Condylar position

In the recent article “Condylar position assessed by magnetic resonance imaging after various bite position registrations” (Kandasamy S, Boeddinghaus R, Kruger E. Am J Orthod Dentofacial Orthop 2013;144:512-7), the authors made a major claim that the findings from their study negate the results of several previous studies. As the authors admit, these previous investigations found that centric relation (CR) can be consistently found with repeatable accuracy. It begs the question as to why Dr Kandasamy, who made the CR bites, was unable to achieve similar accuracy with his 19 subjects when so many others have been able to do so.

The answer to this question may be explained in an ingenious study on recording CR and training. This study found that without proper training, dentists were able to accurately locate a repeatable CR in 0 of 132 attempts. However, with 3 hours of training from experienced clinicians who locate CR routinely in their offices, the newly trained dentists could locate CR on the same joints to within 0.11 mm 106 of 110 times on the first attempt. On the second attempt, the results were 4 of 4.

Dr Kandasamy has long professed his objections to placing any importance on condylar position in orthodontics. As such, it raises the question as to whether he is an experienced and unbiased choice to gather accurate data on techniques to locate the condylar positions, something he has gone to great lengths to vilify. The decision to use chin-point guidance where he forced the condyles posteriorly in the fossa suggests that his understanding of CR is several decades out of touch. Even this article acknowledges that a posterior position in the fossa as the goal of CR was “before 1968.” Why design a study to investigate a concept that has not been the predominant view of CR in 45 years? This study might have been relevant once upon a time—one predating the birth of many of today’s orthodontists. Today, however, it is just a fatally flawed application of an interesting idea.

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Apr 6, 2017 | Posted by in Orthodontics | Comments Off on Condylar position
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