Assessment of the Three-Dimensional Condylar and

Dental Positional Relationships in CR-to-MIC Shifts

Ryan Tamburrino, DMD ■ Antonino Secchi, DMD, MS ■ Solomon Katz, PhD
Andres Pinto, DMD, MPH ■ University of Pennsylvania School of Dental Medicine
Department of Orthodontics

Author DDS, Bio Summary

Ed diam, sim acillup tatincilit in ut Many previous studies have attempted to qualify a relationship between
ing erci et, con henisci llandre magna
accum vendreet, corer sequam et,
temporomandibular dysfunction (TMD) and various aspects of static and
quatum quis ad deliquat, quipsusci functional occlusion. Every study was attempting to associate joint dysfunc-
te dolum dolore volesequis ad ero tion and displacement with what could be readily observed at the level of
euisl dolum do erat. Sandre commodi the dentition, when this may or may not be a valid observation. The purpose
ametum aut adip esto dolut ad magnit
alit augiam, veliquat num dolore vel
of this study was to investigate the magnitude of dental slides and occlusal
elit lut prat am, quat. changes related to the magnitude of the corresponding condylar shift. The
results suggest there is no relationship between the amount of dental slide
Author DDS, Bio in any direction and condylar displacement from CR to MIC. Therefore,
Ed diam, sim acillup tatincilit in ut
ing erci et, con henisci llandre magna
assuming the direction and/or magnitude of condylar displacement from an
accum vendreet, corer sequam et, observed intraoral dental slide from CR to MIC is not appropriate.
quatum quis ad deliquat, quipsusci
te dolum dolore volesequis ad ero
euisl dolum do erat. Sandre commodi
ametum aut adip esto dolut ad magnit
alit augiam, veliquat num dolore vel
elit lut prat am, quat.

Introduction against the posterior slopes of the articular eminence with

Many previous studies have attempted to qualify a relation-
ship between temporomandibular dysfunction and various
aspects of static and functional occlusion. These projects
have studied static criteria, such as molar Angle classifica-
tion, overjet, overbite, crossbites, and other occlusal charac-
teristics, by observing them intraorally on a patient in centric
occlusion or on nonarticulated study casts (1–21). In addi-
tion, several studies have attempted to incorporate dynamic
criteria, such as nonworking interferences (11–12, 15–17)
and the magnitude and direction of dental slides (1–10, 15),
into the criteria used to determine a patient’s predisposition
to TMD symptoms.
The slide that is referred to in these articles is the tooth
and jaw positional shift that is observed as the patient closes
from a centric relation (CR) position to maximum inter-
cuspation (MIC) of the teeth. Okeson defines CR, or the
musculoskeletally stable position, as the “most orthopedi-
cally stable joint position… when the condyles are in their
most superoanterior position in the articular fossa, resting
the discs properly interposed” (22). According to classical
functional occlusion texts, when the mandible is in CR, only
pure rotational movements of the jaw occur until the lateral
temporomandibular ligament stops the motion and induces
the condyles to move forward (23). Therefore, with the con-
dyles seated in CR and the jaw arcing closed, the patient’s
teeth will eventually contact. This location of the first tooth-
tooth contact is referred to as the primary contact. In most
patients, as Utt et al. (24) have shown, this primary tooth
contact is not likely to be coincident with bilateral equivalent
centric stops as a stable position, and the teeth and jaws will
subsequently slide from this primary contact into the more
stable tooth position of MIC.
As this slide occurs, not only do the tooth relationships
change to accommodate the teeth in MIC, but the condylar po-
sition adjusts from a stable CR position to a new location that is
a slave to the mandibular position of MIC. The direction of the
slide depends on the way the occlusion must be altered to best
accommodate the dentition, irrespective of condylar position.

RWISO Journal | April 2009 7

 Several previous studies on TMD and occlusion have
concluded that signs and symptoms of TMD are seen in
patients who have a larger slide (15), assuming that larger
dental slides correspond to larger condylar shifts from CR
to MIC. Other studies, however, have found no correlation
of TMD symptoms with slides of any magnitude or direction
(6–10). To date, no article has ever proposed a quantifiable
relationship between the amount of observed dental slide
and the corresponding condylar positional change in three
dimensions. This may be the reason for the mixed conclu-
sions of the previous studies. Every study was attempting
to associate joint dysfunction and displacement with what
could be readily observed at the level of the dentition, when
this may or may not be a valid observation. The purpose of
the present study, therefore, was to investigate the magnitude
of dental slides and occlusal changes related to the magni-
tude of the corresponding condylar shift.
Materials and Methods
Population
For this study, we examined 42 orthodontically untreated
children between the ages of 7 and 17 who were seen for
routine treatment in the graduate orthodontic clinic or the
faculty practice at the University of Pennsylvania. No prefer-
ence was given to sex, race, occlusal pattern, skeletal pattern,
number of permanent primary teeth present, or reason for
seeking orthodontic treatment. This population contained
subjects who were included in a larger study on functional
occlusion in orthodontically untreated children and adoles-
cents. The age range of the subjects in the present study was
limited solely to keep this study consistent with future proj-
ects that will use other criteria from this database.
Children who had space maintainers, wore extraoral
or intraoral appliances, had a history of prior orthodontic
treatment, were uncooperative, or had systemic conditions
with craniofacial deformities were excluded from the study.
Records
Maxillary and mandibular impressions were taken on each
child. A CR bite as described by Wood et al. (25), an MIC
bite, and estimated face-bow were also taken on each child.
No attempt was made to prescribe splint therapy for children
who were difficult to manipulate into CR, or who had symp-
tomatic temporomandibular joint (TMJ) or muscle pain at
the time records were taken, nor was any child recalled to
retake the CR bite at a later date. The CR bite obtained on
the initial visit was used as the most accurate bite that could
be obtained on that day.
The maxillary and mandibular impressions were tak-
en with Identic alginate in rim lock alginate trays, poured
8 Tamburrino et al. | Three-Dimensional Condylar and Dental Positional Relationships in CR-to-MIC Shifts
in hand-mixed Vel-mix die stone, and maxillary split cast
mounted with Kerr #2 rapid-set dental plaster on a Panadent
(PCH) semiadjustable articulator in CR. The CR bite was re-
corded using DeLar bite registration wax, and the MIC bite
was recorded using Moyco 10x wax.
Model Examination
The relationships among specific occlusal features of the
models were observed both in MIC, with the MIC wax bite
interposed, and in mounted CR, at the point of the primary
contact. From both of these positions, the following data
were recorded for each patient, using a periodontal probe
for measurement: overjet, overbite, midline position, and po-
sition of the mesiobuccal cusp tip of the maxillary 1st molar
on the buccal surface on the corresponding mandibular 1st
molar. The overbite was defined as the distance in millimeters
from the incisal edge of the mandibular central incisor to the
incisal edge of the maxillary central incisor. In the case of a
height discrepancy between the central incisors, the one mea-
surement with the greater overbite was used. The overjet was
defined as the distance in millimeters from the facial surface
of the mandibular central incisor to the lingual surface of the
maxillary central incisor, tangent to the incisal edge of the
maxillary central incisor. In the case of a buccolingual dis-
crepancy between the central incisors, the one measurement
with the smaller overjet was used. The midline position was
defined as the horizontal difference in millimeters between
the midlines of the maxillary and mandibular dentitions.
The magnitudes of the horizontal change in overjet and
position of the mesiobuccal cusp tip of the maxillary 1st mo-
lar projected on the buccal surface of the mandibular 1st mo-
lar, the vertical change in overbite, and transverse difference
of the midlines were all calculated and recorded.
CPI Recording
The three-dimensional condylar position data for each pa-
tient were collected according to the protocol described by
Crawford (26) and measured with the Panadent Condylar
Position Indicator (CPI).
Results
The results in Figures 1 and 2 show that 21 (50%) of the
patients had posterior condylar movement of the right con-
dyle, and 18 (43%) had posterior condylar movement of the
left condyle. Nineteen of the patients (45%) had mesial right
condyle CR-to-MIC movement, and 23 (55%) had mesial
movement of the left condyle. Thirty-seven patients (88%)
had inferior movement of the right condyle and 33 (79%)
had inferior movement of the left condyle.
 R Condylar CR-MIC Directional Movement
tionship more closely conforms to class II (24, 27). Statisti-
Horizontal Number Percentage
cally, these negative values of the changes in pseudo-class III
Distal 21 50% patients would have falsely represented the data. Therefore,
Mesial 19 45% all positional changes were converted to positive values.
None 2 5% To compare the data, the correlation between dental
Vertical
movements and corresponding condylar movements was
Inferior 37 88%
Superior 5 12% plotted and calculated, as shown in Figure 3. The data were
None 0 0% statistically analyzed by two methods. First, the correlation
coefficient was determined between two variables. Next, the
L Condylar CR-MIC Directional Movement
data for two variables were plotted and a linear “best-fit”
Horizontal Number Percentage
trend line was constructed. The data were correlated to this
Distal 18 43% trend line. The purpose of examining the data in this way
Mesial 23 55% was twofold. First, correlation between two variables was ex-
None 1 2% ecuted to determine whether the CPI-directional and tooth-
Vertical
directional movements were related. Second, the correlation
Inferior 33 79%
Superior 5 12% to the trend line was determined to examine the feasibility
None 4 9% of predicting condylar movement in a certain direction by
observing the dental movement in the same direction.
Figure 1 CPI directional movements.
Dental CR-MIC Movements (mm)
Average Minimum Maximum
CPI R Condyle
Overjet Change 0.74 0.0 3.0
Horizontal Shift
-4.00 Overbite Change 0.99 0.0 3.0
-3.00 L MB6 Movement 0.78 0.0 3.0
-2.00 R MB6 Movement 0.69 0.0 2.5
-1.00 Midline Movement 0.61 0.0 3.0
Vertical Shift

-3.00 -2.00 -1.00 0.00 1.00 2.00 3.00

0.00

1.00 Figure 3 Range of dental movements in millimeters.

2.00

3.00

4.00
For all correlations between pairs of data sets, the R
values were such that no direct relationship between dental
movement and condylar shift in any direction could be made.
CPI L Condyle
In addition, the regression R2 value was determined for each
Horizontal Shift
-4.00 pair of data. For these too, nearly all of the data sets showed
-3.00
no statistically significant value (R2>0.10). However, for two
-2.00

-1.00
of the data sets, the R2 value was 0.164 and 0.156 for CPI
Vertical Shift

3.00 2.00 1.00 0.00

0.00
-1.00 -2.00 -3.00
left vertical versus overbite and CPI average vertical versus
1.00 overbite, respectively.
2.00
The summary of the correlation statistics is shown in
3.00

4.00
Figure 4, and the dataplots with regression lines are shown
in Figure 5.
Figure 2 Compilation of CPI recordings.

Data concerning dental movements were obtained and

analyzed using Microsoft Excel 2004 software. For all vari-
ables, only the magnitude of the movements was recorded.
This was because several of the subjects had pseudo-class III
functional shifts in which the anterior overjet decreased and
the overbite increased from CR to MIC. Studies have already
described that, in dental movements from CR to MIC, the
overjet increases, the overbite decreases, and the molar rela-
continued on next page...

RWISO Journal | April 2009 9

 Comparison Correlation Coefficient (R) Regression (R2)

CPI L Horizontal/OJ 0.06 0.003

CPI R Horizontal/OJ -0.31 0.094
CPI Avg. Horizontal/OJ -0.15 0.019

CPI L Horizontal/MB6 L -0.14 0.020

CPI R Horizontal/MB6 L -0.17 0.030
CPI Avg. Horizontal/MB6 L -0.09 0.050
CPI L Horizontal/MB6 R -0.14 0.023
CPI R Horizontal/MB6 R -0.23 0.009
CPI Avg. Horizontal/MB6 R -0.09 0.009

CPI L Vertical/OB 0.26 0.164

CPI R Vertical/OB 0.41 0.069
CPI Avg. Vertical/OB 0.39 0.156

CPI Transverse/Midline 0.08 0.005

Figure 4 Data correlation statistics.

OJ change Line Fit Plot

OB change Line Fit Plot
2.5
3

2.5 2

2
ABS Avg. Vert.

1.5
ABS Avg. Horiz.

1.5

0.5 0.5

0
-3 -2 -1 0 1 2 3 4 0
-1.5 -1 -0.5 0 0.5 1 1.5 2 2.5 3
OB change OJ change

MB6 mvmt L Line Fit Plot

MB6 mvmt R Line Fit Plot
2.5
2.5

2
2

1.5
ABS Avg. Horiz.

ABS Avg. Horiz.

1.5

1
1

0.5
0.5

0 0
-2 -1 0 1 2 3 4
-1 -0.5 0 0.5 1 1.5 2 2.5 3
MB6 mvmt L
MB6 mvmt R

CPI Transverse Line Fit Plot

3.5

2.5
Transverse Difference

1.5

0.5

0
0 0.5 1 1.5 2 2.5
CPI Transverse

Figure 5 Data plots of magnitudes of average CPI values vs. dental characteristics, with regression line.

10 Tamburrino et al. | Three-Dimensional Condylar and Dental Positional Relationships in CR-to-MIC Shifts
 Intraoperator reliability testing was performed on a ran-
dom sample of ten patients. The initial data for these patients
were taken during the summer of 2007 or earlier. The data
for these patients were remeasured in May 2008, and the
correlation results shown in Figure 6 indicated good repro-
ducibility of the data.

Comparison Pearson’s Correlation Coefficient

L CPI Horizontal 0.97

L CPI Vertical 0.92
R CPI Horizontal 0.98
R CPI Vertical 0.93
CPI Transverse R 0.94
CPI Transverse L 0.85

CO Overbite 0.98
CR Overbite 0.99
CO Overjet 0.86
CR Overjet 0.98

CO Coincident Midlines 1.00

CR Coincident Midlines 1.00
CO Mandibular Midline L 0.99
CR Mandibular Midline L 1.00
CO Mandibular Midline R 1.00
CR Mandibular Midline R 0.99

MB6 Movement L 1.00

MB6 Movement R 1.00

Figure 6 Reliability testing data for a ten-patient sample.

Discussion to prescribe deprogramming therapy for each patient.

The results obtained in this study are based on first accu-
rately mounting the patient’s casts in CR on a semiadjust-
able articulator. The CR bite registration with a hard an-
terior stop used in this study has been previously validated
as an appropriate technique for recording the CR position
of the mandible (25, 28-30). A basic assumption made for
accurately recording the CR position with this technique is
that the patient’s musculature is relaxed and the joints are
stabilized. An appropriate method for ensuring muscular
relaxation is to use a deprogramming device, such as an oc-
clusal splint or anterior bite plate, for a specified period of
time determined on a case-by-case basis (31-34). However,
the size and time constraints of this study made it impractical
For this study, a modified method of neuromuscular
deprogramming was employed. Following the principles of
simulating a Lucia jig (34, 35), two cotton rolls were placed
between the patient’s maxillary and mandibular incisors,
and patients were instructed to clench and unclench their
teeth onto these rolls intermittently for two minutes before
the centric relation bite registration was taken. While this
method is not ideal, it does interrupt the masticatory muscle
engrams to achieve initial deprogramming of the muscula-
ture and make manipulation of the jaw into CR easier. This
initial recording was sufficient for the purposes of this study.
The CPI data for patients in this study were similar to the re-
sults obtained by Utt et al. (24) and were physiologically sen-

RWISO Journal | April 2009 11

sible, as shown in Figure 7. In addition, Cordray (36) found With a pure dental fulcrum (37), the primary tooth con-
that in 97% his subjects the movement of the condyles was tact in CR is usually on the most posterior teeth in the dental
inferior, with 66.7% of these also having posterior displace- arch. As the patient tries to achieve MIC, this primary con-
ment, while 25.4% had anterior displacement. Only 11.5% tact serves as the point of rotation for the mandible. The por-
of the patients in Cordray’s study had no vertical component tion of the mandible anterior to this contact point will rotate
to their CR-to-MIC condylar shift. Figure 8 compares the counterclockwise upward and forward to close the bite. The
findings of the present study with those of earlier studies on portion posterior to this contact point, which contains the
condylar positional shifts from CR to MIC. condyle, will also rotate counterclockwise, but downward
and backward. Figure 9 illustrates this point with a graphi-
R Condylar CR-MIC Movement
cal representation and a typical CPI recording.
Horizontal Tamburrino, et al Utt, et al15
Distal 21 (50%) 47 (43%)
Mesial 19 (45%) 41 (38%)
None 2 (5%) 19 (18%)
Vertical
Inferior 37 (88%) 80 (75%)
Superior 5 (12%) 9 (8%)
None 0 (0%) 18 (17%)

L Condylar CR-MIC Movement

Horizontal
Distal 18 (43%) 42 (39%)
Mesial 23 (55%) 42 (39%)
None 1 (2%) 23 (32%)
Vertical
Inferior 33 (79%) 80 (75%)
Superior 5 (12%) 7 (7%)
None 4 (9%) 20 (18%)
Figure 9 CPI and graphical representation of a dental fulcrum.
Figure 7 Comparison of percentages of various unidirectional
condylar movements to Utt et al. results. For an anterior displacement, shown in Figure 10, the
Most of the patients in this study also had condylar CPI recording represents what happens when the primary
distractions that were posterior-inferior or anterior-inferior. contact in CR is located on a cuspal incline. As the mandible
This is representative of what happens to the condylar po- closes into MIC, the entire mandible shifts forward along
sitional shift with a dental fulcrum or an anterior displace- the dental inclines. Consequently, the condyle cannot move
ment, respectively. in a direct horizontal fashion, since it is positioned on the

Condylar CR-MIC Movements (Percentage)

Direction Tamburrino, et al. Utt, et al.24 Cordray36 Crawford26

Posterior-Inferior 46 39 66.7 70
Anterior-Inferior 38 29 25.4 Not reported
Posterior-Superior 0 3 Not reported Not reported
Anterior-Superior 8 5 Not reported Not reported
Anterior/Posterior Only 5 18 11.5 Not reported
Inferior/Superior Only 4 6 5.7 Not reported

Figure 8 Comparison of percentages of various multidirectional condylar

12 Tamburrino et al. | Three-Dimensional Condylar and Dental Positional Relationships in CR-to-MIC Shifts
posterior slope of the articular eminence in CR. Therefore, in
order to accommodate the anterior shift of the dentition, it
must move both downward and forward on the eminence.
Figure 10 CPI and graphical representation
of an anterior displacement.
Several of the data points indicated that the condyles
moved upward and forward. This indicates one of two
conditions, both of which present in the same way on the
mounted models and the CPI, as shown in Figure 11. The
primary contact in these cases is usually on a premolar or
anterior tooth, and the mounting in CR commonly has a
posterior open bite. This may signify that the patient’s CR
was not captured accurately due to muscle splinting, or that
the patient postured the mandible forward while CR was
being recorded. However, in the mixed dentition, this condi-
tion is commonly seen even if CR was captured accurately.
This can happen when an erupting permanent tooth causes
a slight supereruption of the primary tooth it is replacing,
which subsequently causes this tooth to be the primary con-
tact. Since the subjects included many preadolescent patients,
this is the most likely explanation for these results.
Figure 11 CPI representation of an anterior primary contact.
No CPI record indicated that either condyle moved in a
posterior-superior direction from CR to MIC on any patient.
This is an anatomically impossible movement, due the defi-
nition of CR and the boundaries of the glenoid fossa. This
observation further supports the biological accuracy of the
data and verifies the other CPI findings for these patients.
When the magnitude of the condylar movements on the
CPI was compared with the magnitude of the dental move-
ments, no correlation was found between horizontal condy-
lar movement and changes in overjet or molar relationship at
the level of the mesiobuccal cusp of the maxillary 1stmolar
projected onto the buccal surface of the mandibular1stmolar.
Midline shifts did not correlate with the transverse move-
ment of the condyles. However, two groups of data compar-
ing vertical condylar movements to changes in overbite did
show weak correlations (R2>0.10). This suggests that for
15.6% of the population, there was a reasonable correlation
between the change in overbite and the average bilateral con-
dylar vertical movement; and that for 16.4% of the popula-
tion there was a correlation between the with overbite and
the left vertical condylar movement. While these values may
be statistically significant, they are not clinically relevant.
These findings are illustrated by the fact that several pa-
tients demonstrated large dental movements with minimal
condylar shift, while the converse was true for others. We
will understand why if we study the geometry of the man-
dible. As shown previously with the evaluation of the CPI
data, the direction of the condylar shift can vary, depending
on the location of the primary contact. Dental slides from
the primary contact to MIC exhibit different behaviors when
the contact is made on a marginal ridge, on acuspal incline,
or on an anterior or posterior tooth. One must also remem-
ber that the primary contact, or contacts, can be unilateral
or bilateral, and that each contact will affect the direction,
and the extent to which each individual condyle will move in
three planes of space. Thus, while the CPI data give a graphic
unidirectional representation of each dimensional movement
of the condyle, the actual movement in the patient is the re-
sultant vector of these three motions. Also, each condyle
moves individually in response to the motion needed to ob-
tain MIC from CR.
Furthermore, the extent of expression of the dental
movement at the condylar level depends on the distance of
the primary contact from the condyles. Due to the geom-
etry of the system, the movement of contacts that are closer
to the condyles will be will be greater than the movement
of contacts that are farther from the condyles. Since each
patient’s dental anatomy is unique, as are the dimensions of
the mandible and the condyles in each patient, the extent
of expression of the dental slide at the condylar level must
RWISO Journal | April 2009 13
be different for each patient. Therefore, since the movement
of the condyle depends both on the resultant vector of the
dental slide and on the individual geometry of the patient’s
masticatory system, it is impossible to predict the extent of
CR- to-MIC condylar shift by observing only the intraoral
dental slide. Figure 12 illustrates the many variables and ge-
ometries that determine CR-to-MIC shift at both the dental
and the condylar levels. All of these factors must be taken
into account.
Figure 12 Illustrations of the complex variables (red), such as
location of tooth contact, mandibular geometry, distance from
the condyle, location of mandibular center of rotation, and
dental shift in three dimensions, that determine the three- di-
mensional condylar positional changes (green).
The clinical importance of this finding is fourfold. First,
it shows that the clinician cannot deduce condyle positional
changes by observing dental movements. Instead, he or she
must measure the positional movements of the temporoman-
dibular joints with instrumentation specifically designed for
this purpose, such as the CPI. Second, in order to determine
the positional changes of the condyle, the clinician needs to
observe the patient’s dentition from models mounted on an
articulator in CR. Otherwise, the instrumentation for mea-
suring the condylar CR-to-MIC positional change cannot be
used, because there is no way to use the CPI or similar in-
strumentation with hand-articulated or heel-trimmed dental
casts. Third, by measuring the CR-to-MIC condylar shift, the
clinician can convert a lateral cephalogram taken in MIC to
one in CR, as Shildkraut et al. (27) have demonstrated. Pre-
vious studies have shown that patients have larger overjets,
shallower overbites, and more closely conform to class II in
the molar and canine region, when they are in CR than when
they are in MIC (24, 27). Since good occlusal function with
good dental health and stability is one of the goals of treat-
ment set forth by the AAO (38), the case should be treatment
planned from CR to allow the clinician to achieve that goal.
Converting the cephalogram helps the clinician to arrive at
an accurate diagnosis. Finally, since the data have shown
that patients with small dental slides can have large condylar
shifts, and patients with large slides can have small condy-
14 Tamburrino et al. | Three-Dimensional Condylar and Dental Positional Relationships in CR-to-MIC Shifts
lar shifts, these results suggest that mounting every case and
observing the condylar position change from CR to MIC in-
creases the likelihood of a correct diagnosis. The clinician
cannot obtain this information, or determine which cases
need articulator mountings, from a patient exam alone.
The results of this study suggest one reason for the dis-
crepancy among studies on TMD and occlusion regarding
the significance of the relationship between the dental slide
and TMD symptoms. If the condylar, rather than the dental,
shift plays a role in the development of these symptoms, this
may partly explain why some patients with gross malocclu-
sions and large dental slides have minimal TMD symptoms,
while other patients with relatively normal occlusions and
small dental slides have severe TMD symptoms. Of course,
this does not take into account the other multifactorial as-
pects of TMD, or the patient’s adaptive capacity—but it does
provide an impetus for further research on this topic to de-
termine the extent of the condylar shift in these subjects.
Conclusions
The data have demonstrated that the magnitude of den-
tal and condylar movement from a CR-to-MIC shift does
not correlate in the horizontal and transverse dimensions,
and that there is an extremely weak correlation in the verti-
cal dimension, which is not clinically significant. The geom-
etry and morphology of each patient’s masticatory system is
unique; this can affect the relationship between the condyles
and the dentition. If the clinician’s objective is to record the
position of the condyles in both CR and MIC so as to under-
stand the direction and magnitude of the condylar shift from
CR to MIC, he or she must use appropriate instrumentation.
Thus, clinically observed dental CR-to-MIC slides in any di-
rection are not valid criteria to associate with joint function
or dysfunction. ■
Notes
1. Pullinger, A.G., D.A. Seligman, and W.K. Solberg.“Temporomandib
ular Disorders.Part I: Functional Status, Dentomorphologic Features,
and Sex Differences in a Nonpatient Population.” Journal of Prosthetic
Dentistry 59.2 (1988): 228–35.
2. Pullinger, A.G., D.A. Seligman, and W.K. Solberg. “Temporoman-
dibular Disorders. Part II: Occlusal Factors Associated with Temporo-
mandibular Joint Tenderness and Dysfunction.” Journal of Prosthetic
Dentistry 59.3 (1988): 363–67.
3. Seligman, D.A., A.G. Pullinger, and W.K. Solberg. “Temporomandibu-
lar Disorders. Part III: Occlusal and Articular Factors Associated with
Muscle Tenderness.” Journal of Prosthetic Dentistry 59.4 (1988): 483–89.
4. Runge, M.E., C. Sadowsky, E.I. Sakols, and E.A. BeGole. “The Re-
lationship between Temporomandibular Joint Sounds and Malocclu-
sion.” American Journal of Orthodontics and Dentofacial Orthopedics
96.1 (1989): 36–42.
5. Pullinger, A.G., and D.A. Seligman. “Quantification and Validation
of Predictive Values of Occlusal Variables in Temporomandibular Dis-
orders Using a Multifactorial Analysis.” Journal of Prosthetic Dentistry
83.1 (2000): 66–75.
6. Seligman, D.A., and A.G. Pullinger. “Association of Occlusal
Variables among Refined TM Patient Diagnostic Groups.” Journal of
Craniofacial Disorders: Facial & Oral Pain 3.4 (1989): 227–36.
7. Pullinger, A.G., and D.A. Seligman. “Overbite and Overjet Char-
acteristics of Refined Diagnostic Groups of Temporomandibular
Disorder Patients.” American Journal of Orthodontics and Dentofacial
Orthopedics 100.5 (1991): 401–15.
8. Pullinger, A.G., D.A. Seligman, and J.A. Gornbein. “A Multiple Lo-
gistic Regression Analysis of the Risk and Relative Odds of Temporo-
mandibular Disorders as a Function of Common Occlusal Features.”
Journal of Dental Research 72.6 (1993): 968–79.
9. Seligman, D.A., and A. G. Pullinger. “Analysis of Occlusal Variables,
Dental Attrition, and Age for Distinguishing Healthy Controls from
Female Patients with Intracapsular Temporomandibular Disorders.”
Journal of Prosthetic Dentistry 83.1 (2000):76–82.
10. Thilander, B., G. Rubio, L. Pena, and C. de Mayorga. “Prevalence
of Temporomandibular Dysfunction and Its Association with Maloc-
clusion in Children and Adolescents: An Epidemiologic Study Related
to Specific Stages of Dental Development.” Angle Orthodontist 72.2
(2002): 146–54.
11. Egermark-Eriksson, I., G.E. Carlsson, and T. Magnusson. “A
Long-Term Epidemiologic Study of the Relationship between Occlusal
Factors and Mandibular Dysfunction in Children and Adolescents.”
Journal of Dental Research 66.1 (1987): 67-71.
12. Williamson, E.H. “Temporomandibular Dysfunction in Pretreat-
ment Adolescent Patients.” American Journal of Orthodontics 72.4
(1977): 429–33.
13. Gazit, E., M. Lieberman, R. Eini, N. Hirsch, V. Serfaty, C. Fuchs,
and P. Lilos. “Prevalence of Mandibular Dysfunction in 10–18 Year
Old Israeli Schoolchildren.” Journal of Oral Rehabilitation 11.4
(1984): 307–17.
14. Riolo, M.L., D. Brandt, and T.R.TenHave. “Associations between
Occlusal Characteristics and Signs and Symptoms of TMJ Dysfunction
in Children and Young Adults.” American Journal of Orthodontics and
Dentofacial Orthopedics 92.6 (1987):467–77.
15. Nilner, M.“Functional Disturbances and Diseases of the Stomato-
gnathic System: A Cross-Sectional Study.” Journal of Pedodontology
10.3 (1986): 127–40.
16. Kampe, T., G.E. Carlsson, H. Hannerz, and T. Haraldson. “Three-
Year Longitudinal Study of Mandibular Dysfunction in Young Adults
with Intact and Restored Dentitions.” Acta Odontologica Scandinavia
45.1 (1987): 25–30.
17. Kirveskari, P., P. Alanen, and T. Jamsa. “Association between
Craniomandibular Disorders and Occlusal Interferences in Children.”
Journal of Prosthetic Dentistry 67.5 (1992): 692–96.
18. Gunn S.M., M.W. Woolfolk, and M.W. Faja. “Malocclusion and
TMJ Symptoms in Migrant Children.” Journal of Craniomandibular
Disorders 2.4 (1988): 196–200.
19. Keeling, S.D., S. McGorray, T.T. Wheeler, and G.J. King. “Risk
Factors Associated with Temporomandibular Joint Sounds in Children
6–12 Years of Age.” American Journal of Orthodontics and Dentofa-
cial Orthopedics 105.3 (1994): 279–87.
20. Vanderas, A.P. “Relationship between Craniomandibular Dysfunc-
tion and Malocclusion in White Children with and without Unpleasant
Life Events.” Journal of Oral Rehabilitation 21.2 (1994): 177–83.
21. Motegi, E., H. Miyazaki, I. Ogura, H. Konishi, and M. Sebata.
“An Orthodontic Study of Temporomandibular Joint Disorders. Part I:
Epidemiological Research in Japanese 6–18 Year Olds.” Angle Ortho-
dontist 62.4 (1992): 249–56.
22. Okeson, J.P. Management of Temporomandibular Disorders and
Occlusion. 5th ed. St. Louis, MO: Mosby; 2003:113.
23. Dawson, P.E. Functional Occlusion: From TMJ to Smile Design.
St. Louis, Mo: Mosby; 2007:142.
24. Utt, T.W., C.E. Meyers, T.F. Wierzbe, and S.O. Hondrum. “A Three-
Dimensional Comparison of Condylar Position Changes between
Centric Relation and Centric Occlusion Using the Mandibular Position
Indicator.” American Journal of Orthodontics and Dentofacial Ortho-
pedics 107.3 (1995): 298–308.
25. Wood, D.P., K.J. Floreani. K.A. Galil, and W.R. Teteruck. “The
Effect of Incisal Bite Force on Condylar Seating.” Angle Orthodontist
64.4 (1994): 53–62.
26. Crawford, S.D. “The Relationship between Condylar Axis Position
as Determined by the Occlusion and Measured by the CPI Instrument
and Signs and Symptoms of TM Joint Dysfunction.” Angle Orthodontist
69.2 (1999): 103–15.
27. Shildkraut, M., D.P. Wood, and W.S. Hunter. “The CO-CR
Discrepancy and Its Effect on Cephalometric Measurements.” Angle
Orthodontist 64.5 (1994): 333–42.
28. Williamson, E.H., R.M. Steinke, P.K. Morse, and T.R. Swift.
“Centric Relation: A Comparison of Muscle-Determined Position and
Operator Guidance.” American Journal of Orthodontics 77.2 (1980):
133–45.
29. Girardot, R.A. “ Condylar Displacement in Patients with TMJ
Dysfunction.” CDS Review 89.8 (1989): 49-55.
30. Lundeen, H.C. “Centric Relation Records: The Effect of Muscle
Action.” Journal of Prosthetic Dentistry 31.3 (1974): 244–53.
31. Shore, N.A. Temporomandibular Joint Dysfunction and Occlusal
Equilibration. 2nd ed. Philadelphia: Lippincott; 1976: 238–41.
32. Dyer, E.H. “Dental Articulation and Occlusion.” Journal of Pros-
thetic Dentistry 17.3 (1967): 238.
33. Calagna, L.J., S.I. Silverman, and L. Garfinkel. “Influence of Neu-
romuscular Conditioning on Centric Relation Registrations.” Journal
of Prosthetic Dentistry 30.4 (1973): 598–604.
RWISO Journal | April 2009 15
34. Karl, P.J., and T.F. Foley. “The Use of a Deprogramming Appliance
to Obtain Centric Relation Records.” Angle Orthodontist 69.2 (1999):
117.

35. Lucia, V.O. “A Technique for Recording Centric Relation.” Journal

of Prosthetic Dentistry 14.3 (1964): 492–505.

36. Cordray, F.E. “Three-Dimensional Analysis of Models Articulated

in the Seated Condylar Position from a Deprogrammed Asymptomatic
Population: A Prospective Study. Part I.” American Journal of Ortho-
dontics and Dentofacial Orthopedics 129.5 (2006): 619–30.

37. Roth, R.H., and D.A. Rolfs. “Functional Occlusion for the Ortho-
dontist. Part II.” Journal of Clinical Orthodontics 15.2 (1981): 100.

38. Poulton, D.R. Guest editorial. Angle Orthodontist 71.2 (2001): 80

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