SYSTEMATIC REVIEW

Clinical significance of immediate mandibular lateral

translation: A systematic review
Thomas D. Taylor, DDS, MSD,a Avinash S. Bidra, BDS, MS,b Elena Nazarova, DMD, PhD,c and
Jonathan P. Wiens, DDS, MSDd

Very little in the occlusion liter- ABSTRACT

ature has caused more discus- Statement of problem. Immediate mandibular lateral translation (IMLT) has been widely described
sion, argument, and confusion in theory, but its clinical significance in prosthodontics and restorative dentistry is not clear.
than the phenomenon of im-
Purpose. The purpose of this study was to systematically review the existing literature to identify
mediate mandibular lateral
the clinical significance of IMLT (immediate side shift).
translation (IMLT).1-23 Multiple
names have been used to Material and methods. An electronic search for articles in the English language literature was
describe this phenomenon: side performed independently by multiple investigators using a systematic search process with the
PubMed search engine. After applying predetermined inclusion and exclusion criteria, the final list
shift, immediate side shift,
of studies was analyzed to identify the clinical significance of IMLT.
Bennett shift, and Bennett side
shift.1-23 It has been written Results. The initial electronic search yielded 858 titles. The systematic application of the inclusion
and exclusion criteria eventually produced 23 studies addressing IMLT in 914 human participants.
about extensively, although
Eleven studies reported use of voluntary movements, 5 articles reported use of only induced
clinical research into the phe- movements, 2 studies reported use of both voluntary and induced movements, and 5 articles did
nomenon has been minimal. not report the recording method. The amount of IMLT reported ranged from 0 to 3 mm with
According to the glossary of minimal clarity among authors on the exact description of IMLT. No studies reported on any clinical
prosthodontics terms, IMLT has implication (harm or benefit to patients or clinicians) of incorporating IMLT in diagnosis and
been defined as “the translatory treatment planning.
portion of lateral movement in Conclusions. This systematic review did not identify any scientific evidence on the clinical impli-
which the nonworking side cations of IMLT. Furthermore, there is a lack of clear terminology related to IMLT and the timing of
condyle moves essentially the side shift, occurrence of IMLT on the working versus nonworking condyle, and induced versus
straight and medially as it leaves noninduced methods of recording and measuring. Current scientific evidence does not support the
the centric relation position.”24 need to include IMLT as a factor when prosthodontic or restorative treatment is planned and
executed. (J Prosthet Dent 2016;115:412-418)
Previous authors have argued
that it does not exist or that it is
of no clinical significance and may be ignored, while others manuscript, Dr Bennett described a study in which he
have argued that IMLT must be recorded and accounted for participated as the sole participant in an experimental
in the fabrication of all dental restorations.4,5 Evidence is demonstration of mandibular motion. The experiment
currently lacking as to the appropriate emphasis that should was performed by using 2 incandescent lightbulbs
be placed on IMLT and the manner of its recording. attached to a mandibular arch bow fastened to the
The history of IMLT dates back to a manuscript remaining mandibular teeth (Dr Bennett was missing
published by Dr Norman G. Bennett in 1908.25 In this his mandibular molars). His head was stabilized in a

a
Professor and Head, Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, Conn.
b
Program Director, Post-Graduate Prosthodontics, Department of Reconstructive Sciences, University of Connecticut Health Center, Department of Reconstructive
Sciences, Farmington, Conn.
c
Associate Professor, Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, Conn.
d
Private practice, West Bloomfield, Mich.

412 THE JOURNAL OF PROSTHETIC DENTISTRY

April 2016
Clinical Implications
When planning and executing prosthodontic or
restorative treatment, clinicians may ignore the
phenomenon of immediate mandibular lateral
translation.
mounted device to prohibit head movement, and the
images of the incandescent lights focused through a
magnifying glass onto the adjacent wall were traced in
both the sagittal and frontal planes. The emphasis of this
study was on examining the possibilities of single or
multiple centers of rotation of the mandible during
movements; the description of lateral mandibular trans-
lation was incidental to the topic of the paper. The
movement Bennett described may have been artifact or
an incorrect description of the phenomenon seen. Pre-
iskel2,3 noted that the phenomenon of mandibular lateral
translation had been described previously by Bell in 1833
and Balkwill in 1866, yet Bennett’s name has been
indelibly linked to it.
Mandibular translation has been defined as “the
translatory (medial-lateral) movement of the mandible
when viewed in the frontal plane. While this has not
been demonstrated to occur as an immediate horizontal
movement when viewed in the frontal plane, it could
theoretically occur in an essentially pure translatory form
in the early part of the motion or in combination with
rotation in the latter part of the motion or both.”24
Mandibular translation is comprised of immediate,
early, and progressive mandibular lateral translation.24
Thus, mandibular lateral translation has been shown to
change at varying points along the protrusive path,
although, by definition, lateral translation from any point
other than the centric relation position cannot be
considered immediate in nature.22 The reported inci-
dence of IMLT ranges from being present in no partici-
pants to being present in all participants.11,22
Various studies have reported mean IMLT values in
the range of 0 to 3 mm, depending on the method of
recording, the position of the recording device, and
whether the lateral movements were recorded as
assisted or unassisted movements.1-23 Tupac6 was the
first author to report a significant variation in me-
chanical pantographic recordings, depending on
whether the movements were assisted or unassisted
and whether the operator was experienced or inexpe-
rienced. His recommendation was to use assisted
mandibular movements for recording and programming
fully adjustable articulators to ensure the complete
reproduction of mandibular border movements. The
argument against this recommendation has been
that assisted or forced border movements are not
Taylor et al
413
reproducible without external guidance and therefore
are artificial and of no clinical relevance. Others
demonstrated that the clutch angle19 and the location of
the recording table relative to the terminal hinge
axis17,21 altered IMLT recordings. The use of sedation
also affected the recording of IMLT.8
Some clinicians have taken the viewpoint that
recording and transferring IMLT to the articulator is
necessary for the correct fabrication of the occlusal
anatomy of posterior teeth. Lundeen and colleagues4,5
argued that the movement that occurred at the working
condyle was in the same order of magnitude at the
occlusal surface of the first molar. Other authors have
argued that lateral movement at the level of the condyle
is reduced by more than 50% at the level of the first
molar because of the overlapping contact of the anterior
teeth, particularly the canines, which limit the ability of
the mandible to shift laterally while the teeth are in
contact with each other.2,3
Despite the extensive historical discussion and pub-
lication regarding IMLT, questions remain about the
harm that may be done by not accounting for IMLT and
the clinical significance of IMLT. The purpose of this
systematic review is to attempt to elucidate the clinical
significance of IMLT and to clarify the discussion of
IMLT.
MATERIAL AND METHODS
An independent electronic search of the English lan-
guage literature was performed by multiple investigators
using the PubMed search engine. The specific terms used
for the electronic search were as follows: immediate
mandibular lateral translation or mandibular lateral
translation or mandibular translation or immediate lateral
translation or immediate side shift or immediate
mandibular side shift or mandibular side shift or Bennett
side shift or Bennett movement.
The PICO (Patient-Intervention-Control-Outcome)
question for this systematic review was as follows: In
dentate patients with natural teeth or restored teeth,
does immediate mandibular lateral translation as
compared with lack of immediate mandibular lateral
translation affect any clinical outcomes in prosthodon-
tics and restorative dentistry? The time period searched
was from January 1951 to March 1, 2014. The only
search limits applied to the electronic search were the
English language and humans. The predetermined in-
clusion criteria were as follows: any English language
article on humans in a peer-reviewed journal containing
any of the search terms; any article published between
January 1951 and March 1, 2014, describing a clinical
study involving any of the search terms and at least 1
human participant. The predetermined exclusion criteria
were as follows: articles that did not pertain to items
THE JOURNAL OF PROSTHETIC DENTISTRY
414
described in the inclusion criteria; review articles,
monographs, or technique articles without associated
clinical study and data; in vitro studies, cadaver studies,
or animal studies; orthodontic manuscripts in which
side shift was meant as a unilateral reverse articulation;
participants or data repeated in other included articles;
and article descriptions that did not provide clinical data
or did not allow extraction of clinical data on immediate
mandibular lateral translation.
The electronic search process was systematically
conducted in 3 stages. In stage 1, three investigators
independently screened all relevant titles of the elec-
tronic search, and any disagreement was resolved by
discussion. In situations in which the application of the
exclusion criteria was not clear, the controversial article
was included for consideration in the abstract stage. In
stage 2, the investigators independently analyzed the
abstracts of all selected titles, and disagreements were
resolved by discussion. In situations of uncertainty, the
abstract was included for the subsequent full-text stage.
After the application of the exclusion criteria, the
definitive list of articles was screened at stage 3 by the
investigators to extract qualitative and quantitative data.
A supplemental search was conducted based on the
references from the definitive list of full-text articles
from stage 3 and additional articles published beyond
the terminal search date (March 1, 2014, to April 30,
2015). Data from all included studies were then tabu-
lated, analyzed, and compared to satisfy the study
objectives.
RESULTS
The initial electronic search using the specific search
terms from the PubMed search engine yielded a total
of 858 titles, out of which 100 abstracts were applicable
to the study. Further scrutiny resulted in the elim-
ination of 53 full-text articles. From the remaining 47
full-text articles, another 28 articles were excluded,
resulting in a total of 19 studies from which the results
were extracted. A supplementary search for articles
resulted in 4 additional articles for a total of 23 studies
describing IMLT in humans. A subsequent supple-
mental search for articles published after the terminal
search date (March 1, 2014, to April 30, 2015) was
done, and no additional articles were identified. Of the
23 studies included for analysis, all studies involved
mandibular movement recording of some sort for at
least 1 participant (Table 1). The number of partici-
pants examined ranged from 11 to 1635 for a total of
914 individuals. All 23 studies were observational/
cross-sectional without experimental clinical control.
The method of recording primarily included panto-
graphic/axiographic recordings and 2 studies used an
ultrasound scanning method to demonstrate IMLT.
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 115 Issue 4
The use of guided or induced mandibular border
movements versus voluntary movement was reported
in some studies but not in others.
Eleven studies reported using voluntary movements,
5 articles reported using only induced movements, 2
used both voluntary and induced movements, and 5
articles did not report the method of recording. The
amount of IMLT reported ranged from 0 to 3 mm with
minimal clarity amongst authors on the exact descrip-
tion of IMLT.
None of the studies in this systematic review re-
ported on any specific harm or beneficial effects for
patients or clinicians by incorporating IMLT, other than
to postulate that the presence of IMLT would alter
cuspal pathways in restored occlusal anatomy. No
published reports were identified of adverse clinical
outcomes such as extensive occlusal adjustments or
compromised esthetics and occlusion. No reports were
identified of negative patient treatment outcomes such
as harm to the restorations or temporomandibular joints
by placing restorations without accounting for the
IMLT, nor were there any negative consequences of not
using pantographic equipment or a fully adjustable
articulator.
DISCUSSION
This systematic review did not identify any reports
related to actual harm to teeth restorations, perio-
dontium, muscles, or joints as the result of ignoring
IMLT in prosthodontic or restorative treatment plan-
ning. Most articles identified in this review described
the influence of the border IMLT on mandibular
movement and did not describe the significance of
IMLT at the level of the teeth. Historically, the
importance of IMLT has always been hypothesized as
a condylar determinant that could impact the occlusal
surfaces of posterior teeth. The 23 studies in this sys-
tematic review revealed no evidence of clinical factors
that must be accommodated in the treatment of pa-
tients in whom IMLT has been demonstrated to exist
as judged by the clinician. These findings question the
relevance of, or need for, IMLT in planning for
extensive restorative or prosthodontic treatment. With
the emergence of evidence-based prosthodontics, cli-
nicians should recognize the distinction between sur-
rogate outcomes and true outcomes.26 Surrogate
outcomes include measures that are not of direct
practical importance but are believed to reflect out-
comes that are important as part of a disease process.27
In contrast, true outcomes reflect unequivocal evidence
of tangible benefit to the patient.27 In this regard,
recording IMLT is clearly a surrogate outcome that has
not been demonstrated in the literature to provide any
tangible benefit or harm to the patient or the clinician.
Taylor et al
April 2016 415

Table 1. Qualitative data on 23 studies identified in systematic review that described data on immediate mandibular lateral translation in humans
Clinical
Implication of
IMLT (Harm or
Method of Benefit to
No. of Recording Amount of IMLT Data Method of Patient or
Participants/ Age Data of Study IMLT (Induced Reported by Authors Measurement Clinician)
Author, Year Patients Participants or Voluntary) (in millimeters) Reported by Authors Reported
Watt, 1968 1 NR NR 0.2 to 1 mm (from 6 Pantographic tracings None
observers on 1 patient)
Preiskel, 1971 18 NR NR 0.2 to 2 mm in each participant; Ultrasound scanning None
mean value was 1.07 mm method
Preiskel, 1972 27 19 to 23 y Voluntary, and 5 participants had less Ultrasound scanning None
pre-rehearsed than 0.5 mm; method
10 had 0.5 to 1.5 mm; and
7 had more than 1.5 mm
Lundeen and Wirth, 1973 50 20 to 55 y Voluntary, and 0 to 3 mm, median was Movements recorded in None
pre-rehearsed 1 mm; occurred during “first plastic blocks engraved by
few millimeters” air-turbine drills
Lundeen et al, 1978 163 20 to 65 y Induced Mean value was 0.75 mm Movements recorded in None
Almost 80% of participants plastic blocks engraved by
had 1.5 mm or less air-turbine drills
Tupac, 1978 136 Age was reported Induced and Amount of IMLT was Denar pantographic tracings None
for 3 groups (group Voluntary age-dependent
A–24 to 36 y; group Group A–0.016 mm
B–23 to 35 y; group voluntary and 0.053 mm
C–45 to 62 y) induced
Group B–0.026 mm
voluntary and 0.280 mm
induced
Group C–0.236 mm
voluntary and 0.83 mm
induced
Bellanti and Martin, 1979 80 Age was reported Voluntary Mean value was 0.3 mm and Pantographic tracings None
for 2 groups (first 13% of participants had
group of 40 IMLT greater than 0.2 mm
participants–15 to
30 y and
secondgroup of 40
participants–“over
30 y”)
Jackson, 1979 3 18 to 20 y Induced NR Denar panthographic None
tracings
Mongini, 1980 30 20 to 60 y Voluntary In 2 patients, IMLT was 2 Lateral tomography in 4 None
mm; in 11 patients, range planes at 3 mm intervals
was 0.3 to 1 mm plus two pantographic
tracings
Simonet and Clayton, 1981 12 21 to 56 y Induced and On mediotrusive side, Denar pantographic tracings None
Voluntary voluntary movement ranged
from 0.15 to 0.42 mm and
for induced movement from
0.15 to 0.56 mm On
laterotrusive side, voluntary
movement ranged from 0.40
to 1.02 mm and for induced
movement from 0.48 to
1.55 mm
Levinson, 1984 2 NR Induced NR Pantograph and None
sirognathograph
Hobo, 1984 50 20 to 50 y NR Mean value was 0.79 mm Electronic measuring system None
(right condyle); 0.75 mm capable of measuring 6
(left condyle) degrees of freedom
Lundeen and Mendoza, 9 NR Induced Right condyle: 1.04 mm for Mechanical pantographs None
1984 intra-oral measurement and
1.66 mm for extraoral
measurement
Left condyle: 0.96 mm for
intraoral measurement and
1.50 mm for extraoral
measurement
Hobo, 1986 11 21 to 32 y NR Mean value was 0.38 mm Electronic mandibular None
recording system
Beard et al, 1986 86 15 to 63 y Voluntary, and Mean value was 0.36 mm Electronic pantographs None
pre-rehearsed
(continued on next page)

Taylor et al THE JOURNAL OF PROSTHETIC DENTISTRY

416 Volume 115 Issue 4

Table 1. (continued) Qualitative data on 23 studies identified in systematic review that described data on immediate mandibular lateral translation in
humans
Clinical
Implication of
IMLT (Harm or
Method of Benefit to
No. of Recording Amount of IMLT Data Method of Patient or
Participants/ Age Data of Study IMLT (Induced Reported by Authors Measurement Clinician)
Author, Year Patients Participants or Voluntary) (in millimeters) Reported by Authors Reported
Curtis, 1989 20 Mean reported age Voluntary, and Mean value was 0.54 mm Pantographic tracings None
was 31 y pre-rehearsed but ranged from 0.53 mm to
0.81 mm depending on
recording method
Price et al, 1989 2 NR NR Amount of IMLT was Mechanical Pantronic None
dependent on type of hinge pantographs
axis recorded:
Right condyle: 0.23 mm for
arbitrary hinge axis and 0.14
mm for true hinge axis Left
side: 0.19 mm for arbitrary
hinge axis and 0.17 mm for
true hinge axis
Goldenberg et al, 1990 40 22 to 81 y Voluntary NR Denar pantographic None
tracings
Gross and Nemcovsky, 1993 7 31 to 57 y Induced Range was 0 to 1.3 mm Pantronic None
Theusner et al, 1993 49 22 to 56 y Voluntary Amount of IMLT was SAM axiograph None
dependent on TMD status
of patient:
In participants without TMD,
range was 0.5 ±0.7 mm
(right) and 0.27 ±0.43 mm
(left)
In participants with TMD,
range was 0.35 ±0.54 (right)
and 0.25 ±0.4 (left)
Zwijnenburg et al, 1996 20 18 to 30 y Voluntary, and Right condyle range was OKAS 3D System None
pre-rehearsed 0.5 ±0.6
Left condyle range was
0.9 ±0.7
Son et al, 1998 25 23 to 62 y Voluntary, and Amount of IMLT was Denar Pantograph None
pre-rehearsed dependent on forward
movement of nonworking
condyle; record was made
At 1 mm, 0.31 ±0.19 mm;
at 2 mm, 0.44 ±0.24 mm;
at 3 mm, 0.51 ±0.27 mm;
at 4 mm, 0.62 ±0.28 mm;
at 5 mm, 0.65 ±0.31 mm,
at 6 mm, 0.66 ±0.36 mm
Canning et al, 2011 73 22.8 ±6.8 y Voluntary, and In 39 of 73 participants Cadiax None
pre-rehearsed (55%), values for right side
IMLT were 0, and in 50 of 73
participants (70%), values for
left side were 0. Of 146 IMLT
recordings, only 5
participants measured 0.5
mm or greater

NR, not reported; IMLT, immediate mandibular lateral translation.

IMLT can be graphically demonstrated on the
articulator, but this “phenomenon” has been difficult to
demonstrate clinically. Recognizing the inherent diffi-
culties of recording and demonstrating the presence of
IMLT in a patient is an important consideration. Clay-
ton and Kotowicz28 reported that changes in the
occlusal vertical dimension, the central bearing guid-
ance surface, and the presence of tooth guidance could
all alter the graphical tracings of mandibular movement.
Variations in recording IMLT can occur with the
orientation of the recording plates, determination of the
transverse horizontal axis, patient age, operator induced
versus voluntary patient mandibular movement, and
neuromuscular release or sedation.6,8,10,11,19,21 The
presence of canine guidance also decreases the reported
measurements of IMLT.2,3,19 Additionally, IMLT of the
mandible may not be a physically possible phenomenon
when the condyles are fully braced against the emi-
nentiae.11 All of this has led many clinicians to question
the existence of IMLT itself.
One of the biggest challenges encountered by the
authors of this systematic review was that previous

THE JOURNAL OF PROSTHETIC DENTISTRY Taylor et al

April 2016
authors have not differentiated between immediate and
progressive mandibular lateral translation nor have they
recorded true border movements versus intraborder
movements during functional and operator induced
(manipulated) recordings. Reports cited in this sys-
tematic review have used inconsistent definitions for
IMLT and have attempted to record the presence or
absence of IMLT with significantly different methods. In
a number of the cited studies, the description of IMLT
versus progressive lateral translation is unclear, and the
reader has to judge whether, in fact, the authors were
measuring a progressive shift but reporting it as an
immediate shift. Another important observation in this
systematic review is that there is an obvious disagree-
ment between various authors as to whether IMLT
should be measured at the working side condyle or at
the nonworking condyle. The substantial differences
reported in several studies between the amount of
IMLT reported when the patient makes passive, unas-
sisted border movements versus assisted or manipu-
lated movements is also a source of disagreement as to
the relevance of recording assisted movements that
cannot be replicated by unassisted or physiologic
movements. Like most systematic reviews, despite an
exhaustive search process, the authors may have failed
to identify additional articles.29 However, whether
incorporating these omitted articles would have
changed the conclusions of this systematic review is
unknown.
Preiskel2,3 recognized that lateral translatory
movements of the human mandible have yet to be
completely evaluated, remain elusive, and appear to be
unsupported. The current scientific literature reporting
on the presence of IMLT reveals that it is inconsistent,
of limited magnitude, and has high probability for
variability and distortions, thus having minimal clinical
implications (for patients and clinicians). These ob-
servations reveal the potential to misdiagnose the
presence of IMLT and to provide associated well-
meaning but misguided or unnecessarily complicated
treatment. Moreover, an improved understanding of
occlusion and the current emphasis on restoring the
dentition with a mutually protected articulation
scheme (with canine guidance) has diminished the
need for factoring in specific posterior determinants in
the articulator that may only occur when the teeth are
apart and may therefore be of no clinical importance.
To be clinically relevant, IMLT would need to occur
when the teeth are in contact, that is, with the
elevator muscles contracting and the condyles seated
against the glenoid fossae. With the condyles so
braced against the fossae, the possibility of immediate
lateral movement of the condyles would seem unlikely
at best.2,3,11 The findings from this systematic review,
therefore, question the clinical relevance and need to
Taylor et al
417
include IMLT when prosthodontic treatment is plan-
ned and executed.
CONCLUSION
This systematic review identified 23 studies in the liter-
ature that examined immediate mandibular lateral
translation, but none reported on the clinical implications
(harm or benefit to clinicians or patients) of this phe-
nomenon. Furthermore, there is a lack of clarity in the
terminology related to IMLT and the timing of the side
shift, the occurrence of IMLT at the working versus
nonworking condyle, and induced versus noninduced
methods of recording and measuring. Current scientific
evidence does not support the need to include IMLT as a
factor when prosthodontic or restorative treatment is
planned and executed.
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CSRs of 92.6% and 92.7%, respectively. Comparisons of the study variables with respect to CSR were largely
nonsignificant. However, there were significant differences in CSRs between anterior vs posterior locations and
rough- vs smooth-surfaced implants in addition to some prosthesis types, ages, and bone qualities. The overall CSR of
92.6% in the present study is high and comparable to survival rates observed in previous long-term analyses of
mandibular implants. The significant differences observed between implant locations, patient age groups, bone
qualities, and prostheses were not suggestive of any remarkable trends.
Conclusion. Patient sex, age, degree of edentulism, implant location, time of loading, implant size and type, bone
quality, prosthesis type, and the presence of multiple implants did not result in any significant effect on long-term
implant survival. The CSR observed after 10 to 27 years of follow-up in a single private prosthodontic center was high
(92.6%) and supports the use of endosseous dental implants as a long-term treatment option for the rehabilitation of
the edentulous and partially edentulous mandible.

Reprinted with permission of Quintessence Publishing.

THE JOURNAL OF PROSTHETIC DENTISTRY Taylor et al