Correlation between facial morphology,mouth opening ability,and condylar movement during opening-closing jaw movements in female adults with normal occlusion

The aim of this study was to investigate the relationship between parameters of facial morphology, maximal voluntary mouth opening ability, and condylar movements in 21 adult females, aged between 20 and 24 years. The subjects had a normal occlusion without sign or symptoms of temporomandibular joint (TMJ) dysfunction. Mandibular movements were recorded using an opto-electric jaw movement recording system with six degrees of freedom under a series of maximal mouth opening-closing movements. Maximal jaw opening and coincident condylar movement were measured three-dimensionally. The mean values of the incisor and condylar path were 41.1 +/- 3.5 mm (range 35.6-50.9 mm) and 12.8 +/- 2.8 mm (range 8.1-19.2 mm), respectively. Although the positive correlation between maximal jaw opening and facial morphology was significant, none of the variables significantly differed between the value of the condylar path and facial morphology. The length of the path of maximum incisor movement and the condylar path during mandibular movement also did not correlate. Stepwise multiple regression analysis indicated a positive association between the maximal length of the incisor path and the cephalometric value of mandibular ramus inclination (R2 value was 0.369). The results of this study suggest that facial morphology size has a limited effect on maximal voluntary mandibular opening and condylar movements in normal adult female subjects.     

联合动态MRI和下颌运动轨迹描记仪分析健康人开闭口时下颌运动轨迹特征

目的：结合动态MRl分析健康人开闭口时下颌运动轨迹特征。方法：18例健康人最大开闭口过程进行动态MRI和下颌运动轨迹描记仪检查，分析髁状突及下颌前牙切点的运动特点及范围。结果：动态MRI显示闭口位关节盘本体部呈双凹形，本体部位于髁状突横嵴的前方（盘分界角〈10。）。健康人下颁前牙切点运动轨迹平滑，双侧运动中心运动轨迹左右对称；运动轴始终保持平行，呈现开闭口初、末时密度比开闭口中时大；运动中心运动距离（13．2±3．1）mm，切点运动距离（41．1±3．8）mm。结论：下颌运动轨迹描记能记录髁状突运动轨迹并且间接反映颞下颌关节的关节盘在开闭口运动中的位置变化情况，为初步建立下颌运动轨迹描记对辅助诊断关节病的参考标准奠定了基础。     

髁突运动中心大张口轨迹与关节窝形态的关系及临床应用探讨

目的　探讨髁突运动中心大张口轨迹与关节窝形态的关系 ,对TMD患者髁突运动中心轨迹特征进行初步研究。方法　利用自行开发的髁突运动中心轨迹显示分析系统 ,分别以运动中心、终末绞链轴点作为参考点 ,观察 10名健康人和 7例临床检查怀疑盘前移位的TMD患者大张口轨迹 ,与磁共振成像得到的相应关节窝形态及关节盘位置诊断结果进行比较。结果　健康人左右侧运动中心轨迹与关节窝形态曲线重合率分别为 80 % (8/ 10 )和 90 % (9/ 10 ) ;终末绞链轴点轨迹与关节窝形态重合率均为 0 (0 / 10 )。TMD患者中 ,11侧盘前移位关节 ,除 1侧可复性盘前移位关节外 ,髁突运动中心轨迹均与正常的轨迹明显不同 ,出现各种改变 ;3侧正常盘位关节 ,髁突运动中心轨迹均与健康人的轨迹相似。结论　运动中心轨迹较终末绞链轴点个体稳定 ,可认为是较理想的研究髁突运动轨迹的参考点     

Associations between incisor and mandibular condylar movements during maximum mouth opening in humans

This study evaluated the common clinical assumption that condylar translation and mouth opening at the incisor are closely related. The sample studied comprised 27 adult females (23-35 years), selected for normal temporomandibular function, occlusion, and skeletal patterns. Condylar and mandibular central incisor movements (straight-line distances and curvilinear pathways) were recorded in three dimensions (3D) for 20 s with an optoelectric (Optotrak(R)) jaw-tracking system while each participant performed multiple maximum opening cycles. Masticatory analysis and multilevel statistical programs computed the 3D movements of the incisors and condylar hinge axis during opening and closing. The incisor point moved an average straight-line distance of 46.6 mm during opening and 45.9 mm during closing; the lengths of the opening and closing curvilinear pathways were 48.6 and 47.7 mm, respectively. The condyles moved average straight-line distances of 11.9 and 12.2 mm during opening and closing, respectively. The condyles' curvilinear pathways during opening and closing were 14 and 14.6 mm, respectively. Ranges of condylar movement varied widely between individuals. The straight-line distances and curvilinear pathways were highly correlated for the incisors (R=0.98) and the condyles (R=0.98). Neither the straight-line distances nor curvilinear pathways of the incisors were correlated with those of the condyles. Incisor straight-line distances and curvilinear pathways were moderately correlated with mandibular rotation (R(between subjects)=0.82 and R(between repeats)=0.88). During repeated openings, both condylar and incisor excursions increased, but during repeated closings only incisor excursions increased. It is concluded that (1) maximum incisor opening does not provide reliable information about condylar translation and its use as a diagnostic indicator of condylar movement should be limited, (2) healthy individuals may perform normal opening with highly variable amounts of condylar translation, (3) the straight-line distances of the incisor and condyles provide adequate information about the length of the curvilinear pathway, and (4) variation in maximum incisor opening is largely explained by variation in the amount of mandibular rotation.     

Influence of choice of reference point on the condylar movement paths during mandibular movements

summary Series of four open-close, protrusive and lateral movements were recorded by the six degrees of freedom jaw movement recording system OKAS- 3D in 20 healthy subjects. Consequently the movement paths of nine condylar points, the palpated lateral pole and eight points located on a square parallel to the sagittal plane with an edge of 10 mm and centred around the lateral pole were calculated. For all movements except the protrusive movements, the 3-D excursions of the condylar points strongly depended upon the choice condylar reference point (ANOVA, P < 0 001). During laterotrusive movements the Bennett angle and the Bennett shift also varied significantly according the position of the reference point (ANOVA, P < 0 001). The results of this study underline that comparison of condylar movements between different studies only possible when the same condylar reference point is used. General consensus on the choice condylar reference point is thus needed.     

The intra-articular distance within the TMJ during free and loaded closing movements

Previous studies on free opening and closing movements of the mandible have demonstrated that the opening movement traces of the condylar kinematic center (i.e., the condylar point for which the protrusive and the opening movement traces coincide) lie closer to the articular eminence than the closing traces. This indicates the presence of an intra-articular distance within the joint during free closing. Since the mandible behaves like a class III biomechanical lever, a counteracting mechanical load on the mandible during closing will press the condyle-disc complex against the articular eminence. Therefore, in this study the hypothesis was tested that the difference between opening and closing movement traces of the kinematic center is reduced when the closing movements are counteracted by a mechanical load. From 10 healthy participants, 20-second movement recordings were obtained by a six-degrees-of-freedom opto-electronic jaw movement recording system (OKAS-3D) for three types of movements: (1) free opening and closing movements, (2) free opening and loaded closing movements (i.e., the participants closed against a small or high manually applied downward-directed force to the chin), and (3) gum chewing. Off-line, the opening and closing movement traces of the kinematic center were reconstructed, and the average difference between the traces (the intra-articular distance) was calculated. The average intraarticular distance was significantly smaller during loaded closing than during free closing, whereas no significant differences were found in the intra-articular distances between the loaded situations of low and high manual loading and contralateral chewing (ANOVA and post hoc Bonferroni multiple comparisons of means test, p<0.005). In conclusion, loading of the mandible during closing movements reduces the intra-articular distance within the temporomandibular joint.     

A comparison and validation of amorphous sensor condylar movement analysis to MRI diagnosis of anterior disc displacement

This study compared temporomandibular joint condylar movements in a sample of six patients with clinically normal joints, with those of nine patients with joints diagnosed by magnetic resonance imaging (MRI) to have anterior disc displacement with reduction (ADD). The aim of this study was to compare and validate the use of the amorphous sensor to MRI diagnosis in condylar movement analysis. The measuring device consisted of an amorphous sensor and a small magnet. Condylar and jaw movements were recorded simultaneously over the course of 10 open-close cycles. Maximum velocity of condylar movement during the opening phase in the ADD joints was significantly higher than the normal joints. The degree of jaw opening at the turning point of condylar movement in the ADD joints was significantly larger than the normal joints. The diagnostic sensitivity and specificity of the maximum velocity of condylar movement during the opening phase was 75.0 and 75.0%, respectively, while those of the degree of jaw opening at the turning point of condylar movement were 91.7 and 91.7%, respectively. These results suggest that the analysis of condylar movement, employing the amorphous sensor may be a reliable method for diagnosis of ADD.     

Condylar movement analysis in subjects with clinically normal temporomandibular joints,utilizing an amorphous sensor

The purpose of this study was to determine the range of condylar movements in normal subjects, by the use of an amorphous sensor. The pair-matched sample consisted of 17 Caucasian males (aged 25.8 +/- 2.5 years) and 17 Caucasian females (aged 25.5 +/- 2.8 years) who had no subjective or objective symptoms related to temporomandibular joint (TMJ) sounds. Bilateral condylar and jaw movements were recorded simultaneously. The results showed that the typical condylar movement points plotted on the X-Y coordinates indicated a uniform or approximately straight line, that is X = Y. The mean +/- standard deviation (s.d.) for the maximum velocity of condylar movement during the opening and closing phases was 32.6 +/- 16.9 and 39.8 +/- 21.5 mm s-1, respectively. The mean +/- s.d. for the degree of jaw opening at the turning point of condylar movement was 36.9 +/- 21.7%. Significant correlations existed between any two measurements of maximum velocity of condylar movement. Moreover, significant correlations existed between the left and right sides in the degree of jaw opening at the turning point of condylar movement. These results suggest that a range of normal values of condylar movements can be developed when utilizing the amorphous sensor method.     

Development of an experimental optoelectronic device to study the amplitude of mandibular movements

This study aimed to present a wireless mandibular motion tracking device and optoelectronic data acquisition system developed to analyze the real-time spatial motion of the entire mandible during mouth opening and closing with no restriction of any movement. The procedures were divided into three phases: confection of a kinematic arch, dynamic digital video image acquisition, and image processing and analysis by using graphic computation. Four sequences of jaw opening/closing movements were recorded in lateral view: two from the maximum intercuspation (MIC) and the other two from a forced mandibular retruded position. Jaw motion was recorded by a digital video camera and processed as spatial coordinates corresponding to the position variation of the markers in the kinematic arch. The results showed that the method was capable of recording and processing the dynamics of the mandibular movements during jaw opening/closing using pixel-magnitude points. The mandible showed points with less displacement located near the temporomandibular joint during the opening/closing movements from the mandibular retruded position. When the jaw movements were recorded from MIC, these points were located near the mandibular foramen.     

Sex differences in mandibular movements during opening and closing.

This study evaluated the sex differences in maximum 3-dimensional opening and closing movements. The sample included 29 men (ages, 23-39 years) and 27 women (ages, 23-35 years), who were selected for normal Class I occlusion, temporomandibular function, and skeletal patterns. Condylar (hinge axis) translation and mandibular incisor movements, were recorded with an optoelectric jaw-tracking system; each participant performed 4 maximum opening/closing cycles. The results showed significant (P <.05) sex differences for incisor opening and closing movements, with most of the differences in the vertical component. Male incisor straight-line distances and curvilinear pathways averaged 52.1 mm and 54.8 mm, respectively. Female straight-line distances and curvilinear pathways averaged 46.0 mm and 48.1 mm, respectively. There were significant (P <.05) sex differences for condylar translation, with most of the differences in the anteroposterior component. Male condyles translated 15.4 to 17.6 mm (straight-line distances) and 20.5 to 20.7 mm (curvilinear pathways); female condyles translated 12.4 to 12.7 mm (straight-line distances) and 16.2 to 17.9 mm (curvilinear pathways). Mandibular length accounted for some of the sex difference in interincisal opening and for most of the sex differences in condylar translation. Closing movements showed the same pattern of sex differences as opening movements. Mandibular opening rotation was approximately 4 degrees larger in men than in women. The shapes of the condylar opening and closing pathways also differed significantly between men and women. For both sexes, condylar translation did not correlate with incisor opening or closing movements. It was concluded that (1) significant sex differences exist in incisor opening movements that are independent of mandibular size, (2) sex differences in condylar translation are dependent on mandibular size, (3) incisor opening movements should not be used as an indicator of condylar translation, and (4) sex differences in the shapes of the condylar pathways indicate sex differences in articular eminence morphologic features.     

Nonsurgical Treatment of Anterior Disk Displacement Without Reduction of the Temporomandibular Joint: A Case Report on the Relationship between Condylar Rotation and Translation

Farrar reported that in chronic anterior disk displacement without reduction (ADD w/o R) of the temporomandibular joint (TMJ), the range of mandibular movement gradually increases and the condylar movement normal-disk is still displaced anteriorly. The relationship between condylar rotation and translation was studied in opening/closing jaw movements before and after joint stabilization splint therapy in a patient with ADD w/o R. Movements were recorded by means of an optoelectronic jaw tracking system (Metropoly, Jaws-3D) consisting of three cameras that register the position of six light-emitting diodes (LEDs) mounted on two target frames separately attached to the upper and lower jaw. A computer produced plots of the condylar paths in the sagittal, frontal, and horizontal plane, as well as the opening angle against the anterior condylar translation. Results indicated some variations in the relationship between condylar rotation and translation during jaw opening movement. In the joint with ADD w/o R an increase in anterior condylar translation was found and the relationship between rotation and translation became more linear after joint stabilization therapy. This study supported a hypothesis of Farrar's that condylar movement in chronic ADD w/o R is similar to that expected in asymptomatic TMJs.     

健康人髁突运动中心前伸和大张口轨迹特征的研究

目的 探讨髁突参考点选择不同对髁突运动轨迹形态的影响。方法 利用自行开发的髁突运动中心轨迹显示分析系统，分别以运动中心，终末绞链轴点作为参考点，研究30名健康人下颌前伸和大张口时髁突运动的矢状面轨迹。结果 运动中心位于终末绞链轴点的前上方，二者轨迹不同。健康人的髁突运动中心大张口迹轨，为一斜向前下方的平滑曲线，形态稳定，没有轨迹异常特征出现且左右侧对称，大张口运动轨迹起止点连线距离与前伸运动轨迹起止点连线距离的比值大于1．5。而终末绞链轴点大张口轨迹左右侧不对称，形态不稳定，会出现不规则形状，大张口运动轨起止点连线距离与前伸运动轨迹起止点连线距离的比值较小。结论 对于同一健康个体，运动中心轨迹较终末绞链轴点轨迹更恒定。     

Concomitant mandibular and head-neck movementsduring jaw opening–closing in man

To test the hypothesis of a functional relationship between the human mandibular and cranio-cervical motor systems, head-neck movements during voluntary mandibular movements were studied in 10 healthy young adults, using a wireless optoelectronic system for three-dimensional (3D) movement recording. The subjects, unaware of the underlying aim of the study, were instructed to perform maximal jaw opening–closing tasks at fast and slow speed. Movements were quantified as 3D movement amplitudes. A consistent finding in all subjects was parallel and coordinated head-neck movements during both fast and slow jaw opening–closing tasks. Jaw opening was always accompanied by head-neck extension and jaw closing by head-neck flexion. Combined movement and electromyographic recordings showed concomitant neck muscle activity during head-neck movements, indicative of an active repositioning of the head. No differences in 3D movement amplitudes could be seen with respect to speed. The head movement was 50% of the mandibular movement during jaw opening, but significantly smaller (30–40%), during the jaw closing phase. In repeated tests, the 3D movement amplitudes of the concomitant head movements were less variable during slow jaw movement and during the jaw opening phase, than during fast and jaw closing movements, suggesting speed- and phase-related differences in the mechanisms controlling the integrated mandibular and head-neck motor acts. The present results give further support to the concept of a functional trigemino-cervical coupling during jaw activities in man.     

Rotational head motion concurrent to rhythmical mandibular opening movements

We have previously demonstrated the existence of a functional-rhythmical coupling between the head and the mandible using maxillary and mandibular incisal tracking points. However, that data did not provide information neither on the movement of the head as a whole nor on the location of its instantaneous centre of rotation. Thus, the objective of the present study was to determine whether the head undergoes a rotational motion during mouth opening and to locate its putative instantaneous centre of rotation. The same 6 d.f. (degree of freedom) measuring device employed in our previous studies was used again to analyse data from five male adults (age range: 26-29 years old) chosen as subjects. Concomitant head and mandibular movements were assessed in the sagittal plane by allocating several reference points in the head (upper incisor, cranial base, occipital and parietal points) and a mandibular incisor point during maximal mouth open-close movements. Then, the magnitude and inclination of the vectors of motion in each reference point during the opening phase were calculated. The instantaneous centre of rotation was defined as the point showing the least amount of motion in a determined area around each head reference point. The mandibular incisal point and the maxillary incisal point showed concomitant movements; that is, during opening the mandibular point moved downwards and the maxillary incisor point upwards. Making a large jaw opening movement caused an inferior-anterior displacement in the O point, a posterior-inferior displacement of the P point, and an anterior-superior displacement in the C point in all subjects. During jaw closing all points followed a trajectory opposite to that described above. In other words, during opening the head moved clockwise and counter-clockwise during closing, at least in the sagittal plane of the subjects' left side. These results suggest that the head undergoes a rotation-like sagittal movement during mouth opening whose rotation centre seems to be located above the cranial base point, which was set close to the centre of mass of the head. However, its location varies according to the magnitude of mouth opening.     

Three‐dimensional analysis of jaw kinematic alterations in patients with chronic TMD – disc displacement with reduction

The study investigated whether chronic TMD patients with disc displacement with reduction (DDR), performing non‐assisted maximum jaw movements, presented any changes in their mandibular kinematics with respect to an age‐matched control group. Moreover, it was examined whether jaw kinematics and a valid clinic measure of oro‐facial functional status have significant associations. Maximum mouth opening, mandible protrusion and bilateral laterotrusions were performed by 20 patients (18 women, 2 men; age, 18–34 years) and 20 healthy controls (17 women, 3 men; age, 20–31 years). The three‐dimensional coordinates of their mandibular interincisor and condylar reference points were recorded by means of an optoelectronic motion analyser and were used to quantitatively assess their range of motion, velocity, symmetry and synchrony. Three functional indices (opening–closing, mandibular rototranslation, laterotrusion – right and left – and protrusion) were devised to summarise subject's overall performance, and their correlation with the outcome of a clinical protocol, the oro‐facial myofunctional evaluation with scores (OMES), was investigated. TMD patients were able to reach maximum excursions of jaw movements comparable to healthy subjects’ performances. However, their opening and closing mandibular movements were characterised by remarkable asynchrony of condylar translation. They had also reduced jaw closing velocity and asymmetric laterotrusions. The functional indices proved to well summarise the global condition of jaw kinematics, highlighting the presence of alterations in TMD‐DDR patients, and were linearly correlated with the oro‐facial functional status. The jaw kinematic alterations seem to reflect both oro‐facial motor behaviour adaptation and a DDR‐related articular impairment.     

Trajectories of condylar points during nonworking side and protrusive movements of the mandible.

STATEMENT OF PROBLEM: During lateral excursive and protrusive jaw movements, condylar points are distant from any instantaneous rotational center. Therefore, it is likely that different condylar points would follow similar trajectories during these movements. PURPOSE: This study evaluated the effect of changes in condylar point location on trajectories of condylar points on the nonworking side and during a protrusive jaw movement and compared these changes with the effects described for open-close and working-side condylar movements in the same group of subjects. METHODS: The movements of 5 clinically determined condylar points were recorded in 44 subjects during a contralateral excursion and during protrusion (7 radiographically determined condylar points in 2 subjects). RESULTS: During any single jaw movement, the trajectory of each condylar point was similar in form and dimension to the other condylar points within that subject. CONCLUSION: Changes in condylar point location had little effect on the trajectories of condylar points on the nonworking side and during protrusive jaw movement.     

Influence of tooth contacts during mandibular retrusion on terminal jaw relations and EMG activity during habitual opening and closing movements]

The purpose of this study was to clarify the influence of tooth contacts during mandibular retrusion on terminal jaw relations (TJR) and the surface EMG activity during habitual opening and closing movements. The age of five healthy subjects were 25 to 28 years. The maxillary stabilization splints with steep retrusive contacts (S-SP) and with flat retrusive contacts (F-SP) were prepared for each subject who was instructed to wear S-SP for one week and then to wear F-SP for one week after an interval of two weeks without S-SP. The EMG activity of the masseter and temporal muscles and the TJR during habitual opening and closing movements using a device for recording jaw movements in 6 degrees of freedom were simultaneously measured by an intraoral central bearing device. The results were as follows: 1. The TJR recorded after wearing F-SP shifted more posteriorly than that of wearing S-SP. 2. The posterior temporal muscle activity after wearing F-SP, compared with that of wearing S-SP, resulted in a significant increase. In conclusion, the elimination of the retrusive guidance caused the predominance of posterior temporal muscle activity, and posterior displacement of the mandible.     

Masticatory muscles. Part VI. Masticatory muscles and movement of the lower jaw

The movement paths of the kinematic center of the temporomandibular joint were recorded by means of a jaw movement recording system (OKAS-3D) under 3 conditions: 1. free open and close movements; 2. free opening and loaded closing movements (subjects closed against a small, manually applied, downward directed force on the chin); and 3. during chewing of chewing gum. During free jaw movements, the opening path of the kinematic center lies above the closing path. During loaded closing movements, the opening and closing paths coincide. This indicates that during opening and loaded closing, the condyle-disc complex is slightly pressed against the articular eminence. However, during free closing, there is more space between the articulating surfaces. During gum chewing, the opening and closing paths of the condyle coincide on the balancing side, on the working side they don't. Thus, the joint on the balancing side is loaded and the joint on the working side is not.     

Does induced masseter muscle pain affect integrated jaw–neck movements similarly in men and women?

Normal jaw opening–closing involves simultaneous jaw and head–neck movements. We previously showed that, in men, integrated jaw–neck movements during jaw function are altered by induced masseter muscle pain. The aim of this study was to investigate possible sex‐related differences in integrated jaw–neck movements following experimental masseter muscle pain. We evaluated head–neck and jaw movements in 22 healthy women and 16 healthy men in a jaw opening–closing task. The participants performed one control trial and one trial with masseter muscle pain induced by injection of hypertonic saline. Jaw and head movements were registered using a three‐dimensional optoelectronic recording system. There were no significant sex‐related differences in jaw and head movement amplitudes. Head movement amplitudes were significantly greater in the pain trials for both men and women. The proportional involvement of the neck motor system during jaw movements increased in pain trials for 13 of 16 men and for 18 of 22 women. Thus, acute pain may alter integrated jaw–neck movements, although, given the similarities between men and women, this interaction between acute pain and motor behaviour does not explain sex differences in musculoskeletal pain in the jaw and neck regions.