CBCT and digital axiography promising methods for sagittal condylar guidance angle assessment

Precise assessment of the condylar guidance angle can aid successful prosthodontic treatment. However, the reliability and accuracy of current methods remain unclear. The purpose of this systematic review was to evaluate the reliability and accuracy of current methods of determining the sagittal condylar guidance angle, including protrusive interocclusal records, axiography, cone beam computed tomography (CBCT), and panoramic and cephalometric radiographs. A literature search was conducted using BASE, Embase, PubMed, and Web of Science databases up to June 2022. Inclusion criteria involved studies that compared protrusive interocclusal records against other methods of sagittal condylar guidance angle assessment in adult dentate and edentulous patients. Studies that did not provide the values for the right and left joint separately were excluded. The methodological quality of the included studies was assessed by using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Data were tabulated and analyzed for correlations and their significance. Results: A total of 24 articles qualified for the analysis. The differences between protrusive interocclusal records and panoramic radiograph sagittal condylar guidance angle values were up to 9 degrees. Lateral cephalometric radiographs revealed greater condylar guidance values than facebow transfers or the Bonwill methods. Correlations between average sagittal condylar guidance angle values obtained from CBCT and protrusive interocclusal records differed depending on the method of registration. For protrusive interocclusal records, axiographic or pantographic measurement variance analysis showed that the condylar inclination values recorded with wax were statistically lower than those recorded with a pantograph (P<.05). Although CBCT appears to be the most suitable method of evaluating the sagittal condylar guidance angle, the limitations and discrepancies among methods, including protrusive interocclusal records and panoramic and cephalometric radiographs, should be acknowledged. Digital axiography, with its potential to capture comprehensive functional data, may surpass other techniques. The use of mean values for articulators may be a practical solution for some patients. Further research is needed to refine sagittal condylar guidance angle assessment methods and to develop more reproducible and reliable approaches for the future.

Reference:

Lassmann Ł, Nowak Z, Żółtowska A. Sagittal condylar guidance angle measurement methods: A systematic review. J Prosthet Dent. 2023 Dec 19:S0022-3913(23)00768-0. doi: 10.1016/j.prosdent.2023.11.017. Epub ahead of print. PMID: 38123416.

Keywords:

CBCT, digital axiography, sagittal condylar, guidance angle assessment, Lassmann Ł, Nowak Z, Żółtowska A, journal of prosthetic dentistry