Centric relation registration: intra- and interexaminer agreement after a calibration program

Abstract

Centric relation (CR) has been considered a maxillomandibular position of choice for some dental and prosthetic procedures. Although regarded as a fully reproducible relation, there is great controversy about its clinical use and recording technique, especially in patients with signs and symptoms of temporomandibular disorders (TMD). This study aimed at evaluating the effectiveness of a training program on intra- and interexaminer agreement when determining the clinical record of the CR position. Forty individuals constituted the sample, divided into symptomatic (TMD) and asymptomatic groups. Three previously calibrated examiners performed the initial assessment and the second evaluation after 30 days in a blind design, using Dawsons bilateral manipulation technique with and without an anterior stop. The amount of frontal and sagittal deviations in relation to intercuspal position, the presence of pain and discomfort during manipulation, and the first occlusal contact in CR were analyzed. Kendall and Kappa tests with a 5% level of significance were used to determine agreement. Values for both intra- and interexaminer agreement were deemed good. The best results were obtained for frontal deviations and assessment of pain (or absence of it) during manipulation. Sagittal deviations showed the lowest agreement in both examinations. The authors concluded that a calibration program could be effective for intra- and interexaminer agreement when recording centric relation. However, caution is recommended when analyzing some isolated items.