To determine the position of condyle radiographically in the wax check bite stage, the Gothic arch tracing and post insertion of denture to decide the clinically comfortable position of condyle at the dentulous and edentulous state can be determined by radiographic means.
10 male patients from age group 45 to 65 years were selected. In order to standardize the intracranial radiograph of either side a modified radiographic head positioner was fabricated. For infracranial radiography, the patient was seated in the chair in the same position as that when the jaw relation was recorded. the relative position of condyle by radiographic means in different clinical stages i.e. in wax check bite record, Gothic arch tracing and post insertion of complete denture was recorded. Tracing of radiograph were obtained. And based on it study was concluded.
It showed that the position of condyles is posterior most in gothic arch tracing, anterior most in the wax check bite record the position of condyle was anterior to gothic arch tracing and posterior to tentative jaw relation after denture insertion.
Findings showed that there existed unequal joint space between the head of condyle and the glenoid fossa at various stages of denture.
Among the many concepts in denture construction which have been accepted by many professionals, the concept of the "Centric position" stands out as the vaguest and most ambiguous, Although certainly one of the most important. Recent research into Temporomandibular joint function suggest that a Re-evaluation of basic hypotheses indicated. Commonly accepted premises are taken and scientific facts because they are familiar and they produce empirically acceptable results. The position of the mandibular condyles in the glenoid fossae is an important factor for the success of prosthodontics treatment which may otherwise lead to temporomandibular joint disorders, myofascial pain dysfunction syndrome. while treating a complete edentulous patient we are supposed to establish the centric occlusion at the recorded centric relation. After recording the centric relation in wax check bite record or in Gothic arch tracing method, Comparatively the position of the condyle should be same.
According to
To find out the relative position of condyle by radiographic means in different clinical stages i.e. in wax check bite record, Gothic arch tracing and post insertion of complete denture.
Recording of clinical centric in wax check bite and its position of condyle.
Recording of clinical centric in Gothic arch tracing state and its position of condyle.
Recording of clinical centric after denture insertion and its position of condyle.
To check relative position of condyle at right and left side and its variation in wax check bite record, Gothic arch tracing and post denture insertion.
To standardize the accurate head position of patient and its relation to the X-ray machine by modified head positioner.
To evaluate the success rate at different Stages of denture preparation and after delivering the prosthesis after 7days of follow-up was determined.
The following study was carried out in Government Dental College and Hospital, Nagpur, in the department of prosthetic dentistry. The study was undertaken to determine the position of condyle at various methods of recording centric relation in wax check bite record and the Gothic arch tracing and its effects in complete denture fabrication by radiographic examination.
10 male patients from age group 45 to 65 years were selected amongst those visiting the department of prosthetic dentistry. Such completely edentulous patients were examined thoroughly. Priority to the healthy oral conditions were given. Conditions such as healthy alveolar ridges, non-flabby tissues, normal TMJ movements, normal ridge relationship, patient’s economic status, General Health were taken into consideration.
A thorough clinical examination of the oral cavity and extra oral structures was carried out. A detailed history was obtained by direct questioning and patients consent was taken.
In order to standardize the infracranial radiograph of either side a modified radiographic head positioner was fabricated. It was similar to that of
1. The horizontal bar to adjust the distance of cone and film.
2. The vertical arm for holding the X-ray cone.
3. The vertical arm for holding the cassette of radiographic film.
It consists of two rods; one embedded into another which has a sliding mechanism. Also it consists of a measuring scale and a thumb screw to tighten the sliding rod. Measuring scale is so fixed that the zero coincides with one end of the sliding bar.
The cone is fabricated in clear methyl methacrylate resin in which the X-ray cone fits. It is mounted on an acrylic ring that has a taper and rotates around an axis to adjust the horizontal angulation with the help of screw.
The whole assembly can slide vertically downwards and upwards with the help of the thumb screw to which again a pointer is attached for recording the readings. To measure the horizontal angulation a protractor is fixed with a pointer attached to the ring.
It consists of a "U" shaped cassette holding device made up of clear acrylic resin at the lower end. The whole cassette holding device can slide with the help of thumb screw to which again a pointer is attached to mark the readings.
For the Infracranial projection, an X-ray film cassette is positioned against the side of the patients Head, parallel to the sagittal plane, next to the TMJ of interest. The X-ray tube head is placed on the side of the skull opposite the TMJ to be imaged. It is angulated so that the control beam is directed cranially 5 to 10 degrees and approximately 10 degrees posteriorly. This position ideally directs the central x-ray beam through the tube side mandibular sigmoid notch, below the base of the skull, through the oropharynx and finally through the film.
For infracranial radiography, the patient was seated in the chair in the same position as that when the jaw relation was recorded. The radiographic head positioner was positioned in such way that the horizontal bar was touching the patient's head. The cassette for radiographic size of 6"× 8" was placed in the "U" shape cassette holding device and x-ray cone was placed in such a way that it fixed snugly in the cone of same size and shape of the radiographic head positioner.
After thorough clinical evaluation and detailed case history, complete denture for each patient was fabricated in balanced occlusion following each step meticulously. Initially the primary impression in compound (Y-dents) was made. Primary Casts were obtained in plaster of Paris and special trays in tray material were made. Final impression was recorded by establishing the peripheral seal in low fusing compound (Aslate) and wash impression in zinc oxide eugenol paste for (polynol). After preparation of the final cast, permanent record bases of heat curing polymethylmethacrylate resin (stellon) were made by slow curing cycle. Jaw relation was recorded by the wax check bite record. After this the infracranial radiograph of either side of TMJ as described in the technique was taken in the department of oral diagnosis, medicine and radiology of government Dental College and Hospital, Nagpur. After the radiograph, face bow record and transfer was done and extraoral Gothic arch tracing were made. Intraoral plaster records were made in centric relation and protrusive position after which again radiographs of either side were taken. Patients dentures were selected and arranged in balanced occlusion after try-in, the dentures were fabricated and delivered. patients were asked to take care regarding the oral hygiene and cleanliness of dentures. After 7 days when patient was adapted to dentures, again radiographs of either side were Taken with the same readings on scale with dentures in centric occlusion in patient's oral cavity.
The radiograph was checked for the quality and clearance. The external auditory meatus, the glenoid fossa and the head of the condyle was traced with a microtip pen of black colour directly on the X-ray by keeping it on the X-ray viewer. All the tracings were then transferred on the graph papers with the help of carbon paper.
As described by
Centric relation is a classical reference and treatment position in complete denture Prosthesis. It has been defined in so many different ways that its creditability for the clinician is questionable. According to glossary of prosthodontics term, "centric relation is defined as the maxillomandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective disks with the complex in the anterosuperior position against the slopes of the articular eminences. This position is independent of tooth contact. This position is clinically discernible when the mandible is added directed superiorly and anteriorly. It is restricted to a purely rotary movement about the transverse horizontal axis". The present study had tried to find out the amount of displacement in condylar position in relation to various methods of Jaw relation record by TMJ radiographs. Radiographs of either side of TMJ were made to check for the position of condyle at three different stages.
Wax check bite record.
Gothic arch tracing and
Post denture insertion
The relative position of condyle was assessed by measuring the spatial difference between the glenoid fossa and the head of the condyle. The present study has shown no significant difference in the supero inferior position of condyle. The second point is that the circumcondylar joint spaces do not appear to have been of equal in size radiographically. This finding was in agreement with the finding of
In the present study, a significant change in the position of condyle was found in different methods of recording centric relation. The position of condyle in wax check bite record was found to be anterior than the position of condyle in Gothic arch tracing method, also there was a significant change in the position of condyle after the denture insertion. The position of condyle after 7 days of recall after denture delivery was found to be anterior to the position of condyle in Gothic arch tracing but the position was not as anterior as the position in the wax check bite record.
Although the literature Bounds with many studies done on the temporomandibular joint and related structures, no attempts have been made to study the position of condyle at various stages of denture fabrication and to find the change in relative position of condyles radiographically. From the present study, we can state that the Gothic arch tracing method is superior over the wax check bite record method as the position of condyle lies nearer to the Gothic arch tracing method after denture insertion.
Since the TMJ radiographs serve as an important aid in diagnosis and treatment planning, in prosthodontics, in the planning of complete denture treatment, it is essential to determine the position of condyle after recording the centric relation. This can be considered for the future reference while treating the patient by new centric relation. Hence the TMJ radiographs aid us to determine the position of condyle in the centre relation. It is to be noted that there were few limitations in the study. Since the position of condyle is an area, a three dimensional view is a necessary to assess its position.
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| 1. | S-S1 | 2 | 1.5 | 1.5 | 1 | 3 | 2 |
| P-P1 | 1 | 1 | 0.5 | 1.5 | 2 | 2.5 | |
| A-A1 | 2.5 | 1.5 | 2 | 2 | 1 | 0.5 | |
| 2. | S-S1 | 3 | 4 | 2.5 | 3 | 3 | 3 |
| P-P1 | 2.5 | 2 | 2 | 1.5 | 2 | 3 | |
| A-A1 | 1.5 | 1 | 2.5 | 2 | 2.5 | 0.5 | |
| 3. | S-S1 | 2 | 1.5 | 1 | 2 | 2 | 1.5 |
| P-P1 | 1.5 | 1 | 1 | 1 | 1.5 | 1 | |
| A-A1 | 0.5 | 0.5 | 2 | 2 | 1 | 2 | |
| 4. | S-S1 | 1.5 | 3 | 1 | 3 | 3 | 3 |
| P-P1 | 2 | 1.5 | 1 | 1 | 1 | 1 | |
| A-A1 | 4 | 4 | 3 | 3 | 3 | 4 | |
| 5. | S-S1 | 4 | 4 | 2 | 3 | 3 | 3 |
| P-P1 | 5 | 3 | 1 | 1.5 | 3 | 1.5 | |
| A-A1 | 2 | 1.5 | 0.5 | 2 | 1 | 1 | |
| 6. | S-S1 | 1.5 | 4 | 3 | 2 | 3 | 2 |
| P-P1 | 1 | 2 | 1 | 1.5 | 1 | 2 | |
| A-A1 | 1 | 0.5 | 1 | 1.5 | 2 | 2 | |
| 7. | S-S1 | 4 | 2 | 2 | 3 | 3 | 3 |
| P-P1 | 4 | 2 | 1 | 2 | 2 | 2 | |
| A-A1 | 2 | 2 | 3 | 1 | 1 | 1 | |
| 8. | S-S1 | 4 | 2 | 2 | 2 | 1 | 2 |
| P-P1 | 6 | 1 | 1 | 1 | 1 | 1 | |
| A-A1 | 1 | 2 | 2 | 2 | 1 | 1 | |
| 9. | S-S1 | 4 | 5 | 2 | 4 | 1 | 5 |
| P-P1 | 3 | 2 | 2 | 1.5 | 1 | 1 | |
| A-A1 | 2 | 1 | 1 | 1 | 1 | 1 | |
| 10. | S-S1 | 1 | 1.5 | 2 | 1 | 1 | 1 |
| P-P1 | 2 | 1.5 | 1.5 | 1 | 2 | 1.5 | |
| A-A1 | 4 | 5 | 2 | 4 | 4 | 2.5 | |
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| 1 | S-S1 | 0.5 | 0.5 | 1.5 | 1 | 1 | 0.5 |
| P-P1 | 0.5 | 0.5 | 0.5 | 1 | 1 | 1.5 | |
| A-A1 | 0.5 | 0.5 | 1 | 1.5 | 1.5 | 1 | |
| 2 | S-S1 | 0.5 | 1 | 0.5 | 0 | 0 | 1 |
| P-P1 | 0.5 | 0.5 | 0 | 1.5 | 0.5 | 1 | |
| A-A1 | 1 | 1 | 0 | 1.5 | 1 | 0.5 | |
| 3 | S-S1 | 1 | 0.5 | 1 | 0.5 | 0 | 0 |
| P-P1 | 0.5 | 0 | 0.5 | 0 | 0 | 0 | |
| A-A1 | 1.5 | 1.5 | 1 | 0 | 0.5 | 1.5 | |
| 4 | S-S1 | 0.5 | 0 | 2 | 0 | 1.5 | 0 |
| P-P1 | 1 | 0.5 | 0 | 0 | 1 | 0.5 | |
| A-A1 | 1 | 1 | 0 | 1 | 1 | 0 | |
| 5 | S-S1 | 2 | 1 | 1 | 0 | 1 | 1 |
| P-P1 | 4 | 1.5 | 2 | 0 | 2 | 1.5 | |
| A-A1 | 1.5 | 0.5 | 0.5 | 1 | 1 | 0.5 | |
| 6 | S-S1 | 1.5 | 2 | 0 | 0 | 1.5 | 2 |
| P-P1 | 0 | 0.5 | 0 | 0.5 | 0 | 0 | |
| A-A1 | 0 | 1 | 1 | 0.5 | 1 | 1.5 | |
| 7 | S-S1 | 2 | 1 | 1 | 0 | 1 | 1 |
| P-P1 | 3 | 0 | 1 | 0 | 2 | 0 | |
| A-A1 | 1 | 1 | 1 | 2 | 1 | 1 | |
| 8 | S-S1 | 2 | 0 | 1 | 0 | 3 | 0 |
| P-P1 | 5 | 0 | 0 | 0 | 5 | 0 | |
| A-A1 | 1 | 0 | 1 | 1 | 0 | 1 | |
| 9 | S-S1 | 2 | 1 | 1 | 1 | 3 | 0 |
| P-P1 | 1 | 0.5 | 1 | 0.5 | 2 | 1 | |
| A-A1 | 1 | 0 | 1 | 0 | 1 | 0 | |
| 10 | S-S1 | 1 | 0.5 | 1 | 0 | 0 | 0.5 |
| P-P1 | 0.5 | 0.5 | 0.5 | 0.5 | 0 | 0 | |
| A-A1 | 2 | 1 | 2 | 1.5 | 0 | 2.5 | |
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| TJR | GAT | DD | ||
| 1 | S-S1 | 0.5 | 0.5 | 1 |
| P-P1 | 0 | 0 | 0.5 | |
| A-A1 | 1 | 0 | 0.5 | |
| 2 | S-S1 | 1 | 0.5 | 0 |
| P-P1 | 0.5 | 0.5 | 1 | |
| A-A1 | 0.5 | 0.5 | 1 | |
| 3 | S-S1 | 0.5 | 0 | 0.5 |
| P-P1 | 0.5 | 0.5 | 0.5 | |
| A-A1 | 0 | 1 | 1 | |
| 4 | S-S1 | 1.5 | 0 | 0 |
| P-P1 | 0.5 | 0 | 1 | |
| A-A1 | 0 | 1 | 1 | |
| 5 | S-S1 | 0 | 1 | 0 |
| P-P1 | 2 | 0.5 | 1.5 | |
| A-A1 | 0.5 | 1.5 | 0 | |
| 6 | S-S1 | 2.5 | 1 | 1 |
| P-P1 | 1 | 0.5 | 1 | |
| A-A1 | 0.5 | 0.5 | 0 | |
| 7 | S-S1 | 2 | 2 | 0 |
| P-P1 | 2 | 2.5 | 0 | |
| A-A1 | 0 | 0.5 | 0 | |
| 8 | S-S1 | 2 | 0 | 1 |
| P-P1 | 5 | 0 | 0 | |
| A-A1 | 1 | 0 | 0 | |
| 9 | S-S1 | 1 | 2 | 4 |
| P-P1 | 1 | 0.5 | 0 | |
| A-A1 | 1 | 0 | 0 | |
| 10 | S-S1 | 0.5 | 1 | 0 |
| P-P1 | 0.5 | 0.5 | 0.5 | |
| A-A1 | 1 | 2 | 1.5 | |
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| S-S1 | 2.70 | 2.85 | 1.90 | 2.40 | 2.30 | 2.55 |
| P-P1 | 2.80 | 1.70 | 1.20 | 1.35 | 1.65 | 1.65 |
| A-A1 | 2.05 | 1.90 | 1.90 | 2.05 | 1.70 | 1.55 |
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| S-S1 | 1.22 | 1.31 | 0.61 | 0.96 | 0.94 | 1.11 |
| P-P1 | 1.70 | 0.63 | 0.48 | 0.33 | 0.66 | 0.70 |
| A-A1 | 1.18 | 1.48 | 0.84 | 0.89 | 1.07 | 1.09 |
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| S-S1 | 0.80 | 0.45 | 0.40 | 0.15 | 0.40 | 0.30 |
| P-P1 | 1.60 | 0.35 | 0.45 | 0.30 | 1.15 | 0.05 |
| A-A1 | 0.15 | 0.20 | 1.20 | 0.50 | 0.35 | 0.35 |
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| S-S1 | 0.90 | 0.90 | 1.20 | 0.33 | 0.85 | 0.56 |
| P-P1 | 2.11 | 2.40 | 2.30 | 2.74 | 1.90 | 2.42 |
| A-A1 | 2.42 | 2.68 | 2.32 | 2.80 | 2.10 | 2.32 |
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| S-S1 | NS | NS | NS | NS | NS | NS |
| P-P1 | 0.05% | 0.03% | 0.02% | 0.01% | 0.07% | 0.05% |
| A-A1 | 0.03% | 0.02% | 0.02% | 0.02% | 0.05% | 0.05% |
Fig .15.Radiograph of right side condyle after Gothic arch tracing.
Fig. 16.Radiograph of left side of condyle after Gothic arch tracing
In the present study, the position of condyle was determined in wax check bite record, Gothic arch tracing and post insertion of denture by radiographic means. Ten edentulous male patients were selected for the purpose of study.
To find the significance between change in position of condyles, distance between points S-SI, P-PI and A-AI in wax check bite records, Gothic arch tracking and after denture insertion was subjected to statistical analysis.
The observation are of quantitative type and the sample size is 10 i.e. less than 30. So the test of significance applied
was unpaired student's ‘t’ test.
The formulae that were used are -
Degree of freedom = n1 + n2-2
Probability Value = To be calculated from the’t’ table.
t =
Table No.8.Shows the significance of each vale in percentage.
The S-S1 value of 't' test in all the cases was insignificant i.e. no significant change in the superoinferior position of condyle from TJR to GAT, from GAT to DD and from TJR to DD at both the right and left side was observed.
The P-P1 values from TJR to GAT on the right side was significant by 0.05% and on left side by 0.03%. From GAT to DD stage the values were significant by 0.02% on the right side and 0.01% on the left side. From the TJR to DD stage, the value were significant by 0.07% on right side and 0.05% on the left side.
The A-A1 values from the TJR to GAT were significant 0.03% on the right side and 0.02% on the left side. From GAT to DD they were significant by 0.02% on both the sides. From TJR to DD the values were 0.05% on both the sides.
The bar diagram showing the mean values at the three stages, shows position of condyle in different positions at different stages and thus significantly changed,
The condyle does not change its position significantly superoinferiorly but changes significantly from TJR to GAT. At GAT it goes posteriorly. From GAT to DD it comes anterior to the position of condyle at GAT.
From TJR to DD, change is by 0.07% of the right side and by 0.05% on the left side was observed. This is greater than the change in position at TJR to GAT and GAT to DD.
It shows that the position of condyle is posterior most in gothic arch tracing, anterior most in the wax check bite record. The position of condyle was anterior to GAT and posterior to TJR after denture insertion.
In the study the TMJ radiographs were used for correlating the findings of the position of condyle at various stages. TMJ radiographs made using the head positioner provide a valuable adjunct to diagnosis and treatment planning in determining the position of condyle at centric relation and centric occlusion. Findings showed that there existed unequal joint space between the head of condyle and the glenoid fossa at various stages of denture.
Position of condyle in wax check bite record was found anterior to the position of condyle in Gothic arch tracing.
Position of condyle was found posterior after denture insertion so that the position of condyle in wax check bite record.
Position of condyle was anterior most in the wax check bite record and posterior most in the Gothic arch tracing.
The position of condyle after 7 days of recall was near to Gothic arch tracing.
Subjective evaluation was done by direct questioning to check for comfort and it was found comfortable after 7 days recall after denture delivery.
S- Superior reference point on the glenoid fossa.
S1- Superior point on the condyle
P - Posterior reference point on the condyle
P1- Posterior point on the condyle
A - Anterior reference point on the glenoid fossa.
A1- Anterior point on the condyle
TJR - Tentative jaw Relation
GAT- Gothic Arch Tracing
DD- Denture Delivary.
Derangements of the TMJ
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