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[Linear tomography and the Zonarc TMJ program. Reproducibility of condylar position of TMJ after surgical correction of dysgnathia].

In this clinical study the position of the mandibular condyles of 40 patients treated for malocclusion by surgical splitting of the mandibular ramus alone or combined with Le Fort I osteotomies was studied on lateral linear TMJ tomograms. Linear tomograms of the right and left TMJ with the mandible closed were taken from each patient prior to surgery and 6 months postoperatively. The postoperative changes in condylar position wee assessed in terms of direction and amount. Condylar displacements were found in 89% of the examined joints, most of them were less than 2mm. All types and combinations of displacement occurred, however, general trends in direction depending on the type of treatment could not be established with statistical significance. The type of surgical correction, its direction and amount did not seem to have an effect on the direction and amount of condylar displacement resulting. A comparison of the measured values with data in the literature showed that the amount of condylar displacement was markedly less--this seemed to be attributable to our precise evaluation method and a more sophisticated surgical technique.

Adolescent↗

[Occupational differentiation in dentistry 3. Hypermobility of the temporomandibular joint and condylar position at maximal mouth opening].

Hypermobility of the temporomandibular joint is only noted when it interferes with smooth mandibular movements. These interferences may result from a condylar dislocation beyond the temporal eminence at maximum mouth opening. Aim of this study was to test whether the condyle of a symptomatically hypermobile temporomandibular joint is positioned more anterosuperiorly to the temporal eminence at maximum mouth opening than a condyle without hypermobility. Nine persons with a hypermobile temporomandibular joint and 9 control persons participated. Diagnostics were based upon opto-electronic mandibular movement recordings. Condylar positions at maximum mouth opening were assessed by magnetic resonance imaging. A small significant difference in condylar position was found between groups. Condyles of persons with a hypermobile temporomandibular joint moved beyond the temporal eminence. However, this was also true for nearly half of the control persons. This suggests that condylar position alone is not a sufficient condition for symptomatic hypermobility of the temporomandibular joint. Maybe, symptoms of hypermobility only become apparent in combination with a particular line of action of the masticatory muscles.

Adult↗

The relationship between morphological changes of the condyle and condylar position in the glenoid fossa.

AIMS: To investigate whether condylar morphological changes influence the condyle position in the glenoid fossa as well as the amount of condylar movement from the intercuspal position (IP) to the reference position (RP). METHODS: Helical computed tomography was used for precise measurement of the joint spaces at IP and RP in 22 subjects (mean age 22.7 years). Subjects were divided into 2 groups, those without condylar bone changes (n = 11) and those with condylar bone changes (n = 11). The latter group was further subdivided into a flattening subgroup and an osteophyte subgroup, according to the type of condylar bone change. RESULTS: There were no significant differences in the width of the anterosuperior or posterosuperior joint spaces at IP between either the 2 groups or the 2 subgroups. On the other hand, during condylar movement from IP to RP, the condyles moved significantly more superiorly and posterosuperiorly in the bone-change group than in the no-bone-change group. There was also greater absolute horizontal condylar movement between IP and RP in the bone-change group. In addition, within the bone-change group, the type of condylar bone change influenced the amount of condylar movement. Joints with osteophyte formation showed the most superior, posterosuperior, and absolute horizontal movement from IP to RP. CONCLUSION: The findings that condyles of the bone-change group, especially those with osteophyte formation, were located significantly more anteroinferiorly in the glenoid fossa at IP than RP than the condyles of the no-bone-change group suggest that condylar IP-RP positional changes might be related to condylar shape alteration.

Adult↗

Is condylar position a predictor for functional signs of TMJ hypermobility?

Temporomandibular joint (TMJ) hypermobility is noted only when it interferes with smooth mandibular movements. These interferences (viz. clicking sounds and jerky mandibular movements) result from condylar dislocation in front of the eminence at wide mouth opening, or alternatively in front of the articular disc (posterior disc displacement). The aim of this study was to test the hypothesis that condyles of hypermobile persons are positioned more anterosuperiorly to the crest of the eminence during maximum mouth opening than those of persons without TMJ hypermobility. Possible posterior disc displacement was also evaluated. Nine persons with symptomatic hypermobility and nine control persons free of internal derangements were included, their diagnoses being based upon opto-electronic movement recordings. Condylar positions during maximum mouth opening were analysed on magnetic resonance images with two slightly different methods, showing the degree to which the condyles are displaced around the eminence. No posterior disc displacements were found in any of the magnetic resonance images. After excluding an outlier and using both measurement methods, a small difference in condylar position was found between the two groups of subjects. The condyles of all hypermobile persons travelled beyond the eminence; however, so were the condyles of nearly half of the non-hypermobiles. The large overlap between both groups suggests that condylar position alone is not a good predictor for symptomatic TMJ hypermobility. It is probably the combination of condylar location in front of the eminence with a particular line of action of the masticatory muscles, which gives rise to functional signs of hypermobility.

Adult↗

Evaluation of TMJ by conventional transcranial radiography and indirect digitized images to determine condylar position in primary dentition.

The aim of this study was to evaluate temporomandibular joint radiographs of children in primary dentition, obtained by conventional transcranial radiography, indirect digitization, digitized images using 3D and brightness/contrast tools. Condyle position was also determined measuring anterior, superior and posterior joint space. The X-Ray machine GE-1000 and the head positioner Accurad 200 were used. Radiographs were digitized using a scanner with transparency and registered in Adobe Photoshop 5.0. Images were evaluated by four examiners as follows: 0--unacceptably quality; 1--poorly diagnostic quality; 2--optimal visualization quality. Articular space was measured using a digital caliper. A significant difference (Sign Test) was found between conventional radiography and the remaining modalities (Conventional/Unenhanced p<0.001; Conventional/3D p<0.001; Conventional/Brightness and Contrast p=0.017). The mean distance of anterior, superior and posterior regions was 2.2(0.5), 3.5(0.9) and 3.9(1.2) mm, respectively. Conventional and brightness/contrast digitized radiographs showed higher diagnostic quality. The posterior joint space was larger than the anterior one, demonstrating anterior condylar position.

Child↗

[A radiographic assessment of condylar position after therapy with the Michigan plate].

The paper analyses condylar movement in the sagittal plane following four months of therapy using a Michigan-type plate in a group of 19 patients with craniomandibular disorders. An OLTP radiographic examination was used; X-rays carried out before and after therapy were compared using a special image subtraction technique. From the analysis of results it emerged that 63.12% of patients showed a mono- or bilateral condylar movement which was visible by X-ray.

Adult↗

Relationship between condylar position, dentofacial deformity and temporomandibular joint dysfunction: an MRI and CT prospective study.

The possible relationship between the morphometric characteristics (condylar and temporomandibular joint (TMJ) disc position) of the TMJ and the TMJ clinical findings (normal versus TMJ disorders) in different types of dentofacial deformities was studied. Forty-eight patients with dentofacial deformities (96 TMJs) were investigated preoperatively and 10 patients (20 TMJs) without deformities were studied as a control group, clinically and radiographically, using computer tomography (CT) and magnetic resonance imaging (MRI), to assess the position of the mandibular condyle and the TMJ disc in the sagittal, coronal and horizontal planes. Fifteen of the 28 joints (53.6%) of patients diagnosed as class II dentofacial deformity had internal derangements and anteriorly displaced discs. The incidence of internal derangement in the class I and class III groups was lower (10%). An increased horizontal angle of the mandibular condyle and a posteriorly seated condyle were found in patients diagnosed as class II dentofacial deformity when compared with the control group. The rest of the patients studied showed no significant differences. The same results were encountered when the patients with moderate to severe TMJ pathology were studied, both clinically (using the Helkimo index modified by Athanasiou) and by MRI.

Adolescent↗

Reproducibility and condylar position of a physiologic maxillomandibular centric relation in upright and supine body position.

Better understanding of the physiologic features of the masticatory system has led to the evolution of the concept of maxillomandibular centric relation from the mechanical to physiological bases. However, the reproducibility of physiologic methods for centric relation determination has been criticized. In this clinical study the swallowing technique was modified to establish a physiologic centric relation in a reproducible manner. Condylar and disk positioning and reproducibility of the proposed modified swallowing technique (MST) were compared with the same parameters of a traditional technique, namely, the chin point guidance technique (CGT). Both techniques were studied with the patient in the upright and supine positions. Three interocclusal records were obtained for each technique-position combination for each of the 30 patients. The recorded maxillomandibular relations were analyzed on the three-dimensional analyzer. MST positioned the condyles in a more superoanterior position than did CGT, which was interpreted as a better seating of the condyles and disk in the articular fossae. There was no significant difference in reproducibility between MST and CGT on x, y, or z axes (p > 0.05), indicating that it is possible to establish a physiologic centric relation in a reproducible manner. The term "functional centric area" was proposed in this study to define a neuromuscularly determined centric occlusal scheme.

Adult↗

Relationship between fossa-condylar position, meniscus position, and morphologic change in patients with Class II and III malocclusion.

OBJECTIVE: To evaluate fossa-condylar-meniscus morphologic changes in patients with skeletal and dental Class III and Class II division 1 and 2 malocclusion to determine which type is related to internal derangement of the temporomandibular joint (TMJ) and whether the variation of TMJ structure is related to a particular type of malocclusion. MATERIALS AND METHODS: Seventy-two pretreatment orthodontic patients, ranging in age from 10 to 27 years, underwent examination of the right and left TMJs with corrected Schöller's position radiographs. Bilateral TMJ relationships of the fossa-condyle were examined through subjective evaluation and linear and area measurements. In addition, in 20 of the 72 patients, meniscus positions and morphologic changes were imaged with a 0.5 T sagittal magnetic resonance imaging system on the right and left TMJ. RESULTS: (1) The variation of condyle-fossa positions for identical types of malocclusion was very large. (2) Skeletal and functional Class III malocclusion patients demonstrated significantly more anteriorly positioned condyles. (3) Class II division 1 patients showed concentrically positioned condyles, but with slightly anterior displacement. (4) Class II division 2 patients demonstrated more posteriorly positioned condyles. (5) When condyles were in anterior or concentric positions, meniscus positions and morphology were normal and in concavoconcave shapes. (6) When condyles were in posterior positions, most meniscus positions were in normal or slightly anterior range and their shapes were also concavoconcave. The rest were significantly more anterior and their shapes were abnormal, as evidenced by thickened anterior bands. CONCLUSION: Class III and Class II division 1 malocclusion demonstrated normal structure and function of the TMJ. Class II division 2 malocclusion was obviously associated with abnormal structure and function of the TMJ.

Adolescent↗

Accuracy of measures of temporomandibular joint space and condylar position with three tomographic imaging techniques.

Fourteen temporomandibular joints in seven dry skulls, representing the distribution of horizontal and vertical condylar axis inclinations of a larger population, were imaged with three tomographic projection techniques. Closest anterior and posterior joint spaces were measured on radiographs, and sectioned plaster casts were made from impressions of actual joint space, Individualized horizontal and vertical correction of the condylar axis produced significantly more accurate (p less than 0.005) measures of condylar space than either standard 20-degree horizontal correction (SHC) or individualized horizontal correction (IHC) of the axis. Representations of joint space by SHC and IHC were not significantly different from each other. Numbers of uninterpretable images displayed a similar pattern of 9.5% for individualized horizontal and vertical correction, 14% for IHC, and 17% for SHC. This study supports the use of fully individualized condylar axis correction with temporomandibular joint tomography for increased accuracy of visualization of the osseous anatomy of the joint.

Humans↗

An analytic method for evaluating condylar position in the TMJ and its application to orthodontic patients with painful clicking.

The purpose of this study was to develop a new method for evaluating the three-dimensional position of the mandibular condyle relative to the glenoid fossa and further to investigate its clinical application to orthodontic patients with temporomandibular disorders (TMD). A three-dimensional configuration of the temporomandibular joint was constructed by 108 triangles for the condyle and 180 triangles for the glenoid fossa. The shortest distance between the condyle and glenoid fossa (CGFD) was calculated in the model along a line perpendicular to the center of gravity of a triangle on the condyle. The CGFD was determined in the anterior, posterior, middle, lateral, and medial areas on the condyle. Preliminary investigation revealed that the present technique is accurate, regardless of condylar rotation and/or inclination to the tomographic table. The technique was applied to the diagnosis of orthodontic patients with painful clicking and TMD. It is shown that the present approach provides a method for evaluating the positional relationship between the mandibular condyle and glenoid fossa in patients with TMD.

Adolescent↗

A comparative assessment of mandibular condylar position in patients with anterior disc displacement of the temporomandibular joint.

PURPOSE: The purpose of this study was to determine whether the position of the mandibular condyle in patients with anterior disc displacement (ADD) is different from that of a control group with normal joints using a novel method to quantify the irregular shape of the temporomandibular joint (TMJ). MATERIALS AND METHODS: Twenty-six magnetic resonance images of TMJs with ADD were evaluated and compared with 14 normal joints. The position of the condyle was determined by using 2 different methods: 1) measuring the horizontal and vertical normalized distances in millimeters between the geometric centers of the glenoid fossa and the condyle and 2) calculating the anteroposterior joint space ratio. RESULTS: Using the first method, the horizontal distance between the centers of the condyle and the glenoid fossa was 14.0 +/- 11.1 in the ADD group and 5.3 +/- 10.9 in the control group (P <.001). The vertical distance was 64.7 +/- 22.7 in the ADD group and 68.3 +/- 32.9 in the control group (P =.015). The ratio of the horizontal and the vertical condylar displacement in the ADD group was 2.4. Using the second method, the anteroposterior joint space ratios in the ADD group and in the control group were 1.7 +/- 0.5 and 1.2 +/- 0.4, respectively (P =.001). CONCLUSION: This study found that condyles of patients with ADD were situated more posterior and superior in the fossa than those in the control group. Moreover, in the ADD group, the posterior condylar displacement was noted to be 2.4 times greater than the superior condylar displacement.

Adolescent↗

An evaluation of the condylar position of the temporomandibular joint by computerized tomography in Class III malocclusions: a preliminary study.

The position of the condyle within the glenoid fossa was investigated in 21 adult patients with untreated skeletal Class III relationships and 18 adult patients with normal occlusions as controls. Axial computerized tomography (CT) was used for precise measurements of the bony structures of the temporamandibular joints. In horizontal sections, the mediolateral dimensions of the condyles of the patient group were found to be statistically higher in the fossa. The anteroposterior glenoid fossa dimensions were found to be smaller in Class III malocclusions. The smaller anterior joint space dimensions in the Class III relationships were also found to be statistically significant. The analysis of the measurements suggests that relative condylar protrusion with a relative mediolateral elongation of the condyle within a relatively smaller glenoid fossa are correlated with the anterior mandibular displacement in skeletal Class III malocclusions.

Adult↗

[Bimaxillary osteotomy with and without condylar positioning--a 1981-2002 long-term study].

PURPOSE: The introduction of the four-splint technique in our hospital in 1997 made possible the reproducible centric condyle positioning in bimaxillary osteotomies, while taking the auto rotation of the mandible into consideration and avoiding steps in the mandibular osteotomy line. PATIENTS AND METHODS: From 1981 to 2002 a total of 622 patients underwent bimaxillary osteotomy surgery. During 1981-1997 a total of 395 patients (63.5%) underwent surgery without or only with centric condyle positioning in sagittal ramus osteotomy of the mandible. During 1997-2002 a total of 227 patients (36.5%) underwent surgery with continuous centric condyle positioning with the four-splint technique. RESULTS: In patients with preoperative functional disorders, surgery with continuous centric condyle positioning resulted in statistically significant (p<0.05) improvement compared to those who underwent surgery without continuous centric condyle positioning. CONCLUSION: The results confirm the indication for continuous centric condyle positioning in bimaxillary osteotomies.

Dental Occlusion, Centric↗

Biologic laws governing functions of muscles that move the mandible. Part II. Condylar position.

A model to quantify muscle response to occlusal contacts is useful in developing an understanding of the mechanism by which the occlusion programs muscle function. A knowledge of how the occlusion programs muscle function enables the dentist to develop manipulative skills of the mandible which are necessary for diagnosis and effective occlusal treatment. This article presents complicated neuromuscular responses (reflexes) to occlusal contacts in an oversimplified way and with analogies so that the clinical significance of these neuromuscular reflexes in diagnosis and treatment can be more easily understood.

Biomechanical Phenomena↗

Radiographic study of condylar position in centric relation and centric occlusion.

The present study was conducted to compare the spatial relationship of the condyles to their fossae in the centric occlusion and centric relation positions. Right and left TMJ radiographs were obtained on 40 young adults in the two positions. Direct measurments of the anterior, posterior, and superior spaces between the condyles and their fossae were made on the radiographs. Results were statistically analyzed; the following findings and conclusions were derived: (1) In the centric relation position, both condyles were placed more posteriorly and superiorly in their fossae than in the centric occlusion position. (2) In the centric occlusion position, both condyles were symmetrically placed in their fossae with equal spatial distances anteriorly and posteriorly. (3) Greater spatial differences existed between the centric occlusion and centric relation positions on the left side, which was the orbiting (balancing)side in most subjects. (4) Further studies are needed to develop a more physiologic approach for correctly relating the mandible to the maxillae when reconstructing the occlusion in both dentulous and edentulous patients.

Adult↗