Estudio piloto in vitro para determinar la precisión del ARCUSdigma en la determinación de posiciones condilares

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Abstract

En este trabajo pretendemos determinar la precisión, entendida como el grado de concordancia de las medidas entre si, de un pantógrafo electrónico (ARCUSdigma) en la determinación de dos posiciones condilares seleccionadas, sobre una muestra constituida por los modelos de siete pacientes montados en articulador semiajustable. Tras analizar los resultados obtenidos y teniendo en cuenta las limitaciones con que cuenta el estudio, podemos concluir que dicho instrumento presenta una alta precisión a la hora de realizar tales determinaciones.

Translated abstract

In this work we seek to determine the accuracy (it is the concordance of the measures) of an electronic pantograph (ARCUSdigma) to determine two condylar positions. We have a sample constituted by the models of seven patients mounted in a semiajustable articulator. In spite of the limitations of this study, the results indicate that the instrument has a high precision for these determinations.

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Most cited references 41

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Condylar axis position, as determined by the occlusion and measured by the CPI instrument, and signs and symptoms of temporomandibular dysfunction.

S D Crawford (1999)

The importance of occlusion as an etiologic factor in signs and symptoms of TMD has been a source of controversy. Very few studies have examined occlusion-dictated condylar position using instrumentation, and none has compared an ideal sample against an untreated control. The purpose of this study was to determine if there is a relationship between condylar axis position as determined by the occlusion and signs and symptoms of TMD, using the condylar position indicator (CPI). A sample of subjects with ideal occlusions, defined as centric relation approximating centric occlusion, was compared with a control sample of untreated subjects. The comparison was based on written patient histories, clinical exams, and CPI measurements. The ideal sample of 30 subjects was selected from a population that had undergone full-mouth reconstruction using gnathologic principles that included centric relation (CR) being coincident with centric occlusion (CO). The control group consisted of 30 untreated subjects from the general population and was matched with the ideal sample with regard to sex. A duplicate written exam was given to the subjects in the ideal sample to assess symptoms prior to treatment. The CR bite registration technique developed by Roth was used. When the pre- and posttreatment examination scores of the ideal sample were compared, an 84% reduction in symptoms was found after treatment. A high correlation (p<.001) between signs and symptoms of TMD and CPI values was documented. Since condylar axis position is dictated upon closure of the dentition into maximum intercuspation and since condylar axis position was shown in this study to be strongly correlated with TMD symptomatology, it can be concluded that a statistically significant relationship exists between occlusion-dictated condylar position and symptoms of TMD.

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Mandibular condyle position: comparison of articulator mountings and magnetic resonance imaging.

Dayna Alexander, Richard Dubois, R. Moore (1993)

This study evaluated the reliability of jaw positions, the existence of distinct jaw positions, and condyle-disk-fossa relationships in a symptom-free population by using articulator mountings and magnetic resonance imaging (MRI). The subjects examined included 28 men, 22 to 35 years of age, all having Angle Class I molar relationships and no discernible TMJ dysfunction. Records taken included the following: an axiographic face-bow to locate retruded hinge axis position, an interocclusal registration of retruded position (RE), a series of interocclusal registrations for centric occlusion (CO), a leaf gauge-generated centric relation (CR), a series of interocclusal registrations for CR, and MRI. The mandibular position indicator of the SAM articulator (Great Lakes Orthodontics, Ltd., Tonawanda, N.Y.) was used to determine reliability and existence of distinct jaw positions. Magnetic resonance imaging also evaluated jaw positions and anatomic relationships. The results indicate: (1) The articulator analysis of CO and CR is statistically replicable. (2) A distinct jaw position could be demonstrated for CO that was separate from RE and CR. It was not possible to discriminate between RE and CR. (3) Condylar concentricity was observed in half of the sample and remained consistent in RE, CO, and CR. (4) Of the sample 13% demonstrated anteriorly displaced disks that were not influenced by posterior condyle placement. (5) The clinical concept of treating to CR as a preventive measure to improve disk-to-condyle relationships was not supported by this study.

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Three-dimensional analysis of models articulated in the seated condylar position from a deprogrammed asymptomatic population: a prospective study. Part 1.

Frank E Cordray (2006)

The seated condylar position (SCP), also known as centric relation (CR), is considered the most reliable and reproducible reference point for accurately recording the relationship of the mandible to the maxilla. Therefore, a determination of the SCP/CR is a prerequisite for the analyses of the dental interarch, condylar position, and skeletal relationships. The purpose of this prospective study was to statistically evaluate the 3-dimensional nature of dental interarch displacement and condylar displacement between the SCP/CR and maximum intercuspation or centric occlusion (MIC/CO). The records of 596 consecutive asymptomatic patients having routine orthodontic treatment in a private practice were used. The initial premature occlusal contact and 3-dimensional dental interarch displacement were measured by the analysis of models, mounted on an articulator (Panadent, Grand Terrrace, Calif) in the SCP/CR, by using the modified (nonmanipulated) 2-piece wax SCP/CR recording method with deprogramming. Three-dimensional condylar displacement was measured by analysis of the graphic registrations, produced by condylar position instrumentation, and evaluated for frequency, direction, and magnitude of displacement. The dental interarch discrepancy in the SCP/CR was significantly different from that observed in MIC/CO, with posterior premature contacts (94.0%), increased overjet, decreased overbite, midline differences, and Angle classification changes. A difference in condylar position between the SCP/CR and MIC/CO in at least 1 plane was detected for every asymptomatic patient and every condyle. The most prevalent types of directional change in condylar position were inferior (down) (97.0%) and distal (posterior) (66.7%) when the teeth were brought into MIC/CO. The mean difference in condylar position between the SCP/CR and MIC/CO was .86 mm in the horizontal plane, 1.80 mm in the vertical plane, and .26 mm in the transverse plane. No correlation was found between a patient's age or sex and the magnitude of condylar displacement. There is a significant difference in the occlusion when it is dictated by the teeth and when it is dictated by the condyles. This difference is quantifiable at both the occlusal and condylar levels.