Journal of Oral Rehabilitation, 1978, Volume 5, pages 1-7

The concept of the sagittal condylar guidance:

biological fact or fallacy ?

L. V. CHRISTENSEN a«JJ. C. G. SLABBERT School of Dentistry,

University of the Witwatersrand

Summary
The clinical concept of a sagittal condylar guidance pertaining to the human temporo-
mandibular joint is discussed in the light of selected studies on the anatomy, radio-
graphy and cineradiography of this joint, and clinical attempts at recording a sagittal
condylar guidance. It seems as if there is no single and well defined sagittal condylar
guidance in vivo, and thus no single and well defined sagittal condylar guidance angle
applicable to the adjustable articulator.

Introduction
In clinical dentistry it appears to be common belief that mandibular movements
in vivo can be reproduced to a large extent with the use of an adjustable articulator
(e.g. Ramfjord & Ash, 1966; Posselt, 1968). One factor gowrning the movements of
an adjustable articulator is the sagittal condylar guidance. The latter is defined as the
path which the transverse rotation, or hinge, axis of the mandibular condyles travels
during normal depression and protrusion of the mandible. The sagittal condylar
guidance is commonly measured in degrees relative to a horizontal plane (Fig. 1),
e.g. the orbitale to tragion, i.e. the Frankfurt plane (Ramfjord & Ash, 1966).
The sagittal condylar guidance is often believed to be related to the balanced
articulation, occasionally also referred to as balanced occlusion, of either natural or
artificial maxillary and mandibular teeth, as expressed in Hanau's quint and Thiele-
mann's formula. The latter, a simplification of Hanau's quint, states:

CA X CS X PO
where BA = balanced articulation, CG = sagittal condylar guidance, IG = sagittal
incisal guidance, CA = sagittal cusp angle, CS = curve of Spee, and PO = sagittal plane
of occlusion (Ramfjord & Ash, 1966).
Moreover, in the fabrication of complete removable dentures the sagittal condylar
guidance is believed by some clinicians to play a crucial role for the setting of artificial
teeth. It is believed that 'the inclination of the condylar guidance does not change
and once it is registered should be accepted' (Van Reenen & Thomas, 1967). Also, it

Correspondence: Dr L.V. Christensen, School of Dentistry, University ofthe Witwatersrand, 1 Jan

Smuts Avenue, Johannesburg 2001, Republic of South Africa.
2 L. V. Christensen and J. C. G. Slabbert
Superior '1:.1:1'. " i . • :

HP
Anterior
Fig. 1. Sagittal condylar guidance (CG) and sagittal condylar guidance angle (V) relative to horizontal
plane (HP).

has been contended that the sagittal cusp angulation of artificial teeth can be com-
puted by the following formula:

for a point half-way between the incisal and condylar guides of an adjustable articu-
lator (Van Reenen & Thomas, 1967).
The above formulae are based on the premise that the sagittal condylar guides of
the human temporomandibular joint and the adjustable articulator are rectilinear, as
seen in the Hanau and Dentatus articulators. On the other hand, other adjustable
articulators, such as the Ney articulator, are equipped with curvilinear sagittal con-
dylar guides. Indeed, great efforts have been expended to debate whether the sagittal
condylar path does and should scribe a straight or a curved hne (e.g. Luce, 1889;
Angel, 1948; Beck, 1966; Pipko, 1969).
It seems as if Thielemann's formula, and also Hanau's quint, 'is of limited value for
analysis and adjustment ofthe natural dentition where balanced occlusion is not even
an objective' (Ramfjord & Ash, 1966). In the normally functioning mandibular
locomotor system of man one may question whether there is, in fact, a reproducible
and reliable sagittal condylar guidance, and thus a single, well defined and clinically
applicable sagittal condylar guidance angle. The present paper presents a discussion
ofthe concept ofthe sagittal condylar guidance and its application to clinical dentistry.

Selected studies on the sagittal condylar guidance

Based on anatomical studies of the temporomandibular joint of macerated human
skulls. Angel (1948) thought that the sagittal condylar guidance coincided more or
less with the height and slope of the posterior surface of the articular tubercle. He
writes that 'an arbitrary plane of motion of the mandibular condyle was set as a line
from the apex of the articular eminence tangent to the fossa-eminence transition zone.
This line was labelled the eminence slope.' In children. Angel found that this slope
created an angle of about 28° relative to the Frankfurt plane, and in adults it was
about 40°. Since there is total absence of all extra- and intra-articular soft tissues,
e.g. fibro-cartilage, disc, capsule, ligament and muscle, in macerated skulls, it follows
that no valid conclusions can be drawn from such skulls regarding tbe sagittal and
other in vivo movements of the mandibular condyles. Also, one should not expect to
be able to draw valid conclusions regarding such condylar movements from the study
and manipulation ofthe mandible and temporomandibular joints of cadavers, among
other things because of the rigor mortis.
To obtain a clinical impression of the sagittal condylar guidance it is common
 Sagittal condylar guidance 3

procedure to register two different positions of the mandible by means of intra-oral

records; that is, one record of the centric occlusion position and a second record with
the mandible more or less symmetrically and voluntarily protruded, in that a protru-
sive distance of four to five millimetres is usually advocated. With the additional use
of a face-bow the first record is used to relate the maxillary and mandibular models in
an adjustable articulator, and the sagittal condylar guides of the latter are adjusted
by means of the protrusive record (Posselt, 1968). However, comparisons between
different protrusive records obtained with the use of a fairly well defined clinical
method, such as wax records, and obtained by the same or different operators, yield
sagittal condylar guidance angles that differ considerably from each other, even when
the records are obtained from the same person. These findings apply to dentulous as
well as edentulous subjects (Carlsson & Astrand, 1964; Agerberg & Carlsson, 1969).
A number of matched maxillary and mandibular bite planes were fabricated in an
adjustable articulator, while the sagittal condylar guides were set at different degrees
for the different bite planes. But when the latter were inserted into the oral cavity of
an experimental subject there were no appreciable differences as regards the articula-
tory contacts, i.e. balanced articulation, between the upper and lower bite planes during
in vivo mandibular movements (Ericson & Ransjo, 1963).
Hence, it seems as if the artificial mandibular movements made possible by an
adjustable articulator bear little or no relevance to mandibular movements in vivo,
and that the clinical procedure of recording the sagittal condylar guidance is not a
reliable and accurate one.
On lateral radiographs of the human temporomandibular joint various angles,
commonly believed to be related to or identical with the sagittal condylar guidance
angle, were measured relative to different horizontal planes. Some of the angles were
constructed by tracing the eminence slope of Angel (1948), or by the tangent to the
posterior bony surface of the articular tubercle, or by drawing a straight line from one
position of the condyle, when the mandible was in maximal intercuspal position, to
another condylar position when the mandible was protruded by four millimetres.
The measurements revealed that no radiographically determined sagittal condylar
guidance angle coincided with that obtained with the use of intra-oral records. The
radiographically determined angle showed a greater mean value than that determined
by intra-oral records, but an individual having the largest clinically determined sagittal
condylar guidance angle showed the smallest angle when radiographic measurements
were applied. Moreover, an individual exhibiting an extremely large difference between
the inclinations of the sagittal condylar guidances of the right and left side, as deter-
mined by intra-oral records, showed almost identical guides for the two sides when
radiographic measurements were used (Agerberg & Carlsson, 1969).
It follows that determination of the sagittal condylar guidance angle, as measured
on radiographs of the temporomandibular joint with the mandible in a protruded
occlusal position, or as determined by the slope of the posterior bony surface of the
articular tubercle, cannot be compared with the sagittal condylar guidance angle
obtained with the use of intra-oral records. It should also be noted that such radio-
graphs do not take into account the presence of articular soft tissues, and that the
use of intra-oral records is not a reliable clinical procedure, as noted above.
By locking the mandible in two different protruded positions, and in the maximally
depressed position, Ingervall (1972, 1974) studied the sagittal condylar and sagittal
incisal guidances by a roentgencephalometric method. He felt certain that the path
:4: L. V. Christensen and J. C. G. Slabbert

of anterior translation, or bodily shift, ofthe mandibular condyle 'from the intercuspal
position corresponds to the outline of the articular tubercle' (Ingervall, 1974). The
analysis demonstrated that the extreme range of movement of the mandible was not
related to the height of the articular tubercle or to the sagittal condylar guidance.
Also, there was no interdependence between the inclinations of the sagittal condylar
and incisal guides, and during protrusion the inferior translation of the condyle was
independent of the relationship between the maxillary and mandibular incisors, i.e.
overbite and overjet. Nor was there any correlation between the sagittal condylar
guidance and the number of tooth contacts in lateral mandibular positions, implying
that tooth contacts in such functionally important positions (Moller, 1973) depend on
the morphology of the dentition only. Finally, it was shown that the height of the
articular tubercle and the depth of the articular fossa increase during the years of
growth and development, so it seems as if the path of the sagittal condylar guidance
may become steeper with increasing age.
Thus, it seems as if a rigid mechanical formula for balanced articulation, encom-
passing the sagittal condylar guidance, is not applicable to the mandibular locomotor
system in vivo. But it should be noted that no true functional condylar movements
were traced in Ingervall's studies, only three static positions. Also, it should be noted
that the measurements did not take into account the presence of articular soft tissues,
and that no evidence was presented to the effect that there exists a single condylar
rotation axis and that the condyle is guided by the outline of the articular tubercle
during protrusive mandibular movements.
Instead of using lateral radiographs of the temporomandibular joint with the
mandible fixed in two different protruded, but static positions, it might be advantage-
ous in the study of condylar movements to record a series of lateral radiographs while
the mandible is locked at variable degrees of depression. This method was applied
by Kamijo et al. (1967) who fixed the mandible in the following static positions:

(2) (3)

Superior
Superior

HP -«« — HP
Anterior Anterior

(4) (5)

Superior

HP
Anterior Anterior

Fig. 2. Anterior-superior path of sagittal condylar guidance relative to horizontal plane (HP).
Fig. 3. Anterior-inferior-anterior path of sagittal condylar guidance relative to horizontal plane (HP).
Fig. 4. Anterior-inferior path of sagittal condylar guidance relative to horizontal plane (HP).
Fig. 5. Anterior path of sagittal condylar guidance relative to horizontal plane (HP).
 Sagittal condylar guidance 5

maximal intercuspation, depression of 5, 10, 15 and 20 mm, and maximal depression.

Roughly, the sagittal condylar guidance could be described as tracing four different
movement patterns. The first and second patterns entailed a more or less curvilinear
path, as illustrated in Fig. 2 (anterior-superior path) and Fig. 3 (anterior-inferior-
anterior path), and these patterns occurred most frequently in healthy adults. The third
and fourth patterns comprised more or less rectilinear paths, as illustrated in Fig. 4
(anterior-inferior path) and Fig. 5 (anterior path), but the paths were never completely
straight, as judged from the original tracings. The latter two patterns occurred most
frequently in children and aged denture wearers. In children, the path was ascribed,
to absence of a fully developed articular tubercle, while in the aged the path was
ascribed to joint pathology, such as osteoarthrosis. As determined by the movements
ofthe mandibular central incisors, it was shown in all subjects that the sagittal depres-
sion path of the mandible did not coincide with the sagittal elevation path, implying
that the transverse rotation axis of the mandibular condyles, underlying the definition
of sagittal condylar guidance, is not a stationary axis during mandibular sagittal
movements.
In fact, it may be so that it is impossible to clinically determine only one condylar
rotation axis (Trapozzano & Lazzari, 1967), and if it occasionally exists then it seems
to pass through the mandibular condyles only when the mandible is depressed from
and maintained in its most retruded position, which again is an abnormally strained
mandibular position (Shanahan & Leff, 1959, 1966). During unstrained depression,
and also elevation, ofthe mandible the transverse rotation axis ofthe mandible changes
constantly, and the different centres of rotation are located far beyond the borders
ofthe mandibular condyles (Kamijo et al, 1967).
Thus, it seems as if another of the premises for a rigid definition of the sagittal
condylar guidance is a biological fallacy, and the rigid mechanical laws governing the
movements of an adjustable articulator seem inapplicable to the dynamic mandibular
locomotor system of man. Also, it should be noted that the tracing of the above
mentioned static condylar positions do not fully take into account the dynamic actions
of the jaw muscles.
At present, the best direct method for studying condylar movements in vivo seems
to be the use of cineradiography of the temporomandibular joint (Saxby & Franks,
1976). In cineradiography, serial radiographs are taken at a very high exposure rate
so that a series of images can be projected as a motion picture. In human subjects with
various types of occlusion, Lundberg (1963) studied different sagittal condylar move-
ments by means of this method, and since the maxillary and mandibular teeth were
not in contact during the movements these were labelled free movements of the tem-
poromandibular joints. In subjects with mandibular prognathism, no true sagittal
condylar guidance could be registered because the subjects were unable to sufficiently
protrude the mandible, and in subjects with deep overbite the sagittal condylar
guidance might be steeper than that of subjects having a normal overbite. Lundberg
notes that 'in all cases the path ofthe translatory movements (ofthe condyle) approxi-
mately corresponds to the outline ofthe dorsal surface of the tuberculum articulare'.
However, analysis of his tracings reveals that this is not so, among other things because
the posterior bony surface ofthe articular tubercle is never parallel with the more or less
curvilinear or zig-zag paths scribed as the sagittal condylar movements (Figs 6 and 7).
Furthermore, the tracings showed that no single sagittal condylar guidance angle can
be established, as illustrated in Figs 6 and 7.
 L. V. Christensen and J. C. G. Slabbert

(6) • (7)

4 Superior
1 Superior

HP ^^ ^ HP
Anterior Anterior
Fig. 6. Cineradiographic demonstration of discrepancy between sagittal condylar guidance angles
created by tracings of the posterior bony surface of articular tubercle and the path of movement of
mandibular condyle. HP: horizontal plane.
Fig. 7. Cineradiographic demonstration of several sagittal condylar guidance angles relative to
horizontal plane (HP).

Other investigators bave studied tbe free sagittal movements of the mandibular
condyles by means of cineradiography, and it appears tbat these movements are
neither curvilinear nor rectilinear, but of the zig-zag type illustrated in Fig. 7, and
during mandibular depression the path scribed as the sagittal condylar movement
differs widely from tbat scribed during mandibular elevation, and this difference
becomes more pronounced when tbe experimental subject is placed in a posteriorly
inclined position (Berry & Hofmann, 1959; Mattila, 1967; McLeran et al., 1967).
However, tbe latter phenomenon may be an artefact inherent in tbe radiographic
technique (Saxby & Franks, 1976).
From the above it seems as if the sagittal condylar guidance, traced by means of
radiographs of static positions ofthe temporomandibular joint, does not fully coincide
with the guidance traced more naturally by means of cineradiograpby. Also, it follows
that if we wish to speak of a sagittal condylar guidance, tben we cannot speak of a
single straight patb, but of a multidirectional path, consisting of several short paths
that have highly variable directions. Further, because it is determined by a variety of
factors the sagittal condylar guidance angle is not a single and well defined angle, but
a number of highly variable angles might be said to exist.

Concluding remarks
Occasionally, it is argued tbat a rigid mechanical formula for balanced articulation,
encompassing the concept ofthe sagittal condylar guidance, is valid for the adjustable
articulator. Consequently, a sagittal condylar guidance must be recorded clinically.
However, the argument is absurd since dental prostheses should not be fabricated for
an articulator, but for a living patient. Relative to tbe adjustable articulator it should
also be borne in mind tbat its use has pronounced limitations in tbe meaningful
fabrication of dental prostheses, because it cannot fully reproduce in vivo mandibular
movements (Shanaban & Leff, 1966; Weinberg, 1976). One may further ask which
sagittal condylar guidance angle should be chosen, and if one is chosen whether there
is any need for it since articulatory contacts occur normally only when tbe mandibular
teeth are in their final phase of approaching tbe maximal intercuspal position during
mastication (Moller, 1973). Tbat is, in modern man balanced articulation occurs only
for a very short distance of a millimetre or so.
The present discussion has cast doubt on the existence of tbe clinically consistent
 Sagittal condylar guidance 1

and reproducible sagittal condylar guidance, frequently referred to and described in

various texts on clinical dentistry. Consequently, the following question may be asked:
is it possible and necessary to record clinically a sagittal condylar guidance ? The answer
seems to be negative, which again is consistent with the opinion expressed by Agerberg
& Carlsson (1969).

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Manuscript accepted 25 October 1976