Eliminating the Myth of a Static Centric Relation in Dentistry

Dec. 1, 2012
A new and better era is dawning for dentistry. For many decades, dental schools have taught a number of false and harmful ...

Philips Oral Healthcare hosted its Power of Innovation Challenge, where dental professionals and students were invited to share their views on how innovation has impacted the dental industry. Philips Sonicare and Zoom are proud to share the winning essay in the dental category.

By Philip H. Levy, DDS

A new and better era is dawning for dentistry. For many decades, dental schools have taught a number of false and harmful diagnostic and treatment myths that have enjoyed unwarranted status and importance as physiologic entities in dentistry. For example, a static centric relation concept continues to be regarded as a crucial point of reference, and it is taught to every dental student.

Dentistry’s efforts and its potential to provide positive and comprehensive care has been compromised and circumscribed, and this is because of its allegiance to several mechanically derived concepts that lack physiologic validity. It has long been held that the temporomandibular joints guide and control mandibular movements, and that the correct mandibular posture was as retruded as possible, and also that its position relative to the upper jaw was genetically fixed and unalterable. That admonition was applicable to all treatment. Orthodontically that admonition translated to the usual extraction of premolar teeth in class II cases.

The fixed retruded positional concept for the mandible, centric relation, is historically traceable to early prosthetic denture attempts to obtain duplicable bites. The original method or tool for relating the maxillary and mandibular jaws for the edentulous patient erroneously gained acceptance as a physiologic entity for edentulous patients as well as those with teeth. Ultimately, static centric relation led to entire systems of replication that involved all mandibular movements that attempt to match occlusal contacts with a “fixed envelope of motion.”

Dentistry’s adherence to a fixed and retruded mandibular posture concept that disregards special malrelationships of the jaw has misdirected diagnoses and treatment for orthodontic care (namely extraction of teeth in class II cases), orthognathic surgery, prosthetic dentistry, and temporomandibular joint and associated disorders. In particular, TMJ disorders have been totally misdiagnosed to be multifactorial, when in fact their cause is often due to a misalignment of the mandible. Common orthodontic treatment that involves extraction has often triggered TMJ symptoms or exacerbated the TMJ/MPD syndrome.

That the problem is not more widespread is a tribute to the body’s compensatory capacity and tolerance to insult. That the dentist is generally not held accountable is a tribute to patients’ ignorance of cause and effect. It has become painfully apparent that dentistry’s continued tenacity and loyalty to outmoded and nonphysiologic mechanically derived practices and procedures is untenable. The Hippocratic “Primum non nocere” (first, do no harm) has become a compelling call for change in light of the present knowledge.

Beyond the function of tooth repair or replacement, and coexisting with the maintenance of periodontal health, today’s dentist has the opportunity and obligation to render comprehensive care that is physiologically sound and therapeutically rewarding.

Functional jaw orthopedics is a physiologic concept that demonstrates that the mandible is totally adaptable and responsive to an improved posture. Resolution and cure of TMJ symptoms and cosmetic improvement routinely accompany functional treatment without the removal of teeth during surgery.

Successful care requires an understanding of the normal homeostatic interplay of the occluding dentition, mandibular posture, neuromusculature, temporomandibular joints, naso-respiratory function, and soft tissue involvement.

The stomatognathic apparatus (operating in the dentist’s sphere of influence and under his or her supervision) has dramatic implications in many other parts of the body. Thus, the dentist’s potential role and importance as a primary health team member is magnified far beyond historical or common perception.

The opinions expressed in this article do not necessarily reflect those of Dental Economics or Philips

Please read the full Article by Dr. Philip Levy at http://alterablecentricrelation.org/index.php/monograph

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