Abstract
In the rehabilitation of a patient with loss of vertical dimension, repositioning of the condyle may be crucial to avoid loading on the retrodiscal area of the temporomandibular joint (TMJ). However, establishing a new position of the condyle within the glenoid cavity is not a simple procedure, and several indications exist in the literature. Digital techniques and 3D visualization using cone beam computed tomography (CBCT) can help. In this clinical case, the procedure for the repositioning of the condyle is described on the basis of the restoration of the normal widths of the intra-articular spaces using a recently introduced software (Avantis3D). After the end of the rehabilitation with the splint, a second examination confirmed the accuracy of the repositioning with this full digital procedure which represents, in selected cases, a useful choice.
Highlights
The position of the mandibular condyle in the glenoid fossa is of great practical importance in dentistry, since many researchers consider it to be the main criterion for projecting prosthetics or orthodontic rehabilitations
There are various opinions upon the correct position of the condyle in the space of the articular fossa: several authors believe that the heads should be centered on the glenoid fossa [1]; others individuate it in a forward position, close to the articular tubercle [2,3]; some other researchers collocate condyles in the distal and upper position during their rehabilitation [4]
Condylar positional changes might be related to condylar shape alteration; for example, previous studies show that condyles with osteophyte formations are located significantly more antero-inferiorly in the glenoid fossa at interocclusal position than reference position [6]
Summary
The position of the mandibular condyle in the glenoid fossa is of great practical importance in dentistry, since many researchers consider it to be the main criterion for projecting prosthetics or orthodontic rehabilitations.There are various opinions upon the correct position of the condyle in the space of the articular fossa: several authors believe that the heads should be centered on the glenoid fossa [1]; others individuate it in a forward position, close to the articular tubercle [2,3]; some other researchers collocate condyles in the distal and upper position during their rehabilitation (reference position) [4]. The position of the mandibular condyle in the glenoid fossa is of great practical importance in dentistry, since many researchers consider it to be the main criterion for projecting prosthetics or orthodontic rehabilitations. Some researchers consider that the condyles can be located at any position, which is defined by normalization of masticatory muscle tone [5]. Condylar positional changes might be related to condylar shape alteration; for example, previous studies show that condyles with osteophyte formations are located significantly more antero-inferiorly in the glenoid fossa at interocclusal position than reference position [6]. It is reasonably believed that one of the causes of intra-articular pain is compression of the bilaminar zone caused by uncorrected position of condyles [7], and one of the manifestations of this condition is a radiologically-diagnosed decrease in the upper and posterior width of the joint space. From a therapeutic point of view, if joint space is increased, allowing smoother condylar translation beyond the disc surface, irregularities and positional abnormalities disappear [7]
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