New definition for relating occlusion to varying conditions of the temporomandibular joint (original) (raw)

P e t e r E. D a w s o n , D D S a Center For Advanced Dental Study, St. Petersburg, Fla. Centric relation is the accepted term for defining the condylar axis position of intact, completely seated, properly aligned condyle-disk assemblies. However, some structurally deformed temporomandibular joints may function comfortably, even though they do not fulfill the requirements for centric relation. A wide range of temporomandibu-lar disorders from partial to complete disk derangements with or without reduction may adapt to a conformation that permits the joints to comfortably accept maximal compressive loading by the elevator muscles. There has been no accepted terminology to define the condition or position of such joints. The purpose of this article is to define a n e w term, adapted centric posture, and to explain its rationale and how it is determined. Verification of successful adaptation is an important step in diagnosis, because it rules out structural intracapsular disorders as a source of orofacial pain and establishes responsible guidelines for initiation of occlusal treatment or prosthetic dentistry. It also establishes a m u c h needed terminology for more specific description of temporomandibular joint position and condition for clinical research on the relationship between occlusion and the temporomandibular joints. (J PROSTHET DENT 1995;74:619-27.) Confusion about the relationship between dental occlusion and the temporomandibular joints (TMJs) has been evident in the literature for many years. Many authors advocate that condyle position is critical to the equilibrium of the masticatory system at maximal inter-cuspationY TM Others have argued that little or no relationship exists between faulty occlusion and temporoman-dibular disorders. 2~ In contrast to published information that occlusion is not a factor in temporomandibular disorders (TMDs), a review of the literature suggests that such a conclusion is not totally supported, because the information is routinely devoid of specific details about the position or the condition of the temporomandibular joints in relation to occlusal contacts.20-2t Further confusion results from the use of the single term "TMD" to denote a whole constellation of signs or symptoms with no specificity of the type of intracapsu-lar deformation or whether any structural deformation has even occurred. It is important to determine the type of intracapsular deformation or change in TMJ structures before attempting to determine the optimal relationship between the temporomandibularjoints and maximal intercuspation of the teeth. Because the position of the condylar axis can be aDirector. Copyright 9 1995 by The Editorial Council of THE JOU~AL OV PROSTHETIC DENTISTRY. 0022-3913/95/$5.00 + 0. 10/1/67765 altered by these changes, this article attempts to clarify the rationale for positioning healthy condyle-disk assemblies in centric relation and suggests more definitive terminology and rationale for positioning temporomandibularjoints that have undergone intracapsular deformation and structural change. This article suggests three categories for condyle-fossa relationships: centric relation, adapted centric posture, and treatment position. These categories will be defined, explained, and related to maximal intercuspation of the teeth.

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