Comparison of Techniques for Obtaining Centric Relation Based on the Reproducibility of the Condylar Positions in Centric Relation-A Systematic Review.

Daniela Micheline Dos Santos,André Luiz De Melo Moreno,Clóvis Lamartine De Moraes Melo Neto,Marcelo Coelho Goiato,André Pinheiro De Magalhães Bertoz

doi:10.1055/s-0041-1735903

Daniela Micheline Dos Santos, André Luiz De Melo Moreno + Show 3 more

Open Access

https://doi.org/10.1055/s-0041-1735903

Copy DOI

Abstract

The objective of this systematic review was to compare centric relation (CR) techniques that belong to the same method of obtaining CR (guided, graphical, or physiological method), to verify which CR technique within each method of obtaining CR generates the greatest reproducibility of the condylar positions (or mandibular position) in CR. The PubMed, Cochrane Library, SciELO, Scopus, and Web of Science databases were searched for articles published up to May 5, 2021. The search terms were combinations of “dental centric relation” (MeSH), with each of the following terms (individually): “reproducibility of findings” (MeSH); “jaw relation record” (MeSH); “chin point”; “gothic arch”; “bimanual manipulation”; “swallowing” (MeSH); and “jig.” Inclusion criteria: clinical studies in English; individuals without temporomandibular dysfunction and with complete or almost complete dentition or complete edentulous; and comparison between CR techniques belonging to the same method of obtaining CR based on the reproducibility of condylar positions in CR. For each method of obtaining the CR, the following CR techniques were considered: guided method (chin point guidance and bimanual manipulation); graphic method (intraoral and extraoral gothic arch tracing); and physiologic method (swallowing and tongue retrusion along the palate). A total of 1692 articles were screened. After the inclusion and exclusion criteria were applied, six articles were included in this review. None of the included studies evaluated edentulous individuals. All included articles compared CR techniques of the guided method. Three articles concluded that the bimanual technique showed greater reproducibility of the condylar positions in CR than the chin point guidance technique, two articles showed equivalence between these techniques, and 1 article concluded that the chin point guidance technique showed greater reproducibility of the condylar positions in CR than the bimanual technique. Thus, in this systematic review, the bimanual technique was often superior (generated greater reproducibility of the CR) or at least equivalent to the chin point guidance technique. Therefore, for individuals with complete dentition and without temporomandibular disorders, the bimanual technique is more recommended.

Highlights

The most recent edition of the Glossary of Prosthodontic Terms states that centric relation (CR) is “a maxillomandibular relationship, independent of tooth contact, in which the condyles articulate in the anterior-superior position against the posterior slopes of the articular eminences; in this position, the mandible is restricted to a purely rotary movement; from this unstrained, physiologic, maxillomandibular relationship, the patient can make vertical, lateral or protrusive movements; it is a clinically useful, repeatable reference position.”[1,2]
The reasons for exclusion of the other articles that received a full-text review are indicated in ►Table 2.13–18 ►Tables 3 and 4 show the data collected from the six articles included in this systematic review.[7,8,9,10,11,12]
Hobo and Iwata, and Keshvad and Winstanley found that the bimanual technique generated greater reproducibility of the condylar positions in CR when compared with the chin point guidance technique.[7,10,11]

Summary

Introduction

The definition of centric relation (CR) has been redefined several times over the years.[1,2,3] The most recent edition of the Glossary of Prosthodontic Terms states that CR is “a maxillomandibular relationship, independent of tooth contact, in which the condyles articulate in the anterior-superior position against the posterior slopes of the articular eminences; in this position, the mandible is restricted to a purely rotary movement; from this unstrained, physiologic, maxillomandibular relationship, the patient can make vertical, lateral or protrusive movements; it is a clinically useful, repeatable reference position.”[1,2]. CR is inherently individual to each person.[2] regardless of the definition of CR,[1,3] the dentist must gently guide the patient’s mandible in the direction posterior to the maximum intercuspation, until the patient’s anatomical components (e.g., muscles, ligaments, condyles, and discs) and physiological limits establish his or her CR. A CR technique that generates the greatest reproducibility of condylar positions in CR plays an extremely important role in clinical practice.[2]

Methods

Results

Conclusion