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The Centric Relation Conundrum – The Occlusion Camps

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Debate (and some confusion) around the topic of occlusion, and its contribution to the success or failure of dental treatment, has been ongoing for some time. Differing philosophies, variation in theories, and the absence of a commonly understood definition have split dentists into various occlusion camps. To help move the debate and our understanding forward, Dr. Mike Racich, frequent Oasis contributor, is here to give a presentation on all things centric relation within a modern dental treatment context, and to tell us which occlusion camp he is in.

Dr. Mike Racich

Dr. Mike Racich is a general dentist in Vancouver, British Columbia, and a graduate of UBC Dental School with more than 30-years of clinical experience. Since the late 1990’s, he has been mentoring his dental colleagues and does so currently via didactic and clinical study clubs, coaching, consultation, proprietary programs, and lecturing. He has also written several dental articles in several publications, and authored three books.

During this video presentation, Dr. Racich discusses:

  • A case study: treatment of a patient who received orthodontics resulting in reduced periodontal support in the upper mouth.
  • How to define centric relation within a modern dental context.
  • An overview of how occlusion camps formed within dentistry.
  • Joint-based or biased occlusions and consistently reproducible positions.
  • Classifications of positions.
  • Why occlusion (or centric relation) is not just the joint.
  • How to build stable and reproducible occlusion positions and the 1, 2, 3 positions of dentistry.
  • How to ascertain a proper vertical dimension of occlusion.
  • Applying facially generated treatment planning using the rule of thirds.
  • Approaching centric relation as a facially generated position rather than a joint biased occlusion.
  • Habit bite position vs. clinically reliable position.
  • The importance of educating patients about keeping teeth apart.
  • When to use centric relation, consistently reproducible, and clinically reliable positions.

Read/download the transcript of the presentation (PDF)

Oasis Moment/Preview (1.23″)

Full Presentation (24.45″)

Which occlusion camp are you in? We want to hear from you!

Leave a comment about this post in the box below, send your feedback by email or call us at 1-855-716-2747.

Until next time!

CDA Oasis Team

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5 Comments

  1. Doug Cowdrey May 15, 2019

    Hello Dr. Racich great presentation. I was at ODA -ASM last Friday and listened to Dr. Lee Ann Brady speak on Occlusion fundamentals. Interestingly she stated she will treat to MI, CR, and NM (LVI)! I am a CR/Facially generated guy myself, I did at one point for 5 years about 400 IME’s for MVA-related facial injury/TMJ injury issues, and at least 4 times saw requests for “rehab re treatment” wherein all four cases were originally rehabbed using NM (LVI) modality, so that was enough to convince me. The trouble I see is that the nature of the disk, especially if post traumatic, changes.
    I would ask you the same question as I did Dr. Brady (Have not heard her response) she is quite Dawson/Pankey oriented, as am I, and her goal is typically cuspid guidance, however she does do group function to premolars. The research shows non axial loading of posterior deflective contacts can via PDL receptors, stimulate masseter/temporalis activity, and others, so at what point does a wearing down cuspid guidance begin to elicit potentially harmful PDL receptor response ie brux/clench, as the posterir PDL receptors begin to get stimulated?

    Reply
    1. Dr. Paul Belzycki, DDS May 15, 2019

      This reply is in regards to Dr Cowdrey’s comment. Clearly, the theme of Michael’s presentation was totally misunderstood. Michael takes great effort to try and dispel the concept of “different occlusal camps” and here we have a question mentioning all the different occlusal camps as if they have equal efficacy and/or reality in treatment.

      With regards to “The research shows non axial loading of posterior deflective contacts can, via PDL receptors, stimulate masseter/temporalis activity, and others”…one needs to question the source of “research”. All research and literature is not equal. Some is a product of gurus in a particular “occlusal camp/cult” and may be biased to prove themselves correct and to attract new disciples.

      The human body is an infinitely complex piece of biological machinery and some may make the error in assuming there’s a simple causal effect for processes that we observe in this system; so there’s a desire to find a simple causal relationship such as lateral forces on molars triggering something in the PDL to trigger bruxism. Peer-reviewed literature states that the cause for bruxism is multifactorial and often mysterious. But to consider this, one is left with little mechanical treatment options. In some minds, this proves unsatisfactory so having a theory that bruxism is caused by “lateral forces on a PDL” gives license to the practitioner to offer a simple solution and charge a fee. And finally consider this: I have patients who have worn the occlusal table flat on all the teeth so there’s no lateral interferences whatsoever; and yet, they continue to brux.

      It is my suggestion that Dr. Crowdrey review Dr. Racich’s presentation again.

      1. Doug Cowdrey May 16, 2019

        First I would say the Oasis series are fabulous, in particular the ability to post/comment, and the expediency of some replies.
        Perhaps I was not concise and clear, and I do apologize if that caused any misunderstanding on the part of Dr. Belzycki that I may be party to. However, it is quite clear on review of the above response by me above that my statement, in respect of Dr. Brady’s statement at the ASM last week, is NOT a question, it would have been followed in that case, by a Question mark. I reviewed my response and nowhere is there a clear statement, nor is it inferred “and here we have a question mentioning all the different occlusal camps as if they have equal efficacy and/or reality in treatment”. This is hyperbole, and untrue. Dr. Belzycki has entirely missed my point, the statement was made as an observation only, in fact Dr. Brady is possibly acknowledging that the three “camps” are in reality one….as Dr. Belzycki suggests above “Michael takes great effort to try and dispel the concept of “different occlusal camps”. This was suggested by Dr. Racich in the video and confirmed in the body of Dr. Belzycki’s response to my response…”Michael takes great effort to try and dispel the concept of “different occlusal camps.” What I found interesting was that a Dawson/ Pankey trained professional made a comment that acknowledges that there may be room for all three “camps”…the first time in my experience that any particular “camp” protagonist has taken such a position. In fact I will confirm with Dr. Brady that I heard her properly, as I have not yet reviewed the tapes of the ASM.
        Dr. Belzycki then goes on at length to point out what constitutes science, or lack thereof, and he subtly implies by speaking in the third person that certain professionals somehow have been trapped by some guru’s pronouncement that putative PDL receptor triggers lead to bruxism and other pathologies constitutes the Golden Rule. That certain professionals somehow conclude that one might charge a fee on the basis of a single “theory”. Wrong, again, at least in my case.
        I respectfully would suggest that perhaps Dr. Belzycki read my response to the awesome Oasis video by Dr. Raicich twice. And in fact, my name was misspelt. Twice.

        Respectfully,
        Dr. Doug Cowdrey MSc, DDS

  2. Dr. Paul Belzycki, DDS May 15, 2019

    Dear Michael… The content of your presentation is eerily timely. I am a fellow presenter on Oasis. My last two presentations involved complex clinical cases that I restored with conventionally accepted protocols and durable materials. I had taken for granted that most clinicians assumed that the “occlusion” was managed in an effective manner as TMJ symptoms were not initially an issue and they remained absent during and after the course of treatment.

    I received strong comments from a member claiming I had overlooked and failed to address all the “occlusal disease” present in both cases and in doing so, he boldly prophesied the failure of treatment without examining the patients first-hand. I attempt to sidestep issues of occlusions because as you rightly point out, “camps” do exist. One makes enemies in their choice. I find myself in no such camp, but rely on the tenets of occlusal management taught to us at University of Toronto back in the late 1970’s. Your presentation is a thorough and skillful review of those tenets. I reframe from using the term “philosophy of occlusion” as this now has come to denote that there are several methods to occlusal/joint management, all on an equal footing, so choose one and get on with it.

    My response to the disgruntled member advises all clinicians to consider the peer-review literature before ascribing to an “occlusal camp” as you call them. My reference would be “occlusal cult”.

    It is fortuitous that you did present this information at this time. It will save me many hours in not having to do so. Our management particulars may differ slightly, but the overarching principles are identical and well supported by the literature. I urge all to review this presentation twice.

    I did.

    Dr. Paul Belzycki, DDS

    Reply
  3. Michael Y Zuk DDS May 22, 2019

    I am surprised the CDA would publish an article concerning the lack of support for a neuromuscular bite as a cure for TMJ problems and if a dentist is reviewed in a disciplinary situation a local authority would use a CR expert but both decline to officially make a statement to warn dentists they are venturing into the danger zone. Many lab-promoted seminars have taught dentists that a certain bite is needed and this has inspired many unnecessary FULL MOUTH ‘de-construction’ cases where patients are forever dealing with complications from the decision. The lab wins, the dentist wins …but the patient is slammed. I see the ‘cult’ term and know these dentists have been led to believe they are helping the patients but really shouldn’t the profession be addressing the corruption in continuing education and not pretending it is protecting the public?

    Reply

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