The Relationship Between Centric Occlusion and The Maximal Intercuspal Position and Their Use as Treatment Positions for Complete Mouth Rehabilitation: Best Evidence Consensus Statement

Abstract

Purpose The purpose of this Best Evidence Consensus Statement was to evaluate the existing literature relative to two focus questions: How often does centric occlusion coincide with maximal intercuspal position in dentate and partially dentate populations?; and should centric occlusion or maximal intercuspal positions be equivalent for dentate and partially dentate patients undergoing complete mouth rehabilitation? Materials and Methods Keywords used in the initial search were: intercuspal position, centric occlusion, centric relation, maximal intercuspal position, prosthodontic rehabilitation, and occlusion. The search was then limited to Systematic Reviews, Randomized Controlled Studies, Meta‐analyses and Clinical Trials. Results The initial search strategy related to the selected search terms resulted in more than 15,000 articles. When the subsequent search was limited to Systematic Reviews, Randomized Controlled Studies, and Meta‐Analysis and Clinical Trials, 313 articles were selected for further analysis. Conclusions Review of the literature reveals that most dentate and partially dentate patients do not have coincident centric occlusion and maximal intercuspal position. There is support for coincidence between centric occlusion and maximal intercuspal position as the preferred occlusal relationship in complete mouth rehabilitations. The literature does not report conclusive evidence of adverse prosthodontic outcomes with complete rehabilitations in centric occlusion or maximal intercuspal position in a healthy population. However, there is support for an association between centric occlusion‐maximal intercuspal position discrepancies and occlusal instability as well as temporomandibular joint disorders. Hence, it is concluded that partially and completely dentate patients requiring complete mouth rehabilitation should be restored in centric occlusion.

Centric relation: A needed reference position

“…In a survey of Fellows in the Academy of Prosthodontics, 95% of the respondents would use CR (creating a CO) rather than an existing MIP for reconstruction of both arches, and 83% for the reconstruction of one arch 1 . A recent best evidence consensus statement that reviewed 175 articles relative to the focus question concluded “that partially and completely dentate patients requiring complete mouth rehabilitation should be restored in centric occlusion.” 3 This does not mean that an existing MIP cannot be used for conservative restorations in a healthy mouth as demonstrated by 92% of respondents who indicated they would use the existing MIP for one quadrant in one arch 2 …”

“…Centric relation (CR) is a universally recognized term and an acceptable reference position with a long history of success. The problem is that there is little consensus as to its definition [1][2][3][4] or the method of recording it, 5 and this has created an uprising to abolish it. 4 To understand CR, it is critical to look into its epistemology and to go back to first principles.…”

“…[6][7][8] It is a reproducible, physiologically acceptable position that eliminates retrusive considerations and maintains eccentric control both on the articulator and intraorally. [1][2][3] Clinicians have traditionally utilized this position for diagnostic and restorative patient care and there are no compelling clinical studies that report failures of patients restored in CR. 3…”

An evidence-based guide to occlusion and articulation. Part 7: Guidelines for mechanical articulator use; conclusions and a note on complexity

“…I hope too, that the definitions so beloved by the American Academy make a little more sense and that you can separate the nonsense from the sense. A recently published consensus review of the literature 20 is still hung up on 'centric occlusion' and 'maximum intercuspal position' and ignored the fact that there is no point. Sorry, I'll put that another way: there is no point contact but there must be freedom, so find a starting position that is repeatable and call it whatever you want, and know that the patient will function around an area, albeit a small one.…”

The Role of Maxillofacial Structure and Malocclusion on Condylar Displacement in Maximum Intercuspation and Centric Relation in Patients Seeking Orthodontic Treatment—A Scoping Review

“…Condyle position may play a role in the etiopathogenesis of temporomandibular disorders (TMD) as one of many factors [ 22 ]. Data from certain studies back the notion of increased CD with occlusal instability as well as dysfunction [ 23 , 24 , 25 , 26 , 27 ]. In previous studies, a clinically significant CD threshold of 2 mm in the vertical and horizontal planes was considered diagnostic and 0.5 mm in the transverse plane may have adverse effects on the TMJ [ 7 , 8 , 27 , 28 ].…”