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Statement of problem. The extent to which intraoral excursive tooth contacts are duplicated correctly in the articulator is constantly being investigated. Purpose. This study evaluated whether data from unguided or guided hinge axis movement are superior in duplicating excursive tooth contacts. Material and methods. Intraoral records of tooth contacts from intercuspal position to 4 mm protrusion and laterotrusion were obtained from 50 subjects by using occlusogram wax. These movements were simulated in a SAM2 "P" articulator using horizontal condylar inclination and Bennett angle from recorded guided and unguided mandibular movements. Occlusograms were compared with contacts generated by the articulator. Results. On average, the articulator duplicated approximately 73% of intraoral protrusive and 81% of intraoral laterotrusive contacts for up to 4 mm of movement, using either data from unguided or guided movements. Both movements yielded identical means and no significant difference of duplicated contacts. However, individual differences scattered within approximately ±32%. Conclusion. Exclusive recommendation of guided movement can be questioned for accurate imitation of dynamic tooth contacts. In addition to the type of movement, other factors must be detected to enhance articulator adjustment and workings. (J Prosthet Dent 1999;81:14-22.)

The study investigated two mandibular positions based upon computerized axiography recordings of hinge axis movements of 262 subjects. Next to the well-known guided closure position RP (reference position by chin-point guidance), the position of final deglutition (FD) was quantified. FD represented the hinge axis position at the end of the swallowing movement. The results elicited average linear distances of 0.32 +/- 0.43 mm on the right and 0.33 +/- 0.40 mm on the left side between both positions in the sagittal plane. The average distance in the frontal plane was 0.02 mm (right) and 0.04 mm (left). Approximately 46 per cent of FD recordings were found anterior and inferior to RP, and showed significant difference to posterior and anterior-superior FD recordings. The replicability of both positions was tested on 53 subjects and averaged 0.04 mm (FD) and 0.09 mm (RP). Average deviations of repeated recordings within the subject ranged from 0.07 to 0.47 mm (FD) and 0.07 to 0.57 mm (RP) for each spatial direction. The results of this study showed a relative coincidence of an average FD and RP Variation of FD in anterior inferior direction questioned the clinical reliability of FD to reassure the guided closure position.

Computerized axiography was used as an objective instrumental method of evaluating the response of patients with temporomandibular joint (TMJ) symptomatology to occlusal splint therapy. Diagnosis was performed in a standardized manner by systematically analyzing TMJ path tracings obtained by computerized axiography. Thirty-six patients were axiographed before and after therapy with full-arch occlusal stabilizing appliances, followed by assessing the effect of therapy on various path curve parameters. The data obtained for the patient group treated with splints was compared to that of six patients also axiographed, but left untreated for a period of six weeks before a second TMJ tracing was obtained. The results show that splints have a certain effect on reciprocal TMJ clicking (response rate 67%). Retral stability and path characteristics are also substantially improved (response rates 44% and 40%). Less influence was noted on hypomobile joint paths (response rate 29%), the quality of movements (response rate 28%) and Bennett angle values (response rate 23%). Patients with disk displacements without reduction were not treated with splints, they underwent surgery. Their results will be reported later. By contrast, TMJ tracings in the control group remained essentially unchanged.

Unguided protrusive and retrusive mandibular movement was investigated in 76 asymptomatic volunteers and temporomandibular joint (TMJ) patients using computerized axiography. In 38 of these subjects, guided pro-/retrusion was also recorded. Measurements were performed in a three-dimensional Cartesian coordinate system (x = anteroposterior; y = transversal, toward the hinge axis; z = craniocaudal). Transversal shift (y) was measured and evaluated as well as the distance "s" and horizontal condylar inclination (HCl) at the point of maximum transversal deviation. The patterns of the tracings were analyzed with a view to diagnostic improvements. The objective of this study was to evaluate transversal shift and to examine the postulate of symmetrical behavior of the TMJs in pro-/retrusion. The mean mandibular shift was 0.15 mm to the left. This maximum deviation was seen in a mean distance "s" of 7.42 mm in relation to the Cartesian coordinate system in reference position. These results suggest a functional dominance of the right part of the mandible in protrusive and retrusive movement.

The objective of this series is to observe and analyze movements of the temporomandibular joint (TMJ). With the information from these studies, orthopedic standards for jaw movements will be established in further investigations according to the neutral-zero method used in general orthopedics. Any restricted range of motion can thus be defined as a deviation from these standards. Direct interpretation and objective evaluation of joint functions has major practical implications. With the aid of computerized axiography, mediotrusive movements of 48 asymptomatic volunteers and 66 jaw patients were evaluated. The movements performed were either free or guided. The mean curve lengths, as well as the Bennett angles at 3 mm and at the end point were recorded. An average group was defined, containing the values of 50% of all volunteers. The interquartile range was calculated for lengths of mediotrusive movements as well as for Bennett angles. The average range of free mediotrusive movement for female volunteers was 11.06-11.98 mm (mean 11.55 mm) on the right side and 10.47-11.75 mm (mean 11.24 mm) on the left side. Male volunteers showed an average range of 10.23-11.54 mm (mean 11.1 mm) on the right side and 10.24-11.73 mm (mean 11.12 mm) on the left side. The values for female patients amounted to 9.95-1.66 mm (mean 10.8 mm) on the right side and 9.75-11.28 mm (mean 10.55 mm) on the left side. The average range for male patients was 9.06-9.71 mm (mean 9.54 mm) on the right side and 9.17-10.23 mm (mean 9.73 mm) on the left side. The average range for Bennett angles at maximum excursion in free mediotrusive movement was between 0.41 and 5.89 degrees (mean 4.43 degrees) in the volunteers on the right side and between 2.45 and 10.07 degrees (mean 6.87 degrees), respectively, on the left side. The values for patients amounted to 0.19-12.65 degrees (mean 6.93 degrees), on the right side and 1.71-14.15 degrees (mean 6.73 degrees) on the left side.

This study compared the mandibular position at chin-point guided jaw closure, intercuspation and final deglutition (position at the end of swallowing) in 159 asymptomatic subjects and 142 subjects with symptoms in the craniomandibular system. The symptomatic subjects were assigned to four groups showing an adapted centric posture, pain, luxation with reduction of the temporomandibular joint and pain with luxation and reduction. Computer equipment aided recording of hinge axis movements in three dimensions. While the three positions differed significantly in anterior-posterior direction on both sides and in inferior-superior direction on the right, a significant difference between asymptomatic and symptomatic subjects existed only in final deglutition on the left side and in the anterior-posterior location of the guided closure. Final deglutition did not coincide with the guided closure or the intercuspation in approximately 89%. A proportionally large standard deviation gave evidence against a strict relationship of the three positions in asymptomatic and symptomatic subjects. Because of this variability, final deglutition was not recommended for verification of centric relation or the intercuspal position.

This study evaluated the ability of some cephalometric measurements to differentiate between horizontal and vertical malocclusions and normal occlusion. Based upon the Angle classification and the vertical incisor overbite, 122 randomly selected subjects were assigned to 3 horizontal and 3 vertical groups: neutrocclusion, distocclusion, mesiocclusion as well as open bite, normal overbite, and deep bite. Evaluation of the lateral cephalograms was based on Denture Frame Analysis and cephalometric standard measurements (SNA, SNB, ANB, Wits appraisal, Bjork polygon, overbite depth indicator, incisor inclination, incisor protrusion, facial height ratio). The statistical evaluation assessed the ability of the measurements to show significant differences between the individual horizontal and vertical groups. Using Denture Frame Analysis, all vertical groups could be differentiated by the occlusomandibular angle (OP-MP) and all horizontal groups by the angle between the A-B plane and the mandibular plane as well as by the inclination of the upper incisors to the A-B plane with statistical significance (p < 0.05). Among the standard measurements, the Wits appraisal was the only one to show differences between all horizontal groups with statistical significance. None of the standard measurements could fully differentiate the vertical groups. The above measurements from the Denture Frame Analysis distinguished the types of malocclusion in anteroposterior and vertical direction including significant distinction between the neutrocclusion group and the malocclusion groups. Therefore a cephalometric classification was feasible in terms of hyper- and hypodivergence as well as of a mesial or distal dentofacial relationship.

The purpose of this study was to evaluate the Denture Frame Analysis. This adjunctive cephalometric analysis of the lateral headfilm was introduced in Japan, but no data exist for the Caucasian population at present. One-hundred-and-six Caucasians were randomly selected and assigned to one of four groups, according to their malocclusion: Angle Classes I, II, and III, and anterior open bite. Statistical testing showed significant differences among the four groups for most of the measurements investigated. The Denture Frame Analysis distinguished the different types of malocclusion, and evaluated skeletal and dental relationships. The occlusal plane aids in the determination of the objectives and limits of orthodontic therapy.

In order to evaluate the influence of interocclusal environment, condylar movement was investigated by computerized axiography. The sample consisted of 50 dentulous and 50 edentulous Caucasians. The mean length of translation at maximum opening in dentulous subjects was 16 mm, while edentulous subjects showed an average of 11 mm. The mean angle of hinge axis rotation at maximum opening was 30 degrees in dentulous subjects and 17 degrees in edentulous subjects. The mean length of translation and the rotation of hinge axis in opening and closing movements was smaller in edentulous subjects than in dentulous ones. In opening and closing movement of edentulous subjects, the length of translation and the rotation value revealed no significant correlation with age or duration of upper and lower prosthesis. No significant difference was shown between edentulous and dentulous subjects on translative quantity in protrusive movement.

This study compared the accuracy of two noninvasive methods, computerized axiography and magnetic resonance tomography (MRT), in diagnosing temporomandibular joint (TMJ) disorders. Forty-seven subjects underwent axiography and subsquent assessment of the TMJ by MRT. The statistical analysis referred to the correlations of the most relevant clinical diagnoses, i.e., no appreciable disease, disk displacement with reposition, disk displacement without reposition, morphologic alterations, and hypermobility of the condyle. In 70% of the disk-displacement-with-reposition and disk-displacement-without-reposition patient groups, axiography and MRT gave the same information. In other patient groups, the axiography findings agreed with the MRT findings in 45% of the cases. It was concluded that although a large percentage of morphologic alterations could be detected by MRT, axiography determined the dysfunctional dynamics more clearly.