Buroprai Journal of Orlkodonlia 11 (1989) 221-227 © 1989 Europeu OnhodontK Society

Changes in occlusion and condylar positioning

during retention with a gnathologic positioner
Helmut Droschl, Use Permann and Hans-Peter Bantleon
Graz, Austria

SUMMARY To investigate whether orthodontic cases can fulfil gnathologic requirement, models
of 10 adolescent patients (of the Department of Orthodontics at the University Dental Clinic,
Graz) were mounted in an articulator at band removal and 2, 4 and 12 weeks and one year later.
During this year the patients wore a gnathologic positioner. Using a condymeter, discrepancies
between RCP and ICP in three spatial planes were measured and the spatial diagonal computed.
Statistical analysis showed a clear reduction of the means of slide in centric during continuous
wearing of the positioner, after 3 months, RCP and ICP being almost identical. After a further 7
months, during which the positioner was worn only at night, the amount of slide increased again
slightly. The increase of the spatial diagonal was due to an increase of the sagittal and vertical
slides whereas the lateral slide remained constant.

Introduction duced precisely enough with a measuring

Gnathology poses ever increasing requirements
to orthodontists for the achievement of harmo-
nious occlusion in relation to the temporomandi-
bular joint and musculature. Results must be
assessed more critically.
At the end of treatment, the position of the
lower jaw in centric occlusion should be as close
as possible to the centric relation; i.e., the
discrepancy between intercuspidal position
(ICP) and retrusive contact position (RCP)
should be held as small as possible.
A number of studies on this subject, on
patients without previous orthodontic treatment
are reported (Ingervall, 1964a; Horn and Vetter,
1976a and b; Kulmer, 1977; Richter, 1980) and
their results are summarized in Table 1.
The more recent studies used a so-called
'Condymeter' for measurements (Fig. 1). With
six appropriately placed gauges, this device
allows the precise determination of the difference
in condyle position between RCP and ICP in all
three dimensions (Fig. 2) and also indicates the
extent of condylar movement between the two
positions.
The present study aimed to investigate the
following questions:
(1) Can intercuspal position (ICP) be repro-
gauge (the condymeter)?
(2) How large is the discrepancy between retru-
sive contact-position (RCP) and intercuspal
position (ICP) in orthodontically treated
patients immediately after band removal?
(3) To what degree does a gnathologic posit-
ioner lead to a change in condylar position
through fine adjustments in the occlusion?
(4) What does the result look like after one year
of retention?
Ten adolescents, who underwent fixed orthodon-
tic treatment without extraction, were examined.
After band removal, two alginate impressions
were taken of both the upper and lower jaw and
immediately cast in hard plaster. To check the
mounting procedure the upper jaw models were
formed as split-casts. They were then mounted in
the articulator in relation to the cranium with the
help of a SAM facebow.
The centric bite record was made according to
Motsch (1977) using a beauty pink wax plate and
zinc oxide paste facilitating the mounting of the
lower jaw model. Two centric bite records were
prepared for every case. One of the two sets of
mounted models was used for a gnathologic
positioner made according to the methods of
Roth and Gordon (1981) and Schinhammer
(1979).
222 HELMUT DROSCHL, ILSE PERMANN AND HANS BANTLEON

Figure 1 Condymeter.

Figure 2 The three gauges on each side of the condymeter for precise determination of the difference of the condyle position
between RCP and ICP.

The models were mounted in the articulator in
RCP and their occlusion examined. Teeth that
were not yet in ideal occlusion were cut out,
brought into their ideal position, and fixed in
place with wax. Shimstock foil was used to assess
even, multipoint contact all the way around.
Special attention was paid to canine guidance
and to the avoidance of balancing contacts. The
models were then duplicated and the future
positioner modelled in wax on the finished
plaster models. The finished positioner was
finally polymerized in a flask with soft acrylic
resin. When compared with rubber, the soft
acrylic has the advantage of not shrinking during
polymerization.
The positioner was placed two days after band
removal. The patient was instructed to wear it
day and night during the first two weeks, and a
OCCLUSAL CHANGES DURING RETENTION WITH A GNATHOLOGIC POSITIONER 223

Figure 3 The condymeter is closed while the lower part of the upper split-cast is in maximum intercuspation. When the split-
cast is closed the RCP-ICP difference in all three dimensions can be seen on the gauges.

few hours a day, and all night, during the next ten
weeks.
Two, four, and 12 weeks after band removal,
models were again made of all ten subjects by the
method described above and mounted in the
articulator. Thus there were model series of the
ten patients consisting of one model immediately
after band removal (Model 1) and an average of
three control models (Models 2-4). These models
provided the data for the first part of the study.
After screwing the models into the condymeter
and unlatching the upper part, the upper-jaw
model was put into maximum intercuspation to
the lower-jaw model. The split cast was then
closed in this position (Fig. 3).
To evaluate the reproducibility of the adjust-
ment of centric occlusion in the condymeter, it
was determined by four examiners, three times in
all cases.
The influence of examiner, measurement, or

Table 1 RCP-ICP difference (mm) as determined by various authors.

Plane of
Author Method reference Age n Sagittal Vertical Lateral
Posselt(1952) cephalograms Se-N line 50 1.25 0.9 —
Ingervall models occlusal 5a 33 1.12 0.65 0.26
(1964)b cephalograms plane 10a 35* 0.85 1.05 0.36
(1964)a cephalograms 20a 29 0.89 1.34 0.16
Hom + Vetter Dentatus
(1976) articulator 22-28a 21* 0.56/0.49
Kulmer (1977) condymeter axis- 6-9a 16* 0.67 1.12 0.34
orbital- 10-12a 17* 0.70 0.69 0.38
plane 13-16a 25* 0.18 1.15 0.18
Richter(1980) condymeter axis- 5a 58 0.38/0.47 0.30/0.19 0.20/0.20
orbital 25 of 0.28 0.24 0.18
plane them
class I

* Class I occlusion.
224 HELMUT DROSCHL, ILSE PERMANN AND HANS BANTLEON

model on the results was studied by univariate
and two-way variance analysis. For each study,
measurements were made in six directions (right-
lateral, right-sagittal, right-vertical, left-lateral,
left-sagittal, and left-vertical), and in addition,
two spatial diagonals were calculated. The role of
the examiner and the process of measurement on
the results in a specific model and in one of the
eight directions was investigated. The hypothesis
'the measurement results are independent of the
examiner and of the measurement' was com-
pared to the alternative 'the results depend on the
examiner and are therefore not reproducible'.
Two-way variance analysis of four models and
eight directions showed an influence (P < 0.05) of
the examiner in only two of 32 cases. No
statistically significant association with the exa-
miner and/or the measurement was found in the
other comparisons. This demonstrates the results
of the different measurements to be reproducible
by different examiners.
The next question was the simultaneous
influence of the examiner (1-4) and the model (1-
4) on the results of three measurements and eight
directions. In 15 of 24 cases, statistically signifi-
cant (P<0.05) associations were found between
the average of ten measurements. In 15 of 24
cases the hypothesis 'the measurement results are
independent of the examiner and the model'
could not be substantiated. Thus, the respective
model of the series 1 to 4 had a significant
(P < 0.05) influence.
Univariate analysis and paired tests of the
influence of the model with one examiner, one
measurement, and one direction at a time
showed that model 1 (day of bracket/band
removal) often differed significantly from models
2 to 4. Model 1 showed the largest averages,
model 2 usually showed the smallest. In all three
measurements this trend was reflected in the
averages from examiners 1 to 4, the results being
shown in Table 2.
For ICP (intercuspal position), our results are
reproducible by the described procedure with
sufficient precision and independently of the
observer at different measurements. The discre-
pancies of the RCP-ICP difference are relatively
large at first, but decline sharply during the first
two weeks. This is due to the high frequency with
which the patients were requested to wear the
positioner. During the following weeks, the
patients wore the positioner less and so that the
measured values of the RCP-ICP difference rise,
only to decline again markedly at the end of the
period under study.
After the last mounting and measuring, the
patients were instructed to continue to wear the
positioner at night as a retainer.
Since wearing the positioner for three months
clearly improved occlusion, we were very in-
terested in the situation after a one-year reten-
tion time. Consequently at one year all ten
patients underwent a thorough clinical and
instrumental functional analysis.
After making precise impressions and models,
we performed axiography on all patients and
carried out bite-taking and mounting. This series
of models (model 5) was subsequently measured
in the condymeter. The results for all three
dimensions can be seen in Table 2.
After one year retention time, the average
values of the discrepancy between retruded con-

Table 2 RCP-ICP differences (mm) at and after band removal measured with condymeter.
Right side Left side

Model 5 Model 4 Model 3 Model 2 Model I Model 1 Model 2 Model 3 Model 4 Model 5
after after after after band band after after afteT after
1 year 12 weeks 4 weeks 2 weeks removal removal 2 weeks 4 weeks 12 weeks 1 year

Sagittal X 0.29 -0.22 -0.53 -0.52 -0.52 -0.14 -0.14 0.19 0.14 0.33
s 0.61 0.54 0.70 0.78 0.78 0.90 0.90 0.83 0.80 0.65
Vertical X 0.35 0.17 0.05 0.02 0.61 0.43 -0.07 0.33 0.23 0.46
: s 0.45 0.48 0.62 0.49 0.55 0.76 0.69 0.83 0.59 0.69
Lateral X 0.07 -0.03 0.02 -0.40 -0.17 0.17 0.06 -0.02 0.01 -0.07
O ® s 0.19 0.26 0.48 0.41 0.52 0.54 0.40 0.46 0.26 0.19
Spatial X 0.75 0.62 0.95 0.81 1.20 1.22 0.86 0.93 0.77 0.93
diagonal s 0.46 0.54 0.70 0.55 0.63 0.64 0.63 0.93 0.73 0.57
OCCLUSAL CHANGES DURING RETENTION WITH A GNATHOLOGIC POSITIONER 225

Table 3 RCP-ICP differences (mm) of an untreated
group (n = 25) of 13-16 year-old subjects with Class I
occlusion, measured with the condymeter (Kulmer,
1977).
Sagittal X 0.28
s 0.26
Vertical X 1.13
I s 0.42
Lateral X 0.32
O ® s 0.61
tact position and intercuspal position were
+ 0.29 mm for the right sagittal vector and
+ 0.33 mm for the left. The corresponding value
for the right vertical vector was +0.35 mm and
+ 0.46 mm for the left. Laterally, +0.07 mm was
found on both sides. The average spatial diago-
nal was +0.75 mm on the right and +0.93 mm
on the left.
Comparing the situation on the day after band
removal with that after one year's retention, the
overcorrection of the Class I occlusion at the end
of treatment has developed into a minimal slide
in centric. The right vertical vector has decreased
markedly, while the left showed almost no
change. The lateral deviation has clearly
improved, as have the spatial diagonals.
Comparing the situation after 12 weeks with
that after one year—which represent the begin-
ning and the end of the retention time, respect-
ively—a similar case can be made for the sagittal
plane. In the vertical plane, the values increased
on both sides. The lateral deviations were practi-
cally zero. The spatial diagonals increased
slightly on both sides.
Kulmer (1977) obtained measurements by the
same method in 25 untreated patients in the same
group with Class I occlusion (Table 3). With the
exception of the sagittal plane, the values of the
treated patients were below those of the
untreated patients. All together, the treated
patients showed less slide than the untreated
ones.
As summarized in Fig. 4, after three months
wearing time the measured values approached
the zero line (RCP = ICP). The lateral deviation
showed the smallest values; the vertical vector
showed the greatest improvement.
After the one-year retention during which the
positioner was worn at night only, there was a
slight increase in the average sagittal value, an
increase of the vertical, as well as a nearly
constant lateral value close to the zero line. The
spatial diagonal increased only slightly.
The axiographic registration showed a clear
and harmonious course in 90 per cent of the
patients (Fig. 5). With the axiographic values for

-1.0
6 8 10 12 54
Band removal Weeks after band removal
Right > p - o •—— —•
Left > y C T T A j L VERTICAL SPATIAL DIAGONAL

Figure 4 Change of the RCP-ICP difference during the wearing of a gnathologic positioner.
226 HELMUT DROSCHL, ILSE PERMANN AND HANS BANTLEON

jf S i.

Figure 5 The axiographic registration showed a clear and harmonious course in 90 per cent of the patients.

Figure 6a Laterotrusion was primarily canine-guided in all patients.

the HCI (horizontal condyle inclination) and
Bennett's angle, the models underwent an exact
instrumental functional analysis at the individual
articulator adjustment. In centric relation pre-
contacts were frequently found in the premolar
area, but especially at the second molars, which
were not ideally positioned at the end of treat-
ment (Fig. 6a, b). Laterotrusion, which primarily
was canine-guided in all patients, showed mild
balancing contacts. According to Meller (1980),
these are not necessarily pathologic. Protrusion
was completely unhindered. The values for Ben-
nett's angle lay between 5 and 20 degrees. The
mean HCI was 55 degrees. The clinical functio-
nal analysis showed harmonious occlusion in
centric occlusion. This was reflected in the even
contacts of all teeth, as demonstrated with
occlusion foil.
OCCLUSAL CHANGES DURING RETENTION WITH A GNATHOLOGIC POSITIONER
Figure 6b Mild balancing contacts were found in all patients.
Discussion
Gnathologists have long complained that ortho-
dontists produce 'ungnathologic results'. The
present study showed that with exact finishing,
orthodontics produce better results with regard
to 'slight in centric' than found in untreated
children. Thus, the goals of orthodontics and
gnathology concur. This was achieved by over
correcting Class I occlusion towards slight Class
III. The question as to how far similar changes
occur during natural settling was not evaluated
by the present study.
Acknowledgement
I wish to thank Doz.Dipl.-Ing. K. Pfeiffer from
the Institute of Physiology for his help with the
statistical analysis.
Address of correspondence
Professor Dr H Droschl
Department fur Kieferorthopadie
Univ. Klinik fur Zahn-, Mund- und Kieferheil-
kunde
A-8036 Graz,
Austria
227
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