Original Article

Comparison of Condylar Position in Hyperdivergent and

Hypodivergent Facial Skeletal Types
R. Andrew Girardot Jr, DDSa

Abstract: Orthodontists have long been interested in the differences in the diagnosis and treatment of
hyperdivergent and hypodivergent facial types. More recently, many orthodontists have become interested
in treating to a seated condylar position or centric relation. It was the objective of this study to investigate
the difference in condylar position between these 2 extreme facial types. Two groups of 33 subjects, each
representing the extremes in facial type, were randomly selected and matched for age and sex. Mounted
casts and the MPI instrumentation were used to measure and compare the amount of condylar distraction
between the 2 groups in the horizontal and vertical planes. The total amount of change between the 2
groups was examined using a statistical t-test. There was a statistically significant greater distraction of
the condyles in the hyperdivergent group in both the horizontal and vertical planes. (Angle Orthod 2001;
71:240–246.)
Key Words: Hyperdivergent face type; Hypodivergent face type; Intercuspal position; Centric relation;
Seated condylar position; Condylar position; MPI instrumentation

INTRODUCTION
Orthodontists have long been interested in the multitude
of differences in the diagnosis, treatment, and treatment re-
sponse between hyperdivergent or dolichofacial facial types
and hypodivergent or brachyfacial facial types. Moreover,
in recent years, an increased number of orthodontists desire
to achieve a treatment result wherein the upward and for-
ward or a seated position of the condyle is maintained when
the patient closes the mandible to the intercuspal position
(ICP). Most orthodontists who look carefully at this joint-
to-dentition relationship would agree that the larger the dis-
crepancy between the seated condyle and tooth intercus-
pation pretreatment, the more difficult it is to achieve the
desired result posttreatment. For the clinicians with this
treatment perspective, it would be beneficial to know if hy-
perdivergent cases might present a greater condylar distrac-
tion. If this were so, hyperdivergent patients would present
a greater problem in achieving a seated condylar position.
In many cases, it is possible to demonstrate that a small
change in condylar position can have a profound effect at
a
Private practice, Denver, Colo.
Corresponding author: Andrew Girardot, DDS, 4380 Syracuse
Street, Suite 501, Denver, CO 80237.
(e-mail: DrGortho@msn.com).
Based on a paper presented by Dr Girardot at the national meeting
of The Edward H. Angle Society of Orthodontists in Aspen, Colo,
September 1995.
Accepted: November 2000. Submitted: July 1998.
q 2001 by The EH Angle Education and Research Foundation, Inc.
the level of the dentition (Figure 1). Due to the geometry
of the skeletal pattern in general and the mandible in par-
ticular, this phenomenon may be more pronounced in the
hyperdivergent skeletal type than the hypodivergent skeletal
type.
There is substantial evidence indicating that, when dental
influences are eliminated, a healthy elevating musculature
will position the condyle in its most upward and forward
position against the eminence.1–11 This seated condylar po-
sition has been referred to as centric relation. Centric re-
lation has become a desirable goal for a growing number
of orthodontists, primarily due to the influence of Roth.12,13
Moreover, there is agreement among numerous authors, cli-
nicians, and teachers, recognized for their knowledge of
gnathic function, that this seated condylar position is a de-
sirable physiologic goal for the orthodontist.14–18 Okeson19
defined and described the importance of the musculoske-
letally stable position of the temporomandibular joints. That
definition is congruent with the seated condylar position
identified above. Subsequently, Okeson19 said, ‘‘I believe
the goal of every orthodontist should be to finalize the oc-
clusion in harmony with the musculoskeletally stable po-
sition of the temporomandibular joints.’’ McNeil20 de-
scribed what would be his treatment goal for the joints and
dentition at the termination of orthodontic treatment as,
‘‘The condyles should be seated in the fossae, ideally in
the anterior, superior position against the articulare disc. A
mutually protected occlusion is ideal and desirable if pos-
sible.’’
The purpose of this study was to determine if the centric

Angle Orthodontist, Vol 71, No 4, 2001 240

CONDYLAR POSITION IN HYPERDIVERGENT AND HYPODIVERGENT FACES
FIGURE 1. Casts from subject HY 31 in this study. (A) The inter-
cuspal position is shown on the left, while (B) the seated condylar
position is shown on the right. Averaging condylar shifts from the
seated condylar position to the intercuspal position for left and right
joints yielded a horizontal movement of 1.75 mm and a vertical
movement of 2.5 mm. Corresponding positional changes at the in-
cisal edge of the lower central incisor are 4 mm in the horizontal
(overjet) and 2.5 mm in the vertical (overbite). Note changes in po-
sition of the distal marginal ridge of the lower second molar from
intercuspal to seated condylar positions of the mandible.
relation to intercuspal position discrepancy was larger in
patients with hyperdivergent facial type compared with pa-
tients with hypodivergent facial type.
It was hypothesized that a group of adolescent and young
adult subjects with hyperdivergent facial-skeletal patterns
would demonstrate greater condylar displacement from the
upward and forward position to the intercuspal position
than a matched group of subjects with hypodivergent facial-
skeletal patterns.
REVIEW OF THE LITERATURE
A computer search of the literature reveals no published
articles specifically studying the interrelationship between
facial type and condylar position. Burke et al21 investigated
a possible correlation between condylar characteristics and
facial morphology in Class II adolescents. They used to-
mograms to measure joint spaces and found patients with
vertical facial morphology (hyperdivergent) had decreased
superior joint spaces while patients with horizontal facial
morphology (hypodivergent) had increased superior joint
spaces.
Stringert and Worms22 studied the relationship between
skeletal pattern and internal derangement. They found a
greater incidence of internal derangement in hyperdivergent
skeletal patterns.
METHODS AND MATERIALS
Subjects for the study were gathered randomly by a pe-
rusal of patient charts taken from an orthodontic practice
treating adolescents and adults. Subjects were selected first
241
by age and then by facial-skeletal characteristics, as mea-
sured cephalometrically, to generate 2 matched groups of
33 subjects each. Age was a criterion for subject selection
since the intention was to study young adult subjects having
completed or nearly completed growth. The final sample
selected was composed of 10 males ranging in age from 16
to 30 years, with a mean age of 23.6 years, and 56 females
ranging in age from 13 to 36 years, with a mean age of
24.2 years.
Facial-skeletal type was determined by using the Jarabak
cephalometric analysis. Subjects were considered to be fa-
cially hyperdivergent if the posterior-anterior face height
ratio (sella-gonion/nasion-menton) was 59% or less while
the lower half of the gonial angle (nasion-gonion-menton)
was 76 degrees or more. Subjects were considered to be
hypodivergent if the posterior-anterior face height ratio was
65% or more while the lower gonial angle was 69 degrees
or less (Figure 2A,B). For those not familiar with the Jar-
abak cephalometric analysis, the mean mandibular plane
angle was 34 degrees for the hyperdivergent group and 16
degrees for the hypodivergent group.
In addition, subjects were excluded from the sample if
there had been orthodontic treatment within the last 5 years,
there were obvious signs of degenerative changes in the
temporomandibular joints as determined by tomographic
radiographs, or there was a history of significant trauma or
surgery to the temporomandibular joints. It was felt these
factors could significantly affect condylar length and/or the
occlusion, which would in turn distort data gathered for the
study.
The records utilized included study casts mounted on an
articulator in centric relation or the seated condylar posi-
tion, tomograms of the temporomandibular joints, and lat-
eral cephalometric radiographs. Radiographs were taken in
centric occlusion or the intercuspal position of the mandi-
ble.
Study casts were poured in die stone and the maxillary
cast was mounted in the articulator using the arbitrary face-
bow. The mandibular cast was mounted to the maxillary
cast using a modified Roth power centric bite registration
record as follows: Delar blue wax (Great Lakes Orthodon-
tics, Buffalo, NY) was softened in a water bath at 1308F.
The wax wafer was cut to 2 thicknesses posteriorly and 4
thicknesses anteriorly (in some cases of anterior open bite,
the anterior section was thicker). After initial indexing of
the wax wafer via repeated, gentle guided closures of the
lower teeth into the wax (to prevent protrusion), the thicker
anterior section of the wax was thoroughly chilled and
hardened in ice water. Then the 2-thickness posterior sec-
tion was further softened in a flame. The wax bite was
subsequently repositioned onto the maxillary teeth via the
anterior tooth indexing, and the mandible was again gently
guided to the previously determined mandibular incisor in-
dices. The patient was then instructed to bite firmly against
the hard anterior wax segment until the lower posterior
Angle Orthodontist, Vol 71, No 4, 2001
242 GIRARDOT

teeth registered cusp-tip indices approximately 1 to 1.5 mm

deep in the soft wax of the posterior segment. Finally, the
entire wax registration was chilled in ice water, repositioned
in the mouth, and the mandible guided to open and close
into the wax as a last check and means of reducing distor-
tion.
Articulator-mounted casts enabled measuring movement
of the condylar axis from the up/forward condylar position
(centric relation) to the intercuspal position (centric occlu-
sion) of the mandible. The MPI (SAM I*) instrument was
used to measure and quantify differences between the 2
condylar axis positions. This instrumentation has been
shown to be both accurate and reliable.11,23–26 Horizontal
and vertical measurements were recorded on 1-mm graph
paper to the nearest 0.25 mm. Each MPI recording was
measured and remeasured at least 3 times. The average of
the 2 of 3 closest measurements was recorded.
Data gathered from the MIP measurements were tabu-
lated and organized to compare in the horizontal and ver-
tical dimensions the magnitude and direction of condylar
axis movement from centric relation to centric occlusion
between the hyperdivergent and hypodivergent groups.

RESULTS

Figure 3 shows the total of horizontal (x axis) condylar

displacements for the 2 groups. The hyperdivergent group
totaled 79.75 mm, which was 1.8 times greater than the
corresponding 43.75 mm measured for the hypodivergent
group. Mean values were also nearly twice as great for the
hyperdivergent group (Table 1).
Figure 4 shows data comparing the total vertical (z axis)
condylar displacements for the 2 groups. Note the hyper-
divergent group totaled 112.50 mm, 1.4 times greater than
the corresponding 79.0 mm measured for the hypodivergent
group. Mean values are shown in Table 1. A statistical t-
test was performed for the total X (horizontal axis) values
for the hyper- and hypodivergent groups and the total Z
(vertical axis) values for the hyper- and hypodivergent
groups.
The t-test values for both the Z (vertical) and X (hori-
zontal) dimensions were significant at the .01 confidence
interval (Table 1). Thus, these findings are, by definition,
statistically significant, ie, one can be 99% certain that the
differences in these numerical values will not occur natu-
rally or that the differences are not due to coincidence.
Displacement of the condyles in the horizontal (X axis)
plane can be subdivided into forward (1X) and backward
(2X) components. Figure 5 compares the forward and
backward condylar displacements for the 2 groups. The for-
ward displacement of condyles in the hyperdivergent group
totaled 37.25 mm, which was over twice the 17.5 mm of
forward displacement totaled for the hypodivergent group.
FIGURE 2. (A) Hyperdivergent (dolicocephalic) facial type. (B) Hy-
podivergent (brachiocephalic) facial type.
A similar comparison of the backward component of the
horizontal displacement had the hyperdivergent group to-

Angle Orthodontist, Vol 71, No 4, 2001

CONDYLAR POSITION IN HYPERDIVERGENT AND HYPODIVERGENT FACES 243

FIGURE 3. A comparison of the total of horizontal (X axis) condylar

displacement for the 2 groups. The hyperdivergent group totaled
79.75 mm, which was 1.8 times greater than the corresponding
43.75 mm for the hypodivergent group.

TABLE 1. Mean Values for Condylar Deflection in the Horizontal and

Vertical Directions for the Hypo- and Hyperdivergent Faces (mm) FIGURE 4. A comparison of the total of vertical (Z axis) condylar
and Calculated as 2 Condyles per Subject, ie, Number of Subjects displacements for the 2 groups. The hyperdivergent group totaled
5 33; Number of Condyles 5 66 112.50 mm, which was 1.4 times greater than the corresponding
79.0 mm for the Hypodivergent group.
Horizontal (x axis) Vertical (z axis)
Hyper Hypo Hyper Hypo
of the hyperdivergent pattern would dictate condylar func-
Total deflections 79.75 43.75 112.50 79.00 tion further out of the fossa. Logic suggests that the unfa-
Standard deviation 0.92 0.63 1.44 0.77 vorable posterior/anterior face height ratio dictates greater
Mean 1.21 0.66 1.70 1.20
t-Test 0.000114 0.007634 condylar distraction (especially in the vertical dimension)
in order to bring anterior teeth to functional contact.
The purpose of this study was to test the hypothesis that,
on average, there is a greater degree of condylar distraction
taling 42.5 mm, which was 1.6 times greater than the 26.25
from centric relation to centric occlusion in hyperdivergent
mm of backward displacement totaled for the hypodiver-
(dolicho) facial types than in hypodivergent (brachy) facial
gent group. Thus, condyles in the hyperdivergent group
types. Movements of the condylar axis in the horizontal and
were, on average, deflected a greater distance, both anteri-
vertical dimensions represented the amount and direction of
orly and posteriorly, compared with the hypodivergent
the condylar displacement. The magnitude and direction of
group.
displacement for the hyper- and hypodivergent facial pat-
terns was compiled and compared. The data clearly showed
DISCUSSION
that the hyperdivergent subjects had greater displacement
When observing the considerable difference in skeletal of the condyle in both the horizontal and vertical dimen-
form between the hyperdivergent and hypodivergent facial sions. Statistical significance was high at the .01 level.
patterns, one might suspect that the anatomical constraints Notable from the horizontal, or X-axis, data (Figure 5),

Angle Orthodontist, Vol 71, No 4, 2001

244
FIGURE 5. A comparison of the total of forward (1X) and backward
(2X) condylar displacements for the 2 groups. Regardless of the
direction, the condyles in the hyperdivergent group were deflected
a significantly greater distance than those of the hypodivergent
group.
the forward shift (1X) for the hyper group totaled 37.25
mm, or over twice the 17.5 mm recorded for the hypo
group. Of all the dimensions totaled and compared, this one
showed the greatest difference between the 2 groups. Thus,
one might suspect the amount of forward condylar displace-
ment for the hyperdivergent patient, on average, will be
about twice that of the hypodivergent patient. For nearly
every dimension recorded, the hyperdivergent group was
from 1.4 to 1.8 times greater than the hypodivergent group.
When the 2 groups were compared concerning anterior
or posterior deflection of the condyle, it was found that the
greatest movement occurred to the posterior in the hyper-
divergent group (Figure 5). This supports Roth’s concept
of a molar fulcrum and may be important since posterior
displacement of the condyle away from the eminence would
theoretically compromise joint stability and/or function.
It has been hypothesized that displacement of the condyle
away from the eminence may be detrimental to joint health
and/or stability since there is subsequent loss of juxtapo-
sition between the condyle, disc, and eminence.27–29 In or-
thopedics, a border joint position is generally thought to be
more stable than a nonborder position.30 The increased in-
tra-articular space may predispose to internal derangement,
either through mechanical posterior displacement of the
condyle31–34 as demonstrated in monkeys by Isberg and Is-
acsson35 and/or hyperactivity of the superior head of the
lateral pterygoid muscle.36 Some studies indicate the su-
perior head of the lateral pterygoid muscle inserts into the
articular disc;37–42 posterior condylar distraction in conjunc-
tion with activity of this muscle could hypothetically put
Angle Orthodontist, Vol 71, No 4, 2001
GIRARDOT
TABLE 2. Number of Condyles Displaced 2 mm or More
Hypodiver-
Hyperdivergent gent
Condyles displaced vertically 19 5
2 mm or more
Condyles displaced horizontally 16 4
2 mm or more
Condyles displaced forward 6 1
2 mm or more
Condyles displaced backward 10 3
2 mm or more
the joint at risk for complication such as internal derange-
ment. In cases where the condyle is distracted away from
the eminence, the temporomandibular ligament may be
elongated in order to accommodate this mandibular posi-
tion.43,44 Hylander45 has shown that the horizontal fibers of
the temporomandibular ligament insert at the lateral pole of
the condyle along with the collateral ligament that secures
the disc to the condyle. Tanaka46 has stated there is evidence
that disc displacements are most frequently initiated at the
lateral pole of the condyle.
Stringert and Worms22 found hyperdivergent facial types
to have a greater frequency of internal derangement than
hypodivergent facial types. They suggested this might be a
consequence of degenerative changes within the temporo-
mandibular joints or, as they said, ‘‘. . . for some reason,
persons with hyperdivergent characteristics are more prone
to internal derangements.’’ It should be noted that all sub-
jects in this study had temporomandibular joint tomograms
as part of their records, and a criteria for case selection was
no obvious degenerative changes as seen on tomograms.
The comparative differences in condylar shift between
the 2 facial types became even more conspicuous when
measuring the number of condyles that were displaced to
the extreme (2 mm or more). The differences were evident
regardless of the direction in which the extreme measure-
ments were compared (Table 2). For example, the number
of hyperdivergent joints shifting 2 mm or more in the ver-
tical plane (Z axis) numbered 19, almost 4 times greater
than the 5 condyles that were recorded in the hypodivergent
group.
Some cases in the hyperdivergent group presented with
anterior open bite and minimal condylar distraction. It is
valid to conclude such cases would have registered a great-
er condylar distraction had the mandible been closed over
the molar teeth to incisal contact. In other words, the an-
terior open bite likely prevailed instead of significant con-
dylar shift. Anterior open bite may be associated with com-
promised health and/or stability of the gnathic system.47,48
For the orthodontist desiring to treat to the upward and
forward or seated condylar position, this study is helpful
because it shows most pretreatment patients will have a
centric relation to centric occlusion discrepancy. The infor-
mation gathered from mounted casts can have a profound
CONDYLAR POSITION IN HYPERDIVERGENT AND HYPODIVERGENT FACES
affect on treatment planning.49 The data gleaned from this
study is particularly valuable because it indicates the cli-
nician can generally assume condylar distractions will be
much greater in hyperdivergent facial patterns than in hy-
podivergent ones. Certainly each case must be evaluated
separately, but the clinician is better prepared for diagnosis
with this knowledge.
SUMMARY AND CONCLUSIONS
The amount of condylar movement from the upward and
forward position (joint dominated) to the intercuspal posi-
tion (tooth dominated) was measured and compared for 2
matched samples of subjects with hyperdivergent and hy-
podivergent facial types.
It was hypothesized that the hyperdivergent group would
exhibit greater condylar displacement than the hypodiver-
gent group. The findings of this study demonstrated signif-
icantly greater condylar distraction for the hyperdivergent
group in all 3 dimensions.
REFERENCES
1. Lundeen HC. Centric relation records: the effect of muscle action.
J Prosthet Dent. 1974;March:244–251.
2. Hansson T, Oberg T, Carlsson GE. Thickness of the soft tissue
layers and the articular disk in the temporomandibular joint. Acta
Odontol Scand. 1977;35:77–83.
3. Williamson EH, Evans DL, Barton WA, Williams BH. The effect
of bite plane use on terminal hinge axis location. Angle Orthod.
1977;47:25–33.
4. Williamson EH. Laminagraphic study of mandibular condyle po-
sition when recording centric relation. J Prosthet Dent. 1978;39:
561–564.
5. Williamson EH, Steinke RM, Morse PK, Swift MD. Centric re-
lation: a comparison of muscle-determined position and operator
guidance. Am J Orthod Dentofac Orthop. 1980;77:133–145.
6. Teo CS, Wise MD. Comparison of retruded axis articulator
mounting with and without applied muscle force. J Oral Rehab.
1981;8:363.
7. Lundeen HC, Gibbs CH. Advances in Occlusion. Postgraduate
Dental Handbook. Series Vol 14. University of Florida, Gaines-
ville, Fla: John Wright Publisher; 1982:7–10.
8. Ito T, Gibbs CH, Marquelles-Bonnet R, Lupkiewica SM, Young
HM, Lundeen HC, et al. Loading of the TMJ’s with five occlusal
conditions. J Prosthet Dent. 1986;56:478–485.
9. Girardot RA. The nature of condylar displacement in patients with
temporomandibular pain-dysfunction. Orthod Rev. 1987;1:16–23.
10. Wood DP, Floreani KJ, Galil KG, Teleruck WR. The effect of
incisor bite force on condylar seating. Angle Orthod. 1994;64:53–
62.
11. Crawford SD. Condylar axis position, as determined by the oc-
clusion and measured by the CPI instrument, and signs and symp-
toms of temporomandibular dysfunction. Angle Orthod. 1999;69:
103.
12. Roth RH, Rolfs DA. The maintenance system and occlusal dy-
namics. Dent Clin North Am. 1976:20:761–788.
13. Roth RH. Functional occlusion for the orthodontist. J Clin Or-
thod. 1981;15:100–123.
14. Okeson JP. Management of Temporomandibular Disorders and
Occlusion. 3rd ed. St Louis, Mo: CV Mosby; 1993:113.
15. Slavicek R. Clinical and instrumental functional analysis for di-
245
agnosis and treatment planning. Part 4. Instrumental analysis of
mandibular casts using the mandibular position indicator. J Clin
Orthod. 1988;22:575.
16. Dawson PE. Evaluation, Diagnosis and Treatment of Occlusal
Problems. St Louis, Mo: CV Mosby; 1974:50.
17. McHorris WH. Occlusion with particular emphasis on the func-
tional and parafunctional role of anterior teeth. J Clin Orthod.
1979;13:606–620.
18. Lee RL. Anterior guidance. In: Lundeen HC, Gibbs CH, eds.
Advances in Occlusion. Bristol, England: John Wright and Sons
Ltd; 1982:65.
19. Okeson JP. When Is Orthodontic Therapy Indicated for the Man-
agement of TMD? [audiotape]. Birmingham, Ala: Practical Re-
views in Orthodontics, Educational Reviews; 1998.
20. McNeill C. Reply to questionnaire presented by Dr. Robert Frantz
at the Annual Meeting of The Cranial Mandibular Institute; 1992;
Squaw Valley, Calif.
21. Burke C, Major P, Glover K, Narashimha P. Correlations between
condylar characteristics and facial morphology in Class II pre-
adolescent patients. Am J Orthod Dentofac Orthop. 1998;114:
328–346.
22. Stringert HG, Worms FW. Variations in skeletal and dental pat-
terns in patients with structural and functional alteration of the
temporomandibular joint: a preliminary report. Am J Orthod.
1986;89:285–297.
23. Slavicek R. Clinical and instrumental functional analysis for di-
agnosis and treatment planning. Part 4. Instrumental analysis of
mandibular casts using the mandibular position indicator. J Clin
Orthod. 1988;23:566–575.
24. Utt TW, Meyers CE, Wierzba TF, Hondrum SO. A three-dimen-
sional comparison of condylar position changes between centric
relation and centric occlusion using the mandibular position in-
dicator. Am J Orthod Dentofac Orthop. 1995;107:298–308.
25. Wood DP, Korne PH. Estimated and true hinge axis: a comparison
of condylar displacements. Angle Orthod. 1992;62:167–175.
26. Alexander SR, Moore RN, DuBois LM. Mandibular condyle po-
sition: comparison of articulator mountings and magnetic reso-
nance imaging. Am J Orthod Dentofac Orthop. 1993;104:230–
239.
27. Ricketts RM. Provocations and Perceptions in Cranio-Facial Or-
thopedics, Dental Science and Facial Art. Denver, Colo: Rocky
Mountain Orthodontics; 1989:612.
28. Roth RH. Temporomandibular pain-dysfunction and occlusal re-
lationships. Angle Orthod. 1973;43:136–153.
29. Shore NA. Temporomandibular Joint Dysfunction and Occlusal
Equilibration. 2nd ed. Philadelphia, Penn: JB Lippincott; 1976:
140–142.
30. Sicher H. Oral Anatomy. 4th ed. St Louis, Mo: CV Mosby; 1965:
179.
31. Ricketts RM. Abnormal function of the temporomandibular joint.
Am J Orthod. 1955;41:435–441.
32. McNeill C. Nonsurgical management. In: Helms CA, Katzberg
RJ, Dolwick MF, eds. Internal Derangements of the TMJ. San
Francisco, Calif: Radiology Research and Education Foundation;
1983:212.
33. Thompson JR. The Triad of Dentistry. Chicago, Ill: Northwestern
University Dental School; 1992:44–62.
34. Moffett BC. Histologic aspects of temporomandibular joint de-
rangements. In: Moffett BC, Westessonk Per-L, eds. Diagnosis of
Internal Derangements of the Temporomandibular Joint. Vol. 1.
Double-Contrast Arthrography and Clinical Correlation. Seattle,
Wash: University of Washington Continuing Education, Univer-
sity of Washington Press; 1984:47–49.
35. Isberg AM, Isacsson G. Tissue reactions of the temporomandib-
ular joint following retrusive guidance of the mandible. J Cran-
iomandibular Pract. 1986;4:143–148.
Angle Orthodontist, Vol 71, No 4, 2001
246
36. Sicher H. Oral Anatomy. 4th ed. St Louis, Mo: CV Mosby; 1965:
497.
37. Okeson JP. Management of Temporomandibular Disorders and
Occlusion. 3rd ed. St Louis, Mo: CV Mosby; 1993:18.
38. Carpentier P, Jung J, Marquelles-Bonnet R, Meunissier M. Inser-
tion of the lateral pterygoid: an anatomic study of the human
temporomandibular joint. J Oral Maxillofac Surg. 1988;46:477–
482.
39. Dusek TO, Kiely M. Quantification of the superior lateral pter-
ygoid insertion on TMJ components [abstract 1246]. J Dent Res.
1991;70:421.–482
40. Marguelles-Bonnet, Jung J, Carpentier P, Meunissier M. Tempo-
romandibular joint serial section made with mandible in the in-
tercuspal position. J Craniomandibular Pract. 1989;7:97–106.
41. Tanaka TT. Advanced Dissection [videotape]. San Diego, Calif:
Clinical Research Foundation; S1989.
42. Tanaka TT. TMJ Microanatory: An Approach to Current Contro-
versial [videotape]. San Diego, Calif: Clinical Research Foun-
dation; 1992.
43. Okeson JP. Management of Temporomandibular Disorders and
Angle Orthodontist, Vol 71, No 4, 2001
GIRARDOT
Occlusion. 3rd ed. St Louis, Mo: CV Mosby; 1993:193–205,404–
406.
44. Slavicek R. Clinical and instrumental functional analysis for di-
agnosis and treatment planning. Part 1. J Clin Orthod. 1988;22:
365.
45. Hylander WL. Functional Anatomy. In: Sarnat BG, Laskin DM,
eds. The TMJ, a Biological Basis for Clinical Practice. Philadel-
phia, Penn: WB Saunders; 1992:60–92.
46. Tanaka TT. Head, Neck and TMD Management. 4th ed. San Di-
ego, Calif: Clinical Research Foundation; 1989.
47. Mohlin B, Ingervall B, Thiland B. Relation between malocclusion
and mandibular dysfunction in Swedish men. Eur J Orthod. 1980;
2:229–238.
48. Riolo ML, Brandt D, TenHave TR. Associations between occlusal
characteristics and signs and symptoms of TMJ dysfunction in
children and young adults. Am J Orthod Dentofac Orthop. 1987;
92:467–477.
49. Shildkraut M, Wood DP, Hunter WS. The CR-CO discrepancy
and its effect on cephalometric measurements. Angle Orthod.
1994;64:333–342.