10 • T H E J O U RN A L O F T H E A M E R I C A N DEN T AL A SSO C I A T I O N

th e cro w n s w ere tilted slig h tly . T h e te e th th e sam e lesion . R o e n tg e n o g r a p h ic e x a m ­

rela ted to th e lesio n w ere fo u n d to b e in a tio n o f th e le sio n from d ifferen t an g les
v ita l. D istu rb a n ce o f o cclu sio n is a c lin i­ a n d in d ifferen t v iew s, in a d d itio n to as­
cal fea tu re th a t o fte n reveals th e p resen ce p ira tio n b iop sy , esta b lish es th e p rop er
o f th e lesio n , p a rticu la rly in th e im m a tu re d ia gn osis. T h e se stu d ies also en su re
a ctiv e sta g e o f its d e v e lo p m e n t. p ro p er p la n n in g o f th e o p e r a tiv e p r o ­
On ro e n tg e n o g r a p h ic ex a m in a tio n ced u re.
ch a ra cteristic m u ltip le ro u n d r a d io lu cen t C o n serv a tiv e surgery, sp a rin g th e re­
areas w ith a m u ltilo c u la r a p p ea ra n ce th a t la ted teeth , a n d o v erex ten sio n o f th e
s im u la ted o th er typ es o f fibrous d y sp la sia ex cisio n is th e trea tm en t o f ch o ic e . P ref­
g iv e th e a p p e a r a n c e o f c o tto n w o o l, era b ly , su rgery s h o u ld b e fo llo w e d by
g ro u n d glass or ash y d en sity or p u n c h e d irra d ia tio n , p a rticu la rly w h e n th e o ssify­
o u t areas, a n d th e stip p led e ffe c t fo u n d in g p eria p ica l fib rom as are m u ltip le a n d
is d u e to v a ria b le disp ersed ra d io p a city . in th eir im m atu re a ctiv e stage. Ir r a d ia ­
S u c h fin d in g s rev ea l th e ex iste n c e o f v a ri­ tio n m a y p rev en t fu rth er g ro w th or re­
ou s d eg rees o f m a tu rity a n d a ctiv ity in cu rren ce o f th e lesion.

R a n g e o f m o v e m e n t o f th e m a n d ib le

U l f P o s s e lt, O d o n t . D ., M a l m ö , S w e d e n

T h e p u rp ose o f th is p a p er is to d escrib e an terior p art o f th e m a n d ib le d escrib es a

th e ra n g e o f m a n d ib u la r m o v e m e n t as rh o m b o id figu re.2,3 T h is is k n o w n as th e
m ea su red fro m a p o in t at th e an terio r m o v e m e n t area o n th e h o r iz o n ta l p la n e
p art o f th e m a n d ib le or o n e fix ed in c o n ­ (F ig . 1 ) . A t a g iv e n v e rtica l o p e n in g , n o
n e c tio n w ith it. T h e a v era g e h a b itu a l m o v e m e n ts ca n b e m a d e o u tsid e th e e x ­
o p e n in g a n d clo sin g p a th s are d escrib ed trem e lim its o f th is area. A m o v e m e n t
in rela tio n to th e to ta l ra n g e o f m a n d ib ­ area ca n also b e record ed o n th e m ed ia n
u la r excu rsion s. S ev era l im p o r ta n t p o si­ p la n e. T h erefo re, e a c h p o in t o n th e m a n ­
tio n s, th e o c c lu sa l p o sitio n , th e rest d ib le or in fix ed c o n n e c tio n w ith it h a s a
p o sitio n a n d th e retru d ed p o sitio n , are d efin ite ran g e o f m o v e m e n t. T h e ex trem e
an a ly zed a n d classified. p a th s lim itin g th is ran ge are rep ro­
d u c ib le .4
M O V E M E N T AREAS

A >>í : $ ; Q! W# í ) ! >>í # ; ’ “ Z ! ; “ í ) QZ ! “ ! W ; # Q“ ! ’ Q í )

T h e reg istra tio n o f G o th ic -a r c h a n d í : : ^ / >; ^ ; ’ ; ^ < >$ > ; ’ “ # ! Z; ' $ ^ $ Q; Q$ í ’ , Rí <; ^ D! ’ Q; ^ S: Z í í ^ .

L G < >$ , A. B ! $ Q# ; _ Z/ “ A# Q$ «/ ^ ; Q$ í ’ >W # í ' $ ! “ . B! # ^ $’ ,
n e e d le -p o in t tra cin g s h a v e b een k n o w n A. H$# >: Z ( ; ^“ , 1908.
for th e pa st 5 0 yea rs.1 T h e y are g ra p h ic 2. F $ >: Z ! # , Q R. D$ ! G ) ) ’ / ’ _>' ! ( ! _/ ’ _! ’ “ ! > U ’ Q! # -
«$ ! ) ! #> / ’ “ $ Z# ! W $ ! “ ! # _; ' ! ; “ A # Q$ «/ ^ ; Qí # . S: Z ( ! $ Z .
records o f a h o rizo n ta l p la n e . W h e n th e M >: Z # . Z; Z ’ Z «. 4 5: 86 7 O : Q. 1935.
3. G < >$ , A . , ’ Kí ^ ! # , L. Z; ’ ! # > ; QZ «/ ’ ! . B! # ^ $’ ,
m a n d ib le carries o u t a ll p ossib le m o v e ­ U # ' ; ’ ; ’ “ S: Z ( ;
;

# Z ! ’ ' ! # _,
“ Z

1929, W.
Z

U I7 I.
“

m en ts o n th is p la n e , th e excu rsio n s o f a 4. Pí >>) ! ^ Q✴ U. SQ/ “ $! > $’ QZ ! “ í ' $ ^ $ Q< í ) QZ ! Z / “ ; ’

“ ; ’ “ $' ^ ! . A: Q; í “ í ’ Q. >: ; ’ “ $’ ; : . ( S/ WW^ . 10) 10: 19
p o in t th a t is fix ed in c o n n e c tio n w ith th e 1952.
 POSSELT . . . V O L U M E 56, J A N U A RY 1758 • 11

T h e h o riz o n ta l m o v e m e n t areas b eco m e

sm aller as m a x im a l o p e n in g is a p ­
p ro a c h e d . T h is m e a n s t h a t th e m o v em e n t
a r e a o n th e m e d ia n p la n e gets n a rro w e r
a n d en d s in a p o in t a t th e m a x im a l o p e n ­
ing. T h e m o v e m e n t a re a is re la te d to th e
skull as is show n o n a profile ro e n tg e n o ­
g ra m in F ig u re 2.

M O V EM EN T SPACE

By c o m b in in g th e g ra p h ic a n d ro en tg e n o -
g ra p h ic re co rd s o f d iffe re n t p lan es a n d
levels, it is possible to c o n stru c t th e m o v e ­
m e n t space o f a n a n te r io r p o in t (F ig. 3 ) .
T h e sp ace is chiefly co n tro lled by th e
F ig. 2 • Movem ent area In m e d ia n p la n e draw n
jo in t g u id an ce s. Its u p p e r su rface, h o w ­ on p r o file r o e n t ge n o gr a m
ev er, is g o v e rn e d m a in ly by th e occlu sal
su rfaces of th e te e th (su rfa c e of c o n ta c t H A B IT U A L O P E N I N G A N D
m ovem ent).® C L O S IN G M O V E M E N T S
T h e m o v e m e n t sp ace h as a c h a r a c ­
teristic sh a p e in m o st in d iv id u a ls, a l­ In c o n ju n c tio n w ith re g istra tio n s o f ex­
th o u g h it differs so m ew h a t fro m o n e p e r­ tre m e m o v em en ts, th e h a b itu a l closing
son to a n o th e r. T h e sh a p e o f th e m o v e ­ m o v em en ts also w e re e v a lu a te d .4 T h e se
m e n t sp ace h as b e e n in d ic a te d by F isc h e r2 p a th s o f closure v a rie d a n d alw ays fell
a n d H a n a u .8 w ith in th e e x tre m e m o v e m e n t areas.
T h e y , th e re fo re , c a n be ca lle d in tra e x ­
tre m e m o v em en ts (F ig. 4 ) .
A t a g re a te r v e rtic a l o p en in g , th e
h a b itu a l clo su re p a th is a n te r io r to th a t
of th e h in g e m o v em e n t. T h e re co rd s also
in d ic a te d t h a t re st p o sitio n , gen erally ,
c a n be co n sid ered a p o sitio n on th e
h a b itu a l p a th of closure.4

M O V E M E N T A R E A O N M E D IA N P L A N E

T h e m o v e m e n t a re a on th e m e d ia n p la n e
c a n b e re c o rd e d g ra p h ic a lly , o r it c a n be
c u t as a m e d ia n section o f th e m o v em en t
space.
T h e a re a show n in F ig u re 4 is a n a v e r­
ag e fig u re d e riv e d fro m 20 n o rm a l p a -

5. P í >>! ^ Q, U . M í : ! “ ! ’ Q ; # ! ; > í ) QZ ! “ ; ’ “ $' ^ ! . J.

P # í >. D ! ’ . 7: 3 75 M ; < 1957.
F ig. I • Above : Sk e t c h of gr a p h ic r e c o r d in g ap­
6. H; ’ ; / , R. L. D! ’ Q; ^ ! ’ _$ ’ ! ! # $ ’ _. SZ ; ^ ^ (! ; “ ; / >Q
paratus u se d . Be lo w : Rh o m b o id f igu r e , it s p o s­
; ’ ; # Q$ : / ^ ; Qí # Qí : í ’ ) í # “ Qí ; ’ ; Qí “ $ : ; ^ ; ’ “ Q! : Z ’ $: ; ^
t e r i o r a sp e c t dow nw ard, u su a l l y re corde d on g l a ss # ! © / $ # ! “ ! ’ Q> í # “ ; < (! ! ) W! : Q í / # W ; Q$ ! ’ Q> Qí ) $Q ; ’

p la t e ; : ! # ; _! ; # Q$ : / ^ ; Qí # ? J. N ; Q. D. A. 9: 5 95 J / ^ < 1922.
 12 • T H E J O U R N A L O F T H E A M E R I C A N DEN T AL A SSO C I A T I O N

tients. T h e fig u re show s th e fo llow ing 0

c h a ra c te ris tic s :
1. T h e e x tre m e p o ste rio r o p e n in g is
in d ic a te d by th e line R C — M . Its u p p e r
p a r t is th e h in g e m o v e m e n t, H , w h ic h c a n
be m a d e to fro m 2 t o 2/2 cm . o f o p e n in g .4
R e tru d e d p ositio ns a t d iffe re n t degrees of
o p e n in g in side th e h in g e -o p e n in g ra n g e
lie o n th e h in g e -m o v e m e n t p a th .
2. T h e e x tre m e o p e n in g m o v em en ts
d iffe r fro m th e h a b itu a l o p e n in g a n d
closing m o v em en ts.
3. P o ste rio r h in g e m o v e m e n t is a p u re
r o ta tio n a r o u n d a n in te rc o n d y la r axis.
N o o th e r p a th o f o p e n in g is c o n c e n tric
w ith it, a n d n o n e o f th e o th e r o p e n in g
p a th s a re o f th e sam e c h a ra c te r.
F ig. 4 • A ve r age m ove m e nt area on m e d ia n
4. T h e a n te r io r e x tre m e o p e n in g is p la n e , sh o w i n g h a b it u a l c l o si n g m ove m e nt (h ),
n o t a h in g e m o v e m e n t since it is n o t c o n ­ r e st p o si t i o n (r), li n e p a r a lle l to o c c l u sa l p la n e
(O ), re trude d contact p o si t i o n (RC ), o c c l u sa l
c e n tric w ith th e h in g e -m o v e m e n t p a th
( i n t e r c u sp a l ) p o si t i o n (i), protruded c o n t a c t p o si ­
b ec au se th e co ndyles m o v e f u r th e r fo r­ t io n { P ), h in ge m ove m e nt (H ) and m a x im a l o p e n

w a rd w h e n th e m a n d ib le m oves fro m th e p o si t i o n (M ). A p p r o x im a t e ly natural si z e

m a x im a l p r o tru d e d c o n ta c t p o sitio n , P,
to m a x im a l o p en in g , M .
5. T h e fo rw a rd a n d b a c k w a rd glide
b etw e e n R C a n d P is so m e w h a t irre g u la r
b ecause o f in cisal a n d o th e r to o th g u id ­
ances.

T H R E E IM P O R T A N T P O S IT IO N S
OF T H E M A N D IB L E

F ig u re 4 show s th e av e ra g e re la tio n sh ip
in p a tie n ts w ith o u t p a th o lo g ic co n d itio n s
of th e th re e im p o rta n t positio n s : occlusal
( i ) , re st ( r ) , a n d r e tr u d e d c o n ta c t p o si­
tio n ( R C ) . T h e re la tio n sh ip b etw een
these po sitions, o f co urse, v arie s in d i­
v id u a lly in p a tie n ts w ith o u t p ath o lo g ic
co n d itio n s. T h e o cclu sal o r in te rc u sp a l
po sitio n does n o t co in cid e g en e rally w ith
th e re tr u d e d c o n ta c t p o sitio n .4,7,8
T h e rest p o sitio n is n o t s itu a te d o n th e
h in g e -m o v e m e n t p a th . R est p o sitio n a n d

7. Dí ’ í : ; ’ , R. W. C! W Z ; ^ í “ ! Q# $ : ; ’ “ Q! “ Wí # í “ ; ’ ­
“ $' / ^ ; # ; í $’ Q # ; “ $ í _# ; WZ $ : >Q/ “ < í ) ’ í #“ ; ^ ; ’ “ ; ' ’ í # “ ; ^
) / ’ : Q$ í ’ í ) QZ ! Q! “ W í # í “ ; ’ “ $' / ^ ; # ; í $ ’ Q>. D $ >>! # Q; Q$ í ’ ,
Ní # QZ ( ! >Q! # ’ U’ $ : ! # >$ Q< D! ’ Q; ^ S: Z í í ^ , 1953.
F ig. 3 • Movem ent sp a c e of p o in t on an a n t e r io r 8. P í >>! ^ Q, U . A ’ ; ’ ; ^ <Z ! # ) í # “ ; ’ “ $' / ^ ; # Wí >$ Q$ í ’ > .

p o r t io n of m a n d ib le J . P # í >. D ! ’ . 7: 3 68 M ; < 1957.

 H I RSC H — W EI N REB . . . V O L U M E 56, J A N U A RY 1958 • 13

o cclu sa l p o sitio n are in tra ex trem e p o si­ p o sitio n s, su c h as th o se o n th e h in g e -

tions. m o v e m e n t p a th ( H ) , are n o n c o n ta c t e x ­
c e p t o n e— th e retru d ed c o n ta c t p o sitio n
C L A S S IF I C A T IO N O F M O V E M E N T S ( R C ) (F ig . 4 ) .
A N D P O S I T I O N S O F T H E M A N D IB L E A n y m a n d ib u la r p o sitio n o r m o v e m e n t
c a n b e cla ssified a n d , a t th e sa m e tim e,
D iffe r e n tia tio n b e tw e e n ex trem e m o v e ­ c a n b e ch a ra cterized b y m ea n s o f th is
m en ts a n d in tr a e x tr e m e m o v e m e n ts h as n o m en cla tu re.
b een su g g ested . I t is im p o r ta n t to d iffe r ­
e n tia te b e tw e e n c o n ta c t m o v e m e n ts, th a t S U M M A R Y A N D C O N C L U S IO N
is, m o v e m e n ts m a d e w ith c o n ta c t b etw een
th e u p p er a n d lo w e r te e th , a n d n o n c o n ­ T h e ra n ge o f m a n d ib u la r m o v e m e n t in
ta ct m o v em en ts. I n a d d itio n , m o v e m e n ts n o rm a l p a tien ts w ith o u t p a th o lo g ic c o n ­
are ch a ra cterized b y th eir d ir e c tio n , su ch d itio n s h a s b een d escrib ed . I t h as n o t
as forw a rd a n d la tera l. P o sitio n s o f th e b een th e p u rp o se o f th is p a p er to discuss
m a n d ib le , h o w ev er, c a n n o t b e ch a ra cter­ th e p rin cip les u sed in b ite registratio n and
ized b y in d ic a tio n o f d irectio n . o cclu sa l r e h a b ilita tio n in rela tio n to th e
M a n d ib u la r p o sitio n s' ca n b e classified id e a l o cclu sa l p o sitio n .
as fo llo w s: T h e o c c lu sa l p o sitio n ( i) is an I n p a tie n ts w ith p a th o lo g ic co n d itio n s,
in tra ex trem e c o n ta c t p o sitio n , w h erea s a ll th ree p ositio n s— o cclu sa l, rest and
th e rest p o sitio n (r ) is a n in tra ex trem e h in g e p ositio n s— m a y h a v e u n d erg o n e
n o n c o n ta c t p o sitio n . L ik ew ise, extrem e ch a n g es.

M a r g in a l fit o f d ir e c t a c ry lic re s to ra tio n s

L . H ir s c h , D r .m e d .d e n t., a n d M a x M . W e in r e b ,* D .D .S .,
M .S ., T e l- A v iv , Is r a e l

A n im p o rta n t p rereq u isite o f a p erm a ­ restoratio n fro m th e ca v ity w a lls w ith re­
n e n t fillin g m a teria l is its a d a p ta b ility to su lta n t lea k a g e or e v e n clin ic a l lo o sen in g
th e ca v ity w a lls, th a t is, its a b ility to h o ld o f th e fillin g.
a tig h t m a rg in , fo r it is o b v io u s th a t a A series o f exp erim en ts h a v e b een
fillin g m a teria l is n o b etter th a n its ca v ity - u n d erta k en , resem b lin g as clo sely as p o s­
sea lin g property. sible a c tu a l clin ic a l c o n d itio n s, in a n a t­
O n e o f th e m o st d ifficu lt p ro b lem s e n ­ tem p t to assess th e c a v ity -se a lin g p ro p er­
co u n tered w ith self-p o ly m erizin g resin is ties o f th e n ew er self-cu rin g resins. S om e
th e v o lu m etric sh rin k a g e o f th e fillin g
d u rin g p o ly m eriza tio n .
I t h as b een rea so n ed th a t th e acrylic TZ$> W; W ! # # ! : ! $: ! “ QZ ! A. G# ; ' í : A( ; # “ ) í # D! ’ Q; ^
R! >! ; # : Z , 1956.
resins d o n o t seal ca v ities w ell b eca u se o f F# í “ QZ ! B. Gí QQ^ $ ! ' Pí >Q- _# ; “ / ; Q! & R ! >! ; # : Z I’ ­
>Q$ Q/ Q! , D! ’ Q; ^ A >> í $ ; Q$ í ’ í I ># ; ! ^ , T! ^ -A: $ : .
th is ex cessiv e sh rin k a g e, a n d th a t this : )

• A’ ; Qí “ < “ ! W ; # Q“ ! ’ Q, D! ’ Q; ^ S: Z í í ^ , H! ' # ! ( U’ $ ­
sh rin k age m a y resu lt in co n tr a c tio n o f th e : ! # >$ Q< , J! # / >; ^ ! “ .