I no longer record my bite registration in CR (centric relation).
Your observations and clinical awareness is correct that when one uses CR with deranged or dysfunctional TM joints the position will change typically more anterior over time from the initial position. Most often if one uses the CR position and the the patient’s mandible is shifting anteriorly the patient may not in physiologic terms be asymptomatic as one may believe.
The very definition of CR definition no. 6 according to the Glossary of Prosthodontic Terms says: “The relation of the mandible to the maxillae when the condyles are in the uppermost and rearmost position in the glenoid fossae. This position may not be able to be recorded in the presence of dysfunction of the masticatory system.” Definition no. 7 says, “A clinically determined position of the mandible placing both condyles into their anterior uppermost position. This can be determined in patients without pain or derangement in the TMJ.”
Therefore if my patients have masticatory dysfunction, joint derangement problems and pain I technically according to the rules should not use CR as my recording technique. For that reason according to the rules of dentistry I use an optimized Myo-centric position and method without manual manipulation. When I do so, I have less anterior shift of my mandibles from the initial position and less follow up visits in general.
– Clayton A. Chan, D.D.S. – Las Vegas, NV
Leaders in Gneuromuscular & Neuromuscular Dentistry