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Results for “Condylar position”

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PubMed1991

[Morphofunctional changes in the stomatognathic apparatus: the relation between radiologic findings and objective and anamnestic comparisons].

A clinico-anamnestic and radiological study was performed using multidirectional tomography in 50 patients aged between 15 and 69 years old with dysfunction of the stomatognathic system. Anamnestic and objective parameters were statistically correlated with radiological parameters which essentially concerned the condylar position within the glenoid cavity, the protruding condylar excursion and the presence of morphological lesions on articular surfaces. The most significant statistical associations were between articular pain and respectively rear dislocation and limited condylar excursion; between articular noise, above all if grating, and the presence of structural lesions. These lesions were most frequently observed in older subjects. No relationship was found with other data, such as the presence of cephalea, parafunctions, or a loss of the vertical dimension. The interdependence between clinical and radiological findings is stressed.

Adolescent↗

PubMed2026

Assessment of temporomandibular joint space changes after orthognathic surgery in skeletal malocclusion patients: a systematic review.

PURPOSE: To interpret postoperative changes in temporomandibular joint (TMJ) joint space dimensions and condylar position following orthognathic surgery in patients with skeletal malocclusions, and to determine whether reported alterations represent clinically meaningful displacement or physiological adaptive remodeling. MATERIALS AND METHODS: A comprehensive search of PubMed, SCOPUS, Web of Science, EBSCOhost, and Cochrane Library was performed to assess pre- and postoperative TMJ changes using three-dimensional imaging. Joint spaces including anterior (AJS), superior (SJS), and posterior (PJS) and condylar morphology were evaluated. Methodological quality was appraised using the Joanna Briggs Institute (JBI) checklist. Due to methodological and clinical heterogeneity, findings were synthesized narratively with attention to malocclusion type and surgical movement. RESULTS: A total of 16 studies consisting 628 patients undergoing BSSO, Le Fort I osteotomy, vertical ramus osteotomy, or bimaxillary surgery were included. Most studies reported minor, adaptive postoperative changes in AJS, SJS, and PJS. Class II patients showed more consistent increases in AJS/SJS, whereas Class III patients demonstrated variable posterior or anterior remodelling depending on surgical movement. Volumetric analyses revealed region-specific adaptations without significant condylar displacement. Postoperative temporomandibular disorder symptoms were infrequent, and no consistent evidence supported detrimental TMJ effects attributable to surgery. CONCLUSION: Postoperative TMJ joint space changes after orthognathic surgery primarily represent physiological adaptive remodeling rather than pathological condylar displacement, with reported variability driven by malocclusion type, surgical movement, fixation method, and imaging protocol. Recognizing these predictable patterns is essential to prevent overinterpretation of postoperative imaging and to improve clinical assessment through standardized three-dimensional and long-term evaluation strategies.

Humans↗

PubMed1996

A classification system for occlusions that relates maximal intercuspation to the position and condition of the temporomandibular joints.

Interarch occlusal relationships are defined by temporomandibular joint (TMJ) position. Determination of the most physiologic joint position is a logical prerequisite for occlusal analysis. Existing classification systems for occlusion do not consider TMJ position or condition when relating the mandibular arch to the maxillary arch or the range of adaptive changes that can affect the position of the condyles or influence long-term occlusal stability. If the relationship between occlusion and TMJ position is as important as many clinicians believe, condylar position must be defined precisely as an essential control in any clinical study that purports to evaluate the relationship between occlusion and any masticatory system disorder to include temporomandibular disorders. This article presents a new classification system that defines the relationship between maximal intercuspation and the position and condition of the TMJs. The classification uses guidelines that are specific enough to be consistent and verifiably reproducible. A recently introduced term, "adapted centric posture," is used in this classification to distinguish deformed TMJs that have remodeled or adapted to a conformation that can comfortably accept maximal loading. This classification is necessary because deformed but adapted joints may within certain conditions function with the same degree of comfort as intact, properly aligned condyle disk assemblies in centric relation.

Adaptation, Physiological↗

PubMed2006

Morphology of the temporomandibular joint in subjects with Class II Division 2 malocclusions.

INTRODUCTION: Temporomandibular joint (TMJ) morphology has not been studied adequately in subjects with various types of malocclusion, and it is not known if TMJ morphology and facial morphology are related. Such knowledge might assist in the establishment of biological treatment strategies, especially when the TMJ is the target of the treatment plan. The aim of this study was to explore the morphological characteristics of the TMJ in subjects with skeletal Class II Division 2 malocclusions. METHODS: The material consisted of corrected lateral tomograms of 94 joints in 47 subjects with Class II Division 2 malocclusions (age range, 8.3-42.8 years). The subjects were divided into 5 groups according to age. RESULTS: Intragroup comparisons showed statistically significant differences for condylar angle, condylar position, eminence height, eminence inclination, ramus height, and condylar-neck height. These differences were found mainly between the youngest and oldest groups. The Pearson correlation coefficient was greater than 0.60 for eminence height and eminence inclination, eminence height and ramus inclination, eminence inclination and ramus inclination, fossa posterior-eminence midpoint and fossa posterior-eminence top, and fossa posterior-eminence midpoint and fossa posterior-fossa roof. Condylar shape was most often round, followed by oval, flattened, and triangular; fossa shape was most often oval, followed by triangular, trapezoidal, and round. CONCLUSIONS: The results suggest that (1) fossa morphology and condylar length attain their final sizes early; (2) articular eminence and ramus morphology (height, inclination) have great variability; (3) some joint components such as eminence height with eminence inclination, eminence height with ramus inclination, eminence inclination with ramus inclination, and fossa anteroposterior dimensions are highly correlated with each other; and (4) the most prevalent condylar and fossa anteroposterior shape is oval.

Adolescent↗

PubMed1999

Case report: treatment for a patient with a history of TMJ disorder.

Establishing a knowledge-based protocol for the treatment of orthodontic patients who report a history of temporomandibular dysfunction can alert the practitioner to potential treatment pitfalls before they happen. While the joints can be extremely adaptive, some individuals are subject to painful and/or limited function. Others have acquired condylar positions that, if not recognized, could lead to serious alterations in the original treatment plan. Combining a thorough diagnostic protocol with a therapeutic regimen that seeks to establish a stable condylar and occlusal position-prior to initiating treatment- is essential.

Adult↗

PubMed2001

Plate fixation after mandibular osteotomy.

Skeletal asymmetry in patients who undergo orthognathic surgery is frequently associated with postoperative temporomandibular joint (TMJ) disorders caused by condylar rotation. This study was designed to elucidate the relation between changes in the condylar long axis and TMJ function after bisagittal split osteotomy (BSSO). A total of 42 patients with mandibular prognathism underwent BSSO. Split osseous fragments were secured by standard titanium plates in 22 patients; bent titanium plates were used to secure fragments in 20 patients. The angle of the bent plates was adjusted to avoid displacement of the condyle after osteotomy, as compared with condylar position on preoperative submental-vertical (S-V) cephalograms. The postoperative position of the condyle was assessed on X-ray film, and changes in TMJ function were evaluated. The condylar long axis differed significantly on X-ray film between patients using a standard titanium plate and those using a bent plate (P<0.05), and no sign of TMJ functional impairment was noted in the bent-plate group. Although the use of bent plates requires further study, maintenance of a suitable position of the condyle relative to the condylar axis is one of the conditions for a successful outcome of BSSO.

Analysis of Variance↗

PubMedDate not supplied

The four dimensions of orthodontic diagnosis--part 1.

This article discusses the three usual dimensions of diagnosis - transverse, vertical, and the anterior-posterior position of the maxilla and mandible and the important fourth dimension - condylar position. Also discussed is how the proper diagnosis and treatment of these dimensions lead to: The Seven Keys to Facial Beauty and TMJ Health. An accurate diagnosis of crowding cannot be made from a panorex or study models alone - the panorex can be very misleading. Also, an accurate diagnosis of the transverse width of the maxilla and mandible cannot be made from a lateral cephalogram, a panorex, or study models - how they can also be very misleading. A method of facial diagnosis based on facial esthetics and the patient's smile that more accurately evaluates arch width problems and the need for arch expansion. An early orthopedic phase of treatment in certain types of cases can head off a major crowding problem and/or impacted cuspids. It is important to develop the maxilla to its proper size and arch form to allow for complete mandibular development and positioning. Three patient examples are shown using these methods and the results achieved.

Activator Appliances↗

PubMed1980

Condylar displacement after sagittal splitting of the mandibular rami. A short-term radiographic study.

In a radiographic follow-up study the extent, frequency and direction of condylar displacement after surgical correction of bite anomalies by sagittal splitting of the mandibular rami was investigated. 35 patients were involved in the study. Pre- and post-operatively P.A.-views of the skull, linear tomograms and individualized lateral oblique radiographs of each temporomandibular joint were taken. Postoperative changes of condylar position were measured on the lateral oblique radiographs. The results indicate that condylar displacements are found frequently after sagittal splitting of the rami. Most of them are combined with rotation or tilting of the axis of the condyle or the condylar neck. Method of osteosynthesis and direction of movement of the tooth bearing fragment seem to influence the direction and amount of condylar displacement.

Adolescent↗

PubMed1996

Radiographic changes in the temporomandibular joint in patients with generalized osteoarthritis and rheumatoid arthritis.

This is the first study concerned with radiographic characteristics in patients with generalized osteoarthritis and signs and symptoms of temporomandibular joint involvement. For comparison, patients with rheumatoid arthritis and temporomandibular joint involvement were used. The patient material comprised 20 patients with generalized osteoarthritis (20 joints) and 21 patients with rheumatoid arthritis (21 joints). The radiographic methods were corrected sagittal tomography (hard tissue changes, joint space, and condylar position), frontal tomography (hard tissue changes), and individualized oblique lateral transcranial projections (condylar translation). Sixteen (80%) joints in the group of patients with generalized osteoarthritis and 15 (71%) joints in the group with rheumatoid arthritis revealed structural changes. The condyle was the predominant location. No radiographic criterion was pathognomonic for generalized osteoarthritis or rheumatoid arthritis. However, osteophytes, flattening of the condyle, or a reduced joint space was observed more often in joints with generalized osteoarthritis, whereas erosions in the condyle were more common in joints with rheumatoid arthritis. The radiographic findings in patients with generalized osteoarthritis are more similar to those seen in patients who have the common form of temporomandibular joint osteoarthritis than to those in patients with rheumatoid arthritis.

Adolescent↗

PubMed1995

Temporomandibular joint mobility assessment: a comparison between four methods.

Temporomandibular joint (TMJ) mobility is assessed in different ways. Measurement of the interincisal distance in maximal mouth opening added to the vertical overlap of the dentition, i.e. linear mouth opening (LMO); measurement of angular displacement of the mandible relative to the cranium at maximal mouth opening, i.e. angle of mouth opening (AMO); assessment of the condylar position relative to the articular eminence performed on transpharyngeal radiographs in maximal mouth opening, i.e. condylar mobility (CM); measurement of angular displacement of the mandible at maximal mouth opening relative to the closed mouth position of the mandible, assessed on transpharyngeal radiographs in maximally opened and in closed mouth position, i.e., radiographic angle of mouth opening (RAMO). To compare these TMJ mobility assessment methods and to analyse the relationship between LMO, AMO and mandibular length (ML), 28 healthy volunteers (13 females, 15 males), mean age 29-6 years (range 21-41) with a symmetrical mouth opening pattern were assessed. LMO, AMO, ML, and RAMO were measured and CM was assessed on transpharyngeal radiographs. LMO and AMO were strongly and significantly related (r = 0.71). LMO was significantly influenced by AMO and ML. No significant differences between AMO and RAMO were found. CM was strongly and significantly related to AMO (r = 0.72) and weakly but significantly related to LMO (r = 0.42). Based on the results of this study recommendations are made regarding the appropriate application of TMJ mobility assessment methods.

Adult↗

PubMed1999

The functional shift of the mandible in unilateral posterior crossbite and the adaptation of the temporomandibular joints: a pilot study.

Changes in the functional shift of the mandibular midline and the condyles were studied during treatment of unilateral posterior crossbite in six children, aged 7-11 years. An expansion plate with covered occlusal surfaces was used as a reflex-releasing stabilizing splint during an initial diagnostic phase (I) in order to determine the structural (i.e. non-guided) position of the mandible. The same plate was used for expansion and retention (phase II), followed by a post-retention phase (III) without the appliance. Before and after each phase, the functional shift was determined kinesiographically and on transcranial radiographs by concurrent recordings with and without the splint. Transverse mandibular position was also recorded on cephalometric radiographs. Prior to phase I, the mandibular midline deviated more than 2 mm and, in occlusion (ICP), the condyles showed normally centred positions in the sagittal plane. With the splint, the condyle on the crossbite side was displaced 2.4 mm (P < 0.05) forwards compared with the ICP, while the position of the condyle on the non-crossbite side was unaltered. After phase III, the deviation of the midline had been eliminated. Sagittal condylar positions in the ICP still did not deviate from the normal, and the splint position was now obtained by symmetrical forward movement of both condyles (1.3 and 1.4 mm). These findings suggest that the TMJs adapted to displacements of the mandible by condylar growth or surface modelling of the fossa. The rest position remained directly caudal to the ICP during treatment. Thus, the splint position, rather than the rest position should be used to determine the therapeutic position of the mandible.

Adaptation, Physiological↗

PubMed1979

Sagittal splitting of the mandibular ramus. Electromyography and radiologic follow-up study of temporomandibular joint function in 44 patients.

A follow-up study was performed on 44 patients operated with sagittal splitting of the mandibular ramus for correction of a mandibular protrusion. The study included clinical examination, electromyography and masticatory efficiency test as well as radiography of the temporomandibular joint. The maximum opening capacity and protrusion of the mandible decreased one to three years after the operation. The activity of the temporal muscle decreased in rest position after the operation. Masticatory efficiency was unchanged. The position of the condyle in the fossa was unchanged postoperatively, while a posterior and superior condylar movement occurred during the fixation period. Normalization of the condylar position tended to occur one year after the operation. In 37 of 86 condyles, a double contour was seen on the postesuperior margin of the condyle one year after the operation. Possible mechanism behind the development of the new condylar bone layer is discussed.

Electromyography↗

PubMed1983

Surgical orthodontics and the temporomandibular joint. I. Superior repositioning of the maxilla.

Ten randomly selected adults who had undergone orthodontic treatment and isolated superior repositioning of the maxilla for vertical maxillary excess (VME) were evaluated clinically and radiographically (mean, 48.7 months postsurgery) for signs and symptoms of masticatory and temporomandibular joint dysfunction. The patients ranged from 18 years to 37 years of age (mean, 26.2 years) when evaluated. A three-part evaluation of the subjects was performed. This consisted of an anamnestic evaluation (previous medical history), a clinical examination, and a radiographic evaluation. The anamnestic evaluation revealed that, prior to surgery, facial pain was reported by one patient and was not present in any of the patients upon follow-up examination. We believed that the pain was not related to the masticatory musculature and/or the temporomandibular joint. No patients reported pain or sounds in their joints preoperatively, while 30 percent (3/10) of the patients related a history of temporomandibular joint sounds immediately after release of intermaxillary fixation, which subsequently was reported to have resolved in all instances without treatment. Clinical examination of the temporomandibular joints at the time of recall evaluated mandibular movements and the presence of pain or sounds during joint function. These examinations revealed that clinical measures of mandibular movements were somewhat reduced relative to normal. All patients were free of temporomandibular joint and masticatory muscle pain during function, upon contralateral masticatory loading, and upon palpation. Fifteen percent (3/20) of the joints examined demonstrated sounds (popping or crepitation) via auscultation. Masticatory loading in the contralateral premolar region did not induce noise in any of the joints examined. Cephalometric laminagraphic radiographs were obtained of each of the twenty temporomandibular joints with the mandible in three positions; maximum intercuspation, mandibular rest position, and maximal opening. Numerous anatomic relations were quantified from these radiographs. However, only three parameters (condylar position, movement, and evidence of arthrosis) were compared to normative data available in the literature. These comparative data suggested that persons who had undergone orthodontic treatment in conjunction with superior maxillary repositioning demonstrated (1) a relatively retropositional condyle within the fossa and (2) reduced condylar movement during maximal mandibular opening. Two of twenty temporomandibular joints demonstrated radiographic evidence of arthrosis; one condyle demonstrated articular surface erosions, and another exhibited articular surface sclerosis. The overall incidence of arthrosis was not much greater than normal, with 20 percent (4/20) of the joints demonstrating a reduced interarticular joint space. Overall, the clinical findings revealed a low incidence of pathologic masticatory muscle and temporomandibular joint symptoms and signs compared to normative data in the literature...

Adolescent↗

PubMed1985

Assessment of mandibular condyle position: a comparison of transcranial radiographs and linear tomograms.

Transcranial radiographs are frequently used to assess condyle-fossa relationships. However, their validity in representing condyle position has been questioned. Intermethod comparisons were performed between methods assessing condyle position by subjective evaluation and by linear and area measurement of the interarticular space. Linear measurement of the subjective closest anterior and posterior interarticular space and subjective evaluation were the mutually preferred methods in both transcranial radiographs and tomograms. Statistically significant correlations were shown (p less than 0.05) for condyle position between pairs of clinical transcranial radiographs and linear tomograms of the same temporomandibular joints. However there was a qualitative concordance in assessed posterior concentric and anterior positions in only 80% of the pairs, and a full concordance in the degree of condylar displacement was found in only 60% of the cases. Although still clinically helpful, the use of transcranial radiographs to monitor small changes in condylar position relative to the tomogram was questioned.

Cephalometry↗

PubMed1995

An evaluation of mandibular asymmetry in adults with unilateral posterior crossbite.

A retrospective study was conducted to determine whether mandibular symmetry in adults with untreated unilateral posterior crossbite was different from that found in adults with untreated Class I malocclusions. Thirty adults, 18 years or older, with a unilateral posterior crossbite were compared with 30 adults exhibiting Angle Class I malocclusions. Skeletal and dental symmetry were assessed with submentovertex (SMV) radiographs, whereas condylar position within the glenoid fossa was analyzed with horizontally corrected tomograms. Relative to a mandibular coordinate system, the mandibular first molar on the crossbite side was found to be more lateral and relatively distal in comparison to the contralateral side. Skeletally, the mandible showed no asymmetry. Relative to the cranial floor, the mandible was "rotated" so that the condyle on the crossbite side was positioned relatively posteriorly in comparison to the contralateral side. A relative posterior positioning of the glenoid fossa was inferred, since there was no demonstrable mandibular skeletal asymmetry or condylar displacement within the fossa as shown on corrected tomograms in the crossbite group as compared with the Class I group. The results question whether it is appropriate to correct unilateral posterior crossbites in adults by orthodontic tooth movement alone, given the skeletal remodeling in the temporomandibular joint, which may have already occurred.

Adolescent↗

PubMed1992

Positional changes of the mandibular condyle assessed by three-dimensional computed tomography.

This investigation was designed to test the validity and reliability of three-dimensional computed tomography (3-D CT) for quantification of positional changes of the condyle in a laboratory model. The model consisted of a mounted dried human skull and a mandibular condyle attached to a micromanipulator. Controlled changes in condylar position were made and the condyle/fossa was imaged. Positional changes were measured by triangulation methods based on specific 3-D CT landmarks. The data were analyzed using descriptive statistics, analyses of variance to evaluate the sources of variability, and linear contrasts to evaluate the differences between observed and expected values. The results indicated that selection of appropriate anatomic landmarks for assessment of movement influences technique accuracy. The data also indicate that 3-D CT is most accurate in detecting inferior condylar movements. Lateral and posterior movements were assessed with less accuracy than the inferior positional changes. The clinical significance of these differences has yet to be determined.

Analysis of Variance↗

PubMed1987

Computed tomography of condylar and articular disk positions within the temporomandibular joint.

The computed tomograms of temporomandibular joints in 25 patients (41 joints) were retrospectively evaluated for condylar position and joint space with General Electric computer software. Computed tomography scans of the temporomandibular joint were made in the axial plane with the teeth in centric occlusion, and measurements were made from vertically reformatted images. Interarticular joint spaces were measured anterosuperiorly, superiorly, posterosuperiorly, and posteriorly from the condylar surfaces. This was repeated in five equidistant (3.1 mm) serial sagittal planes across the condyle, beginning and ending, on average, 2.5 mm from the lateral and medial condylar poles. Articular disk positions (anterolateral, anterior, anteromedial, medial, and normal) were correlated with condylar position. Significant differences between disk positions and joint spaces were found most frequently in the anterosuperior and the superior joint interval. When the disk was positioned normally, the anterosuperior joint space was consistent (1.5 to 2.0 mm) across the joint (standard deviation, 0.3 to 0.8 mm). The superior, the posterosuperior, and the posterior joint spaces in the normal joint were greater than the anterosuperior joint space. When the disk was anterior to the condyle, the anterosuperior joint interval was widened. When the disk was medial, the superior joint space was significantly wider than normal across the breadth of the condyle. In those joints in which the disk was anteromedial, there was an absence (0.2 mm) of joint space, and this occurred in all areas of the condyle except in its medial one fourth. In the internally deranged joint, joint space narrowing may be focal in nature.

Adolescent↗

PubMed2007

Three-dimensional cone-beam computed tomography for assessment of mandibular changes after orthognathic surgery.

INTRODUCTION: The purpose of this study was to assess alterations in the 3-dimensional (3D) position of the mandibular rami and condyles in patients receiving either maxillary advancement and mandibular setback or maxillary surgery only. METHODS: High-resolution cone-beam computed tomography scans were taken of 21 patients before and after orthognathic surgery. Ten patients with various malocclusions underwent maxillary surgery only, and 11 Class III patients received maxillary advancement and mandibular setback. Presurgery and postsurgery 3D models were registered on the surface of the cranial base. A new tool was used for graphical overlay and 3D display with color maps to visually assess the locations and to quantify positional changes in the posterior border of the mandibular rami and condyles between superimposed models. RESULTS: The average displacements in condylar position were small--0.77 mm (SD, 0.12 mm) and 0.70 mm (SD, 0.08 mm)--for 2-jaw and 1-jaw surgeries, respectively (not significant, P >.05). All 2-jaw surgery patients had backward rotational displacements of the mandibular rami (mean, 1.98 mm; SD, 1.03 mm), with a maximum surface distance change of > or =2 mm in 8 of 11 subjects. For the 1-jaw surgery, all subjects had small backward rotational displacements of the mandibular rami (mean, 0.78 mm; SD, 0.25 mm), with only 1 subject having a maximum surface distance change > or =2 mm. The difference in mean backward rotational displacement was statistically significant (P <.01). CONCLUSIONS: The visualization of 3D model superimposition clearly identified the location, magnitude, and direction of mandibular displacement. The 3D imaging allowed quantification of vertical, transverse, and anteroposterior ramus displacement that accompanied mandibular, but not maxillary only, surgery.

Adult↗