Centric relation - A historical and contemporary orthodontic perspective

Background. Centric relation (CR) has been a controversial subject in dentistry for more than a century. For at least the past four decades, issues involving CR have been of interest to orthodontists. The definition of CR has changed over the past half-century from a retruded, posterior and, for the most part, superior condyle position to an anterior-superior condyle position. Type of Studies Reviewed. The authors addressed the historical and contemporary orthodontic perspective of CR. The source material for this review came mainly from literature and searches the lead author accumulated over the last 30 years. As there is no evidence-based (EB) model level 3 (systemic) review on the topic of CR, the best evidence on this subject was gleaned only from a thorough examination and evaluation at EB model level 2 (experience plus best available sample studies). There was, however, enough high-quality EB model level 2 information on the topic of CR for the authors to draw conclusions on the basis of a scientific appraisal of relevant research. Results. Although the reliability of CR records has been substantiated, the records' validity has little to no evidentiary support. In addition, population-based sample studies and consensus statements from national conferences support the view that the positions of the temporomandibular joint (TMJ) condyles in relation to the glenoid fossa or CR position are not diagnostic of temporomandiblar disorders. There appears to be little to no benefit of using gnathologic records and articulator-mounted dental casts to discern discrepancies in maximum intercuspation of the teeth coincident with TMJ condyles in an anterionsuperior CR position in orthodontic patients. Clinical Implications. The benefit of using gnathologic CR records and articulators in orthodontics has not been substantiated by scientific evidence.