Laminagraphic study of mandibular condyle position
when recording centric relation
E. H. Wiiliamson, D.D.S., M.S.*
The Ohio State University, Gollege of Dentistry, Golumbus, Ohio
Much controversy has existed between propon-
ents of different techniques for obtaining interoc-
Clusal centric relation records. Some dentists prefer
to assist the patient in retruding the mandible in a
straight posterior direction, while others attempt to
relax the patient with a vibrating motion to achieve
a physiologic position of the jaw. One segment of the
profession tripods the mandible, usirig the two
condyles posteriorly and a small anterior guidance
prosthesis; this has been described by Lucia? T h e
interocclusal record is therefore determined by the
physiologic pull of the muscles that seat the condyles
in a natural position. Strohaver -~ has presented
evidenqe indicating that use of the anterior guiding
prosthesis produces the most reproducible record-
ings.
Definitions of centric relation are somewhat
varied. Some define it as "The jaw relation when the
condyles are in the most posterior Unstrained posi-
tion in the glenoid fossae from which lateral move-
ments can be made at any given degre e of jaw
separation. ''3 Others use a definition which refers to
all three planes of space, i.e., a rearmost, midmost,
and superi0rmost position of the condyles in the
glenoid fossae?" s These condylar relationships tradi-
tionally have been deduced from pantographic trac-
ings a n d / o r the transfer of the maxillomandibular
positions to an articulator. Weinberg ~' has used
transcranial radiograpt W to locate the condyle in the
fossa, and he claims a centered position on the
radiograph to be most ideal for the location of the
mandibular condyle. However, clarity of the radio-
graphs using this technique is limited, as is the
clarity of all transcranial rad!ographs due to the
*Associate Professor and Chairman, l)epartment of Orthodontics,
Medical College of Georgia, School of Dentistry, Augusta,
Ga.
0022-3913/78/053%0561500.40/0 9 1978 The G. V. Mosby Co.
multitude of osseous structures through which the
x-rays must pass.
One radiographic procedure which eliminates the
problem of poor clarity is laminagraphy, also known
as tomography. It is a process whereby a slice may be
made through an anatomic structure, eliminating
osseous structures on each side of the region in focus
(Fig. l). A clear view of the desired anatomy may
then be sccn from a direct lateral position. The
method has been described by Brader and Rick-
etts. 7-1~Another advantage of this technique is the
use of an orthodontic cephalostat for head position~
ing that allows precise rcpositioning of the head in
an upright position for serial laminagraphy. In this
manner the temporomandibular joint ( T M J ) of
symptomatic patients may be monitored and accu-
rately compared by mensuration (Fig: 2).
The purpose of this study was (l) to.determine
radiographically the difference in condyle position
when a forcefully retruded mandibular position was
compared to a physiologic one using the anterior
guidance technique, and (2) to illustrate what might
be termed the normaljohzt space when the anterior
guidance method was used.
M E T H O D S AND MATERIALS
Laminagraphs of the temporomandibularjoints of
20 asymptomatic subjects were made bilaterally
using a Quint* radiographic machine. This unit is
basically a ccphalostat with wooden ear rods that fit
into the patient's ears to stabilize the head to achieve
a reproducible head position for sequential radio-
graphs. Two laminagraphs of each temporomandib-
ularjoint were obtained from each patient. The first
was made while the subject's jaw was manually
retruded to its most posterior position. The patient
*Quint X-ray Inc., Los Angeles, Calif.
TIlE JOURNAL OF PROSTItETIC DENTISTRY 561

( ~
Fig. 1. Diagram illustrating the manner in which a radio-
graphic section may be obtained through any portion of
the mandibular condyle.
was then instructed to close the jaws slowly until first
tooth contact was lightly made. An exposure was
made at this time. With tile subject's head Still in the
head holder a second exposure was made of tile same
joint. This time the anterior guidance prosthesis was
used.'It was made to fit over the maxillary anterior
teeth so that when the patient Closed his jaws only
one mandibular central incisor was in contact. T h e
anterior guidance prosthesis was adjusted so that the
posterior teeth were maximally closed without
making contact. T h e patient was instructed to bite
with moderate force and the second exposure was
made. The total procedure was repeated and lami-
nagraphs were made on the contralateral side.
The joint structures on the first laminagraph were
highlighted by tracing a continuous outline directly
on the film with a sharp pencil. T h e same structures
were highlighted on the second laminagraph by a
brokenpencil line to permit differentiation. In order
to compare the two potentially different positions of
the condyle in the glenoid fossa on the two successive
radiographs, it was necessary to superimpose exactly
the static and constant anatomic structures. This was
accomplished by selecting three specific and iden-
tical boney trabecUlations in different planes along
the cranial base. T h e y were marked respectively on
each film with a small pin hole, and then the holes
were superimposed. This method accurately super-
imposed all cranial landmarks, most specifically the
glenoid fossa. T h e two condylar positions could then
be measured (Fig. 3). This technique was utilized on
562
W1LLIAMSON
~: , ~ ~-~", ,#
J- .-~
i
9 J
J ........
Fig. 2. Patient is positioned in the cephalostat for a
laminagraph of the left mandibular condyle.
the right and left joints of each subject. T h e condyles
were observed to move anterior, posterior, superior,
or inferior. T h e difference in position was measured
to the nearest 0.5 m m using a Rocky Mountain bow
divider* and a metal millimeter ruler.
Tlle following measurements were made on the
radiographs taken when the anterior guidance pros-
thesis was used to determine what might be consid-
ered normal physiologic joint spaces: Anterior, the
shortest distance between the anterior surface of the
condyle and the posterior slope of the eminence.
Posterior, the shortest distance between the posterior
surface of the condyle and the posterior surface of tile
glenoid fossa. Superior, tile shortest distance between
the superior surface of the condyle and the roof of the
glenoid fossa. All data were subjected to a chi-square
statistical analysis.
RESULTS
All subjects demonstrated a change in position of
either the right or left condyle with tile two methods
of positioning the mandible. Thirteen displayed
movement on the right, while nineteen had move-
ment on the left side. A chi-square analysis proved
this difference to be statistically significant
q, < .05).
To critically evaluate the results, all condylar
movements were divided into superior-inferior and
anterior-posterior categories for statistical analysis.
Superior-inferior movement was significant
(p < .01) in the superior direction with the use of the
anterior guidance prosthesis; 25 condyles moved
superior, 2 moved inferior, and 13 did not move in
either of these two directions. Anterior-posterior
*Rocky M o u n t a i n / O r t h o d o n t i c s Inc., Denver, Colo.
MAY 1978 VOLUME 39 NUMBER S
CONDYLE POSITION A N D CENTRIC RELATION

Fig. 3. kaminagraphs are superimposed to enable measurement and comparison of the two
different mandibular condyle positions.

m o v e m e n t a p p e a r e d to be r a n d o m . N o statistical T a b l e I. A m o u n t a n d d i r e c t i o n of m o v e m e n t
difference in a m o u n t of m o v e m e n t was d i s c e r n a b l e with a n t e r i o r g u i d a n c e p r o s t h e s i s
in these directions when the a n t e r i o r g u i d a n c e pros-
thesis was used; 10 condyles m o v e d anterior, I0 Movement (mm)

moved posterior, a n d 20 d i d not move. M e a n s a n d Direction n Mean S.D. Range

s t a n d a r d deviations for tile a m o u n t o f m o v e m e n t
Superior 25 0.9 0.49 0.5-2.5
a p p e a r in T a b l e I. T h e m e a n m o v e m e n t o f those
Inferior 2 1.0 - 0-1.0
condyles m o v i n g s u p e r i o r l y (n = 25) with a n t e r i o r Anterior 10 0.9 0.34 0.5-2.0
g u i d a n c e was 0.9 + 0.49 m m , with a r a n g e o f 0.5 to Posterior 10 0.9 0.31 0.5-1.0
2.5 ram. T h e m e a n m o v e m e n t o f those m o v i n g
N o m o v e m e n t S u p e r i o r - I n f e r i o r : n = 13.
inferiorly (n = 2) was 1.0 ram. T h e m e a n a m o u n t o f
N o m o v e m e n t A n t e r i o r - P o s t e r i o r : n = 20.
m o v e m e n t of those condyles m o v i n g a n t e r i o r l y
(n --- 10) was 0.98 ___ 0.34 m m , with a r a n g e o f 0.5 to
2.0 mm. T h e m e a n m o v e m e n t o f those condyles T a b l e II. Joint spaces with a n t e r i o r g u i d a n c e
m o v i n g posteriorly (n = I0) was 0.9 ___ 0.31 ram, prosthesis*
with a range o f 0.5 to 1.0 m m .
Joint space (mm)
T a b l e II illustrates the results of j o i n t space
m e a s u r e m e n t s when a n t e r i o r g u i d a n c e was used to Direction Mean S.D. Range
|
assist in c o n d y l a r p l a c e m e n t . Tile m e a n a n t e r i o r Anterior 2.2 0.6 1.0-4.0
space was 2.2 ___ 0.6 m m , with a r a n g e o f 1.0 to 4.0 Posterior 2.0 0.5 1.0-3.0
mm. Posteriorly the m e a n space was 2.0 ___ 0.5 m m , Superior 3.4 1.2 1.0-5.0
with a range of 1.0 to 3.0 ram. S u p e r i o r l y the m e a n
* M e a s u r e d in .t0 c o n d y l e s .
space was 3.4 • 1.2 m m , with a r a n g e o f 1.0 to
5.0 m m .
to centric relation or t e r m i n a l hinge position as when
DISCUSSION the condyles are s u p e r i o r in tile glenoid fossae a n d
T h e need for a c h i e v i n g a s u p e r i o r position of the braced against the T M J l i g a m e n t a n d the posterior
condyles when m a k i n g interocclusal centric relation surface of the eminence. T h i s w o u l d also seem to
records becomes a p p a r e n t with the results of this p r o d u c e a most posterior position w h i c h is superior.
study. This l a m i n a g r a p h i c s t u d y also tends to Tile second p o i n t to be n o t e d is that c i r c u m c o n d y l a r
s u b s t a n t i a t e the hypothesis of Dawson," w h o refers j o i n t spaces d o not a p p e a r to have been o f e q u a l size

TIlE JOURNAL OF PROSTIIETIC DENTISTRY 563


laminagraphically when centric relation was located
with the anterior guidance prosthesis. There seems to
be a wide range of spaces between the condyle and
the glenoid fossa that can be considered normal.
However, the spaces observed on the radiographs are
not true spaces that would be observed anatomically.
The condyle and fossa are covered by dense connec-
tive tissue which is not calcified and therefore is not
routinely observed on radiographs.
SUMMARY
Laminagraphs were made of each temporoman-
dibular joint of 20 subjects (1) with the mandible
forcefully retruded to centric relation and (2) with
the mandible positioned by a closing force while an
anterior guidance prosthesis was being used. The
radiographs were compared by measurements of
condylar position; results indicated the condyles to
be significantly more superior in the glenoid fossa
when anterior guidance was used. The difference in
anterior-posterior positioning of the condyles ap-
peared to occur randomly.
Measurements of the joint spaces with the
mandible in centric relation using anterior guidance
indicated that mandibular condyles were not
centered in the fossae. There seemed to be a range in
the size of the space that could be considered
normal.
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564
WILLIAMSON
REFERENCES
1. Lucia, V. O.: A techniquc for recording centric relation. J
PROSTIIET DENT 14:492, 1964.
9. Strohaver, R. A.: A comparison of articulator mountings
made with centric relation and myocentrie position records.
J PRos'niEr DEx'-r 28:379, 1972.
3. Huffman, R. W., Regenos, J. W., and Taylor, R. R.:
Principles of Occlusion. Columbus, Ohio, 1969, H & R
Press.
4. Weinberg, L. A.: Technique for temporomandibular joint
radiographs, j PRosrnET DE.',"r 28:284, 1972.
5. Brader, A. C.: The application of the principles of cephalo-
metric laminagraphy to the studies of the frontal planes of
the human head. Am J Orthodont 35:249, 19t9.
6. Ricketts, R. M.: Variations of the temporomandibularjoint
as revealed by cephalometric laminagraphy. Am J Orthod
3(;:877, 1950.
7. Ricketts, R. M.: Lamlnagraph in the diagnosis of temporo-
mandibular joint disorders. J Am Dent Assoc .16:620,
1953.
8. Ricketts, R. M.: Present status of laminagraphy as related to
dentistry. J Am DenPAssoc 65:56, 1962.
9. Dawson, P. E.: Evaluation, Diagnosis and Treatment of
Occlusal Problems. St. Louis, 1974, The C. V: Mosby
Company.
10. Ricketts, R. M.: Present status of laminagraphy as related to
dentistry. J Am Dent Assoc 46:620, 1953.
Reprint requests to:
DR. E. H. ~VILLIA.MSON
~EDICAL C O L L E G E OF GEORGIA
SCIIOOL OF DENTIS-rRY
A~:GUSrA,GA. 30901
ISSUES
MAY 1978 VOLUME39 NUMBER5