ORIGINAL ARTICLE

Effects of 2 types of facemasks on condylar

position
Hakan Ela and Semra Cigerb
Ankara, Turkey
Introduction: The aim of this study was to compare Delaire and Grummons protraction facemasks with a new
articulator system (Amtech MG1, American Technologies, Brazil) that can record condylar positions.
Methods: Thirty-four patients treated with protraction facemask therapy were divided into 2 groups; 18
were treated with the Delaire facemask (DFM) and 16 with the Grummons facemask (GFM). The observation
periods were 8.5 months for the DFM group and 10 months for the GFM group. Mandibular position indicator
(MPI) recordings were taken with the new articulator system and evaluated before and after the protraction
facemask therapies. Results: MPI recordings in the sagittal plane showed forward and downward movement
from centric relation to maximum intercuspal position for both condyles at the beginning of treatment for most
patients. After treatment, the discrepancy between centric relation and maximum intercuspation was less in
the DFM group than in the GFM group. However, more compressive movement of the condyles through
the glenoid fossa was observed in the DFM group. Conclusions: Although the centric slide amount decreased
more with the Delaire facemask compared with the Grummons facemask, patients treated with the Delaire
facemask must be monitored for signs and symptoms of temporomandibular joint disorder. (Am J Orthod
Dentofacial Orthop 2010;137:801-8)

entofacial orthopedics deals with the adjustment of relationships between and among the
facial bones from heavy forces, or the stimulation and redirection of functional forces in the
craniofacial complex.1 For patients with Class III malocclusion and maxillary deficiency, the use of maxillary
protraction appliances is well documented in the orthodontic literature.
The conventional design of the facemask introduced
by Dr Jean Delaire2 consists of a forehead support,
a chincup, a prelabial arch, and a metal frame (Fig 1,
A). In order to protract the maxillary complex, the mandible and forehead are used as an anchorage unit with
the Delaire facemask (DFM). In general, 700 to 800 g
of orthopedic force is used to protract the maxilla with
70% to 75% of the force transmitted to the temporomandibular joint (TMJ).3 So, the TMJ must be considered
under these heavy intermittent orthopedic forces. Dr
Duane Grummons,4 who supported disengagement of
the mandible during maxillary protraction, introduced
From the Department of Orthodontics, Faculty of Dentistry, Hacettepe University,
Ankara, Turkey.
a
Clinical instructor.
b
Professor.
The authors report no commercial, proprietary, or financial interest in the
products or companies described in this article.
Reprint requests to: Hakan El, Hacettepe Universitesi Dis Hekimligi Fak,
Ortodonti ABD, Sihhiye, 06100 Ankara, Turkey; e-mail, hakanel@gmail.com.
Submitted, April 2008; revised and accepted, August 2008.
0889-5406/$36.00
Copyright 2010 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2008.08.027

a new type of facemask, called the Grummons facemask

(GFM). It uses the zygomatic region as an anchorage
unit for maxillary protraction, and consists of a forehead
support, 2 suborbital pads, a prelabial arch, and a metal
frame (Fig 1, B). The animal study of Jackson et al5
showed that maxillary protraction without a chin support caused no histologic changes in the TMJ. Although
there are hypotheses about the effects of the DFM and
the GFM on the TMJ, the validity of these assumptions
are still controversial.
In the etiology of TMJ disorders, an important factor
is the shift of the mandible due to the premature contacts
in skeletal and dental Class III patients.6 Although TMJ
sounds are less likely to occur in children7 than in
adults,8 untreated mandibular deviations can lead to
TMJ disorders.9 To determine the deviations in the
TMJ and to view the condyles, contemporary radiology
gives orthodontists various choices. However, trying to
determine and evaluate 3-dimensional condylar positions by using 2-dimensional radiographic data is not reliable.10 Therefore, mounting the dental models in
centric relation (CR) to the articulators with condylar
position recording devices and applying the mandibular
position indicator (MPI) procedure are recommended.11
Several companies such as SAM Prazisionstechnik
GmbH (Munchen, Germany), Panadent Corp. (Colton,
CA, USA) and Whip Mix Corp. (Fort Collins, CO,
USA) design and manufacture articulators that are
widely used for this procedure. The instrumentation,
working system, and reliability of these articulators
801

802 El and Ciger

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Fig 1. A, Delaire, and B, Grummons facemasks.

are well documented in the literature. In this study,

a new articulator system called the Amtech MG1
(American Technologies, Brazil) (Fig 2) was used to
evaluate condylar positions.
The purposes of this study were (1) to record the
condylar positions of patients with Class III malocclusion and maxillary deficiency in CR and maximum
intercuspation (MI) positions, (2) to evaluate the centric
slide (CS) amount and direction in Class III patients
with maxillary deficiency with the MPI method, (3) to
examine and compare the effects of the DFM and
GFM on TMJ by using the MPI method.
MATERIAL AND METHODS

The parent sample was chosen from among the

patients who were referred to Hacettepe University,
Ankara, Turkey, with the chief complaint of anterior
crossbite or edge-to-edge incisal relationship. To choose
patients with maxillary deficiency, lateral cephalograms
of these 50 patients (26 girls, 24 boys) were obtained.
All cephalograms were traced, digitized, and evaluated
by using the Jiffy Orthodontic Evaluation (JOE) program (version 5.0, Rocky Mountain Orthodontics, Denver, Colo). Mainly, the Ricketts and Steiner analyses
were used to evaluate whether there was a maxillary deficiency. Furthermore, patients digitized tracings were
superimposed with the race-specific visual norms on
the nasion-basion line at nasion by using the same software. We included patients with ANB angle less than
1 , convexity value less than 1 mm, maxillary depth
less than 90 , Wits appraisal of 1.5 mm or less, overjet
of 0 mm or less, Class III or super Class I molar relationship, no permanent teeth congenitally missing or extracted before or during treatment, apparent maxillary
deficiency seen on the superimpositions, prepubertal
maturation stages 2 and 3 according to the cervical vertebral maturation method,12 and no functional anterior
crossbite.

Fig 2. Components of the Amtech MG1 articulator: 1,

face-bow with nasion relator; 2, MG1 articulator with
condylar housing parts attached; 3, millimetric graph
stickers booklet; 4, condylar position register drums; 5,
bite fork; 6, bite fork assembly; 7, mounting incisal pad.

From the parent sample of 50 patients, 35 patients

who satisfied the inclusion criteria were selected for
this study. One patient moved to another city after the
study started and was excluded. Thus, our study was
completed with 34 patients (15 girls, 19 boys). Patients
were selected randomly for DFM and GFM therapy. The
DFM group consisted of 18 patients (10 girls, 8 boys),
and the GFM group included 16 patients (5 girls, 11
boys). The mean ages at the start of treatment (T0)
were 9.03 6 0.82 years and 9.2 6 1.1 years for the
DFM and GFM groups, respectively.
To obtain the necessary data for the MPI recordings,
maxillary and mandibular casts, MI and CR bite registrations, and face-bow recordings for each patient
were taken before facemask treatment. The bilateral
manipulation method was used to take the CR bite registrations, and another bite registration was also taken
for the MI position.13 The patients maxillary and mandibular casts were mounted on the MG1 articulator
(Fig 3) for the MPI procedure, as recommended by the
manufacturer. First, the maxillary model was mounted
to the articulator by using its custom face-bow. After
mounting the maxillary cast, the articulator was placed
upside down, and the CR wax registration was placed
between the maxillary and mandibular casts. A layer
of plaster was applied, and the lower part of the articulator was closed. After the plaster was set, condylar
housings were replaced with condylar measurement
drums, and the stickers were attached. The centers of
the stickers indicated the condylar position in CR.

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 137, Number 6

Fig 3. A, Maxillary and mandibular casts mounted in MI

position; B, maxillary and mandibular casts mounted in
CR position.

Then, the CR registration wax was replaced with the MI

registration wax. An articulation paper was placed between the condyle and the measurement drum. The
measurement drum was moved outward to contact the
condyle. As a result, a registration corresponding to
the condylar position at MI was obtained on the sticker.
The articulator also allowed recording the mandibular
sliding in a transverse direction from CR to MI. To obtain these data, the sticker was placed on the lower side
of the upper frame. Casts were placed in their respective
frames with the CR registration wax between them. An
articulation paper was placed between the sticker and
the transfer pin. Then the transfer pin was inserted
from the hole on the lower frame until it contacted the

El and Ciger

803

Fig 4. A, CS amount (DY) on the transversal plane; B, CS

amount in the sagittal plane. DX and DZ values refer to
the anteroposterior and superoinferior slide amounts,
respectively.

sticker. The same procedure was repeated with the MI

registration wax between the casts. As a result, 2 registration marks were recorded corresponding to transverse mandibular sliding.
On millimetric graph paper, the transverse (mediolateral) shift was represented by DY (Fig 4, A). The
DY value is negative when the MI position is on the
left of the CR position. The DY value is positive when
the MI position is on the right of the CR position. Sagittal (anteroposterior and superoinferior) shifts of the
condyles were marked and represented by DX and DZ
(Fig 4, B), respectively. The DX value is positive
when the MI position is located anterior of the CR position. The DX value is negative when the MI position is
posterior of the CR position. The DZ value is positive
when the MI position is located inferior to the CR

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American Journal of Orthodontics and Dentofacial Orthopedics

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Differences between DFM and GFM groups in

DX, DY, and DZ at T0

Table I.

T0
DX right condyle (mm)
DX left condyle (mm)
DZ right condyle (mm)
DZ left condyle (mm)
DY (mm)

DFM (n 5 18)

GFM (n 5 16)

Mean

SD

Mean

SD

1.13
1.31
0.97
1.27
0.06

1.46
1.30
0.96
0.88
1.02

0.81
0.90
0.90
1.16
0.07

1.10
1.42
0.57
0.79
0.78

0.427
0.512
0.628
0.557
0.691

Fig 6. Distribution of the MI positions relative to CR position: A, CS amount for the right condyle in the sagittal
plane for the GFM group at T0; B, the left condyle.

Fig 5. Distribution of the MI positions relative to CR position: A, CS amount for the right condyle in the sagittal
plane for the DFM group at T0; B, the left condyle.

position. The DZ value is negative when the MI position

is superior to the CR position. Negative and positive
values for DZ are also called compression and distraction, respectively.

To evaluate the reliability of the MG1 articulator,

the MPI recordings were retaken from 10 randomly selected patients before facemask therapy. Random error
was calculated by using Dahlbergs formula.14 Method
errors for the DX, DZ, and DY linear measurements
were less than 0.3 mm.
In both groups, force was applied through a maxillary fixed labiolingual bar with an anterior point of application. A total of 600 to 700 g of force (300-350 g for
each side) was applied between the lateral incisors and
canines. The angle between the occlusal plane and the
force vector of the facemask was approximately 20
to 25 , and the patients were instructed to wear the
appliance 14 to 16 hours a day in both treatment groups.

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American Journal of Orthodontics and Dentofacial Orthopedics

Volume 137, Number 6

Table II.

805

Treatment changes for DX, DY, and DZ distances between T0 and T1

Variable interval

DFM group
DX right condyle (mm)
DX left condyle (mm)
DZ right condyle (mm)
DZ left condyle (mm)
DY (mm)
GFM group
DX right condyle (mm)
DX left condyle (mm)
DZ right condyle (mm)
DZ left condyle (mm)
DY (mm)

Mean

SD

Median

T0
T1
T0
T1
T0
T1
T0
T1
T0
T1

1.13
0.02
1.31
0.08
0.97
0.03
1.27
0.05
0.06
0.01

1.46
0.14
1.30
0.20
0.96
0.07
0.88
0.08
1.02
0.06

1.48
0.00
1.43
0.00
1.16
0.00
1.35
0.00
0.22
0.00

T0
T1
T0
T1
T0
T1
T0
T1
T0
T1

0.81
0.43
0.90
0.26
0.90
0.59
1.16
0.51
0.07
0.06

1.10
0.72
1.42
0.54
0.57
0.47
0.79
0.55
0.78
0.18

1.08
0.38
1.35
0.30
1.06
0.65
1.01
0.38
0.32
0.05

Minimum

Maximum

1.56
0.25
1.21
0.12
2.51
0.24
3.03
0.27
2.21
0.17

3.44
0.47
3.05
0.71
0.97
0.30
0.50
0.25
1.72
0.18

0.007

1.43
1.00
2.78
1.28
2.00
1.48
2.55
1.76
1.62
0.26

2.34
1.45
2.30
1.00
0.00
0.25
0.00
0.42
1.56
0.33

0.002
0.001
0.000
0.879

0.012*
0.041*
0.001
0.000
0.569

*P \0.05; P \0.01; P \0.001.

After a positive overjet was achieved (T1), the MPI

recordings were repeated as stated previously.
To evaluate the treatment changes between T0 and
T1, Wilcoxon signed rank tests were used, and, to compare the T0 values of both groups, Mann-Whitney
U tests were used. The level of significance was established as P \0.05 for all statistical tests.
RESULTS

The mean age of the patients in the DFM group was

9.03 6 0.82 years, and the mean treatment time was
8.06 6 1.63 months. The mean age of the patients in
the GFM group was 9.20 6 1.10 years, and the mean
treatment time was 10.59 6 1.42 months.
No statistically significant differences were found
for the DX (anteroposterior), DZ (superoinferior), and
DY (mediolateral) distances between the groups at T0
(Table I). When the means of DX of all patients were
evaluated together at T0, 26 patients (76.5%) had a protrusive slide, 6 patients (17.7%) had a retrusive slide,
and 2 patients (5.8%) had no anteroposterior slide for
the right condyle; 27 patients (79.4%) had a protrusive
slide, 6 patients (17.7%) had a retrusive slide, and 1 patient (2.9%) had no anteroposterior slide for the left condyle. When the means of DZ of all patients were
evaluated together at T0, 28 patients (82.4%) had
distraction, 1 patient (2.9%) had compression and 5

patients (14.7%) had no superoinferior slide for the right

condyle; 32 patients (94.2%) had distraction, 1 patient
(2.9%) had compression, and 1 patient (2.9%) had no
superoinferior slide for the left condyle. Graphical representations of CS relative to CR are shown in Figures 5
and 6 for the DFM and GFM groups, respectively. The
transverse slide (DY) was equal (left slide in 17 patients
and right slide in 17 patients) at T0.
There were statistically significant decreases for DX
and DZ in both groups at T1 (Table II, Figs 7 and 8).
However, when the groups were compared in terms of
treatment type, there were significant differences for
the DX values of the right and left condyles and the
DZ value of the left condyle (Table III). Although there
were no significant differences for the DZ value of
the right condyle and the DY value, the discrepancies
between the CR and MI positions decreased more in the
DFM group compared with the GFM group (Table III).
DISCUSSION

In contemporary orthodontics, several methods can

be used to evaluate condylar positions. Several researchers recommended conventional radiography,15,16
and others found that 2-dimensional imaging
techniques are unreliable and insufficient for condylar
position evaluation.10,17 Other than conventional
radiography, it is hard to determine accurate condylar

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El and Ciger

Fig 7. Distribution of the MI positions relative to CR position: A, CS amount for the right condyle in the sagittal
plane for the DFM group at T1; B, the left condyle.

positions from a tomogram or a magnetic resonance

image.18 For this reason, to evaluate 3-dimensional condylar positions and shifts of the condyles, the use of articulators and the MPI procedure are recommended.19-21
CR of the condyles is determined by several
methods.13,22,23 The bilateral manipulation method
described by Dawson13 was used in this study. Previous
studies showed high repeatability of this method.24-26
The condyles could be guided easily to the
superoanterior position in the glenoid fossa,24 and the
method is learned easily compared with other techniques.13 Patient position is important when taking
a CR bite registration. All of the CR bite registrations
were taken by one operator (H.E.) with the patient in supine position. It was suggested that the supine position

American Journal of Orthodontics and Dentofacial Orthopedics

June 2010

Fig 8. Distribution of the MI positions relative to CR position: A, CS amount for the right condyle in the sagittal
plane for the GFM group at T1; B, the left condyle.

could lead to contraction of the genioglossus, lateral

and medial pterygoid muscles, as a defense mechanism
to prevent airway obstruction.27 Therefore, errors can
occur while taking CR bite registrations. However,
Campos et al28 showed no difference electromyographically for those muscles with the patient either in supine
or upright position. Timing is important when manipulating the mandible so that the muscles that protrude the
mandible are not triggered to contract by applying pressure at the wrong time or in the wrong direction.13
The MG1 is an ARCON-type semiadjustable articulator where the condylar ball is located on the lower
frame and the guiding surface is located on the upper
frame of the articulator, mimicking the actual TMJ.
(Fig 2). MPI procedure is similar to the previously

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American Journal of Orthodontics and Dentofacial Orthopedics

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Intergroup treatment differences for DX, DY,

and DZ values between T0 and T1
Table III.

DX right condyle (mm)

DX left condyle (mm)
DZ right condyle (mm)
DZ left condyle (mm)
DY (mm)

DFM (n 5 18)

GFM (n 5 16)

Mean

SD

Mean

SD

1.09
1.45
1.01
1.32
0.05

1.44
0.95
0.97
0.88
1.03

0.38
0.64
0.31
0.65
0.02

0.55
0.96
0.16
0.42
0.74

0.046*
0.044*
0.075
0.007
0.918

*P \0.05; P \.01.

mentioned articulator systems and it is rather easy, and

the mechanism is not as complex as for the SAM articulator. The repeatability and reliability of the MG1 system
are in acceptable limits, according to the consecutive
measurements made before the start of therapy.
The discrepancy between CR and MI positions in
untreated subjects is a well-known phenomenon.13,29
The evaluation of the subjects at T0 showed similar
results to previous studies.19,29 In the sagittal plane
(DX and DZ), downward and forward movement of
the condyles in the glenoid fossa was observed for
most patients at T0 (Figs 5 and 6). It was suggested
that patients with maxillary deficiency tend to position
their mandibles anteriorly as a result of undesirable
anterior tooth contact.30
An important goal of occlusal therapy is the coincidence of CR and MI positions.13 When the MPI data
was evaluated at T1, we observed that, with both facemasks, the CR and MI positions approached each other
(Figs 7 and 8). Although statistically significant
decreases were found for the DX and DZ values in
both groups (Table II), the coincidence of CR and MI
positions was much more prominent in the DFM group
(Table III, Fig 7). It was found that the discrepancy between the CR and MI positions persisted in the GFM
group (Fig 8). This difference probably appeared because of the lack of a chincup in the design of the
GFM and the freedom of movement of the mandible.
However, less compression of the condyle through the
glenoid fossa was observed in the GFM group. In the
DFM group, only one patients MI position was above
the CR position (compression) at T0 (Fig 5). It was an
interesting finding that, with the DFM, compression
was seen in 9 patients (Fig 7), but only 1 patient had
compression at T1 in the GFM group (Fig 8). According
to Deguchi and McNamara,31 the glenoid fossa can be
widened and deepened with a chincup. Since the DFM
includes a chincup in its design, the position of MI
above CR might be an expected result. It is still not clear
in the literature whether the compressive or distractive
position of the condyles are more hazardous to the

807

TMJ, but Slavicek32,33 stated that compression is

a general finding in patients with internal
derangements. The reasons that Grummons4 changed
the conventional design of the facemask were not only
to present an alternative method for the treatment of
Class III malocclusions, but also to prevent the undesirable effects of the chincup over the TMJ.
Although the treatment effect of DFM is well documented in the literature, there are few studies and insufficient cephalometric data concerning the GFM.4,34 So,
a main goal of this study was to increase our knowledge
about the effects of the GFM on the dentofacial complex
by means of MPI and cephalometrics. The effects of the
DFM and GFM on dentofacial structures and dentitions
have also been compared with cephalometrics in the
second part of this study. Our current research focuses
especially on comparison of the 2 facemasks with the
MPI procedure. However, it will be relevant to present
some of our cephalometric findings briefly to support
our conclusions about this study.
Our cephalometric findings showed that the maxilla
moved anteriorly with both facemasks. Although the
force vectors of the facemasks were adjusted to be 20
to 25 with respect to the occlusal plane, counterclockwise rotation of the palatal plane was observed. The
counterclockwise rotation of the palatal plane in the
GFM group was more prominent than in the DFM
group. As for the mandible, posterior rotation was evident in the DFM group. However, the mandible continued its normal forward and downward growth in the
GFM group. Grummons4 defended the idea that the
mandible should be released during maxillary protraction so as not to disturb condyle-disc integrity. Therefore, he suggested that protraction of the maxillary
arch leads to anterior repositioning of the mandible;
thus, optimization of the condyle-disc complex would
be better. Our cephalometric and MPI findings agreed
with those suggestions.
However, it is impossible to say whether the MPI and
cephalometric changes during treatment are caused only
by the facemasks. The TMJ is under constant modification
by growth when the age range of the groups is taken into
account. More than 50% of the eminence development
has been completed by this age,35 but the condyle and glenoid fossa are still under modification and variation.36
Also, simultaneously, the occlusion can change because
of deciduous tooth loss and permanent tooth eruption. It
would, of course, be better if the treatment groups were
compared with a control group to observe the treatment
effects, but this was impossible due to ethical reasons.
Therefore, it can be concluded that, as for all appliances used in orthodontic practice, the DFM and GFM
also have advantages and disadvantages over each other.

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El and Ciger

Although the CS amount decreased more with the DFM

compared with the GFM, patients using the DFM must
be monitored for any signs and symptoms concerning
the TMJ.
CONCLUSIONS

1.
2.

3.
4.

Repeatability and reliability of the MG1 articulator

was within acceptable limits.
A discrepancy between CR and MI positions was
observed for all patients with Class III maxillary
retrusion at T0.
The CS amount decreased more with the DFM
compared with the GFM.
The condyles tended to move superiorly in the glenoid fossa after the use of the DFM, but that effect
was not observed with the GFM.

REFERENCES
1. Proffit WR, Fields HW, Sarver DM. Contemporary orthodontics.
St Louis: Mosby Elsevier; 2007.
2. Delaire J. Maxillary growth: therapeutic conclusions. Trans Eur
Orthod Soc 1971;81-102.
3. Grandori F, Merlini C, Amelotti C, Piasente M, Tadini G,
Ravazzani P. A mathematical model for the computation of the
forces exerted by the facial orthopedic mask. Am J Orthod Dentofacial Orthop 1992;101:441-8.
4. Grummons D. Orthodontics for the TMJ/TMD patient. Scottsdale, Ariz: Wright & Company; 1994.
5. Jackson GW, Kokich VG, Shapiro PA. Experimental and postexperimental response to anteriorly directed extraoral force in young
Macaca nemestrina. Am J Orthod 1979;75:318-33.
6. McLaughlin RP. Malocclusion and the temporomandibular
jointan historical perspective. Angle Orthod 1988;58:185-91.
7. Mohlin B, Pilley JR, Shaw WC. A survey of craniomandibular
disorders in 1000 12-year-olds. Study design and baseline data
in a follow-up study. Eur J Orthod 1991;13:111-23.
8. Pollmann L. Sounds produced by the mandibular joint in young
men. A mass examination. J Maxillofac Surg 1980;8:155-7.
9. Dworkin SF, Huggins KH, LeResche L, Von Korff M, Howard J,
Truelove E, et al. Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls. J Am
Dent Assoc 1990;120:273-81.
10. Pullinger A, Hollender L. Variation in condyle-fossa relationships
according to different methods of evaluation in tomograms. Oral
Surg Oral Med Oral Pathol 1986;62:719-27.
11. Alexander SR, Moore RN, DuBois LM. Mandibular condyle
position: comparison of articulator mountings and magnetic resonance imaging. Am J Orthod Dentofacial Orthop 1993;104:230-9.
12. Franchi L, Baccetti T, McNamara JA Jr. Mandibular growth as
related to cervical vertebral maturation and body height. Am J
Orthod Dentofacial Orthop 2000;118:335-40.
13. Dawson PE. Evaluation, diagnosis, and treatment of occlusal
problems. St Louis: Mosby; 1989.
14. Houston WJ. The analysis of errors in orthodontic measurements.
Am J Orthod 1983;83:382-90.
15. Mikhail MG, Rosen H. The validity of temporomandibular joint radiographs using the head positioner. J Prosthet Dent 1979;42:441-6.

American Journal of Orthodontics and Dentofacial Orthopedics

June 2010

16. Mongini F. The importance of radiography in the diagnosis of TMJ

dysfunctions. A comparative evaluation of transcranial radiographs
and serial tomography. J Prosthet Dent 1981;45:186-98.
17. Aquilino SA, Matteson SR, Holland GA, Phillips C. Evaluation of
condylar position from temporomandibular joint radiographs.
J Prosthet Dent 1985;53:88-97.
18. McNeill C. Temporomandibular disorders: guidelines for classification, assessment, and management. Hanover Park, IL: Quintessence; 1993.
19. Hoffman PJ, Silverman SI, Garfinkel L. Comparison of condylar
position in centric relation and in centric occlusion in dentulous
subjects. J Prosthet Dent 1973;30:582-8.
20. Crawford SD. Condylar axis position, as determined by the occlusion and measured by the CPI instrument, and signs and symptoms
of temporomandibular dysfunction. Angle Orthod 1999;69:103-15.
21. Hidaka O, Adachi S, Takada K. The difference in condylar position between centric relation and centric occlusion in pretreatment
Japanese orthodontic patients. Angle Orthod 2002;72:295-301.
22. Roth R. Gnathologic considerations for orthodontic therapy. In:
McNeill C, editor. Science and practice of occlusion. Hanover
Park, IL: Quintessence; 1997.
23. Wood GN. Centric relation and the treatment position in rehabilitating occlusions: a physiologic approach. Part I: developing an
optimum mandibular posture. J Prosthet Dent 1988;59:647-51.
24. Hobo S, Iwata T. Reproducibility of mandibular centricity in three
dimensions. J Prosthet Dent 1985;53:649-54.
25. Tarantola GJ, Becker IM, Gremillion H. The reproducibility of
centric relation: a clinical approach. J Am Dent Assoc 1997;
128:1245-51.
26. Kantor ME, Silverman SI, Garfinkel L. Centric-relation recording
techniquesa comparative investigation. J Prosthet Dent 1972;
28:593-600.
27. Hairston LE, Blanton PL. An electromyographic study of mandibular position in response to changes in body position. J Prosthet
Dent 1983;49:271-5.
28. Campos AA, Nathanson D, Rose L. Reproducibility and condylar
position of a physiologic maxillomandibular centric relation in
upright and supine body position. J Prosthet Dent 1996;76:282-7.
29. Rosner D, Goldberg GF. Condylar retruded contact position and
intercuspal position correlation in dentulous patients. Part I:
three-dimensional analysis of condylar registrations. J Prosthet
Dent 1986;56:230-9.
30. Ngan P, Hu AM, Fields HW Jr. Treatment of Class III problems
begins with differential diagnosis of anterior crossbites. Pediatr
Dent 1997;19:386-95.
31. Deguchi T, McNamara JA. Craniofacial adaptations induced by
chincup therapy in Class III patients. Am J Orthod Dentofacial
Orthop 1999;115:175-82.
32. Slavicek R. Clinical and instrumental functional analysis and treatment planning. Part 4. Instrumental analysis of mandibular casts using the mandibular position indicator. J Clin Orthod 1988;22:566-75.
33. Slavicek R. Clinical and instrumental functional analysis for diagnosis and treatment planning. Part 8: case studies in CADIAX.
J Clin Orthod 1989;23:42-7.
34. Hegmann M, Ruther AK. The Grummons face mask as an early
treatment modality within a Class III therapy concept. J Orofac
Orthop 2003;64:450-6.
35. Nickel JC, McLachlan KR, Smith DM. Eminence development of
the postnatal human temporomandibular joint. J Dent Res 1988;
67:896-902.
36. Buschang PH, Santos-Pinto A. Condylar growth and glenoid fossa
displacement during childhood and adolescence. Am J Orthod
Dentofacial Orthop 1998;113:437-42.