[An evaluation of 3-dimensional position of mandibular condyle to glenoid fossa using tomogram: an analytical technique and its clinical application].

In recent years, temporomandibular disorder (TMD) is occasionally found among orthodontic patients and has become a great concern in orthodontics. From this point of view, a certain technique has been hopefully anticipated for diagnosis and treatment planning. The purpose of this study was to develop a new method for evaluating three-dimensional position of the mandibular condyle relative to the glenoid fossa and also to investigate its clinical application. Seven-layered tomograms were taken and contours of the condyle and glenoid fossa were traced on an acetate paper. These contours were entered into a personal computer by use of a digitizer and were equally divided into 9 parts for the condyle and 15 parts for the glenoid fossa, consisting of 10 and 16 points on the contours of condyle and glenoid fossa. Three-dimensional configuration of the TMJ was thus constructed by 108 triangles for the condyle and 180 triangles for the glenoid fossa. The shortest distance between the condyle and the glenoid fossa (CGFD) was then calculated along a perpendicular line to center of gravity of a triangle on the condyle. For evaluating the position of the condyle to the glenoid fossa easily in a three dimensional space, surface of the condyle was divided into five areas, i.e. anterior, posterior, middle, lateral and medial areas. In order to investigate whether or not the CGFD is accurate enough to identify the distance between surface of the condyle and glenoid fossa, a model of hemi-spherical solid shell was made, of which the thickness is 3.0 mm. Tomograms of the model were taken to analyze the thickness. Direct measurement of the same area was also made by calipers. Two means were approximately 3.0 mm, which is the thickness itself and no significant differences were indicated at 5% level of confidence. The present technique was applied to diagnosis of an orthodontic patient with painful clicking as TMD. The analyzed CGFDs were coincident with clinical symptom. It is shown that the present approach provides an availability and a possibility to evaluate positional relationship between the mandibular condyle and the glenoid fossa of patients with TMDs.