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ii DEDICATION iii ACKNOWLEDGEMENTS  iv TABLE OF CONTENTS v LIST OF TABLES vii LIST OF FIGURES  viii CHAPTER 1: INTRODUCTION  1 BACKGROUND  1 PURPOSE OF STUDY  2 STATEMENT OF THE PROBLEM  2 SIGNIFICANCE OF THE PROBLEM 3 NULL HYPOTHESIS  3 DEFINITION OF TERMS  4 ASSUMPTIONS  8 LIMITATIONS  8 DELIMITATIONS  9 CHAPTER 2: REVIEW OF LITERATURE 10 HISTORY OF CLASSIFICATION OF MALOCCLUSION 10 ETIOLOGY OF MALOCCLUSION AND THE NEED FOR ORTHODONTIC THERAPY 10 PREVALENCE OF CLASS II MALOCCLUSION 11 CLASS II SKELETAL GROWTH 11 TREATMENT OF CLASS II MALOCCLUSION 13 FUNCTIONAL APPLIANCES USED TO TREAT CLASS II MALOCCLUSION 15 THE HERBST APPLIANCE 17 PATIENT COMPLIANCE AND THE HERBST APPLIANCE 19 TIMING OF TREATMENT WITH FUNCTIONAL APPLIANCES19 SKELETAL TREATMENT EFFECTS OF THE HERBST APPLIANCE 21 DENTAL RADIOGRAPHS 24 TRADITIONAL HEADFILMS24 CONVENTIONAL COMPUTERIZED TOMOGRAPHY 26 CONE BEAM COMPUTED TOMOGRAPHY 27 CBCT IMAGE ACCURACY 28 RADIATION SAFETY 29 TEMPOROMANDIBULAR JOINT ANALYSIS 31 CHAPTER 3: MATERIALS AND METHODS 33 IMAGING PROTOCOL 33 PRINCIPLES OF ANALYSIS 34 IMAGE ORIENTATION OF THE MANDIBULAR CONDYLE 34 SUPERIMPOSING THE MANDIBULAR CONDYLE 36 MEASURING THE MANDIBULAR CONDYLE (SAGITTAL PLANE) 38 MEASURING THE MANDIBULAR CONDYLE (CORONAL PLANE) 40 IMAGE ORIENTATION OF THE GLENOID FOSSA 43 SUPERIMPOSING THE GLENOID FOSSA 44 MEASURING THE GLENOID FOSSA (SAGITTAL PLANE) 45 DATA COLLECTION 49 METHOD ERROR 54 vi CHAPTER 4: RESULTS AND DISCUSSION 55 DISTRIBUTION OF CONDYLE MEASUREMENTS (SAGITTAL) 55 DISTRIBUTION OF CONDYLE CHANGES (CORONAL) 56 SAGITTAL LINEAR MEASUREMENTS 57 SAGITTAL DEGREE MEASUREMENTS 58 SAGITTAL COMPONENT AVERAGE MEASUREMENTS 58 CORONAL LINEAR MEASUREMENTS 58 CORONAL DEGREE MEASUREMENTS 59 CORONAL COMPONENT AVERAGE MEASUREMENTS 59 CHAPTER 5: SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS 61 SUMMARY 61 CONCLUSIONS 62 RECOMMENDATIONS 63 REFERENCE LIST 65 APPENDICES 74 APPENDIX A – IRB EXEMPTION 75 APPENDIX B – PERMISSION TO USE RADIOGRAPHS 76 APPENDIX C CONDYLAR SAGITTAL MEASUREMENTS 77 APPENDIX D CONDYLAR CORONAL MEASUREMENTS 78 APPENDIX E RELIABILITY DATA 79 CURRICULUM VITAE 80

A proposed method for evaluation of morphological changes in the condyle and glenoid fossa by cone beam computed tomography