Journal of Cranio-Maxillo-Facial Surgery 40 (2012) 449e455

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Journal of Cranio-Maxillo-Facial Surgery

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Condylar Position Indicator and T-Scan system II in clinical evaluation of

temporomandibular intracapsular disease
Domenico Ciavarella a, *, Vincenzo Parziale b, Mario Mastrovincenzo c, Antonio Palazzo a,
Antonio Sabatucci c, Maria Michela Suriano a, Maurizio Bossù d, Angela Pia Cazzolla e, Lorenzo Lo Muzio a,
Claudio Chimenti b
a
Department of Surgical Sciences, Faculty of Medicine, School of Dentistry, University of Foggia, viale Pinto, Foggia, Italy
b
Department of Surgical Sciences, Faculty of Medicine, School of Dentistry, University of L’Aquila, Piazzale Salvatore Tommasi, L’Aquila, Italy
c
Department of Oral Sciences, Faculty of Medicine, School of Dentistry, Polytechnic University of Marche, via Tronto, Ancona, Italy
d
Department of Paediatric Dentistry, University of Rome (La Sapienza), via Caserta, Rome, Italy
e
Department of Dentistry and Surgery, University of Bari, Piazza Giulio Cesare, Bari, Italy

a r t i c l e i n f o a b s t r a c t

Article history: Introduction: The pathogenesis of temporomandibular joint intracapsular disease (TMJI) is multifactorial
Paper received 23 January 2009 and its diagnosis is not easy. In this work authors show two types of clinical analysis: the Condylar
Accepted 30 July 2011 Position Indicator (CPI) and T-Scan 2 system.
Material and methods: Twenty patients (mean age of 24.5 years) with TMJI problem and 10 healthy
Keywords: matched subjects (mean age: 25.4 years) were selected. Analysis of TMJI was performed on each patient
Condylar Position Indicator
by means of Condylar Position Indicator (CPI) and T-Scan System II tests.
T-Scan system
Results: Eight patients presented vertical symmetrical condylar distraction greater than healthy subjects
Temporomandibular joint disease
Condylar position
(P-value < 0.001). T-Scan showed a difference of Percentage of Force (POF) not greater than 5%. Seven
Centric Relation patients showed sagittal shift greater than healthy subject (P-value < 0.001). T-Scan records showed
a difference of POF greater than 5%. Five non-healthy subjects presented sagittal, vertical, transverse
shift greater than healthy subjects (P-value < 0.001). T-Scan records show a difference of POF greater
than 5%.
Conclusion: In this work authors present a new method of analysis. CPI indicates discrepancy of the
condyle position in CO from CR and T-Scan allows the operator to study all teeth contacts and occlusal
forces taking place during dynamic jaw movement.
Ó 2011 European Association for Cranio-Maxillo-Facial Surgery.

1. Introduction
In recent years many authors have indicated the importance of
the prevention and early diagnosis of conditions producing
temporomandibular joint (TMJ) disease, in particular intracapsular
TMJ (TMJI) disease that involves the condyle and its disc.
Many authors have suggested that TMJI pathogenesis is
multifactorial (perpetuating, predisposing and initiating factors)
and its diagnosis is not easy. The temporomandibular joint (TMJ)
may be affected by inflammatory, traumatic, infectious, congenital,
developmental, and neoplastic diseases, as seen in other joints
(Scrivani et al., 2008). Patients with temporomandibular disorders
present with pain that is often unilateral and referred to the ears,
* Corresponding author. Tel.: þ39 0881 588080; fax: þ39 0881 588081.
E-mail address: drdomenicociavarella2@yahoo.it (D. Ciavarella).
temporal and periorbital regions, the angle of the mandible, and
frequently to the posterior neck; other symptoms include reduced
or asymmetric mandibular motion, and the characteristic TMJ sound
(Belfer and Kaban, 1982; Gay et al., 1987; Kaplan et al., 1991). Joint
sound is due to a disk or condyle displacement in the glenoid fossa.
Normal jaw opening is due to activation, in two phases, of the
supra hyoid muscles and lateral pterygoid muscles which induce
a rotation and a translational movement of the condyle down and
forward along the articular eminence of the glenoid fossa with the
articular disk between the condyle and the articular eminence of the
glenoid fossa. In TMJI there is a displacement of the TMJ disc from its
normal position to pathologic position with its deformation. In TMJI
disc displacement induces a joint sound in jaw opening movement
(TMJI with disc reduction) or no joint sound in non-reduction
pathology (de Leeuw et al., 1995; de Leeuw, 2008a, b) (Fig. 1).
Joint sounds may be early at the starting or at the ending of the
jaw movement. It may be related to many factors such as bone

1010-5182/$ e see front matter Ó 2011 European Association for Cranio-Maxillo-Facial Surgery.
doi:10.1016/j.jcms.2011.07.021
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maximum intercuspation of the dentition irrespective of the

FACIAL PAIN condyle position is called Centric Occlusion (CO). CR is related to
the resultant vector of elevator muscles that may be directed
Type anterosuperiorly and to the degree of relaxation of the inferior
lateral pterygoid muscles (Dawson, 1979; Okeson et al., 1982;
Diffuse Localized Okeson, 1993; Dawson, 1995; Okeson, 2007).
Many authors suggest that TMJI is associated to functional
Interest disorders that occurs mainly in women (Guralnick et al., 1978;
Laskin, 2007; Laskin, 2008). Many tests and radiographs are neces-
sary for its diagnosis and treatment. The panoramic radiograph
A great area A small area (a single-cut tomogram of the entire jaw) is still the most useful
screening tool (Berrett, 1983). Plain radiographs have been almost
Head and neck Periauricular zone
completely replaced by computed tomography (CT) for evaluation of
bone morphology and pathology of the joint, mandibular ramus, and
Caused by condyle (Cohen et al., 1985; Matteson et al., 1996). Many authors
suggest CT is an unreliable method to study TMJI and condyle
Muscolar spasm; position alterations (Girardot, 1989; Roth, 1995a; Major et al., 1999).
Acromegaly;
Neurovascular orofacial pain Magnetic resonance imaging (MRI) has replaced other imaging
(NVOP, facial migraine);
Blood pressure levels; Capsulitis; methods for evaluation of soft-tissue abnormalities of the joint and
Ocular alteration; Synovitis; surrounding region (Avrahami et al., 1986; Kircos et al., 1987; Weiss
Mengingitis; Condyle luxation;
Traumas; Condyle Growth alteration; et al., 1988; Nakasato et al., 1991; Hayt et al., 2000).
Psychogenic orofacial pain;
Rhinosinusitis;
Osteo arthrosis; Kaya evaluated anterior disc displacement using ultrasonography
Auricular inflammation;
Postural problem;
Tendon inflammation;
(US) and MRI. The authors suggested that this technique was very
Impacted third molars;
Fractures; Anchylosis; reliable in determining the anterior disc displacement (Kaya et al.,
Unilateral headache (Hemicrania) Osteo Arthritis;
Cancer (Fisher DJ) 2010).
Burning mouth syndrome;
Synovitis;
Trigeminal neuralgia bymultiple Bilminar zone compression; MRI is being replaced by real dynamic MRI that allows clinicians to
sclerosis (Sarlani E) Temporomandibular show pronounced disk changes but does not permit precise
Lupus Erythemathosus; intracapsular alterations.
Progressive ossifying measurement because of the poor noise-to-signal ratio (Palla, 2009).
fibrodysplasia (Munchmeyer's
disease)
For this reason patients are often discouraged and so untreated.
Serotonin levels An easy and more intuitive study of TMJI disease, based upon
measureable clinical features, would, therefore, be of great use to
Generate
the general dental practitioner, for the orthodontist and the
surgeon. The use of Dignostic Criteria (DC) is a common approach to
Ansiety;
Fever (i.e. higher in diffuse form than localized); reducing the difficulty of developing a clinical diagnosis of TMJI and
Agitation; to select proper treatment. Recently Naeije et al. demonstrated how
Sleepy alterations;
Tremor; difficult is to develop specific criteria that can accurately separate
Psychologic alterations; the various type of TMJI (Naeije et al., 2009).
Masticatory disturb;
Vertigos.
In this paper the authors describe two types of clinical analysis,
the Condylar Position Indicator (CPI) and T-Scan 2 system, that
Fig. 1. Facial pain description and types. Temporomandibular joint disease allow the influence of occlusion and neuro-musculature on condyle
pathogenesis. (Modified from Axel Bumann, Ulrich Lotzmann. Diagnosi Funzionale e position to be studied.
terapia. Ed. Elsevier, Milano 2000).

2. Materials and methods

changes, lateral ligament tension or disc alterations. Clinical differ-
ence is easy to find using the jaw opening compression test (Fig. 2).
The role of occlusion in the pathogenesis of TMJI is still a very
controversial issue. Occlusion contacts may have an important role
in the aetiology of intracapsular disease but the relationships are
not well understood. Crawford (Crawford, 1999), McNamara,
Seligman and Okeson (McNamara, 1978; Okeson et al., 1982;
Seligman and Pullinger, 1991; Okeson, 1993; McNamara et al.,
1995; Okeson, 2007) explain that there is a lack of scientific and
statistical correlations that explain if occlusion and muscles
function have an influence on the condyle position in the patho-
genesis of TMJI.
One problem is to find all dynamic functional contacts that there
are in masticatory cycles on static casts. TMJI disease treatment
starts with study and research of condylar Centric Relation (CR) in
the glenoid fossa. For orthodontist and the dental practitioner, at
the beginning of orthodontic and prosthetic treatment it is
important to know the right condyle position, Centric Relation (CR)
and the condyle position in Centric Occlusion (CO) (Roth, 1995b).
Centric Relation (CR) is the position of condyle in glenoid fossa in
the most anteriosuperior position against the eminentia with the
articular disc properly interposed. The condyle position in
Twenty patients with a mean age of 24.5 years (range 17e30)
with TMJI problems and 10 healthy matched subjects (mean age:
25.4 years; range: 20e30) were selected and enrolled in the study.
Both patients and controls had no missing teeth or oral lesions.
None was wearing orthodontic appliances of any type.
On each patient analysis of TMJI was done by means of the
Condylar Position Indicator (CPI) and T-Scan System II tests. To
reproduce condyle position on CO and CR, maxillary and mandib-
ular impressions were taken using an irreversible hydrocolloid
material (Orthoprint-ZhermackÒ) in non-perforated rimlok stock
trays. Casts were poured immediately using type IV high-strength
dental stone (Suprastone) and mounted on a Panadent articulator
(Panadent corp, Grand Terrace, CA, U.S.A.) according to the manu-
facturer’s instructions (Fig. 3). The maxillary cast was mounted
using the ear face-bow transfer provided to locate the estimated
hinge axis. The face-bow was oriented on a line parallel to Frankfort
horizontal plane. Two waxes were used to record CO and CR
according to the method described by Roth (Roth and Rolfs, 1981;
Wood and Elliott, 1994; Roth, 1995a, b). The wax bite was taken
with Delar Bite Registration Wax (Delar Corp, Lake Oswego, OR,
U.S.A.) and made in two sections. The anterior section was made by
 D. Ciavarella et al. / Journal of Cranio-Maxillo-Facial Surgery 40 (2012) 449e455 451

folding the softened wax over to form three or more layers, and
included the upper and lower anterior teeth. The posterior section
was two layers thick. The anteroposterior dimension was adapted
to include the first and second molars. During anterior wax
recording patients were reclined at a 45 angle to the floor. Waxes
were softened in water at 135 F and then placed on the maxillary
Joint sound during the jaw opening and closure;
Pain during jaw movement; anterior teeth. Patients were instructed to close the mandible far
Mastication difficulty; back posteriorly until a space of 2 mm could be seen between the
Auricular sound;
Symptoms Vertigos; first posterior teeth contact. For posterior recording, the softened
Muscle spasm; wax was placed on the upper teeth together with the anterior just
Bone degeneration;
Psycologic turbes; recorded wax. In this way the anterior wax acted as a “guide-stop”
Anxiety;
Sleep alterations;
for CR recording by placing condyles in CR.
Disphagia; Condylar position was measured in the horizontal (X), vertical
Weight loss;
(V) and transverse (Z) planes by the CPI instrument (Model CPI-2,
Panadent corp, Grand Terrace, CA, U.S.A.): on a self-adhesive
writing surface with a millimetre grid. Two points of different
colours were impressed; a red point was used to indicate the
condyle position in CO and a black point for the position in CR.
a) Tension of Lateral condyle ligament
1)Initial b) Bone Deformation The T-Scan system is a computerized occlusal analyzer. T-Scan II
c) Condyle/disc dislocation is a reliable and easy-to-use clinical diagnostic device that senses
and analyzes occlusal contact forces using paper-thin, disposable
Classification
sensors. The T-Scan II software offers features that allow the user to
record the patient’s occlusal contact data, to view the patient’s
tooth contacts and to associate them with specific teeth. The
2)Final
a) Condyle glenoid subluxation analytical software displays Percentage of Force (POF) and Centre of
b) Final disc reduction
Force Trajectory (COFT), providing an in-depth understanding of
the overall balance of the occlusion. POF analysis allows the dentist
to examine the total effect of restorative dentistry on the patient’s
maximum closure and excursions, and is as easy as the click of
Fig. 2. Intracapsular differential diagnosis. (Modified from Axel Bumann, Ulrich
a mouse. It is a powerful analytical tool that illustrates the ‘balance’
Lotzmann. Diagnosi Funzionale e terapia. Ed. Elsevier, Milano 2000).
of the occlusion in the ‘active’ Movie or Real-time window, using
a graphic POF marker. The COF pinpoints the location of the sum of

Fig. 3. The Panadent articulator parameters’ setting used were as follow: a) Panadent articulator; b) side-shift 1 mm; c) eminence plane 45 (6 Panadent); d) incisal bar 0 mm; e, f,
g) casts mounted in Panadent articulator with condyle in CR; h, i, j) casts mounted in Panadent articulator with condyle in CO.
452 D. Ciavarella et al. / Journal of Cranio-Maxillo-Facial Surgery 40 (2012) 449e455
the total force of occlusal contacts and is shown in relation to a dual
elliptical target, which represents the ideal location of the centre of
force for any maximum intercuspation closure, and acts as a guide
with respect to a normal occlusion. The inner ellipse shows the area
within which the POF of 68% of a normal population is found, and
the outer ellipse shows the area within which the POF of 95% of
a normal population is found. COFT displays the history of the path
of the POF from the beginning of the recording to the current frame.
The movement of the POF during a closure or movement can be
tracked by playing a movie one frame at a time with POF Trajectory
selected. The trajectory is represented on the screen by a red and
white line that ‘trails’ the POF marker. In a Real-time window, POF
Trajectory simply shows the POF marker and target, without the
trailing line. The location of the POF is determined by calculating
the sum of the medio-lateral force moment of the tooth contacts
about the mid-sagittal axis, and the mean of the left and right
leverage arms in relation to the incisive plane.
These statistics allow the practitioner to identify the location of
the POF for any bite automatically by selecting the POF option from
the view menu. On display T-Scan indicates Percentage of Force
(POF) distribution. The sensor was placed in the patient’s mouth,
with the sensor support pointer between the two central incisors. At
this time, patients were asked to close their jaws and the recording
began. While recording is in progress, the Real-time Status Bar
shows the frame count progress. The recording will automatically
stop when the correct number of frames has been collected. The
registration was done in maximum intercuspation with the Fankfurt
plane parallel to the floor. T-Scan at the end of registration provides
the POF and COFT.
On patients and controls, pain on a trigger point with manual
palpation of the head and neck muscles was evaluated.
The mandibular function and TMJ pain were also evaluated asking
subjects to open their mouth as much as possible: pain, maximum
opening and deviation from the midline frontal plane were
recorded.
3. Results
It has been suggested that, in healthy subjects, CPI measure-
ments 1 mm in either sagittal (X) or vertical (Y) axis and 0.5 mm
in the transverse (Z) axis should be considered normal (Utt et al.,
1995). Bite force evaluated by T-Scan showed that in the control
group there was a difference of POF not greater than 5%. At the same
time in the control group COFT is always localized among the two
central ellipse while in patients COFT were always outside the two
central ellipses and moved towards the side with higher bite force
value (Maness and Podoloff, 1989; Tokumura and Yamashita, 1989).
For a better analysis authors subdivided non-healthy subjects in
three groups:
1. subjects with vertical (Y) condyle distraction;
2. subjects with sagittal (X) shift;
3. subjects with vertical (Y), sagittal (X) and transverse (Z) shift.
Eight non-healthy subjects presented vertically symmetrical
condylar distraction evaluated on the Panadent articulator (Fig. 4).
Red points (i.e. CO condyle position) were 3.41 mm (i.e. mean
value; SEM 0.29) lower than black points (i.e. CR condyle position).
In healthy subjects red points were 0.92 mm lower than black
points (i.e. mean value; SEM 0.15). The pairing mean test showed
a two tailed P-value < 0.001 which was considered extremely
significant.
Tooth interferences in chewing have been difficult to evaluate
on casts. T-Scan records showed a high contact on second molars.
Contacts were represented by a red area, that indicated maximum
contact in close mouth, and a blue area, that indicated low contact
in the closed mouth. In vertical condylar distraction red areas were
bigger on posterior teeth. COFTs were displaced in the posterior
area of the two central ellipses. Bite force evaluated by T-Scan
showed a difference of POF not greater than 5%.
Seven non-healthy patients showed sagittal shift (Fig. 5). On CPI
red points were medial or distal compared to black points (mean
value 3.5 mm; SEM 0.31). Healthy subjects showed little sagittal
shift (0.85 mm mean value; SEM 0.15) (P-value < 0.001). In all
patients sagittal shift affected the two condyles. T-Scan records
showed a difference of POF greater than 5% (POF: mean 82.02%;
SEM 1.8 in affected TMJ side and mean 21.75%; SEM 1.25 in balance
side) (P-value < 0.001). At the same time COFTs were always
outside the two central ellipses and moved towards the side with
higher bite force value. T-Scan POF showed that in healthy group
controls there was no difference of POF greater than 5%.
In third group (five non-healthy subjects with sagittal/vertical/
transverse shift) CO condyle position was distant from the CR
position by more than 1 mm in the three planes (Fig. 6). CPI showed
that two condyles in CO were positioned lower, distal and lateral
than CR. In non-healthy subjects sagittal shift was 3.1 mm (i.e.
mean value; SEM 0.44); vertical shift was 2.2 mm (i.e. mean value;
SEM 0.36); transverse shift 1.66 mm (i.e. mean value, SEM 0.27).
These values were greater than healthy subjects (P-value < 0.001).
T-Scan records showed that these patients had differences of POF
greater than 5% (P-value < 0.0001), COFT moved towards the side
with higher bite force value and occlusal contact stressed condyles
moved them far from the CR.
T-Scan records showed a difference of the timing of the force
(TF) between non-healthy and healthy subjects. TF is the time
(seconds) of patient maximum clench recorded by T-Scan. In
non-healthy subjects TF was lower than healthy subjects. The TF in
non-healthy was 3.225 s (i.e. mean time; SEM 0.2411) while in
healthy was 6.349 s (i.e. mean value; SEM 0.3454). The pairing
mean test showed how the two tailed P value was <0.001. This data
was statistically significant.
4. Discussion
The pathogenesis of intracapsular disease is a matter of great
interest for dental practitioners, orthodontists, maxillo-facial
surgeons and oral rehabilitators. Okeson suggests that temporoman-
dibular disease research studies are of poor study design, lack of
proper controls and have inadequate follow up. This condition
generates the difficulty of developing clinical criteria that can separate
the subcategories of TMD and producing a reliable and functional set
of criteria for the many disorders clinicians manage (Okeson, 2009).
The displacement of disk and condyle from its ideal position is
surely caused by many factors. It is well known that neutral
mandibular position is due to a perfect equilibrium between
anti-gravitational and supra hyoid muscles. In chewing their
functions are coordinate by a perfect neuro-muscular synchronism.
It is well known that for normal muscle function ideal occlusal
contacts are necessary. For many authors teeth interferences are an
important factor in the aetiology of TMJI disease (Lotzmann, 1979;
Lotzmann, 1980a, b; Lotzmann, 1982). It has been suggested that
parafunctional activities may overload the dentition and masticatory
system and might also play an aetiological role for the development of
TMDs (Michelotti et al., 2009). Michelotti et al. found a significant
association between daytime tooth clenching/grinding and myofas-
cial pain that can be ascribed either to a damage of muscle fibres or to
a reduction of blood supply (Larsson et al., 1988; Larsson et al., 2004).
It is still unknown if there is a statistical correlation between
muscle function, tooth contact and intracapsular disease (Castelo
et al., 2005; Glaros et al., 2005).
 D. Ciavarella et al. / Journal of Cranio-Maxillo-Facial Surgery 40 (2012) 449e455 453

Fig. 4. Condylar’s vertical distraction. a) CPI evaluation on Panadent articulator. Red points condyles in CO. Black points condyles in CR. b) T-Scan record. POF indicates bite force
balance. COFT barycentre deviation. Red areas indicate maximum teeth stress.

Fig. 5. Condylar’s horizontal shift. a) CPI evaluation on Panadent articulator. Red points condyles in CO. Black points condyles in CR. b) T-Scan record. POF indicates bite force
unbalancing. COFT barycentre deviation. Red areas indicate maximum teeth stress.
454 D. Ciavarella et al. / Journal of Cranio-Maxillo-Facial Surgery 40 (2012) 449e455
Fig. 6. Condylar’s vertical, horizontal and transverse shift. a) CPI evaluation on Panadent articulator. Red points condyles in CO. Black points condyles in CR. b) T-Scan record. POF
indicates bite force unbalancing. COFT barycentre deviation. Red areas indicate maximum teeth stress.
In this work the authors present a new clinical method of analysis
of this problem. CPI shows condyle position in glenoid fossa. A static
clinical evaluation is a limitation of this analysis method. T-Scan
allows clinicians to study the dynamics of chewing movement and
at the same time provides much information regarding muscle
stress on teeth (POF) and the deviation of barycentre of the force
(COFT) and allows the clinicians to study tooth contacts for all
chewing movements. Many studies have shown how T-Scan force
records were supported by surface electromyography. A direct
correlation seems to exist between contractile muscle activity and
occlusal interference (Kerstein and Wright, 1991).
In this work the authors show that a posterior tooth interference
(T-Scan evaluation: distal red area on second molar) induces a condyle
vertical shift and that unbalanced occlusal contacts may induce
alteration of condyle position distal, medial or lateral with respect to
its CR position. Patients with distal tooth contact presented vertical
symmetrical condylar distraction. In Fig. 4 this is well demonstrated.
The temporomandibular joint and mandible are considered as a lever
of the third order (i.e. the effort is between the fulcrum and the load)
(Taylor, 1986). In patients with distal tooth contact the fulcrum is on
molar, and this changes it to a lever of first order (i.e. the fulcrum is
between the load and the effort). T-Scan II showed how these patients
had no occlusal unbalancing but a large distal red area.
In 13 patients with sagittal or vertical/sagittal/transverse
condylar shift, T-Scan II showed occlusal unbalancing greater than
5%. Unbalanced occlusion guides the condyles out from their
physiologic position (i.e. centric Relation) (Figs. 5 and 6).
T-Scan II additionally evaluated the time of force. Non-healthy
subjects showed a reduction of TF (non-healthy 3.225 s; healthy
6.349 s). This data, in patients with TMJI, is related to the masti-
catory muscles weakness associated with damage of muscles fibres.
The temporomandibular joint is a very delicate system which in
function is regulated by the anatomic shape of joint, by correct
muscle function and by tooth contacts.
Oral appliance (i.e. splint) therapy is widely used for temporo-
mandibular disorders (TMDs). Its mechanism of action still remains
a controversial issue. Modifications of electromyographic activities
and mandibular shifts after splint use have been reported in some
cases (Manns et al., 1993). Many studies have shown that in most
(but not all) patients the condyle position may be changed by using
a stabilization appliance (Williams, 1998; Limchaichana et al.,
2009). The authors suggest to make splints using CPI and T-Scan
evaluation so as to guide condyle displacement in the glenoid fossa
and to reduce the discrepancy between CO and CR. This allows the
condyle to obtain stability before maxillo-facial surgery or before
occlusal therapy (i.e. prosthetic or orthodontic treatment).
Tooth interference during chewing cycles displaces the condyles
from the ideal position. This situation may be prolonged without
symptoms. This biological adaptation may not persist for life. Many
neuro-physiological events induce stress on the masticatory
muscles and cause condyle/disk displacement. This is when TMJI
disease and all related symptoms start.
5. Conclusion
Orthodontists consider centric relation the ideal condyle
position for orthodontic treatment, TMJI rehabilitation and
orthognathic surgical treatment. This position may be changed by
many factors. Occlusion influences the condyle/disk position in the
glenoid fossa. This clinical evaluation helps clinicians in the choice
of TMJI treatment. CPI indicates discrepancy of the condyle position
in CO from CR and T-Scan allows the operator to study all tooth
 D. Ciavarella et al. / Journal of Cranio-Maxillo-Facial Surgery 40 (2012) 449e455
contacts and occlusal forces taking place during jaw movement.
These two methods of analysis are of great interest in orthodontic
and surgical treatment of adult malocclusion in order to reduce the
failure risk.
Conflict of interest
Authors had not financial relationships and conflict of interest
with other people or organisations that inappropriately influence
(bias) their work.
Funding source
Authors had not support in form of grants.
Acknowledgement
This work was written in collaboration with Giovanni Battista
and Laura Guida Department of Surgical Sciences, Faculty of
Medicine, School of Dentistry, University of Foggia.
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