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 tomog-raphy 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 anterosu-perior 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 hori-zontal 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 move-ment. 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.

condylar bone change; helical computed tomography; osteophyte formation

1. Tegelberg A, Kopp S. Clinical findings in the stomatognathic system for individuals with rheumatoid arthritis and osteoarthritis. Acta Odontol Scand 1987;45:65–75.

2. Åkerman S, Kopp S, Nilner M, Petersson A, Rohlin M. Relationship between clinical and radiologic findings of the temporomandibular joint in rheumatoid arthritis. Oral Surg Oral Med Oral Pathol 1988;66:639–643.

3. Seligman DA, Pullinger AG. Association of occlusal variables among refined TM patient diagnostic groups. J Craniomandib Disord Facial Oral Pain 1989;3:227–236.

4. Pullinger AG, Seligman DA, Gornbein JA. A multiple logistic regression analysis of the risk and relative odds of temporomandibular disorders as a function of common occlusal features. J Dent Res 1993;72:968–979.

5. McNamara JA, Seligman DA, Okeson JP. The relationship of occlusal factors and orthodontic treatment to temporo-mandibular disorders. In: Sessle BJ, Bryant PS, Dionne RA (eds). Progress in Pain Research and Management. Vol 4: Temporomandibular disorders and related pain condi-tions. Seattle: IASP Press, 1995:399–427.

6. Slavicek R. Clinical and instrumental functional analysis and treatment planning. Part 4. Instrumental analysis of mandibular casts using the mandibular position indicator. J Clin Orthod 1988;22:566–575.

7. Piehslinger E, Celar A, Celar R, Jäger W, Slavicek R. Reproducibility of the condylar reference position. J Orofac Pain 1993;7:68–75.

8. Fava C, Preti G. Lateral transcranial radiography of tem-poromandibular joints. Part II: Image formation studied with computerized tomography. J Prosthet Dent 1988;59:218–227.

9. Ekberg EC, Petersson A, Nilner M. An evaluation of digital subtraction radiography for assessment of changes in position of the mandibular condyle. Dentomaxillofac Radiol 1998;27:230–235.

10. Blaschke DD, Blaschke TJ. Normal TMJ bony relation-ships in centric occlusion. J Dent Res 1981;60:98–104.

11. Pullinger AG, Solberg WK, Hollender L, Guichet D. Tomographic analysis of mandibular condyle position in diagnostic subgroups of temporomandibular disorders. J Prosthet Dent 1986;55:723–729.

12. Pullinger A, Hollender L. Variation in condyle-fossa relationships according to different methods of evaluation in tomograms. Oral Surg Oral Med Oral Pathol 1986;62: 719–727.

13. Ren Y-F, Isberg A, Westesson P-L. Condyle position in the temporomandibular joint: Comparison between asymptomatic volunteers with normal disk position and patients with disk displacement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:101–107.

14. Cohlmia JT, Ghosh J, Sinha PK, Nanda RS, Currier GF. Tomographic assessment of temporomandibular joints in patients with malocclusion. Angle Orthod 1996;66:27–35.

15. Williams BH. Tomographic stability of condyle fossa relationships in 40 treated temporomandibular disorder patients. J Prosthet Dent 1998;79:570–574.

16. Hayashi T, Ito J, Koyama J, et al. Detectability of anterior displacement of the articular disk in the temporomandibular joint on helical computed tomography: The value of open mouth position. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:106–111.

17. Yamada K, Hanada K, Hayashi T, Ito J. Condylar bony change, disk displacement, and signs and symptoms of TMJ disorders in orthognathic surgery patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91: 603–610.

18. Kahl-Nieke B, Fischbach R, Gerlach KL. CT analysis of temporomandibular joint state in children 5 years after functional treatment of condylar fractures. Int J Oral Maxillofac Surg 1994;23:332–337.

19. Yamada K, Hiruma Y, Hanada K, Hayashi T, Koyama J, Ito J. Condylar bony change and craniofacial morphology in orthodontic patients with temporomandibular disorders (TMD) symptoms: A pilot study using helical computed tomography and magnetic resonance imaging. Clin Orthod Res 1999;2:133–142.

20. Harris MD, Van Sickels JE, Alder M. Factors influencing condylar position after the bilateral sagittal split osteotomy fixed with bicortical screws. J Oral Maxillofac Surg 1999;57:650–654.

21. Alder ME, Deahl ST, Matteson SR, Van Sickels JE, Tiner BD, Rugh JD. Short-term changes of condylar position after sagittal split osteotomy for mandibular advancement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:159–165.

22. Minagi S, Sato T, Kishi K, Natsuaki N, Akamatsu Y. Comparative study of the temporomandibular joint space in maximum intercuspation and canine edge-to-edge positions in deep bite and non-deep bite subjects. J Oral Rehabil 2000;27:517–521.

23. Rammelsberg P, Jäger L, Pho Duc J-M. Magnetic reso-nance imaging-based joint space measurements in tem-poromandibular joints with disk displacements and in controls. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:240–248.

24. Slavicek R. Clinical and instrumental functional analysis for diagnosis and treatment planning. Part 7: Computer-aided axiography. J Clin Orthod 1988;22:776–787.

25. Tanimoto K, Petersson A, Rohlin M, Hansson LG, Johansen CC. Comparison of computed with conventional tomography in the evaluation of temporomandibular joint disease: A study of autopsy specimens. Dentomaxillofac Radiol 1990;19:21–27.

26. Christiansen EL, Thompson JR, Kopp S. Intra- and interobserver variability and accuracy in the determination of linear and angular measurements in computed tomography: An in vitro and in situ study of human mandibles. Acta Odontol Scand 1986;44:221–229.

27. Tyndall DA, Renner JB, Phillips C, Matteson SR. Positional changes of the mandibular condyle assessed by three-dimensional computed tomography. J Oral Maxillofac Surg 1992;50:1164–1172.

28. Cavalcanti MGP, Yang J, Ruprecht A, Vannier MW. Validation of spiral computed tomography for dental implants. Dentomaxillofac Radiol 1998;27:329–333.

29. Cavalcanti MGP, Yang J, Ruprecht A, Vannier MW. Accurate linear measurements in the anterior maxilla using orthoradially reformatted spiral computed tomogra-phy. Dentomaxillofac Radiol 1999;28:137–140.

30. Yang J, Cavalcanti MGP, Ruprecht A, Vannier MW. 2-D and 3-D reconstructions of spiral computed tomography in localization of the inferior alveolar canal for dental implants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:369–374.

31. Christiansen EL, Thompson JR, Zimmerman G, et al. Computed tomography of condylar and articular disk positions within the temporomandibular joint. Oral Surg Oral Med Oral Pathol 1987;64:757–767.

32. Fernández Sanromán J, Gómez González JM, del Hoyo JA. Relationship between condylar position, dentofacial deformity and temporomandibular joint dysfunction: An MRI and CT prospective study. J Craniomaxillofac Surg 1998;26:35–42.

33. Ozawa S, Boering G, Kawata T, Tanimoto K, Tanne K. Reconsideration of the TMJ condylar position during internal derangement: Comparison between condylar position on tomogram and degree of disk displacement on MRI. J Craniomandibular Pract 1999;17:93–100.

34. Artun J, Hollender LG, Truelove EL. Relationship between orthodontic treatment, condylar position, and internal derangement in the temporomandibular joint. Am J Orthod Dentofacial Orthop 1992;101:48–53.

35. Ronquillo HI, Guay J, Tallents RH, Katzberg RW, Murphy W. Tomographic analysis of mandibular condyle position as compared to arthrographic findings of the tem-poromandibular joint. J Craniomandib Disord 1988;2(2): 59–64.

36. Katzberg RW, Keith DA, Ten Eick WR, Guralnick WC. Internal derangements of the temporomandibular joint: An assessment of condylar position in centric occlusion. J Prosthet Dent 1983;49:250–254.

37. Pullinger AG, Baldioceda F, Bibb CA. Relationship of TMJ articular soft tissue to underlying bone in young adult condyles. J Dent Res 1990;69:1512–1518.

38. Yamada K, Oguri Y, Hiruma Y, et al. Influence of condylar bony change and articular disk displacement on mandibular tapping movement in patients with jaw defor-mity. J Jpn Soc TMJ 2000;12:88–97.

39. Roth RH. Functional occlusion for the orthodontist. J Clin Orthod 1981;15:32–51.

40. Williamson EH. Dr. Eugene H. Williamson on occlusion and TMJ dysfunction. Interview by S. Brandt. J Clin Orthod 1981;15:330–350.

41. Parker WS. Centric relation and centric occlusion—An orthodontic responsibility. Am J Orthod 1978;74:481–500.

42. Wood GN. Centric relation and the treatment position in rehabilitating occlusions. Part II: The treatment position. J Prosthet Dent 1988;60:15–18.

43. Johnston LE Jr. Gnathologic assessment of centric slides in postretention orthodontic patients. J Prosthet Dent 1988;60:712–715.

44. Gaither EL, Sadowsky PL, Vlachos CC, Wallace DD. Discrepancies between centric occlusion and centric relation in orthodontically treated patients. Int J Adult Orthod Orthognath Surg 1997;12:23–33.