Dental CPD Australia

Mandibular Bite Relationships

The maxillo-mandibular position of maximum intercuspation is most often the dental treatment position, primarily by default. This is of necessity whenever single tooth preparations or small restorations are involved, since they must fit within the patients existing occlusal scheme. It is only at times of major reconstructive, orthodontic and/or surgical treatments that the option of opening a bite or establishing a new maxillo-mandibular relation may present itself. However, many clinicians still prefer to "play it safe" and retain the existing habitual (CO) maxillo-mandibular relationship, even during major rehabilitative procedures. By definition, the use of centric occlusion as a treatment position excludes re-establishing a proper vertical dimension in an over-closed patient. However, if the patients condition is actively deteriorating this may not be a safe option at all, as the continued physiologic breakdown may lead to failed dentistry and/or a flair up of craniofacial pain.

Centric Relation (CR)

The concept of centric relation has a very long history and was originally devised, at least in part, to accommodate the use of articulators during prosthodontic treatment. Although we now know that the jaw doesn't function like a hinge, originally it was convenient to make that assumption when using articulators to make prostheses. Today, one clear difference between centric relation procedures and strictly muscle-oriented methodologies is the priority given by CR methods to evaluating the function of the temporo mandibular joints. Typically, centric relation operators give first priority to establishing stable joint function, while muscle-oriented (neuromuscular) approaches tend to focus almost exclusively on muscle comfort.

Muscle-related Centric (MC)

In general, muscle-oriented approaches consider joint position and/or stability secondary to muscle function. In the extreme, it is simply assumed that creating "happy muscles" will automatically provide good or atleast adequate joint function. In a more practical view, both joint function and muscle function are seriously evaluated and, when indicated, a compromise is sought to provide both joint and muscle compatibility. This represents an approach that bridges the gap between strict CR and rigid MC approaches. Consequently, a variety of methods have evolved to capture and establish a muscle-related centric position, while maintaining favorable joint function.

Predicting a patient’s response to correcting overclosure

The question is often asked, “How quickly will a patient adapt to a new bite registration?” Even though the object is to “correct” a mal-relationship of the mandible to the maxilla, the patient’s current relationship still has familiarity. The new relationship, no matter how “perfectly” established, will seem strange to the patient at first. There are many factors that influence a patient’s adaptation to a new maxillo-mandibular relation.

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