Journal of Oral Rehabilitation 2000 27; 823–833
Review
An appraisal of the literature on centric relation. Part I
A. KESHVAD & R. B. WINSTANLEY Department of Restorative Dentistry, School of Clinical Dentistry, University of
Sheffield, Sheffield, U.K.
SUMMARY The literature directly and indirectly re-
lated to centric relation (CR) has been reviewed
chronologically. More than 300 papers and quoted
sections of books have been divided into three sec-
tions. The first two parts are related to CR. Studies
in this group mainly compared either the position
of the mandibular condyle or the mandible itself in
different CR recordings. Various tools were dis-
cussed for this purpose. The third part of the paper
Part I: Centric relation
Introduction
In almost any book on occlusion and fixed prosthodon-
tics, centric relation (CR) is the beginning of the story.
A chapter or section is usually dedicated to this subject
and methods of recording this position are described.
CR is the beginning of occlusion, and all treatment
modalities are based on it. There is no doubt that CR is
a joint position and, therefore, requires knowledge and
involvement of the temporomandibular joint (TMJ) in
every CR study. Attempts to implicate TMJ problems as
unrelated to the teeth have missed the fundamental
fact that the condyles and the lower teeth have a fixed
relationship to each other. Excluding surgery, it is
simply not possible to alter jaw to jaw relationships at
the occlusal interface without affecting the position of
the joints, and it is equally impossible to alter the
alignment of the articular components without affect-
ing the occlusion. Thus, one cannot master the subject
of occlusion without also being a student of the TMJ,
and the complexities of TMJ disorders cannot be
grasped as a separate issue. The teeth and the joints are
part of a functional unit that must be considered to-
© 2000 Blackwell Science Ltd
is about CR – centric occlusion (CO) discrepancy. CR
still remains one of the controversial issues in
prosthodontics and orthodontics. Debates such as
mounting casts on the articulator by reproducible
records for orthodontic treatment planning and
end results, and whether or not orthodontic treat-
ment based on CO causes temporomandibular joint
dysfunction, remain unsolved. The references are
listed at the end of Part III.
gether. All parts of the masticatory system are interre-
lated and must work in anatomical and functional
harmony or disequilibrium may result.
Research for more than 50 years in the field of CR
has been controversial. Nowhere else in dentistry can
one see so much debate and opposing ideas among
scientists and clinicians. This challenge is still ongoing
and, periodically, a clinician presents a method to
record CR ‘correctly’ or redefine this mandibular posi-
tion. Such methods have fundamental differences be-
tween each other but, surprisingly, they aim to achieve
the same goal and are claimed to do so. Also unusual is
the change that CR definitions have undergone in the
past 50 years (Glossary of Prosthodontic Terms 1956,
1960, 1968, 1977, 1987, 1994), despite the fact that
the same methods are used and claimed to be valid and
compatible with recent definitions. Perhaps it is the
TMJ that adapts itself to the scientists’ definition each
time it changes, or is the TMJ accepting any position?
Research has indicated that the position is the ideal one
for fixed prosthodontic and complete denture recon-
structions, TMJ therapy, orthodontics and facial pain
treatment. In 1987, when the definition of CR under-
went drastic change from the most posterior superior
823
824 A. KESHVAD & R. B. WINSTANLEY
position to the most superior anterior position, research
outcomes were put under question. It seems that, sub-
sequently, the scientific community was reluctant to
conduct any further research in this field and little
work was carried out. Some researchers (Westling
1995, Sutcher 1996) were still using the words retruded
and posterior position, possibly unaware that the defini-
tion had changed.
Terminology in the field of CR has been confusing as
a result of changes in definition. The Glossary of
Prosthodontic Terms is the publication of the Academy
of Prosthodontics (formerly Academy of Denture Pros-
thetics) and is updated every 6 years. There have been
six updates since its first publication in the Journal of
Prosthetic Dentistry (Glossary of Prosthodontic Terms,
1956). This Glossary has served as the dictionary stan-
dard for terms used in dentistry, particularly
prosthodontics, since 1956. The changes of definition
in the literature are much more extensive and some-
times authors use their own terminology. This process
has confused many students and practitioners. To re-
view the trend of these changes most editions of the
Glossary will be cited, and other references will be used
where more clarity is necessary. The term CR and
centric occlusion (CO) have always been closely, and
sometimes interchangeably, used in dentistry so it is
essential to observe the changes in CO definition as
well as CR. A brief section on definitions adapted from
the Glossary of Prosthodontic Terms will be cited here
before appraisal of the literature on CR. This will avoid
confusion, especially to the inexperienced undergradu-
ate dental student who might wish to use this paper as
a reference.
Definition of CR and CO
The definitions for CR and CO in the first (Glossary of
Prosthodontic Terms, 1956), third (Glossary of Pros-
thodontic Terms, 1968), fifth (Glossary of Prosthodon-
tic Terms, 1987) and sixth (Glossary of Prosthodontic
Terms, 1994) editions of the Glossary are as follows.
First edition (1956); page 11. Centric Relation: ‘The most
retruded relation of the mandible to the maxilla when
the condyles are in the most posterior unrestrained
position in the glenoid fossa from which lateral move-
ments can be made, at any given degree of jaw separa-
tion’.Centric Occlusion: Not defined.
© 2000 Blackwell Science Ltd, Journal of Oral Rehabilitation 27; 823–833
Third edition (1968); page 452. Centric Jaw Relation: ‘(1)
The most retruded physiologic relation of the mandible
to the maxilla to and from which the individual can
make lateral movements. It is a condition that can exist
at various degrees of jaw separation. It occurs around
the terminal hinge axis. (2) The most posterior relation
of the mandible to the maxilla at the established verti-
cal relation’.Centric Occlusion: ‘The centred contact posi-
tion of the lower occlusal surfaces against the upper
ones; a reference position from which all other hori-
zontal positions are eccentric’.
Fifth edition (1987); pages 724 – 725. Centric relation: ‘A
maxillomandibular relationship in which the condyles
articulate with the thinnest avascular portion of their
respective disks with the complex in the anteriorsupe-
rior position against the slopes of the articular emi-
nences. This position is independent of tooth contact.
This position is clinically discernible when the
mandible is directed superiorly and anteriorly and re-
stricted to a purely rotary movement about a trans-
verse horizontal axis. This term is in transition to
obsolescence’. This year the Glossary considered Centric
Relation Occlusion as a synonym for Centric Relation.
Centric Occlusion: ‘The occlusion of opposing teeth
when the mandible is in centric relation. This may or
may not coincide with maximum intercuspation posi-
tion. This is a term in transition to obsolescence. (See
also intercuspation, maximum)’.
Sixth edition (1994); pages 59 and 84. Centric Occlusion:
(same as fifth edition).
Maximum Intercuspation: ‘The complete intercuspation
of opposing teeth independent of condylar position’.
Centric Relation: (same as fifth edition). As can be seen,
the definition of CR has changed over the years from a
posterior, superior position to an anterior, superior
position. It should be pointed out and made clear that
most of the data and research concerning CR record-
ings, are based on recording the posterior–superior, or
retruded, CR rather than the currently accepted CR
position of anterior–superior. Little, or no, objective
data exists regarding the reliability of recording the
anterior–superior CR position. In this review all terms
used as a synonym for CR will be included. Some of
these equivalents include: median retruded relation,
retruded contact position, retruded axis position.
 AN APPRAISAL OF THE LITERATURE ON CENTRIC RELATION
This article although extensive, is a chronological
review of the philosophies, techniques and instrumen-
tation used for CR registration.
Centric relation
Early years. Until the end of the nineteen-century di-
rect interocclusal recording was the most commonly
used method (Schloseer, 1941). This was a non-preci-
sion jaw record obtained by placing a thermoplastic
material, usually wax or compound, between the
edentulous ridges and having the patient close into the
material. This was known as the mush biscuit or squash
bite. Christensen (1905) was one of the early authors to
use impression wax for bite records. One early method
was to adjust the occlusion rims to the chosen vertical
dimension of occlusion, have the patient close in a
retruded position, and attach the rims together for
mounting on an articulator. This was usually carried
out with staples or by sealing the rims with a hot
instrument (Brown, 1954). He also recommended re-
peated closure into a softened wax rim. Gradually
these methods evolved into interocclusal records as we
know them today. Small amounts of wax, compound,
plaster, zinc oxide eugenol or more recently, vinyl
polysiloxane paste are placed between the occluding
rims, and the patient closes the jaw into the CR.
The earliest graphical recordings were based on stud-
ies of mandibular movement carried out by Balkwill
(Fereday, 1994). The intersection of the tracing pro-
duced by the right and left condyles in the horizontal
plane formed the apex of what is now known as the
Gothic arch or arrow point tracing. This technique was
improved and popularized by Gysi (1910) using an
extra-oral incisal tracer. The tracing plate, coated with
wax, was attached to the mandibular rim. A spring-
loaded pin or marker was mounted on the maxillary
rim.
1900 – 1929. Needles (1923) used an intra-oral arrow
point tracer in which the patient retruded the
mandible to its fullest extent. He mounted three studs
on maxillary rims that cut arrow tracings in mandibu-
lar compound rims. After removal from the mouth, the
rims were reassembled with the functional grooves.
The graphic record received much praise and criti-
cism. In 1923, Hanau wrote: ‘The most naive of our
geniuses had intuitions, moulded into metal, attached a
© 2000 Blackwell Science Ltd, Journal of Oral Rehabilitation 27; 823 – 833
825
decorative theory into their accomplishment and, it must be
admitted, they found a goodly number of fanatical believers
and blind followers, whose mental inertia probably did not
care to penetrate even the polish of the nickel plated instru-
ment under consideration’.
Patterson (1923) cut a trough in the upper and lower
occlusal rims. Those were filled with a carborundum
and plaster mixture. The patient would move the jaw
and grind the rims until the proper curvature had been
established. This would ensure equalized pressure and
uniform tooth contact in all excursions.
In 1926, Tench stated that the Gysi tracing technique
was the only means that should be used for centric
records and all other methods were considered decep-
tions and play things. Sears (1926) used a modified
Gysi tracing. He lubricated the rims for easier move-
ment and placed the needle point tracer on the
mandibular rim and the plate on the maxillary rim. He
believed this made the angle of the tracing more acute
and more easily discernible. He then cemented the
rims together for removal.
Phillips (1927) recognized that in the Gysi method
any lateral movements of the jaw would cause interfer-
ence of the occlusal wax rims which could result in a
distorted record. He developed a plate for the upper
rim and tripodal ball bearing mounted on a jackscrew
for the lower rim. The occlusal rims were removed,
and when the patient had the proper extra-oral trac-
ing, softened compound was inserted between the trial
bases. This innovation was named ‘the central bearing
point’, which supposedly produced equalization of
pressure on the edentulous ridges. He also stated that
in the hands of the majority of operators, a wax record
is ineffective as a result of its distortion.
Gysi (1929) tested the reliability of recordings by
using mannequins and never got the same recording
twice with wax or compound. He concluded that the
uneven cooling of the material produced distortion.
The only material he found accurate enough for an
interocclusal record was plaster. He also concluded that
his tracing technique had only a 5 ° error, whereas wax
and compound bites had a 25 ° error.
Criticism of the Gothic arch tracing was made by
Kingery (1952), who stated that equalization of pres-
sure did not occur. Prognathic and retrognathic pa-
tients could not be used, and flabby tissues or large
tongues could cause shifting of bases. Stansberry
(1929) introduced a technique which incorporated a
826 A. KESHVAD & R. B. WINSTANLEY
curved plate with a 4 in. radius (corresponding to
Monson’s curve) mounted on the upper rim. A central
bearing screw was attached to the lower plate with a
3 in. radius curve (reverse Monson’s curve). After the
extra-oral tracing was made, plaster was injected be-
tween the plates to form a biconcave centric registra-
tion. Hall (1929) used Stansberry’s method, but
substituted compound for the CR record. Later the
graphic recording method used the central bearing
point to produce the Gothic arch tracing.
Hanau (1929), an engineer, defined CR as ‘the posi-
tion of the mandible in which the condylar heads are resting
upon the menisci in the sockets of the glenoid fossa, regardless
of the opening of the jaws’. He believed that this relation
is either strained or unstrained but preferred the un-
strained CR associated with an accepted opening for
the reference jaw relation.
1930 – 1949. Schuyler (1932) was the pioneer of ‘free-
dom in centric’ in the field of occlusion. He believed in
using wax interocclusal records as an appropriate
recording media, requesting the patient to place the tip
of the tongue to the back of the palate and to hold it
there while closing. He stated that it was impossible to
protrude the mandible when this position of the
tongue is retained. He did not consider a record made
on compound or wax occlusal rims sufficiently free
from errors to complete the restorations, without addi-
tional checks. He advocated the use of light pressure in
recording CR.
Goodfriend (1933) considered the centricity of the
condyles in CR to be an abnormal position. He stated
that the most desirable position exists when the
condyles rest near the lower posterior border of the
articular eminences with the menisci serving as a cush-
ion. Niswonger (1934) described CR as a position
where the patient could clench the back teeth. Meyers
(1934), using the ‘functionally generated occlusal path
record* (FGP)’, did not attempt to manipulate the
* FGP: basically the method is derived from Meyer’s (1938) chew
in procedure which was originally developed for complete den-
tures. A special wax is applied to the prepared posterior teeth
and, after making some closing movements into it, the patient
executes several lateral and protrusive movements. The cusps of
the opposing teeth inscribe the various pathways in the soft wax
creating a special type of imprint. It is from this imprint that a
stone cast is made which then serves as a countercast for estab-
lishing the occlusal anatomy in wax. In early days the propo-
nents of this technique used a special instrument (the PM
© 2000 Blackwell Science Ltd, Journal of Oral Rehabilitation 27; 823–833
mandible, other than to instruct the patient occasion-
ally in getting started by exerting a little pressure on
the chin. Mandibular manipulation grew in acceptance
with the increased interest in gnathological philosophy.
Schuyler (1935) defined the centro-maxillo-
mandibular position or centric position as the one
when the upper lingual cusps are resting in the central
fossa of the opposing lower bicuspids and molars. It
was believed (Sillman, 1938) that nature provides a CR
position at birth and that, at about the age of 23
months, the mandible is capable of exhibiting all possi-
ble movements. CO was stated to be coincident with
CR and an occlusal sense is developed in the new-born.
Wright (1939) described the four factors he believed
affected the accuracy of CR records: resiliency of tissue,
saliva film, fit of bases and pressure applied. He con-
cluded that the dentist could not control the pressure
at which the record was made, so the best technique
was to record the occlusion at zero pressure. Block
(1953) agreed with the zero pressure philosophy.
Schuyler (1932), Kazis (1952), Payne (1955), Trapoz-
zano (1956) and Jamieson (1956) advocated the use of
light pressure. The problem of pressure in CR records
was also recognized by Boucher (1960) who wrote ‘In
addition to technical errors are the errors which occur as a
result of failure to control jaw activities and pressure at the
time of registration’.
The problem of pressure in those days was one of the
prime discussions in CR records. This pressure could be
from the dentist in manipulative techniques or bite
force in active registration methods. Probably because
manipulative methods had not yet gained popularity,
an instrument was invented by Boos (1940) to investi-
gate pressure in graphical methods. He used the
‘Gnathodynamometer’ to determine the vertical and
horizontal position at which a maximum biting force
could be produced. His bimeter was mounted on the
lower arch with a central bearing point against plaster
on the upper arch. Plaster registrations were made
with the bimeter in the mouth and the patient exerting
pressure. Boos theorized that optimum occlusal posi-
tion and the position of the maximum biting force
would coincide. He also thought that it was essential
that all registrations be made under biting force so that
the displacement of soft tissues, which occur in func-
intrument) but nowadays the Hanau articulator model H, or its
equivalent, is used with the upper cast mounted using a face bow
registration, made at arbitrary axis points.
 AN APPRAISAL OF THE LITERATURE ON CENTRIC RELATION
tion, would occur during bite registration (Boos 1952;
Boos 1954). These assumptions were made based on
the ‘posterior – superior’ positioning of the condyle in
CR records (which is questionable nowadays).
In 1947 Aprile carried out an interesting research
project on cadavers to investigate the effect of TMJ
ligaments and the muscles of mastication on the posi-
tion of the condyle in CR. He used a Gothic arch
tracing and removed ligaments and muscles one by one
to observe any change in the positioning of the
condyles in the TMJ. He expressed the opinion that the
rhombus shape and the location of the apex of the
Gothic arch tracing resulted only from the osseous
formation of the TMJ and that muscles and ligaments
had no influence on the tracing.
1950 – 1969. As the debate on the definition of centric
jaw position escalated, new terms began to appear in
the literature. Posterior border closure, relaxed closure,
bracing position, hinge position, ligamentous position,
retruded contact position and terminal hinge position added
confusion. The different disciplines within dentistry
could not agree on a definition of CR. In fact Sears
(1952) wrote ‘the problem has confused a great number of
readers, which is not surprising, as many of the writers are
also confused’. He postulated that the soft tissue poste-
rior to the ramus, is also a controlling factor of
mandibular position.
Robinson (1951) stated that the mandible could be
retruded beyond what is considered CR, into a strained
retruded position. Posselt (1952) stated that mandibu-
lar border positional movements are controlled by the
ligaments. Kingery (1952, 1959) listed a number of
detrimental influences during the recording of the CR
position.
One of the first attempts at the use of radiographs to
identify CR was by Pyott & Schaffer (1952). The CR
and the vertical dimension of occlusion were deter-
mined by cephalometric radiographs. This method was
somewhat impractical and never gained widespread
usage in subsequent years. However, with the im-
provement in radiographic instrumentation and meth-
ods, research on cephalometry and condylar position
gained popularity again in the 1980s and 1990s. Such
works will be cited later on.
Six years after Aprile (1947) showed that it is the
bony structures of the TMJ which determine condylar
position, Lucia (1953) in his article about fundamentals
© 2000 Blackwell Science Ltd, Journal of Oral Rehabilitation 27; 823 – 833
827
of oral physiology stated that CR is the most retruded
position into which the muscles of mastication can pull
the mandible. He believed that contraction of the mus-
cles of mastication tended to seat the head of the
condyle in the most superior region of the fossa. Lucia
believed in the true hinge movement of the mandible
and the transfer of this axis to the articulator not only
for the accuracy of mounting but as a factor to verify
CR records.
Boos (1954) ignored the role of the CR method by
stating that ‘In normal cases, the occlusion, the temporo-
mandibular joint, the bone, the soft tissue and the muscula-
ture all produce the same relation to each other and any one
of the many registration techniques may be used. A certain
technique might be required for an unusual situation or a
problem patient’.
Sicher (1954) considered CR the ideal position which
coincides with the median occlusal position. McCollum
& Stuart (1955) stated that the mandible is in CR when
the centres of vertical and lateral motion are in their
terminal hinge position provided that the condyles are
in their Rearmost Uppermost Midmost (RUM) position
in their respective fossae. Bear (1956) contended that
CR and physiologic rest position are one and the same,
while Page (1955) and Rader (1955) expressed doubt
about any practical method of locating or using CR.
Sheppard (1959) held the opinion that the relationship
of mandible to maxilla, when the mandible is braced
during swallowing, demonstrates CR.
Pleasure (1955) introduced his Gothic arch tracer
and called it a ‘Coble Balancer’. He stated: ‘The Gothic
arch tracing is the only method of centric relation that
guarantees conformity to the terms of the accepted definition
of centric relation. Plaster checkbites record the unstrained
centric relation and vertical dimension simultaneously,
rigidly and consistently’. He used a plastic disc that was
attached to the tracing plate with a hole over the apex
of the Gothic arch tracing. The CR record could then be
made without a change of vertical dimension.
Hurdy (1942) and Porter (1955) made a depression
with a round bur at the apex of the tracing. The patient
would hold the bearing point in the depression while
plaster was injected for the centric record.
Robinson (1952) designed the equilibrator, a tracing
device with a hydraulic system and four bearing pis-
tons, each one in the bicuspid and molar region. It
produced a functional record of CR with a uniform
distribution of stress over the basal seat. Silverman
828 A. KESHVAD & R. B. WINSTANLEY
(1957) used an intra-oral Gothic arch tracer to locate
the biting point of a patient. The patient was told to
bite hard on the tracing plate. This developed the
functional resultant of the closing muscles, which
would retrude the mandible. The indentation made by
the patient would be used for the centric record
whether or not it corresponded to the Gothic arch
apex.
Payne (1955) stated that the tracing was difficult to
see and too much patient co-operation was needed.
Trapozzano (1955) believed that checkbites were far
more accurate than the central bearing point could
possibly be a result of the unequal pressure produced.
Block (1953) held the opinion that any sore spot under
the base plate could cause an eccentric tracing.
Shanahan (1955), in his physiological technique,
placed cones of soft wax on the mandibular rim and
had the patient swallow several times. During swallow-
ing, the tongue forced the mandible into its CR posi-
tion. The cones of soft wax were moved and the
physiologic CR was recorded.
Lucia (1960) described the chin point guidance
method in his paper. He referred to the Glossary of
Prosthodontic Terms (1956) as the standard for his CR
recording method. He believed that from the anatomy
of the TMJ, it was logical that the most stable position
of the mandible is in CR. He also added that the origin
and insertion of the muscles of mastication, the incli-
nation of the glenoid fossa, the function of the menis-
cus and synovial membrane all indicate that any
functional movement must send the condyles into the
terminal hinge position.
Kaplan (1963) warned of the possibility of recording
an inferior position of the condyles, employing the
chin point guidance technique of CR recording, when
exerting pressure on the chin area toward the condyle.
He stated that this force pushes the condyle backwards
and at the same time downwards, possibly a result of
the rotation of the mandible around the attachment of
the temporomandibular ligament. Other studies (Daw-
son 1985, 1989) have suggested such disposition of the
condyles to be a result of pushing the mandible back,
although the reason was described as sliding the
condyle on the posterior slope of TMJ, therefore, caus-
ing inferior condylar shift.
One of the problems at that time was a suitable
recording material for injection between the arches
while the mandible was in the correct spatial position.
© 2000 Blackwell Science Ltd, Journal of Oral Rehabilitation 27; 823–833
Lucia (1964) criticized the way the registration mate-
rial was left on the occlusal table while the jaw was
manipulated to CR. He stated ‘The mechanical procedures
necessary to relate the mandible to the maxilla present the
problem. Our task would be simple if a magic material that
would solidify at a given word could be inserted between the
teeth when the lower jaw is executing a perfect terminal
closure. Unfortunately, we have no such material’. Lucia
also believed in using some sort of deprogrammer
when recording CR, stating ‘Most patients have a reflex
closure, an engram, determined and guided by the teeth. The
proprioceptive mechanism determined the path of mandibu-
lar closure …. In order to determine whether there is coinci-
dence between centric occlusion and centric relation, it is
necessary to remove the guidance provided by teeth. The
guidance is eliminated by making the recording at an in-
creased vertical dimension.’ He described, in detail, the
construction and adjustment of the anterior jig or Lucia
jig in the same paper. He hypothesized that when the
centres of vertical arcing motion and of lateral motion
coincide and are in the most posterior terminal posi-
tion in relation to the maxilla, the mandible and max-
illa are in CR. He considered the chin point guidance
with an anterior jig ‘the most accurate method in use’.
Although he initially stressed posterior positioning of
the condyle in CR, probably a result of the Glossary of
Prosthetic Terms definition, he put more emphasis on
superior positioning of the condyle by saying ‘unless the
condyles are uppermost, the restoration made will be in supra
occlusion’.
Mohamed et al. (1965) reported the variability of the
Gothic arch tracing with an increase of vertical dimen-
sion. They used an extra-oral tracing and indicated that
by increasing vertical dimension the apex of the tracing
relocates posteriorly and laterally. He concluded that
the Gothic arch tracing is reliable if used at a given
vertical dimension, of jaw separation under the same
controlled condition, on the same individual and at the
same settings. The time factor, known as circadian
periodicity or rhythmicity (Grasso & Sharry, 1968) was
also introduced as an additional variable in the maxil-
lomandibular relationship established by the needle-
point tracing.
Based on clinical research utilizing intra-oral teleme-
try, Pameijer & Glickman (1968) felt that CR does not
seem to be a functional position in swallowing and
chewing.
 AN APPRAISAL OF THE LITERATURE ON CENTRIC RELATION
Schuyler (1969) was one of the pioneers of the
philosophy of freedom in centric. Although he believed
in CR occlusion (coincidence of CR and CO), he op-
posed the idea of constructing the occlusion at the apex
of the Gothic arch tracing as a point. He stated ‘In our
concept of freedom in centric, centric relation and centric
occlusion coincide, but there is a flat area in the central fossa
upon which opposing cusps contact which permits a degree of
freedom in centric movements influenced by tooth inclines’.
The extent of Schuyler’s freedom in centric was
0·5 – 1 mm (antero-posteriorly and laterally) which
could be arranged by incisal pin adjustment on the
articulator. The fact that CR is a biological area in the
TMJ, and not a point, is more consistent with the idea
of freedom rather than a point centric in occlusion.
1970 – 1980. In these two decades there were more
studies about CR than any other time. New instru-
ments were invented or manufactured and industrial
innovations benefitted the practise of occlusion. One of
the advances that affected CR was the introduction of
an electronic device called the kinesiograph (Jankel-
son, Swain & Crane, 1975).
Another key paper was by Long (1970), who pre-
sented for the first time the use of a mechanical device
for the analysis of mandibular motion with the help of
an articulator extra-orally. Long wrote a paper about
the Buhnergraph and described how this custom-made
device could be used for verification of centric jaw
record. He also used the Buhnergraph for evaluation of
hinge axis records, and stated ‘An intra-oral technique
for locating the terminal hinge axis has been described. The
key to the success of this technique lies in the accurate location
of centric relation at two different degrees of jaw separation.
Centric relation can be located by many techniques but there
is some variability in the results obtained by any of them.
Therefore each dentist should have a means of comparing his
registrations so that an intelligent selection can be made. The
Buhnergraph and the technique described here provide a
means of locating centric relation and determining and/or
verifying the location of the terminal hinge axis’. His re-
search was the basis for the construction of different
commercial Buhnergraphs that are used today, not
only for CR verification but for investigating mandibu-
lar positions.
The concept of ‘the more retruded the better’ was still
valid in the 1970s and many of the authors cited were
reporting their methods of positioning the mandible
© 2000 Blackwell Science Ltd, Journal of Oral Rehabilitation 27; 823 – 833
829
more posteriorly. For example Kantor, Silverman &
Garfinkel (1972) showed that, of five popular tech-
niques for recording CR, chin point guidance gave the
most retruded recording while the swallowing tech-
nique consistently produced the least retruded
position.
Celenza (1973) designed an interesting study. He
was trying to identify the factors that limit mandibular
movement in CR. Limitation by ligaments (Posselt,
1952), by neuromuscular apparatus (Boucher & Ja-
coby, 1969), and by bony structures of the TMJ
(Aprile, 1947) had been reported. Celenza used four
techniques, guided (biting point and Gothic arch) and
unguided (guiding bite point and guided Gothic arch)
centric records, and investigated the repeatability and
distalization of the methods. He stated that posterior
location is achievable only with unguided methods and
the most repeatable method is the guided biting point.
He also concluded that there might be several accept-
able CR positions.
Hoffman (1973) carried out a similar study but con-
cluded that the further posterior the guided position,
the more likely the condyles were to be inferiorly
displaced. Hoffman’s study was exceptional in that he
used a large sample size. This is one of only two studies
that fulfil the criteria of a defined sample with a suffi-
cient number of subjects to permit analysis of condylar
position. The other was by Donovan in 1953. He used
temporomandibular and cephalometric radiographs to
compare 100 subjects. Retruded contact position was
achieved when the subject touched their soft palate
with their tongue. Donovan’s results indicated that
there was less condylar translation between CR and CO
in individuals with malocclusion than in those with a
normal occlusion. Although the sample size of Dono-
van’s study gives high validity to the results, the
method of achieving CR is questionable today. Hoff-
man limited his subjects to 52 young males in good
dental health with the aim of determining the normal
range of condylar movement between CR and CO. He
used acceptable methods of CR registration but his
study was designed when the definition of CR was very
much different to the definition today.
Helkimo (1971) discussed the variability of CR when
executed by different operators. He also related the
medio-lateral components to whether the operator was
right or left-handed. However, he advocated the use of
a relatively strong backward pressure against the chin.
830 A. KESHVAD & R. B. WINSTANLEY
Ingervall, Helkimo & Carlsson (1971) stated that a
factor that can affect CR and its records is head posture.
They believed this was of crucial significance in the
active use of tooth contact positions that are near, or
coincident with, centric relation occlusion. They stated
that in a supine position, or when the neck was ex-
tended, active teeth tapping will normally bring the
mandible close to, or fully into, centric relation occlu-
sion. Then a variable number of mandibular posterior
teeth will meet their antagonists in a position that is
posterior and inferior to that of CO by about 0·5 –1 mm.
They stated that if an examiner applies a ‘posteriorly
directed pressure’ to the midpoint of the chin, it is usu-
ally possible to bring the mandible into a passive
retruded contact position that is somewhat posterior to
that of active centric relation occlusion. Tooth contact
at the time of CR was not accepted by some other
investigators (Wirth & Aplin, 1971) who argued that a
narrow anterior stop (e.g. leaf gauge) forms a tripod
effect between the anterior teeth and the condyles as
the patient’s closing musculature functions freely with-
out inflicting proprioceptive guidance caused by deflec-
tive tooth contacts. However, Wirth & Aplin found that
the patient’s own musculature seats the condyles into
CR; thus, avoiding the need for manipulation by the
dentist.
Weinberg (1972) related TMJ dysfunction to mis-
placed mandibular condyles as a result of incorrect CR
registration. He went further by saying that for effec-
tive diagnosis and treatment of occluso-muscular prob-
lems the dentist must be able to position each
condyle-disc assembly precisely in its physiologically
correct relationship to its fossa. He advocated the use of
TMJ transcranial radiography to indicate the correct
(rearmost, uppermost, midmost) condylar position.
Weinberg stated ‘Until a comfortable centric relation posi-
tion is located and verified for each condyle, it is not possible
to fully evaluate occlusal relationships. Because of spasticity
or hypertension of peri-auricular musculature, it is some-
times difficult to position one or both temporomandibular
joints in centric relation. The difficulty may also be due,
however, to intra-articular problems related to the joint
itself. For this reason it is essential to determine the cause of
pain, dysfunction, or even tension in the joint area before any
treatment is advocated’. He believed that TMJ dysfunc-
tion is a multicausal phenomenon (Weinberg, 1974) to
which condyle displacement has been shown to be a
contributing factor (Weinberg, 1972).
© 2000 Blackwell Science Ltd, Journal of Oral Rehabilitation 27; 823–833
He stated that the retruded condylar position was
not necessarily physiological merely because it was
reproducible. He was not alone in saying this since in
1974 Farrar stated ‘For years I have been encouraging my
colleague Dr Long, and others, to view centric as being the
most superior position of the condyle in the fossa, and I
believe that the most retruded should not be used to define
centric relation …. The inclusion of the words most retruded
is confusing and unecessary’. In 1975 Weinberg catego-
rized superior condylar displacement as induced and
natural displacements for establishing CR. He showed
in a series of transcranial TMJ radiographs that the
condyles were compressing the disc and limited the
space between condyle and glenoid fossa. He stated
that superior displacement occurs in functional as well
as dysfunctional joints and can also take place by iatro-
genic or natural causes and that it should be diagnosed
and subsequently treated by inferior repositioning. He
stated that this condition is only one of the three basic
types of condylar displacement (superior, anterior and
posterior) and recommended further radiographs and
an occlusal stent for treatment.
In another study (Weinberg, 1979) he showed that
in all seven patients examined, unilateral posterior
unsupported muscle force caused the condyles to be
displaced superiorly by between 20 and 50% of the
joint space. He strongly believed that superior condylar
displacement is present in one condyle in subjects with
posterior edentulousness with the other condyle
retruded.
In 1973, Calagna, Silverman & Garfinkel once again
opened up the discussion of muscular force and CR
registration. They stated that consistency in the record-
ing of CR might be significantly affected by the condi-
tioning of the masticatory neuromuscular apparatus.
Lundeen (1974) studied the effect of different intensi-
ties of muscular contraction in recording CR using
several methods. He found that different degrees of
muscle activity produced different CR recordings. He
added that heavy muscular contraction in a patient
with a rigid anterior stop, seats the condyles in the
most superior position. The CR definition that he re-
ferred to in his study was the most superior posterior.
Chin point guidance and the Myo-monitor were the
two methods he used in the study and concluded that
the use of the Myo-monitor to determine and repro-
duce CR is extremely questionable. It is interesting to
see that all comparisons that Lundeen made were with
 AN APPRAISAL OF THE LITERATURE ON CENTRIC RELATION
a Whip-mix Buhnergraph†. Hickey (1974) criticized
Lundeen’s position on force and distalization by saying
that a CR record made with the condyles forced superi-
orly could present some problems. He commented that
an occlusion developed on an articulator using this
kind of recording makes initial contact anteriorly when
placed in the mouth, with the posterior teeth out of
contact. Only when strong muscular force was applied
would the posterior teeth come into contact. He added
‘My concept of a proper occlusion for either natural or
artificial teeth would be one in which the opposing teeth come
together evenly on both sides at first contact when the teeth
are in centric occlusion, with only the minimum amount of
muscular force required to bring the teeth together’.
Studies by Weinberg (1976) into the TMJ suspension
system have suggested that an applied muscle force
creates a superior condylar displacement. This rein-
forces Lundeen’s concept, which suggested that if the
objective is to develop a new occlusal relationship for a
patient with restorations that coincide with the most
retruded and superior condylar position, a centric
recording technique employing heavy muscular con-
traction will be helpful.
Glickman et al. (1974) constructed two full mouth
fixed prostheses, one with the dentition in CO and the
other with the teeth constructed in CR, and studied the
teeth contacts and relations by an electronic telemetric
device under conditions of actual use. They concluded
that the use of the terminal hinge in oral rehabilitation
is subject to question, since it appears that the patient
will not function in this position. Its use as a reference
position is variable and unpredictable. However, Gelb
(1975) in his article about static CR states ‘the prepon-
derance of clinical and research investigation supports our
observation that centric relation is dynamic, variable and
that the prevailing centric relation for any given period is
infrequently utilized during normal function’.
Remien & Ash (1974) in a study using 10 subjects
investigated Myo-monitor CR validity and reproduci-
bility. They questioned the validity of this electronic
device for establishing CR, and also added that the
position defined by this apparatus is non-reproducible.
They used their custom made Buhnergraph to evaluate
the centric records and indicated that because the
Myo-monitor centric record relies on muscles, head
posture can alter the record, whereas in guided centric,
†
Whip-Mix Corporation, 361 Farmington Avenue, Louisville, KY
40217, U.S.A.
© 2000 Blackwell Science Ltd, Journal of Oral Rehabilitation 27; 823 – 833
831
records are independent of head posture. They also
indicated that the Myo-monitor places the mandible
anterior and inferior to all other recording techniques.
This position was even anterior to CO.
Federick, Pameijer & Stallard (1974) studied the infl-
uence of two factors, force and distalization, as they
relate to various techniques commonly employed by
the dentist in recording CR. A strain-gauge and chin
cap were used to measure the amount of distal force.
They stated that an increase in the amount of pressure
applied to a patient’s chin resulted in an increase in
mandibular distalization and that the postural position
of the patient, regardless of the retrusion technique
employed, had a definite influence on the magnitude
of the mandibular distalization. They stated ‘it is felt that
on occasion the distalization achieved was beyond the centric
relation position but nevertheless the compressibility of the
tissues of the TMJ allowed this to occur without evoking pain
in the patient’. However, they believed that the most
retruded position of the mandible is the ideal position.
Wilkie, Hurst & Mitchell (1974) used Weinberg’s
(1972) radiographic method to compare the repeatabil-
ity and positioning of the three records, CO, CR and
Myo-monitor. Their aim was to indicate the concen-
tricity of the condyles in the joint. They concluded that
the Myo-monitor places the condyles anteriorly but CO
and CR are capable of concentric records.
Smith (1975) compared three common CR records:
empirical, terminal hinge axis and Gothic arch tracing.
He considered CR as the most retruded position of the
mandible and concluded that the Gothic arch tracing
provides the most retruded and the most repeatable
and thus the most precise method.
Shafagh, Yoder & Thayer (1975) investigated the
diurnal variance of CR. A Vericheck‡ was used to
indicate the possible differences between morning and
afternoon recordings using the chin point guidance
technique. It was concluded that there is a difference in
condylar position between morning and afternoon and
it was suggested that CR be recorded in the afternoon
because the condyles were placed more superiorly.
Because of this fact he supported the incorporation of
freedom in centric (both wide and long centric) in
occlusal reconstructions.
‡
Teledyne Water Pik 1730 East Prospect Road, Fort Collins, CO,
80553, USA. Formerly Denar 901 E, Cerritos Avenue, Anaheim,
CA, 92805, USA.
832 A. KESHVAD & R. B. WINSTANLEY
In the early 1970s, an electronic device was used for
analysing centric records of the mandible. Mandibular
kinesiography, which was probably first used for the
evaluation of centric records by Jankelson, utilizes a
permanent magnet and an array of sensing elements.
The array is dependent on the strength of the magnetic
field, which changes as the distance from the magnet
varies. Therefore, distortion can be detected between
the true mandibular movement and its trajectories
recorded by mandibular kinesiographic recording.
Recording of mandibular positions, i.e. CR and CO, can
be shown on the oscilloscope or recorded by a camera.
The basic idea has remained the same but the device
has been improved and recently the latest version (K6I
diagnostic system) has gained the American Dental
Association (ADA) seal of approval. The company,
founded by Bernard Jankelson§ now manufactures
three different devices for TMJ therapy, all of which
have the ADA seal.
Azarbal (1977) compared three methods; the Myo-
monitor method to capture centric position by identify-
ing muscle contraction, CR using the Gothic arch
tracing, and CO. They recruited 20 subjects for the
study and concluded that the Myo-monitor centric
position is well away from the Gothic arch tracing
registration. The use of CO position in the study is not
clear, as this tooth position is not comparable to CR
position.
As stated previously, Weinberg (1972) used transcra-
nial radiography to indicate the incorrect position of
the condyles in the TMJ for the treatment of TMD.
Williamson (1978) stated that the quality of the radio-
graphs using this technique is limited, as is the clarity
of all conventional transcranial radiographs as a result
of the multitude of osseous structures through which
the X-rays must pass. He added that one radiographic
procedure that eliminates the problem of poor clarity is
laminography, also known as tomography. In a lamino-
graphic study of mandibular condyle position in CR on
20 asymptomatic subjects, he found the condyles to be
significantly superior in the glenoid fossa when an
anterior guidance prosthesis was used. This method of
locating CR has also been described by Brader (1949)
and Ricketts (1950). Williamson et al. (1977) concen-
trated their work on the hinge axis. They stated that
the hinge axis and CR are the same, adding that this
§
Myo-tronics, Inc., 15423-53 Avenue, SO., Tukwila, WA 98188,
U.S.A.
© 2000 Blackwell Science Ltd, Journal of Oral Rehabilitation 27; 823–833
axis occurs when the mandible is in CR and a pure
rotational movement of the mandible is produced in
the sagittal plane. He studied the effect of bite plane
use on terminal hinge axis location and found that the
maxillo-mandibular skeletal relationship can be
achieved more easily after bite plane use. He also
declared that in the presence of erroneous maxillo-
mandibular relationships, inaccuracy is inherent for
occlusal equilibration. A year later Christensen & Slab-
bert (1978) stated that in the frontal plane the terminal
hinge axis is the imaginary straight line that passes
through the two condyles of the TMJ when the
mandible performs pure rotatory and translatory
movements and that under normal conditions motions
around this axis seldom, if ever, occur.
The literature on the hinge axis of the TMJ is exten-
sive and controversial. This position is usually used to
aid mounting of the upper cast in the articulator but
some workers believe it is the same as CR and this idea
has created much confusion in the literature. It is
important here to state that CR, which is a spatial
mandible to maxilla position, regardless of its defini-
tion, has always been used for lower cast mounting
and the hinge axis has always been used for upper cast
mounting. For the sake of clarity it is also necessary to
mention that in at least one articulator¶ a mandibular
face bow is used and the arc of opening (not the hinge
axis point) is used to estimate the angle of sagittal
condylar inclination on the articulator. CR and the
hinge axis are two independent entities that have dif-
ferent definitions and usage
Lucia (1979) stated that the most important consid-
eration in occlusal reconstruction is CR. He stated that
over 90% of normal healthy mouths have a dis-
crepancy between CR and CO, and the most obvious
reason for building an occlusion in CR is because it is
prosthetically convenient. He outlined the following
reasons why CR is functional and thus acceptable for
treatment. (1) It is the only relation that can be repeat-
edly duplicated during treatment. (2) It is readily ac-
ceptable by every patient free of TMJ disease without
the need for an adjustment period. (3) It is mechani-
cally impossible to have the correct path of travel for
the cusps if they do not start from CR position. He
believed that the muscles which close and retrude the
mandible are much more powerful than the ones that
open and protrude it. Therefore, any prematurities in
¶
Condylator Services, Zurich, Switzerland.
 AN APPRAISAL OF THE LITERATURE ON CENTRIC RELATION
CR on posterior teeth while closing the mouth create a
damaging distal rock that may end in tooth loss.
Dawson (1973, 1979, 1989) advocated the bimanual
mandibular manipulation method for recording CR. He
stated that CR is not the most posterior retruded posi-
tion of the condyles; nor is it an unstrained position.
Instead, he thought that CR could be defined as the
most superior position the condyles can assume in the
glenoid fossae. In recording CR he says ‘no pressure
should be exerted until the mandible is arcing freely. If
pressure is used to force the condyles back and up, a stretch
reflex in the lateral pterygoid muscles will cause them to
contract and brace the condyles forward of centric relation.
Pressure too soon causes the patient to fight the opera-
tor … before the condyle position can be accepted as correct, it
must be verified. The condyles are in centric relation only if
there is complete absence of tenderness, tension, or pain in
both joint areas when pressure is applied’. He named the
most superior position of the condyles the apex of force
position, the position from which the condyles can
travel neither forward nor backward without travelling
downward. However, considering the most superior
condylar position as one of the desirable positions,
some investigators (e.g. Simon & Nichols, 1980) have
indicated that there is no significant difference between
the range of mandibular positions recorded using ma-
nipulative techniques. Passive recording of CR showed
a range of variation of mandibular positions up to
about 300 mm in the medio-lateral and antero-poste-
rior directions.
© 2000 Blackwell Science Ltd, Journal of Oral Rehabilitation 27; 823 – 833
833
Myers et al. (1980) defined CR as the most posterior
unstrained relation of the mandible to the maxilla at a
given degree of jaw separation. They stated that the
more posterior the condyles, the more acceptable the
position. Based on this concept they hypothesized that
chin point guidance is less variable and locates the
condyles more posteriorly than the Gothic arch tracing.
Investigation of condylar position using the two meth-
ods concluded that there was no difference in repro-
ducibility or posterior placement of the condyles
between them.
Orthodontists have always been interested in occlu-
sion and CR. Williamson et al. (1980) conducted a
study to monitor the effect of bite force on the posi-
tioning of the condyles during CR recording. They used
a leaf gauge to deprogramme habitual occlusion and at
the same time asked the subjects to bite with different
pressures to see the differences in condylar position.
Electromyography (EMG) was used to indicate the
most active muscle involved in seating the condyles
and the Vericheck was used to compare the mandibu-
lar positions. There was no significant difference be-
tween the different bite forces and the temporal
muscles were the most active ones.
To be continued.
Correspondence: R. B. Winstanley, Department of Restorative
Dentistry, School of Clinical Dentistry, University of Sheffield,
Sheffield, S10 2TA, U.K. E-mail: r.winstanley@sheffield.ac.uk