Guided and unguided mandibular reference positions in asymptomatic individuals

Celar A., Freudenthaler J., Crismani A., Graf A. Guided and unguided mandibular reference positions in asymptomatic individuals ?Orthod Craniofac Res 2013; 16:2835. (c) 2012 John Wiley & Sons A/S Structured Abstract Objectives To determine the difference between guided and unguided mandibular reference positions assessed by articulator simulation. Setting and Sample Population This study was carried out at the Division of Orthodontics at Vienna Medical University. The sample population consisted of 19 men and 18 women aged 2332 years and without temporomandibular disorder. Materials and Methods Three examiners used bimanual operator guidance and unguided mandibular stationary hinging at final jaw closure before occlusal contact and made occlusal wax recordings. The examiners repeated both techniques after 8 and 17 days on the same subjects. Condylar positions were assessed using articulator-mounted casts and a three-dimensional electronic condylar position indicator. Results Bimanual guidance positioned the condylar spheres, on average, 0.1 mm more right and 0.6 mm more posterior and superior to unguided hinging (p < 0.04). The repeatability of bimanual guidance by three operators and on 3 days resulted in inter-repetition standard deviations ranging from 0.19 to 0.4 mm and from 0.41 to 0.76 mm for unguided hinging. The highest fraction of the total variance came from the individuals, followed by days, then intra-operator and interoperator variability. Both methods showed considerable overlap of condylar sphere positions at the 95% confidence level. Conclusion Within the limits of an articulator study, the spatial variability of condylar sphere positions suggested a statistically but not clinically relevant methodological difference between bimanual guidance and unguided stationary hinging.