Journal of Dental Sciences (2013) 8, 151e159

Available online at www.sciencedirect.com

journal homepage: www.e-jds.com

ORIGINAL ARTICLE

Feasibility of differential quantification of

3D temporomandibular kinematics during
various oral activities using a cone-beam
computed tomography-based 3D
fluoroscopic method
Chien-Chih Chen a,b, Cheng-Chung Lin c, Tung-Wu Lu c, Hao Chiang c,
Yunn-Jy Chen a*

a
School of Dentistry, National Taiwan University, Taiwan, ROC
b
Department of Dentistry, Cardinal Tien Hospital, Taiwan, ROC
c
Institute of Biomedical Engineering, National Taiwan University, Taiwan, ROC

Received 22 June 2012; Final revision received 13 September 2012

Available online 26 January 2013

KEYWORDS Abstract Background/purpose: The measurement of mandibular kinematics is critical for

cone-beam CT; studying the function of the temporomandibular joint (TMJ) and for relevant clinical applica-
fluoroscopy; tions. However, none of the existing methods allows the measurement of three-dimensional
image registration; (3D) in vivo motion of the joint during dynamic functional movements without artifactual in-
kinematics; terference. The purpose of this study was to demonstrate the feasibility of a newly developed
temporomandibular cone-beam computed tomography (CBCT)-based 3D fluoroscopic method in differentiating
joint rigid-body kinematics of the TMJ during various functional activities.
Materials and methods: One healthy individual was asked to undergo a CBCT scan and fluoro-
scopic imaging of her mandible and maxilla during various functional activities. CBCT-based 3D
fluoroscopy was used to measure the 3D kinematics of the TMJ.
Results: The 3D rigid-body kinematics of the mandible, movement trajectories of the centers
of the TMJ and the midpoint of the interincisal edge were measured during functional activ-
ities.
Conclusion: A new CBCT-based 3D fluoroscopic method was proposed and shown to be capable
of quantitatively differentiating TMJ movement patterns among complicated functional activ-
ities. It also enabled a complete description of the rigid-body mandibular motion and

* Corresponding author. School of Dentistry, National Taiwan University, Taiwan, ROC.

E-mail address: chenyj@ntu.edu.tw (Y.-J. Chen).

1991-7902/$36 Copyright ª 2012, Association for Dental Sciences of the Republic of China. Published by Elsevier Taiwan LLC. All rights reserved.
http://dx.doi.org/10.1016/j.jds.2012.09.025
152
descriptions of as many reference points as needed for future clinical applications. It will be
helpful for dental practice and for a better understanding of the functions of the TMJ.
Copyright ª 2012, Association for Dental Sciences of the Republic of China. Published
by Elsevier Taiwan LLC. All rights reserved.
Introduction
The development of the theory and clinical practice of
dental articulation has relied on knowledge of masticatory
physiology gained over the years by measuring mandibular
motion relative to the maxilla as controlled by the tem-
poromandibular joint (TMJ) during a well-defined motion,
namely opening and closing.1 5 It was noted that the
accuracy, and thus the complete picture of the TMJ
motion, was significantly influenced by the measurement
techniques available at the time. Therefore, incomplete
information from simplified and/or two-dimensional ob-
servations and analyses was used in clinical dentistry in the
past.6 9 While this information has contributed to current
dental practice, highly accurate, three-dimensional (3D)
measurement techniques are necessary to advance the
current understanding of the function of the TMJ, espe-
cially during more complicated functional movements such
as chewing, to identify etiologies of TMJ disorders and
further improve prosthodontic practice.
Anatomically, the TMJ is divided by the interposed disc
into the upper and lower compartments, facilitating the
translation and rotation of the mandible relative to the
temporal bone.10 Therefore, translation of the mandible at
the condyle is always coupled with rotation of the man-
dible. While rigid-body motion of the mandible involves
three translations and three rotations, conventionally
a pantogram was used to trace the motion of the mandible
using pen and paper, with a reference point on the con-
dyle.11 14 Since condylar movement trajectories are easily
available with pantograph tracings, most dental articula-
tors were designed so that the jaw motion path was
determined in terms of the translation of this particular
reference point, despite the fact that a single point cannot
accurately represent the 3D motion of a rigid body. A major
concern with this technique is that motions of the bilateral
TMJ are difficult to obtain because the measured plot is
a result of the motion of both TMJs. This problem can be
resolved by placing the devices around the bilateral con-
dyles of the TMJ. However, interference with physiological
jaw movements caused by installing the measuring devices
of the pantogram is another major concern. Tracing results
were also shown to be influenced by the anatomy of the
TMJ,15 and the rotation of the condylar head cannot be
obtained. The amount of condylar translation is also
dependent on the reference point.9 Therefore, the need to
use a reference point remains a major limitation for
pantograms.
To overcome the limitations of pantograms, measure-
ment devices for 3D mandibular movements were devel-
oped, from a complicated and bulky device with two
mechanical face bows2,6 to more compact and delicate
systems.16 23 The ability to measure 3D mandibular move-
ments has led to the introduction of several new methods
C.-C. Chen et al
for describing human mandibular kinematics, such as the
kinematic center3,5 and screw axis methods.24,25 For
more widespread application of these systems, techniques
using commercially available skin-marker-based stereo-
photogrammetric systems were also developed. In order to
avoid skin-movement artifacts, i.e., errors associated with
skin-marker movements relative to the underlying bones,26
transoral devices are used. However, transoral devices may
affect the natural motion of the TMJ, which will be neg-
atively affected if the participant was asked to perform
other more natural, clinically relevant movements, such as
chewing. Thus, measuring 3D dynamic mandibular kine-
matics in vivo without the use of interfering transoral de-
vices has great potential in relevant dental clinical
applications.
Imaging methods provide a way of resolving this prob-
lem, by offering the opportunity to measure the motion of
the TMJ without skin-movement artifacts or being affected
by transoral devices. However, none of the existing imaging
methods allows the measurement of the 3D, in vivo motion
of the TMJ during dynamic functional movements, except
a new 3D fluoroscopic method that was recently pro-
posed.27 The 3D fluoroscopic method is based on registra-
tion of CT data of the bones to single-plane fluoroscopic
images, thus enabling the measurement of joint kinematics
in three dimensions. Moreover, a cone-beam computed
tomography (CBCT) system is used to improve its clinical
applicability because CBCT is used clinically in dental
implant therapy due to its low radiation dose during imag-
ing. With CBCT data, the 3D anatomy of the TMJ can be
reconstructed. Therefore, another way of representing the
3D motion of the mandible can be developed without being
limited to the use of single reference points. A new 3D
fluoroscopic method is proposed, and its accuracy and
precision are evaluated using well-controlled experimental
tests.27 The feasibility of the method in differentially
quantifying TMJ motion during more complicated, func-
tional movements is yet to be demonstrated.
The purpose of this study was to demonstrate the fea-
sibility of using the newly developed CBCT-based 3D fluo-
roscopic method to differentiate rigid-body kinematics of
the TMJ, including movement trajectories of the centers of
the TMJ (TMJCs), and the midpoint of the interincisal edge
during functional activities, namely opening-closing the
mouth, chewing, protrusion-retraction, and lateral gliding
to both sides.
Materials and methods
Experimental procedure
A female volunteer (age, 35 years; height, 157 cm; weight,
50 kg) without missing teeth, dental prostheses, or any
Differential quantification of 3D temporomandibular kinematics
neuromusculoskeletal disease of the TMJ participated in
the current study with written informed consent as
approved by the Institutional Research Board. During the
experiment, the participant was asked to sit on a chair with
her head fixed to the head-support by a strap. With the
mandible in a resting position, the mandible and maxilla
were then scanned by CBCT (i-CAT, Imaging Sciences In-
ternational, Hatfield, PA, USA) with a voxel size of 0.4 mm
in three orthogonal directions and a gray intensity of 12 bits
(Fig. 1). The height of the CBCT was adjusted such that the
participant’s chin did not extend beyond the field of view
(FOV) of the image plane at the maximized mouth-open
position. The CBCT scan took 20 seconds with a radiation
dose of 68 mSv according to the manufacturer, which is
comparable to the radiation dose measured in an exper-
imental trial.28 The CBCT data were then segmented and
reconstructed to obtain two sets of subject-specific 3D
models of the mandible and maxilla, namely surface and
voxel-based models, using a software package (Amira,
Visage Imaging, Berlin, Germany) for subsequent registra-
tion of the fluoroscopic images.
Figure 1 During the cone-based computed tomography scan
and fluoroscopy imaging, the participant was asked to sit in
a chair with her head fixed to a head-support by a strap. The
participant is wearing a lead apron to minimize the radiation
absorbed by the body.
153
Functional tasks
Subsequent to the CBCT scan, the participant was asked to
maintain the same posture while being imaged using the
custom-made fluoroscopic function of the CBCT system27 at
a sampling rate of 7.5 frames/second, giving 2D fluoro-
scopic images with an image size of 756  960 pixels and
a pixel size of 0.254  0.254 mm. Fluoroscopic images were
also collected when the participant performed selective
functional activities, namely opening-closing, lateral glid-
ing, protrusion-retraction, and chewing at a self-selected
pace. During the opening-closing motion, the participant
opened her mouth from the maximal inter-cuspational
position (MICP) to the maximum opening at a self-
selected speed, and then returned to the MICP at the
same speed for three complete cycles. During lateral glid-
ing, the participant was asked to glide the mandible from
the MICP to the right as far as she could, and then to return
to the MICP for two cycles. A similar protocol was also
applied to left gliding movement. For the protrusion test,
the jaw of the participant began at MICP, was glided for-
ward as much as she could, and then returned to the MICP
for two cycles. During chewing, the participant was asked
to chew a piece of gum with a size of 15  10  10 mm with
the working side on the right for about seven times within
a 20-second scanning period.
Registration
Prior to data collection, the custom-made fluoroscopic
function of the CBCT system was calibrated for positions of
the image plane and point source X-ray using a purpose-
built calibration object.29 With the calibrated projection
model of the fluoroscopy, 3D poses of the mandibular bone
were obtained by registering the voxel-based model to the
corresponding 2D fluoroscopic images using the weighted
edge-matching score (WEMS) method.30 For this purpose,
a projected image of the mandibular bone was generated
by a perspective projection of the voxel-based model onto
the image plane to construct a digitally reconstructed
radiograph (DRR) resembling a radiograph. In each fluoro-
scopic frame, an optimization procedure was used to find
the pose of the mandible, the DRR of which best matched
the fluoroscopic image according to similarity measures of
the WEMS. The accuracy of this registration method was
evaluated for its TMJ kinematics measurements, giving
means and standard deviations of errors of 1.0  1.4 mm
and 0.2  0.7 for translation and rotation, respectively.27
To assist with visualizing the registration process, a graph-
ical user interface (GUI) was used (Fig. 2). A flowchart
illustrating the overall procedure of the above-described
measurement method is given in Fig. 3.
Anatomical coordinate system
To describe the mandibular kinematics, each bone was
embedded with an anatomical coordinate system (ACS)
defined by selected landmarks on the mandible in the
resting position. The epicondyles and occlusal surfaces
of the teeth were manually digitized using a custom-
developed program. A plane, here referred to as the
154
Figure 2 Graphical user interface assisting the registration of bone models and the corresponding fluoroscopic images through
visualization of the fluoroscopic system and model bones in space. The simulated fluoroscopic system with the registered bone
models in lateral view (top left), inferior view (bottom left), posterior view (top right), and oblique view (bottom right). The
control panel is also shown on the right.
occlusal plane, was fitted to the occlusal surface of the
teeth by minimizing the squared distances between
the plane and vertices on the occlusal surfaces (Fig. 4). The
ACS of the mandible originated at the midpoint between
the epicondyles, with the z-axis directed to the right epi-
condyle, the y-axis directed superiorly, normal to the
Figure 3 The overall procedure of the model-based 3D flu-
oroscopic method for measuring in vivo and 3D kinematics of
the mandible during movements. 2D Z two-dimensional;
3D Z three-dimensional; CBCT Z cone-based computed to-
mography; DRR Z digitally reconstructed radiograph;
WEMS Z weighted edge-matching score.
C.-C. Chen et al
occlusal plane and orthogonal to the z-axis, and the x-axis
as the cross-product of the y-axis and z-axis, and directed
anteriorly (Fig. 4). The ACS of the maxilla was defined so
that it was coincident with that of the mandible in the
resting position. Since the participant’s head was fixed to
the head-support by a strap and remained stationary
throughout the experiment,27 including during the CT scan
and fluoroscopic imaging, the ACS of the maxilla was taken
as the global reference for describing mandibular kine-
matics for all trials.
Data analysis
Given the registered 3D poses of the mandible relative to
the maxillary ACS, angles of the TMJ were obtained fol-
lowing a z-x-y Cardanic rotation sequence31, corresponding
to flexion/extension, adduction/abduction, and internal/
external rotation. The TMJCs were defined as centroids of
spheres which best fit the bilateral mandibular condyles.
The displacement of the TMJCs from the starting position in
the maxillary ACS was then calculated. The displacement of
the midpoint of the central interincisal edges was also
calculated in the same manner.
Results
The patterns of the 3D rigid-body kinematics of the man-
dible during the tested movements are shown in Fig. 5.
Results showed that flexion/extension was the primary
Differential quantification of 3D temporomandibular kinematics
Figure 4 The anatomical coordinate system and movement
components of the mandible. The origin was defined at the
midpoint between the epicondyles, with the z-axis directed to
the right epicondyle, the y-axis directed superiorly, normal to
the occlusal plane and orthogonal to the z-axis, and the x-axis
as the cross-product of the y-axis and z-axis, and directed
anteriorly. The occlusal plane was defined by fitting a plane to
the occlusal surface of the teeth by minimizing the squared
distances between the plane and vertices on occlusal surfaces.
Abd/Add Z abduction/adduction; Flex/Ext Z flexion/exten-
sion; IR/ER Z internal rotation/external rotation.
motion component for opening-closing and chewing move-
ments, and its range was considerably greater during
opening-closing. The primary motion component for lateral
gliding was shown to be internal/external rotation. During
protrusion movement, angular joint motions were small,
but significant anterior/posterior displacements of the
mandible relative to the maxilla were observed (Fig. 5).
During the mouth opening movement, the TMJCs moved
anteriorly and inferiorly during the first 20 , but superiorly
during the remaining movement period (Fig. 6). Similar
patterns were reversed during the mouth closing movement,
but they did not follow the same paths as during opening.
Movements of the bilateral TMJCs were found to be largely
symmetrical during opening-closing movements (Fig. 6).
During lateral gliding, the mandible rotated around the su-
perior/inferior axis with little displacement of the TMJC on
the working side, while the contralateral TMJC on the bal-
ancing side moved anteriorly and inferiorly (Fig. 6). Gen-
erally, the return trajectories of the bilateral TMJCs in the
anteroposterior directions were largely the same. During
protrusion movement, the bilateral TMJCs moved anteriorly
and inferiorly throughout the period, first with a brief period
of slight mandibular opening rotations of about 0.5 , pre-
sumably during anterior guidance, followed by mandibular
closing rotations with a maximum of about 1 . During the
chewing movement, as the opening angle increased, the
bilateral TMJCs both showed significant anterior and inferior
movements, but the total range of displacement on the
balancing side was greater (Fig. 6). While a greater range of
displacement was also found on the balancing side during
155
lateral gliding, the movement of the working side sig-
nificantly differed between lateral gliding and chewing
movements. Displacements of the midpoint of the central
incisor edges during various movements are also shown on
three anatomical planes in Fig. 7. Displacements during
chewing were found to be within the ranges enclosed by the
extremities of the other movements.
Discussion
The current study attempted to demonstrate the feasibility
of a new CBCT-based 3D fluoroscopic method for measuring
the rigid-body kinematics of the TMJ, including movement
trajectories of the TMJCs, and the midpoint of the inter-
incisal edge during functional activities, namely opening-
closing, chewing, protrusion-retraction, and lateral gliding
to both sides. Results showed that the new CBCT-
based 3D fluoroscopic method was capable of quantita-
tively differentiating TMJ movement patterns between
more complicated, functional movements. It also enabled
a complete description of rigid-body mandibular motion
and descriptions of as many reference points as needed for
future clinical applications. This suggests that the new
method will be helpful in dental practice and will provide
a better understanding of the function of the TMJ, con-
tributing to identifying etiologies of TMJ disorders and
further improving prosthodontic practice.
The new method allows the measurement of 3D TMJ
motions during various functional activities in vivo without
the influence of skin-movement artifacts or extra devices
that may affect the natural movement of the joint. Limited
by the measurement techniques used and lacking the entire
range of motion of the TMJ, most previous studies focused
their measurements of mandibular kinematics of opening-
closing movements.1 5 Results of this type of study
formed our current knowledge of the TMJ and relevant
clinical practices. However, as shown by the current re-
sults, rigid-body kinematics of the mandible and movement
trajectories of selected reference points significantly var-
ied during different functional activities (Figs. 5e7). None
of these patterns, either the rigid-body motion or motions
of the reference points, could be solely predicted by those
of opening-closing movements.
Owing to the limitations of the measurement methods
and the need for more clinically relevant descriptions,
previous studies used the motion of certain reference
points to describe the 3D kinematics of mandibular mo-
tions. For example, some authors used trajectories of the
mandibular epicondyles,23 while others introduced the
theory of the kinematic center, an imaginary point derived
from mandibular kinematics.3,5 Trajectories of the mid-
point of the interincisal edge were also used to describe
border motions of the mandible.32 The combination of
translational data with rotation of the mandible in the
sagittal plane, as proposed by Salaorni et al,23 is a concise
description of condylar kinematics in 2D. This is useful for
describing the opening-closing motion. However, as dis-
cussed above, this approach might not be sufficient for
more complicated motions. In the current study, with
complete data of the 3D motion of the mandible, we were
able to produce translation/rotation diagrams in all the
 156
Figure 5 Patterns of the six kinematic components of the temporomandibular joint plotted against movement time during opening/closing, lateral gliding, protrusion/retraction,
and chewing. A/P Z anterior/posterior; Abd/Add Z abduction/adduction; F/E Z flexion/extension; IR/ER Z internal rotation/external rotation; R/L Z right/left;
S/I Z superior/inferior.

C.-C. Chen et al
 Differential quantification of 3D temporomandibular kinematics
Figure 6 Trajectories of the three components of the center of the TMJC position in the maxillary anatomical coordinate system plotted against the joint angles of the primary
motion components during opening/closing, lateral gliding, protrusion/retraction, and chewing. A/P Z anterior/posterior; R/L Z right/left; S/I Z superior/inferior;
TMJC Z centers of the temporomandibular joint.

157
158
Figure 7 Displacement of the midpoint of the central interincisal edges during testing of functional activities. The trajectories
during opening/closing, lateral gliding, and protrusion/retraction are shown in gray dashed lines, while those of the chewing
movement are shown in black solid lines. A/P Z anterior/posterior; R/L Z right/left; S/I Z superior/inferior.
three anatomical planes and demonstrated that significant
movement components also occurred in the other two
planes. Furthermore, motion curves during opening-closing
motions cannot represent the motion of other more com-
plicated functional activities (Figs. 5e7). This suggests that
current clinical practice based on the data on opening-
closing movements may have to be revisited on the basis
of more detailed and complete information of other func-
tionally relevant movement data.
While descriptions of a reference point are easier to
understand and have clinical meanings, the information
provided is limited because the motion of a single point
cannot represent the true 3D motion of the mandible rela-
tive to the maxilla. The helical axis theory bridged this gap,
but the motion of a helical axis in space seemed consid-
erably difficult to be understood by clinicians.24,25 Note that
for a given mandibular motion, different reference points
produced very different trajectories (Figs. 6 and 7),
although each different trajectory may have different clin-
ical meanings. It appears that the choice of the reference
point should be based on the clinical applications required
instead of technical convenience. The current measurement
method, which is 3D in nature and anatomically based, of-
fers a complete dataset from which different representa-
tions of mandibular motions can be achieved according to
clinical needs. The data of rigid-body kinematics of the
mandible and motions of selected reference points can
simultaneously be considered for clinical interpretations.
This is in contrast to the existing measurement methods,
most of which provide rigid-body motions without giving
anatomical or morphological details, while others only pro-
vide the trajectory of a single reference point.
By simultaneously considering rigid-body kinematics,
and trajectories of selected end points of the mandible,
namely TMJCs and the interincisal point, a clearer picture
of motions of the mandible and TMJ can be established. For
example, during lateral gliding, linear and angular dis-
placements of the mandible relative to the maxilla clearly
showed primary motion about a superior-inferior rotational
C.-C. Chen et al
axis (Fig. 5). However, it was simply unclear from these
data whether the mandible rotated relative to the maxilla
about an anatomical pivot. This was resolved by examining
trajectories of the TMJCs (Fig. 6). The displacement of the
TMJC was very small on the working side, indicating that
the position of the pivot must be located near the TMJC on
the working side.
The current study was limited to measuring 3D kine-
matics of the mandible of one normal participant during
various functional activities. This was acceptable to dem-
onstrate the feasibility of the new method in quantitatively
differentiating 3D kinematic patterns among different
functional activities. However, in order to derive more
clinically relevant results, the new method will have to be
applied to more individuals, both normal and those with
pathologies. Future studies can also be dedicated to the use
of the new method for studying the surface kinematics of
the condyles and opposing fossae, which can be derived
from the 3D morphology of the bones and their kinematics.
With additional magnetic resonance (MR) imaging data, the
roles of the condylar disc and ligaments in controlling the
TMJ system can be studied, which will be helpful in better
understanding the etiologies of TMJ disorders and evalu-
ating subsequent treatments.
A new CBCT-based 3D fluoroscopic method was proposed
and shown to be capable of quantitatively differentiating
TMJ movement patterns among complicated functional
activities, namely opening-closing, chewing, protrusion-
retraction, and lateral gliding to both sides. It also ena-
bled a complete description of rigid-body mandibular
motion, and descriptions of as many reference points as
needed for future clinical applications.
References
1. Hannam AG, DeCou RE, Scott JD, Wood WW. The kinesiographic
measurement of jaw displacement. J Prosthet Dent 1980;44:
88e93.
Differential quantification of 3D temporomandibular kinematics
2. Messerman T. A means for studying mandibular movements. J
Prosthet Dent 1967;17:36e43.
3. Naeije M. Local kinematic and anthropometric factors related
to the maximum mouth opening in healthy individuals. J Oral
Rehabil 2002;29:534e9.
4. Wood GD. Recording the opening and closing cycle of the
mandible. Br Dent J 1979;146:305e9.
5. Yatabe M, Zwijnenburg A, Megens CC, Naeije M. Movements of
the mandibular condyle kinematic center during jaw opening
and closing. J Dent Res 1997;76:714e9.
6. Gibbs CH, Messerman T, Reswick JB, Derda HJ. Functional
movements of the mandible. J Prosthet Dent 1971;26:604e20.
7. Gsellmann B, Schmid-Schwap M, Piehslinger E, Slavicek R.
Lengths of condylar pathways measured with computerized
axiography (CADIAX) and occlusal index in patients and vol-
unteers. J Oral Rehabil 1998;25:146e52.
8. Slavicek R. Clinical and instrumental functional analysis for
diagnosis and treatment planning. Part 5. Axiography. J Clin
Orthod 1988;22:656e67.
9. Zwijnenburg A, Megens CCEJ, Naeije M. Influence of choice of
reference point on the condylar movement paths during man-
dibular movements. J Oral Rehabil 1996;23:832e7.
10. DuBrul EL. Sicher and Dubrul’s Oral Anatomy. St. Louis, MO and
Tokyo: Ishiyaka EuroAmerica, 1988.
11. Beard CC, Donaldson K, Clayton JA. Comparison of an elec-
tronic and a mechanical pantograph. Part I: consistency of an
electronic computerized pantograph to record articulator
settings. J Prosthet Dent 1986;55:570e4.
12. Chang WS, Romberg E, Driscoll CF, Tabacco MJ. An in vitro
evaluation of the reliability and validity of an electronic pan-
tograph by testing with five different articulators. J Prosthet
Dent 2004;92:83e9.
13. Piehslinger E, Celar AG, Celar RM, Slavicek R. Computerized
axiography: principles and methods. Cranio 1991;9:344e55.
14. Price RB, Bannerman RA. A comparison of articulator settings
obtained by using an electronic pantograph and lateral inter-
occlusal recordings. J Prosthet Dent 1988;60:159e64.
15. Mongini F. Relationship between the temporomandibular joint
and pantographic tracings of mandibular movements. J Pros-
thet Dent 1980;43:331e7.
16. Airoldi RL, Gallo LM, Palla S. Precision of the jaw tracking
system JAWS-3D. J Orofac Pain 1994;8:155e64.
17. Ferrario VF, Sforza C, Miani A, Serrao G. Kinesiographic three-
dimensional evaluation of mandibular border movements:
a statistical study in a normal young nonpatient group. J
Prosthet Dent 1992;68:672e6.
159
18. Jankelson B, Swain C, Crane P, Radke J. Kinesiometric instru-
mentation: a new technology. J Am Dent Assoc 1975;90:834e40.
19. Kang DW, Mongini F, Rossi F, Tempia-Valenta G, Pedotti A. A
system for the study of jaw movements. Cranio 1993;11:63e7.
20. Karlsson S. Recording of mandibular movements by intraorally
placed light emitting diodes. Acta Odontol Scand 1977;35:111e7.
21. Knap FJ, Richardson BL, Bogstad J. Study of mandibular motion
in six degrees of freedom. J Dent Res 1970;49:289e92.
22. Naeije M, Van der Weijden JJ, Megens CC. Okas-3D: opto-
electronic jaw movement recording system with six degrees of
freedom. Med Biol Eng Comput 1995;33:683e8.
23. Salaorni C, Palla S. Condylar rotation and anterior translation
in healthy human temporomandibular joints. Schweiz Mon-
atsschr Zahnmed 1994;104:415e22.
24. Gallo LM, Airoldi GB, Airoldi RL, Palla S. Description of man-
dibular finite helical axis pathways in asymptomatic subjects. J
Dent Res 1997;76:704e13.
25. Gallo LM, Fushima K, Palla S. Mandibular helical axis pathways
during mastication. J Dent Res 2000;79:1566e72.
26. Chen C-C, Chen Y-J, Chen S-C, Lin H-S, Lu T-W. Evaluation of soft-
tissue artifacts when using anatomical and technical markers to
measure mandibular motion. J Dental Sci 2011;6:95e101.
27. Chen CC, Lin CC, Chen YJ, Hong SW, Lu TW. A method for
measuring three-dimensional mandibular kinematics in vivo
using single-plane fluoroscopy. Dentomaxillofac Radiol (DOI:
10.1259/dmfr/95958184), http://dmfr.birjournals.org/content/
early/2012/07/27/dmfr.95958184.abstract.
28. Roberts JA, Drage NA, Davies J, Thomas DW. Effective dose
from cone beam CT examinations in dentistry. Br J Radiol 2009;
82:35e40.
29. Lu T-W, Tsai T-Y, Kuo M-Y, Hsu H-C, Chen H-L. In vivo three-
dimensional kinematics of the normal knee during active
extension under unloaded and loaded conditions using single-
plane fluoroscopy. Med Engin Phys 2008;30:1004e12.
30. Tsai T-Y, Lu T-W, Chen C-M, Kuo M-Y, Hsu H-C. A volumetric
model-based 2D to 3D registration method for measuring ki-
nematics of natural knees with single-plane fluoroscopy. Med
Phys 2010;37:1273e84.
31. Cole GK, Nigg BM, Ronsky JL, Yeadon MR. Application of the
joint coordinate system to three-dimensional joint attitude
and movement representation: a standardization proposal. J
Biomech Engin 1993;115:344e9.
32. Zarb GA, Bolender CL, Eckert SE, Fenton AH, Jacob RF, Mer-
icske-Stern R. Prosthodontic Treatment for Edentulous Pa-
tients: Complete Dentures and Implant-Supported Prostheses.
Maryland Heights, MO: Mosby, 2003.