Alteration of the functional condition of the mandible during clinical treatment.

Free mandibular movements and their neuromuscular guidance were measured with an ultrasonic device and analyzed with computer software developed by the authors. In all patients examined, we found maxillarly- and mandibularly-fixed axes which maintain a constant distance. This guidance system is named a neuromuscularly-determined dimeric link chain. The position of the mandible is defined by the 2 rotational angles (mu, alpha) around the axes of the dimeric link chain. This dimeric link chain of free movements normally functions according to the principle of least action. The angular velocities around the 2 axes show a constant ratio during the different segments of motion. In the mu-alpha-diagrams, the segments of movements of the mandible are represented by straight lines, the shortest path between 2 positions. Individual cases and statistical data show that the structure of mandibular movements of patients with skeletal mandibular retrognathism combined with dental class-II-relationship without craniomandibular pain significantly differs from the structure in patients with neutral alignment. Mandibular retrognathism and class-II-relationship are accompanied by marked coordination disturbances of rotations around the maxillary and mandibular neuromuscular axes. Following orthodontic-surgical treatment that restored ideal alignment of the occlusal, articular, and skeletal structures, the patients examined showed a similar pattern in the structure of mandibular movements to that of patients with neutral skeletal and dental relationships. Thus, combined orthodontic-surgical treatment leads to measurable functional harmonization not only of the skeletal and dental structures, but also of the neuromuscular guidance system.