SEEMEDJ 2021, VOL 5, NO. 1 Slide in Centric on Students 

176 Southeastern European Medical Journal, 2021; 5(1) 
 

Original article 

Slide in Centric on a Random Sample of Students of the School of 
Medicine in Split 1 

Ivana Strikić Đula 1, Nikolina Lešić 2*, Davor Seifert 3 

 
1 Health Centre Šibenik, Croatia 
2 Dental Office Seifert d.o.o., Faculty of Dental Medicine and Health, J. J. Strossmayer University, Osijek, Croatia; 
School of Medicine, University of Split, Croatia.  
3 Faculty of Dental Medicine and Health, J. J. Strossmayer University, Osijek, Croatia; School of Medicine, 
University of Split, Croatia; Dental Office Seifert d.o.o., 
 
Corresponding author: Nikolina Lešić, nikolina.lesic@gmail.com  

 

Received: Aug 18 2020; revised version accepted: Mar 20, 2021; published: Apr 28, 2021 
  
KEYWORDS: dental occlusion, centric; temporomandibular joint dysfunction syndrome 
 

Abstract 
Introduction: A slide in centric is defined as a slide from centric relation to maximum intercuspation. 
Understanding contact between natural teeth is important for longevity of the stomatognathic 
system, diagnosis and therapy planning. The aim of this study was to determine the difference in the 
length of slide in centric in population according to dental status, sex and previous orthodontic 
therapy. 
Materials and methods: The study was conducted on a sample of 33 students at the University of 
Split, School of Medicine (dental study).  
Results: Slide values do not follow normal or Gaussian distribution according to the Kolmogorov–
Smirnov test (p<0.05). For that reason, they were represented by the median as a measure of central 
tendency. The arithmetic mean of a slide in centric is 0.95 mm ± 0.47 mm. A slide in centric was not 
present in only 10% of the subjects. A slide between 0.5 mm and 1.5 mm to maximum intercuspation 
was present in 90% of the examinees. There was no statistically significant difference in the length of 
slide between the subjects who had all teeth and those who had missing teeth 1-4 (z= 0.507; p= 0.612). 
There was no significant difference in the length of slide between women and men (z= 0, p=1). There 
was no significant difference in the length of slide between the patients who underwent orthodontic 
therapy and those who did not (z=0.253; p=0.800).  
Conclusion: There is some controversy about slide in centric and its etiological role in the 
development of temporomandibular disorders. Slide in centric is very significant because it indicates 
occlusal instability and can eventually lead to temporomandibular dysfunction, which do not have to 
be of the same aetiology.. 
 
(Strikić Đula I, Lešić N, Seifert D. I Slide in Centric on a Random Sample of Students of the School of 
Medicine in Split. SEEMEDJ 2021; 5(1); 176-182) 

 



SEEMEDJ 2021, VOL 5, NO. 1 Slide in Centric on Students 

177 Southeastern European Medical Journal, 2021; 5(1) 
 

Introduction 

Understanding the contact of teeth in certain 
positions and during the movement of the 
mandible is important for longevity of the 
stomatognathic system, diagnosis, planning 
prosthodontic treatment, and treatment of 
dysfunctions (1). Occlusion principles are 
gnathological or of a “freedom in centric” type. In 
the gnathological type of occlusion, maximum 
intercuspation is equal to centric relation. 
Therefore, there are no initial contacts during the 
closing movement around the kinematic axis. 
This type of occlusion is called centric occlusion 
(2). A group of gnathological or organic occlusion 
ensures that during laterotrusion, contacts occur 
only on cuspids, while any other contact or slide 
on any other tooth represents interference (3). 
Numerous authors, among whom Lauritzen (4), 
define cuspid guided occlusion as physiological 
and thus desirable. Cuspid guided occlusion is 
generally found in young population. The other 
type of occlusion is ”freedom in centric” (4, 5, 6). 
Posselt was the first author to describe the 
concept of ”freedom in centric” (7). The freedom 
in centric concept allows a slight initial contact 
of the antagonists during the closing movement 
of the mandible, around the kinematic axis, and 
a slide to the maximum contact between the 
lower and upper teeth. This slide is considered 
normal and physiological only if it occurs in the 
sagittal direction. A slide in centric is defined as 
movement from the initial contact of the 
antagonistic teeth in centric occlusion to 
maximum intercuspation. The slide is 
approximately 0.5-1 mm. It is acceptable when it 
occurs in the anterior direction (8). Mann and 
Pankey use the term “long centric” to describe 
the case where there is an anterior slide 
between the retruded contact position and 
habitual occlusion in a length of approximately 1 
mm (9).  

Freedom in centric defines the possibility of 
movement from the initial centric contacts to 
maximum intercuspation in all orthogonal 
planes: the horizontal, frontal, and sagittal plane. 
Over time, the attitude about physiological 
relations in the temporomandibular joint has 
been changing. Centric relation and its definition 

have been evolving for years. There are at least 
25 definitions of centric relation (10). Initially, it 
was the posterior superior position of the 
condyle in relation to fossa articularis to an 
anterior superior position. The currently 
recognised centric relation definition indicates 
the maxillo-mandibular relation in which the 
condyle articulates with the thinnest avascular 
part of the articular disc with the disc-condyle 
complex in the anterior-superior position against 
the inclined plane of the articular eminences (11). 
Therefore, it is also the most distal unstrained 
physiological relation of the mandible against 
the maxilla, from which lateral movements are 
possible.  

Despite differences between definitions, centric 
relation is a repeatable position and it is used as 
a reference position in prosthetic treatment. 
Only in 10% of the population does maximum 
intercuspation coincide with centric relation, 
which represents a mutually protected 
occlusion or gnathological occlusion. Regarding 
the rest of the population, there is a difference 
between the initial contact in centric relation 
(retruded cuspal position) and maximum 
intercuspation. This slide is approximately 0.5-1.5 
mm. Changing occlusal surface due to 
prosthetic rehabilitation, a prosthodontic 
appliance or a dental filling can cause a 
premature contact during the closing 
movement in central relation and consequently 
to the loss of equilibrium or pathological 
occlusion (12). Slide in centric of 2 mm is one of 
the most important occlusal parameters 
pointing to joint pathology (13, 14) and relates to 
mandibular instability (15). Some studies have 
confirmed the influence of slide in centric (in a 
length of over 2 mm) on joint pathology (16). As 
far as such slide exists between the position of 
centric relation and maximal intercuspation, 
diagnoses given in clinical practice can very 
often reveal pain in the lateral pterygoid muscle. 
This muscle pain disorder represents 
temporomandibular dysfunction and can be 
easily misunderstood for intracapsular 
temporomandibular disorders. 

The aim of this study was to determine if slide in 
centric occurs in young healthy population 



SEEMEDJ 2021, VOL 5, NO. 1 Slide in Centric on Students 

178 Southeastern European Medical Journal, 2021; 5(1) 
 

without any signs of temporomandibular 
dysfunction according to dental status, sex and 
previous orthodontic treatment (with or without 
therapy). 

Materials and Methods 

A cross-sectional study was conducted as a 
clinical examination on each subject. It included 
a random sample consisting of student 
volunteers of the University of Split, School of 
Medicine (dental study). All students were 
informed about the study and 33 students 
signed an informed consent. 

Of the total sample tested, 25 persons were 
students of Dental Medicine and 8 were 
students of Medicine. The youngest subject was 
20 years old and the oldest subject was 24 years 
old. In terms of sex, there were 13 men and 20 
women participating in the study. The mean age 
of female subjects was 22.4+/-1.2 and the mean 
age of male subjects was 22.6+/-1.1 years. The 
mean age of the entire sample was 22.4+/-1.2 
years. From the total sample tested, 21 subjects 
underwent previous orthodontic treatment, 
whereas 12 participants did not. 

During the clinical examination, Decayed, 
Missing, and Filled Permanent Teeth (the DMFT 
index) was defined for each student sample. 
Slide in centric of every participant was 
measured using a wax bite record. The 
participants were positioned in a dental chair in 
an upright position, with the head resting on a 
headrest. A warmed, trimmed and softened wax 
plate was adjusted to the maxillary dental arch. 
Mouth closing in centric relation was achieved 
using the Dawson bimanual guiding technique 
to the point of initial contact between the 
mandibular teeth and the wax bite plate. Closing 
under guidance continued until the wax plate 
was bitten through and the initial contact of the 
antagonistic teeth was made. After registering 
the initial contact in centric relation, participants 
bit the wax plate to the point of maximum 
intercuspation. After removing the wax plate 
from the mouth, the length of slide was 
measured using a caliper. The statistical 
analyses used included the Kolmogorov–
Smirnov test and descriptive analyses. 

Results 

In this clinical examination, dental status was 
recorded. Eleven male subjects and 14 female 
subjects had all teeth, representing 79% of the 
sample. One male subject and two female 
subjects were missing one tooth, representing 
9% of the sample. One male subject and one 
female subject (3% of the sample) had two 
missing teeth. One female subject (3% of the 
sample) had three missing teeth and two female 
subjects (6% of the sample) had four missing 
teeth. Veneer or other dental restorations were 
not observed in any of the participants. 
Orthodontic therapy was administered to eight 
male subjects and 13 female subjects or 64% of 
the sample. The mean value of slide in centric in 
the entire sample was 1 mm (ranging from 0 mm 
to 1.5 mm). Regarding the male subjects, the 
values of slide in centric measured ranged from 
0 to 1.5 mm, with a mean value of 1 mm. The 
same values were obtained upon examination of 
20 female subjects. The slide values do not 
follow normal or Gaussian distribution according 
to the Kolmogorov–Smirnov test (p<0.05). For 
that reason, they were represented by the 
median as a measure of central tendency (min-
max). Arithmetic mean of slide in centric was 
0.95 mm ± 0.47 mm. 

Based on the dental status of the subjects with 
all teeth, slide in centric of 1 mm was observed 
in 25 subjects, ranging from 0 to 1.5 mm, using 
the Mann–Whitney U test 0.612. Slide in centric 
of 1 mm (0-1.5 mm) was equally observed in both 
genders using the Mann–Whitney U test value 
of 1.0. Participants who underwent orthodontic 
therapy had slightly higher values of slide in 
centric – 0-1.5 mm – compared to the 
participants who did not undergo orthodontic 
therapy, whose values ranged from 0 to 1.4 mm, 
Mann–Whitney U test 0.800. 

Table 1 shows the subjects according to 
variables in relation to slide in centric (no centric, 
positive side). Of 25 participants who had all 
teeth, 21 of them had slide in centric with an 
initial contact during closure in centric relation, 
with an equal distribution between male and 
female subjects. A higher percentage of existing 
slide in centric was observed in the participants 
who underwent orthodontic therapy. 



SEEMEDJ 2021, VOL 5, NO. 1 Slide in Centric on Students 

179 Southeastern European Medical Journal, 2021; 5(1) 
 

Table 1. Subjects according to variables in relation to slide in centric (no slide, positive slide) 
  Slide in centric 

  0 (no slide)            Slide 

    

Dental Status Have all teeth  4 21 

 Missing 1-4 

teeth 

2 6 

    

    

Sex Women 4 16 

 Men  1 12 

    

    

Orthodontic 

therapy 

No 1 12 

 Yes 4 16 

 

 

   

 

No statistically significant difference in the 
length of slide in centric between the examined 
subjects who have all teeth and those who had 
missing teeth 1-4 (z= 0.507; p= 0.612) was 
observed in this study. Furthermore, no 
significant difference in the value of slide in 
centric between women and men (z= 0; p = 1) was 
observed in this study. A statistically significant 
difference in the value of slide in centric 
between the subjects who underwent and the 
subjects who did not undergo orthodontic 
therapy (z = 0.253; p = 0.800) was not observed. 
Table 3 shows the number of subjects according 
to the variables studied in relation to slide in 
centric (no slide, slide in centric present). Slide in 
centric was not observed in only five subjects. 

Discussion and Conclusion 

There is some controversy about slide in centric 
and its etiological role in the development of 
temporomandibular disorders. In 1918, Harris 
observed slide in centric of 1 mm or less. Only in 
10 % of the population does centric relation 
coincide with central occlusion, but in 90 % of the 
population, a slide from retruded contact 
position to maximum intercuspation occurs. 
Mandible slide (there is a slide) in an amount of 
0.5 mm-1.5 mm. Results of this study comply 
with the data from the literature because slide in 
centric was not observed in only five subjects 
(33). Ramfjord and Ash (17) and Froemden (18) 
assume that the freedom in centric occlusion 
increases proportionally with age, based on the 
degree of tubercle abrasion. Results of this 
survey do not support Ramfjord’s, Ash’s and 
Froemden’s opinion. This study was carried out 



SEEMEDJ 2021, VOL 5, NO. 1 Slide in Centric on Students 

180 Southeastern European Medical Journal, 2021; 5(1) 
 

on a compact and young age group and it 
indicates a large percentage of slide in centric 
occurrence. Some researchers state that slide in 
centric over 2 mm has a significant etiological 
impact on temporomandibular dysfunctions (p-
value of 0.008) (15, 19). Using a sample of 749 
patients, Nilner showed that 
temporomandibular dysfunction correlates with 
slide in centric (20). Gnathologists confirm that 
malocclusion contributes to the pathology of the 
temporomandibular joint by selective grinding 
after orthodontic treatment (21). In this study, a 
statistically significant difference in slide in 
centric between the subjects who have all teeth 
and the subjects with missing 1-4 teeth (z = 0.507; 
p = 0.612) was not found, as shown in Table 1. 
Those results point out the fact that functional 
adaptation persists by entrenched 
neuromuscular adaptation after a partial loss of 
the teeth. Although a stable relation between 
the mandible and maxilla in the maximum 
habitual intercuspation existed before the loss of 
teeth, it persisted during partial loss of teeth. 
Initial contact of the remaining teeth during the 
closing movement initiates the same 
movements as a jaw with teeth. In this study 
sample, there was no significant difference in 
the length of slide in centric between the 
subjects who underwent orthodontic therapy 
and those who did not (z = 0.253; p = 0.800). This 
was also assumed by Haralur, who confirmed, in 
his study on a sample of 36 patients (who 
underwent orthodontic therapy) and a control 
group (who did not undergo orthodontic 
therapy), that the length of slide in centric and 
orthodontic therapy were not correlated (22). 
There is no significant difference in the length of 
slide between women and men (z= 0, p=1). It is 
obvious that sexual dimorphism was not 
observed in our study. In some studies, there is 
no correlation between slide in centric and 
temporomandibular disorders (23). Slide in 
centric is highly significant because it indicates a 
premature contact during the closure of the jaw 
and possible occlusal instability, which can 
eventually lead to temporomandibular 
dysfunction, which do not have to be of the 
same aetiology. In contrast, Huber and Hall 

stated in their study that slide does not affect the 
temporomandibular joint (24). There is no 
common opinion about slide in centric potential 
pathology because the central nervous system 
could diminish potentially damaging forces 
through neuromuscular control and the 
compensatory mechanism.  

The measurements and applied methodology 
are basic, useful in everyday practice and dental 
offices lacking sophisticated equipment. 
Accuracy is not on a high level, but can provide 
useful information for practitioners. Such a study 
should be repeated on a more comprehensive 
sample in order to identify the differences 
between each group more easily. By using a 
greater sample, the result will be more valuable. 
However, this investigation included only 
student volunteers, who participated in the 
study during one semester. Therefore, the 
sample is relatively small. Nevertheless, the data 
obtained in this study can provide useful 
information for practitioners. In everyday work, 
the difference between the closure of the jaw in 
centric relation and slide of 1 mm can produce 
harmful forces on teeth and TMJs as well as 
cause muscle fatigue and pain. Using a simple 
and quick method, the practitioner can obtain 
necessary information regarding the type of 
occlusion. By doing so, it is possible to avoid 
interreference during reconstructive 
procedures. 

 

 

Acknowledgement. None. 

Disclosure 

Funding. No specific funding was received for 
this study. 
Competing interests. None to declare. 
 
 
 
 
 
 

  



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Author contribution. Acquisition of data: Strikić Đula 
I, Lešić N, Seifert D 
Administrative, technical or logistic support: Strikić 
Đula I, Lešić N, Seifert D 
Analysis and interpretation of data: Strikić Đula I, Lešić 
N, Seifert D 
 Conception and design: Strikić Đula I, Lešić N, Seifert 
D 
Critical revision of the article for important intellectual 
content: Strikić Đula I, Lešić N, Seifert D 
Drafting of the article: Strikić Đula I, Lešić N, Seifert D 
Final approval of the article: Strikić Đula I, Lešić N, 
Seifert D