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Methods of mandibular condyle position and rotation center used for orthognathic surgery planning: a systematic review - 20/07/21

Doi : 10.1016/j.jormas.2021.06.004 
Barretto MDA, Maxillofacial Surgeon, PhD’s Degree Student , Melhem-Elias F, Maxillofacial Surgeon. PhD, Associate Professor, Deboni MCZ, PhD, Associate Professor
 Department of Oral and Maxillofacial Surgery, Prosthesis and Traumatology, School of Dentistry, University of Sao Paulo, Av. Lineu Prestes, 2227, 05088-000 Sao Paulo, SP, Brazil 

Corresponding author.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 20 July 2021

Highlights

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The centric relation (CR) does not describe the condylar position when clinically manipulated in the posterior superior direction.
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We believe that this posterior superior position is the retruded contact position (RCt) while CR is the functional position of the condyle.
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The orthognathic surgery has two occlusal relationships during planning and execution.
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The ideal axis of rotation for orthognathic surgery planning must be fixed, permit individualization for each condyle and be reproducible.
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The 2D planning is obsolete as cannot provide all the necessary tools for an accurate planning.

Le texte complet de cet article est disponible en PDF.

Abstract

We aimed to evaluate whether there is a consensus among bi- (2D) and three-dimensional (3D) evaluations of mandible condyle position and its rotation center. Also, if this data can be replicated in orthognathic surgery planning. The survey was carried out on the major databases (PubMed, SCOPUS, Embase, Cochrane). Human or human bio models evaluations in 2D or 3D of mandibular condylar position concerning its fossa and rotational axis for orthognathic surgery planning were eligible. The heterogeneity of the studies and uncertainties in methodological biases did not allow us to identify the superiority of 2D or 3D methodology in determination of the condylar rotational axis. There is a lot of divergences in the definition of occlusal relationships among dental specialties. Although there was no consensus regarding condylar position in relation to the fossa, the most reported axis of rotation was positioned posterior-inferior. Weak scientific evidence and divergences in dental vocabulary shows the need for clinical studies with more accurate and transparent methodological design to standardize concepts. Despite we cannot affirm, we can suggest that the centric relation (CR) is not the condylar position when clinically manipulated in the posterior superior direction. This condylar position is the retruded contact position (RCt) while CR is the functional position of the condyle. In this way, the orthognathic surgery has two occlusal relationships during planning and execution. The ideal axis of rotation for orthognathic surgery planning must be fixed, permit individualization for each condyle and be reproducible. The 2D planning is obsolete as cannot provide all the necessary tools for an accurate planning.

Le texte complet de cet article est disponible en PDF.

Keywords : Review, Systematic, Virtual surgery planning, Orthognathic surgery, Temporomandibular joint, Terminal hinge axis


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