How to Manipulate into Centric Relation - Dental Minute with Steven T. Cutbirth, DDS

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In this Dental Minute video, Dr. Cutbirth discusses How to Manipulate into Centric Relation
Dr. Cutbirth is the Founding Director of the Center for Aesthetic Restorative Dentistry (CARD) (www.CenterforARD.com) and maintains a full-time restorative and cosmetic practice (www.WacoSedationDentist.com).

[@Swing_park]

Thank you Dr. Cutbirth. This is by far the most helpful and clearly laid out video on CR. God bless you !

[@centerforard]

Thanks. Subscribe to DentistryMasterClasses.com. There is an organized library of all the DM videos plus many complete comprehensive cases.

[@marcmontano3355]

You inspire young people to pursue a career in dentistry. Thank you for your videos.

[@centerforard]

Dentistry is fantastic if you don't get caught up in managed care and corporate dentistry. There is a place for those practices, but the high volume of patients those dentists must see makes it very difficult for them to resolve complex problems. These complex conditions are not "boiler plate" treatments. They take time, not just in treatment but in conversation and patient education so the patient can help the dentist solve their problems.

[@Rutvik_21]

Thank you sir for this excellent explanation

[@centerforard]

You are welcome. Occlusion, Centric Relation and the Diagnosis and Treatment of Myofacial and Intraarticular (TMJ) Pain and Dysfunction are the foundation of my restorative practice and teaching centers. I cannot imagine how any dentist practices dentistry if they are not experts in these areas. These fundamentals are the foundation of everything we do in dentistry.

[@douglasricardomatamorospar5553]

Awesome! You are truly a great professor. Learning and watching your videos from Honduras!

[@centerforard]

Subscribe to DentistryMasterClasses.com. $15/month. You won't be sorry.

[@aboudaboudi8092]

I agree with you

[@aboudaboudi8092]

@@centerforard .

[@dylansaeed7328]

You’re always the best master ♥️

[@centerforard]

Thank you. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@abdulrahmanmohsen4567]

Very informative👏👏

[@centerforard]

Thank you.

[@hughdong4593]

thank you so much for making this video. This is the most clear video about cr I have met. I am a dental lab student, I am learning how to make a complete denture, but I am so confused about the CE, CO and so on.

[@centerforard]

Great. Watch my video on occlusion. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@emadnejm3577]

God BLESS you for all help to us Thanks

[@centerforard]

Thank you.

[@user-jx7dr5yc9l]

Thanks so much😊🌹🌷

[@centerforard]

You are welcome.

[@jerryliu582]

Thank you Dr. Cutbirth for the great presentation! I am a current dental student and your videos are a great help to supplement my education. I have a few questions for this lecture. What if the patient's CR and CO are coincident? I imagine for these patients, the action of sliding into CO can not take place, thus not giving the few mm of opening needed to make an ideal nightguard that puts the patient's bite into CR. What would you do instead for cases like this? Also, for patients that have unstable occlusions, would you still use the first contact of teeth as a signal to slide the patient's mandible into CR? If not, what would you do? Thanks!

[@centerforard]

Take the nightguard or occlusal orthotic appliance occlusal registration record at an open bite position, allowing enough occlusal opening for the vertical thickness of the appliance. It's practically impossible to teach someone how to manipulate a mandible into CR without hands on teaching. Good for you watching the videos. I hope you and your classmates are subscribed to DentistryMasterClasses.com. There is an organized library of all the DM videos plus many complete comprehensive cases and many very important technical articles you all should read. Watch my videos on the principles of occlusal.

[@user-fishodontist]

I would to thanks your camera man. And you deserve all peace 🤍

[@centerforard]

Thank you.

[@san5a89]

hello doctor. very interesting lesson here. if we are talking about a complete arch rehab, what do you do when we have a skeletal II class with a really important overjet? do you still maintain a retruded position or you try to go a little bit forward with the mandible?

[@centerforard]

I always restore into centric relation if an entire arch or full mouth is being restored. The only time I restore into centric occlusion when centric occlusion is not also centric relation occlusion is when I am restoring a single tooth or a "small restorative project" and the patient has no TMJ or myofacial pain or dysfunction symptoms. Your question is perfect for another reason I perform a comprehensive examination on all patients prior to any definitive dental treatment except for emergency treatment. If the patient has a TMJ or myofacial pain/dysfunction issue, you want to be aware of that problem and discuss it and have the patient acknowledge it in writing (on the consultation sheet) prior to treatment. I cannot imagine the stress in a dental practice if a comprehensive examination and consultation is not performed prior to any definitive dental treatment. All sorts of unexpected things would be occurring and the dentist would have to try to explain them "after the fact." That is another conversation I will discuss in forthcoming webinars. All joints in the body should be maximally seated when that system is under stress. Think about the knee, shoulder, etc. You do not want the TMJ to be functioning under stress (clinching) when the condyle is not maximally seated in the socket (centric relation) so it is braced. So many thing to discuss regarding occuusion, centric relation, clinching, etc. In this HMO, coorporate, high volume, treat a toothache dental environment most practices are in I would think there is a lot of confusion and unplanned, undiscussed issues following treatment. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@arditshehu8660]

sir could you please make a video when you registrate lateral protrusive escursion and how to transfer it in the articolator?

[@centerforard]

I do not normally take a lateral (working side) or protrusive records. Set the condylar incline settings on your articulator on 20 and that will ensure 99% of the working and balancing side interferences on posterior teeth are eliminated when crowns or bridges are fabricated.

[@arditshehu8660]

@@centerforard thanks for your prompt answer

[@vishalsehgal1105]

Centric occlusion is the teeth position when the jaw is manipulated into CR. What you've described as CO is actually MIP or maximum intercuspation.

[@centerforard]

Centric occlusion has nothing to do with centric relation. The teeth may be in maximum intercuspation (centric occlusion) when the condyle is maximally seated in the fosse, or not. If maximum intercuspation of the teeth (CO) occurs when the condyle is maximally seated in the fosse (CR), that position is called centric relation occlusion CRO).

[@vishalsehgal1105]

Dental Minute with Steven T. Cutbirth, DDS centric occlusion \sĕn΄trĭk a-kloo΄zhen\: the occlusion of opposing teeth when the mandible is in centric relation; this may or may not coincide with the maximal intercuspal position; comp, MAXIMAL INTERCUSPAL POSITION Glossary of prosthodontic terms-9

[@vishalsehgal1105]

Dental Minute with Steven T. Cutbirth, DDS I'm not trying to take away anything from these incredibly helpful videos. I myself have used them on numerous occasions and only benefitted from them.

[@centerforard]

Centric Occlusion is maximum intercuspation of the teeth when the person bites their teeth together. Centric Relation Occlusion is maximum intercurpation of the teeth when the condyle is seated maximally in the fosse. The condyle seated maximally in the fosse is called Centric Relation. The teeth in maximum intercuspation when the patient bites their teeth together is called Centric Occlusion. The objective is for Centric Occlusion and Centric Relation to occur simultaneously (Centric Relation Occlusion).

[@mikem.5995]

Both of you are right. In school we called CO as MI and CRO as CO to confuse us less but we were told to never be surprised if CO was used as MI.

[@adamcoughran]

Dr. Cutbirth, when you are measuring the CR to CO slide distance, from what dimension are you measuring (overbite, overjet, etc)?

[@centerforard]

I am measuring from the first tooth contact with the condyle disc assembly manipulated into centric relation to the tooth position when the patient squeezes the teeth together into centric occlusion. When I had my hands on teaching center in Dallas for 20 years, CARD hands on center ended with covid, each entire class of dentists practiced CR manipulation on each other in each of the 10 annual 2 day classes. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@winniegrace6782]

Sir, are there any other methods to guide patient into centric relation, other than the ones you have mentioned?

[@centerforard]

Why not just use the methods I am recommending? They predictably work. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@timter3181]

Doctor, i subscribed to dentistrymasterclasse. But there is something i dont understand during the step of increasing vertical dimension. While you manipulate into CR with your two hands, is your assistant holding the cotton tip applicator ?

[@centerforard]

Yes.

[@timter3181]

@@centerforard thank you doctor ! Please, what is the email of your institute ? Cause I have some questions about your products (photogramhy kit...)

[@centerforard]

centerforard.com. Bx Durkin is my chief of staff.

[@timter3181]

@@centerforard thank you

[@soundparadise2342]

Thank you 🇵🇰

[@centerforard]

You are welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@KevinFisch]

I used to have a severe outward angle on my back rear top teeth but when I got crown they modified them to have regular occulsion and be almost an inch long on the outside. ever since then my life has been ruined because I cannot ear ot talk or smile or sleep. Every dentist modifies the shape of the tooth in someway to "idealize the occlusion" and add verticle dimention which causes the problem. I need it restored to the orignal angle that is how my mouth and face work nothing else works I have literally tried everything in between because every dentist modifies it to add verticle dimention somewhat.

[@centerforard]

So sorry! Unfortunately I cannot diagnose the problem or recommend treatment without examining you.

[@KevinFisch]

@@centerforard thank you for responding. I have an X ray showing the original angle and functional position. it basically shows what I explained that the angle was so severe that the tooth only contacted in one spot. Would you always reshape a tooth to be straight even if it is working fine at an angle?

[@centerforard]

It's hard to say without examining you. I try not to ever say "always." If something is not broken, it may not need fixing.

[@brensonyeo1358]

Is this applicable in edentulous patients, doc?

[@centerforard]

Yes, if you can keep the denture in place to manipulate into CR. I do not fabricate plain dentures without securing them with small diameter implants. I do not want to deal with ill fitting dentures in need of constant adjustment appointments. You may be able to consistently fabricate regular dentures that stay in place, I cannot. I do not like to perform dental procedures that are unpredictable and have great potential to require multiple post op adjustments and may never work well.

[@centerforard]

Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.

[@brensonyeo1358]

@@centerforard Awesome, appreciate your time for the reply, thank you so much Dr. Steven.

[@WarexHousexMusic1]

I swear I can capture a crocodile now.

[@centerforard]

Good for you!

[@fenkicorp]

Is CRO the same as RCP - retruded contact position?

[@centerforard]

I am not familiar with that term.

[@fenkicorp]

Maybe its a UK/US thing. RCP = The point at which teeth first meet in centric relation.