yan. Curative effect evaluation by using Andrews' six elements for completed orthodontic treatment cases [J]. West China Journal of Stomatology, 2021, 39(1): 48-52.
[15]	Huang Wei, Li Yinghui, Guo Kaili, Zhou Yongchuan, Li Xiangjun. Finite element analysis of the comprehensive impact of scar and maxillary expansion combined with protraction on the development of maxilla with cleft lip and palate after repair operation [J]. West China Journal of Stomatology, 2020, 38(6): 642-646.