On the analysis of condylar path versus real motion of the temporomandibular joint: application for Sicat Function.

摘要

Analysis of temporomandibular joint (TMJ) function using condylar path tracings is a challenge in functionally oriented dentistry. In most cases, reference points on the skin surface over the TMJ region are defined as "arbitrary", "individual" or "kinematic" condylar hinge axis points, which are displayed as "condylar paths" in motion. To what extent these reference points represent the actual condylar paths in each individual patient is ultimately unclear because the geometric relationship of the actual condyle to the selected reference point is usually unknown. Depending on the location of the point on the condyle and the centers of rotation of mandibular movement, these trajectories can vary greatly during combined rotational and sliding movements (eg, opening and closing movements of the mandible); this represents a grid of points located in the vicinity of the TMJ. To record the actual condylar path as the movement trajectory of a given point (eg, the condylar center), technological solutions are needed with which to link the tracing technology with the appropriate imaging technology capable of scanning the condyle, including the points of interest, and displaying them in real dynamic motion. Sicat Function (Sicat, D-Bonn) is such a solution. Sicat Function links cone beam computed tomography (CBCT) scans (made using the Galileos CBCT scanner; Sirona, Bensheim, Germany) with ultrasound-based, three-dimensional (3D) functional jaw movement recordings of the mandible (made using the JMT+ Jaw Motion Tracker; Sicat, Bonn, Germany). Digital images of the dental arches acquired with the intraoral scanner Cerec system (Sirona) can also be superimposed. This results in the generation of a 3D model of the bony mandible, including the TMJ, which reproduces the 3D real dynamic movement of the condyles simultaneously with that of the condylar paths at defined points (with the condylar centers being a particular point of interest). Sicat Function is an integrated, digital 3D solution for additional instrumental and imaging diagnosis of temporomandibular joint dysfunction (TMD). The primary indication for Sicat Function is persistent, arthrogenic TMD complaints that require additional studies for evaluation of bony structural components of the TMJ.