Anterior condylar displacement: Its diagnosis and treatment

Abstract

A deflective slide in centric relation to centric occlusion does not necessarily mean anterior condylar displacement. Its diagnosis and treatment depend on the correlation of three factors: the direction and magnitude of the mandibular slide from centric relation to centric occlusion, the change in vertical dimension of occlusion during the slide, and the position of the condyles in the fossae when the teeth are in the maximum occlusion (centric occlusion). When the change in vertical dimension almost equals the amount of slide from the deflective contact in centric relation to maximum intercuspation, very little anterior condylar displacement would be expected. Conversely, with proportionately little change in vertical dimension, more anterior condylar translation is required for a given degree of anterior slide. Examples of each type of anterior slide were related to the TMJ radiographs of the condylar position. If the direction and magnitude of the deflective occlusal contact can be correlated with the TMJ radiographs, the centric relation is “functional,” and the clinically retruded mandibular position should be used. When this correlation does not exist, the centric relation is “dysfunctional,” and the terminal hinge position (retruded mandibular position) should not be used for restorative or corrective procedures. Examples of anterior condylar displacement were given, including lateral deviation, with a comparison of “before” and “after” TMJ radiographs.