Dentomaxillofacial Radiology (2007) 36, 341–347

q 2007 The British Institute of Radiology

http://dmfr.birjournals.org

TECHNICAL REPORT
An approach for three-dimensional visualization using
high-resolution MRI of the temporomandibular joint
Y Hayakawa*,1, C Kober2, M Otonari-Yamamoto1, T Otonari1, M Wakoh1 and T Sano1
1
Department of Oral and Maxillofacial Radiology, Tokyo Dental College, Chiba, Japan; 2Faculty of Engineering and Computer Science,
University of Applied Science, Osnabrück, Germany

Objectives: To visualize the temporomandibular joint (TMJ) and the surrounding tissues in detail
utilizing high-resolution MR images for the diagnosis of soft- and hard-tissue abnormalities.
Clinically routine MR slices are processed by tissue segmentation and three-dimensional (3D)
reconstruction and viewed with visualization software.
Materials and methods: A 1.5 T MRI system was used. The double-echo procedure for taking
oblique sagittal images was applied to obtain both proton density-weighted (PDW) and T2 weighted
(T2W) images simultaneously, with separate examinations in both open and closed mouth positions.
Diagnosis of the abnormality in the placement and morphology of articular discs and the joint
effusion status is usually performed using multiple MRI slices. Clinically routine continuous MR
slices were processed by segmentation, reconstruction and visualization algorithms, and the
mandibular condyle, fossa, articular disc and other intra-articular tissues were visualized on the 3D
and two-dimensional (2D) – 3D fusion images.
Results: In a clinical case, the anterior disc displacement without reduction, with mouth open
and closed, was clearly depicted in the 3D images. Also 2D – 3D superposed images with
changeable tissue transparency successfully depicted the stereoscopic TMJ morphology in three
dimensions.
Discussion and conclusion: High-resolution PDW- and T2W MR images could be processed by
tissue segmentation and 3D-reconstruction procedures, and the resultant images showed the
anatomical details in an easily recognizable way. By the simultaneous visualization of both bony
surfaces and soft tissues, disc displacement and deformity can be recognized in a 3D context. The
additional superposition of the 3D visualization with the original 2D MR slices allows for a
combination with conventional diagnostics.
Dentomaxillofacial Radiology (2007) 36, 341–347. doi: 10.1259/dmfr/12894471

Keywords: temporomandibular joint; magnetic resonance imaging; three-dimensional imaging;

temporomandibular articular disc; three-dimensional reconstruction

Introduction

The temporomandibular joint (TMJ) is one of the most
complicated joints in the human body. It consists of the
mandibular fossa above, the mandibular condyle below and
the TMJ capsule with articular disc and several tissues in
between them. Pathological changes of the TMJ often cause
painful disorders. For that reason, TMJ imaging is subject to
intensive research. MRI has evolved as the prime diagnostic
*Correspondence to: Yoshihiko Hayakawa, Department of Computer Sciences,
Faculty of Engineering, Kitami Institute of Technology, 165 Koen-cho, Kitami,
Hokkaido 090-8507, Japan; E-mail: hayakawa@cs.kitami-it.ac.jp
Received 23 May 2006; revised 13 August 2006; accepted 31 August 2006
tool for soft tissue abnormalities of the TMJ.1 – 8 In addition,
MRI is equal to or possibly better than standard tomography
for the detection of cortical bone components despite the
limited visualization of bone.9 Therefore, MRI has replaced
CT and arthrographic examinations of the TMJ.1 – 9
For medical three-dimensional (3D) image rendering, the
shaded surface reconstruction is applied based on manual or
semi-automatic segmentation. Referring to this kind of
research, several attempts at 3D representation of the TMJ
based on MR images have been carried out to assess the 3D
morphology and dynamics.10 – 13 Segmentation consists of
reduction of the considered images to binary data separated
 3D visualization of TMJ
342 Y Hayakawa et al
into black and white according to a user defined strategy. If
tissue differentiation is sufficiently clear, as for bony organs in
CT data for instance, the shaded surface reconstruction is of
generally accepted benefit. However, as regards TMJ-MRI
data of 3 mm slice thickness, the inherent spatial information
about the articular disc is very scarce. Furthermore, the exact
tissue classification is unclear. This possibly makes the
segmentation and rendering processes tedious, error-prone
and highly user dependent.
The purpose of this article is to describe an alternative
approach to 3D rendering of the mandibular condyle and
fossa, articular disc and several tissues that compose the
TMJ. For the sake of future application in the medical
routine of diagnosis and simulation, the method has been
designed to be appropriate for processing TMJ-MRI
data stemming from clinical routine practice. The scarcity
of spatial anatomical information caused by the high slice
thickness is overcome by a combined application of
different visualization techniques. The method is demon-
strated for high-resolution MRI.
Materials and methods
MR image acquisition
MRI was carried out using a 1.5 T MRI system (Magnetom
Symphony Maestro Class; Siemens, Erlangen, Germany),
with the use of bilateral surface coils, “double loop array,”
as receivers. MR image acquisition by double loop array,
with a size of 70 mm in diameter, is optimized for the TMJ
region. As the clinical routine MRI-TMJ examination,
oblique sagittal cross-sectional plane images, which are
oriented according to the individual angle of the mandibular
condyle, are obtained as described by Musgrave et al.14 The
examination to obtain oblique sagittal images is repeated at
both open and closed mouth positions. The slice thickness in
each image was 3 mm, which is standard in clinical routine.
To reduce the cross-talk artefact, caused by the interference
between slices, there are 20% gaps between slices. There-
fore either seven or eight cross-sectional images are taken
for the sagittal examination of each TMJ region.
At those kinds of imaging slices, proton density-weighted
images (PDWI) and T2 weighted images (T2WI) are
simultaneously obtained by the double-echo sequence.6
Settings of repetition time (TR)/echo time (TE) were
3300 ms/14 ms (PDWI) and 3300 ms/85 ms (T2WI). The
matrix was 265 £ 265 and the field-of-view (FOV) was
150 mm. The total examination time for the double-echo
sequences was less than 6 min. Two-dimensional (2D) MR
slices were provided for the diagnosis of positional and
morphological abnormalities of articular discs and mandib-
ular condyle, the absence or presence of the joint effusion etc.
Image segmentation, 3D reconstruction and visualization
Based on 2D slices of MR images, image processing,
segmentation and visualization, especially focused on the
mandibular condyle and fossa, articular disc and surrounding
tissues of the TMJ, were carried out and followed by 3D
reconstruction. The geometry reconstruction from 3D image
data and all visualizations were performed by means of Amira
Dentomaxillofacial Radiology
software (Ver. 3.1.1; Mercury Computer Systems, Berlin,
Germany, http://amira.zib.de/, http://www.amiravis.com/).15
3D surface reconstruction of mandibular condyle and
fossa
After preparatory image processing of the MRI slices
through interactive editing, especially contour filtering, the
mandibular condyle and fossa were semi-automatically
segmented in the 2D MR slices. In order to overcome the
slice thickness of 3 mm and the additional gap of 20%
(0.6 mm) the segmented slices were subjected to cubic
interpolation to nearly isotropic voxel size. After gaussian
flattening of the segmented labels, the built-in Amira
surface generation algorithm was applied. Finally, the
resulting surface model was improved by stepwise
simplification and smoothing.16
Rendering of intraarticular condition of the TMJ including
the articular disc
For rendering the articular disc in 3D context, the voxels
comprising the lateral pterygoid muscle and the space
between the head of the condyle and the glenoid fossa were
segmented in the 2D MRI slices. Thereafter, they were
isolated from the rest of the data set and resampled to
nearly isotropic voxel size. Only these voxels containing
the information about the intra-articular condition of the
TMJ, especially the articular disc and the retrodiscal tissue,
were subjected to direct volume rendering, which is a very
intuitive method for visualizing 3D scalar fields. Each
point in a data volume is assumed to emit and absorb light.
The amount and colour of emitted light and the amount of
absorption is determined from the scalar data by using a
colour map which includes alpha values. With regard to the
applied colour map, there is a wide variety of possibilities
of monochromatic, dichromatic, or polychromatic colour
maps. The articular disc is depicted by low signal in both
the PDW images and the T2W images. For the sake of
emphasis on the disc, the voxels comprising the lateral
pterygoid muscle, and the space between the head of the
condyle and the glenoid fossa, were inverted. The range of
rendered grey values can be manipulated by the lower and
upper bound of the colour scale. By this, it is possible to put
the focus on tissue characterized by low signal such as the
articular disc, for instance, or on tissue characterized by
high signal such as joint effusion.
Finally, the intraarticular tissues, namely the lateral
pterygoid muscle and the space between the head of
condyle, the fossa and the lateral pterygoid muscle’s
tendon (direct volume rendering) the mandibular condyle
(shaded surface rendering) and the glenoid fossa (trans-
parent surface rendering) were simultaneously visualized.
Results
The reported approach enables a 3D visualization of the
anatomical situation. The articular disc, retrodiscal tissue
and some inner structure of the lateral pterygoid muscle
can be identified. This is demonstrated for a clinical case
characterized by TMJ disorders. The comparison of the
 3D visualization of TMJ
Y Hayakawa et al 343

visualization based on PDW and T2W images can serve as

vice versa validation.
As shown in Figure 1, at the left TMJ region examination
of a 23-year-old female patient, the anterior displacement of
the articular disc without reduction is observed. Also the
presence of joint effusion at the upper joint space is clearly
observed on a T2 slice (Figure 1c). The anterior displace-
ment of the articular disc without reduction is also observed
at the right TMJ region (images are not shown).
The mandibular condyle and fossa were reconstructed as
3D surfaces (Figure 2). No abnormalities were observed at
either condyle in this case (the right condyle is not shown).
In Figure 3, the location of the original MRI with regard
to the condylar 3D reconstruction is indicated. Due to the
high slice thickness, only four or five MRI slices were
available for the reconstruction of the condyle’s geometry.
The reconstruction of the condyle for PDW and T2W
images was carried out with the data sets acquired at both
open and at closed mouth positions. By superimposing 3D
mandibular condyle images, the morphological reproduci-
bility was examined as shown in Figure 4. The case of the
left condyle is shown. The superposition of PDWI-based
images at closed and open mouth examinations is
indicated. Also the superposition of PDWI-based and
T2WI-based reconstructions was examined (not shown).
In spite of the above mentioned difficulty of thick slices,
the agreement seemed to be quite satisfactory, including
the superposition based on the same sequence (PDWI or
T2WI) at closed/open mouth. The observed slight dis-
agreement of the reconstructions may be due to different
slice location of closed/open mouth sequences and different
interpretation of the PDWI or T2WI signal during semi-
automatic segmentation. Furthermore, T2W images are not
the first choice for the reconstruction of the anatomy.
As shown in Figure 5, the superposition with 3D-
reconstructed condyle and fossa of the left side on a PDWI
slice clearly showed the visual abnormality of the presence
of the joint effusion at the upper joint space on the left side
of the TMJ.
Alternatively, 2D–3D fusion images, namely the volume
rendering of TMJ with superposed 3D reconstruction, are
presented in Figure 6. For the images acquired at closed
mouth, both PDW and T2W, the articular disc is of low
signal. Based on T2W and PDW images, the lateral pterygoid
muscle (direct volume rendering) and the mandibular condyle
(shaded surface rendering) and fossa (transparent surface
rendering) were simultaneously visualized. The low signal of
the articular disc and the marked high signal of the joint
effusion are simultaneously emphasised in a 3D context.
As a further variant, the original 2D MRI slices can be
added to the visualization in Figure 6. Because the MRI
slices are scrollable by the observer, a combined 2D – 3D
examination of the case is possible. If the range of the
depicted voxels by volume rendering is focused on high
grey values, the T2WI slices provide a very clear
visualization of the joint effusion at the upper joint Figure 1 Three slices of the examined left temporomandibular joint
space; see the upper row of Figure 6. By this, the (TMJ) region. The anterior displacement of articular disc without reduction
can be observed at (a) a proton density-weighted imaging (PDWI) slice at
visualization based on the T2W images is of value on its closed mouth and (b) a PDWI slice at open mouth. (c) The joint effusion at
own. For PDW images (see the lower row of Figure 6) the the upper joint space can be observed at a T2 weighted image slice with
high signal of the joint effusion can also be observed in a closed mouth. No abnormalities are observed on the mandibular condyle

Dentomaxillofacial Radiology
 3D visualization of TMJ
344 Y Hayakawa et al

Figure 2 Three-dimensionally reconstructed condyle and fossa on the

left temporomandibular joint (TMJ). The fossa is drawn in transparent
rendering and ready for the superposition

3D context. Due to high and dense signal of fibre structure

of the lateral pterygoid muscle, the volume rendered parts
and the mandibular fossa were clipped by the central
sagittal plane. By this, a visualization of the articular disc is
possible. If the range of the applied colour scale is reduced
the articular disc is also visible in the T2W images.
This procedure was applied to PDW images as well as
to T2W images for open and closed mouth data. In general,
T2W images are not appropriate for visualizing anatomical
structure. In this context, the visualization based on T2W
images is of twofold benefit; first for additional information
concerning the joint effusion, second for vice versa validation
as regards the visualization based on PDW images. This will
be described in more detail in the next section. Figure 3 Frontal view of the left condyle reconstructed by closed mouth
In Figure 7, 3D reconstruction of the left TMJ based proton density-weighted (PDW) slices. Solid lines superposing the
on T2W images at the open mouth examination and the three-dimensional view of the condyle indicate where each centre of original
superposition with a T2WI slice are shown. The reversed MR slices was located
marked high signal of the articular disc can be observed in a
3D context. For the images acquired at open mouth, again
both PDW and T2W, the articular disc is depicted as a low anatomical structures.4 – 8 On the other hand, T2W images
signal tissue. In order to emphasise tissues the segmented have additional clinical value for diagnosing the existence
voxels (lateral pterygoid muscle and the space between the of joint effusion, inflammation in the TMJ capsule, bone
head of condyle, the fossa and the lateral pterygoid muscle’s marrow oedema etc.4 – 8 For instance, the case presented
tendons) were inverted. By this, the articular disc is again here showed the marked high signal of joint effusion at the
highlighted if subjected to direct volume rendering. upper joint space of the left TMJ. Additionally, T2W
images have a complementary role. Due to the “magic
angle” effect, sometimes called magic angle artefact or
Discussion phenomenon, there is the possibility that both T1W and
PDW images show the increased signal intensity at the
Based on 2D slices of MR images at closed and open magic angle, 558, and for instance it shows the degradation,
mouth examinations, image segmentation, 3D reconstruc- inflammation, or tear of tendons.17 The magic angle effect
tion and visualization were carried out. It is known that is significant at the short TE examinations and never
PDWI and T2WI have been found to be more useful than appears at the T2 examination. Therefore, T2W images are
T1 weighted images in the diagnosis of articular disc of value for differentiating the magic angle effect and
status.6 PDW images are appropriate in visualizing abnormalities.

Dentomaxillofacial Radiology

Figure 4 The superposition of reconstructions is shown with proton
density-weighted imaging (PDWI)-based images at the left temporoman-
dibular joint (TMJ) at closed mouth and open mouth; medial views,
frontal view and dorsal view are shown
This visualization approach was developed for TMJ
imaging based on high-resolution MR PDW and T2W
images stemming from the clinical routine. There, the
acquisition of appropriate MRI sequences is subjected to
practical limitations; for instance, the examination time.
Standard slice thickness is 3 mm with an additional
10 – 20% gap for the prevention of cross-talk artefacts.
This is a challenge in 3D reconstruction. In this context, the
acceptable reproducibility between PDWI and T2WI and
Figure 5 A proton density-weighted imaging (PDWI) slice of the
temporomandibular joint (TMJ) on the left side is superposed with a
three-dimensionally reconstructed condyle and fossa of Figure 4. The
reconstructed condyle was also drawn in transparent rendering. This is a
zoomed image
3D visualization of TMJ
Y Hayakawa et al 345
between closed mouth and open mouth reconstructions
(see Figure 4) serves as validation of the method. The
observed slight disagreement in the reconstructions is due
to initial semi-automatic segmentation, differences in the
PD and T2 acquisition modality and different slice location
of the open and closed mouth sequences. It can be
estimated as inherent to the overall setting.
In Figures 5 – 7, various visualization procedures are
explored. 3D reconstructed condyle and fossa are super-
posed on a single PDWI or T2W slice. Since the selected
superposed slice can be continuously changed from inside
to outside of the TMJ, scrollable by the observer in other
words, such image fusion and animation is of value to 3D
visualization. It is not a difficult task. Additionally the
transparent rendering of the mandibular fossa is helpful to
understand the anatomy of the TMJ region. In Figures 5 – 7,
various 3D visualization tools for the depiction of the TMJ
abnormality are demonstrated. By superposing the 3D
rendered condyle and fossa, the anterior displacement of
the articular disc without reduction and the presence of the
joint effusion were clearly emphasised as low and high
signal intensity structures, respectively, and the lateral
pterygoid muscle and the space between the head of
condyle, the fossa and the lateral pterygoid muscle’s
tendon are also enhanced in visibility. These are reasons
why the method has clinical validity, namely the impact
for the visualization of articular disc displacement, disc
reduction and disc shape in clinical practice.
The previously reported visualizations8 – 11 refer to
reconstruction of TMJ anatomy and functionality rather
than visualization of TMJ pathology as anterior disc
displacement. Price et al10 attempted to make a 3D solid
model experimentally, but there were technical limits at
that time for clinical evaluation. The preliminary study
by Chirani et al12 is based on MRI data from a single
healthy subject without any application to TMJ
disorders. The slice thickness was 2 mm, which is
below clinical standard. The work of Goessi13 carried
out at the University of Zurich refers to an analysis of
TMJ kinematics where 3D shaded surface reconstruction
of articular disc, mandibular condyle and fossa was used
as visualization for dynamic stereometry.
As indicated in the presented case, the focus of this article
is clarification of displacement and pathological morphology
of the articular disc and the presence or absence of joint
effusion. The reported approach enables a 3D visualization of
the anatomical situation. The articular disc, retrodiscal tissue
and some inner structures of the lateral pterygoid muscle can
be identified. Several MRI studies described abnormalities of
the mandibular condyle.18 First tests proved an extension
of the method to the analysis of condylar bone adaptation as
very promising. We are planning to apply the described
method to 3D reconstruction for the depiction of bone marrow
oedema and osteonecrosis in the mandibular condyle. Rather
than the TMJ dynamic analysis, the benefit of the 2D and 3D
MRI and reconstruction is to identify some abnormalities in
the above mentioned tissues.
The described method consists of a combination of
well validated tools of image processing and reconstruc-
tion. Besides an initial semiautomatic segmentation of
Dentomaxillofacial Radiology
 3D visualization of TMJ
346 Y Hayakawa et al

Figure 6 Upper row: three-dimensional (3D) reconstruction of the left temporomandibular joint (TMJ) based on T2W images. The volume rendering of
TMJ with superposed 3D-reconstructed condyle (left). The 3D reconstruction was superposed with a T2WI slice (right). Lower row: 3D reconstruction of
the left TMJ based on proton density-weighted (PDW) images The volume rendering of TMJ with superposed 3D-reconstructed condyle (left). The 3D
reconstruction was superposed with a PDWI slice (right)

Figure 7 Three-dimensional (3D) reconstruction of the left temporomandibular joint (TMJ) based on T2W images at the open mouth examination. The
volume rendering of TMJ with superposed 3D-reconstructed condyle (left). The 3D reconstruction was superposed with a T2WI slice (right). Arrows:
reversed marked high signal of the articular disc

Dentomaxillofacial Radiology

the original slices, there is no user-dependent step in the
method. Though still a prototype, the application of the
method is not very time consuming. Furthermore, it can
be easily automated. The clinical diagnosis in the case
presented showed no changes after these 3D tools were
applied, but its impact for visualization of the articular
disc displacement, disc reduction and disc deformity in
the clinical practice can be emphasised. We also plan
3D imaging to contribute to a biomechanical/biomedical
simulation study of the jaw bone/mandible.19 – 21 The
research will be oriented to the optimization and
automation of the tissue segmentation for clinical
relevance and validation as diagnostic and biodynamic
simulation tools for jaw function.
References
1. Katzberg RW, Westesson P-L, Tallents RH, Anderson R, Kurita K,
Manzione JV Jr, et al. Temporomandibular joint: MR assessment of
rotational and sideways disk displacements. Radiology 1988; 169:
741 –748.
2. Sano T. Recent developments in understanding temporomandibular
joint disorders. Part 1: bone marrow abnormalities of the mandibular
condyle. Dentomaxillofac Radiol 2000; 29: 7 –10.
3. Sano T. Recent developments in understanding temporomandibular
joint disorders. Part 2: changes in the retrodiscal tissue. Dentomax-
illofac Radiol 2000; 29: 260 –263.
4. Sano T, Yamamoto M, Okano T. Temporomandibular joint: MR
imaging. Neuroimag Clin North Am 2003; 12: 583 – 595.
5. Yamamoto M, Sano T, Okano T. Magnetic resonance evidence of
joint fluid with temporomandibular joint disorders. J Comput Assist
Tomogr 2003; 27: 694 – 698.
6. Sano T, Widmalm SE, Yamamoto M, Sakuma K, Araki K, Matsuda Y,
et al. Usefulness of proton density and T2-weighted vs. T1-weighted
MRI in diagnoses of TMJ disk status. Cranio 2003; 21: 253 – 258.
7. Sano T, Yamamoto M, Okano T, Gokan T, Westesson P-L. Common
abnormalities in temporomandibular joint imaging. Curr Probl Diagn
Radiol 2004; 33: 16 –24.
8. Larheim TA, Westesson P-L. Maxillofacial imaging. Berlin,
Germany: Springer, 2006.
9. Laskin DM. Diagnosis of pathology of the temporomandibular joint.
Clinical and imaging perspectives. Radiol Clin North Am 1993; 31:
135 –147.
10. Price C, Connell DG, MacKay A, Tobias DL. Three-dimensional
reconstruction of magnetic resonance images of the temporomandib-
ular joint by I-DEAS. Dentomaxillofac Radiol 1992; 21: 148 –153.
11. Motoyoshi M, Sadowsky PL, Bernreuter W, Fukui M, Namura S.
Three-dimensional reconstruction system for imaging of the tempor-
omandibular joint using magnetic resonance imaging. J Oral Sci
1999; 41: 5– 8.
12. Chirani RA, Jacq JJ, Meriot P, Roux C. Temporomandibular joint: a
methodology of magnetic resonance imaging 3-D reconstruction.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97:
756 – 761.
3D visualization of TMJ
Y Hayakawa et al 347
In conclusion, by the simultaneous visualization of
both bony surfaces and soft tissues, disc displacement
and deformity can be recognized in a 3D context. The
additional superposition of the 3D visualization with the
original 2D MR slices allows for a combination with
conventional diagnostics.
Acknowledgments
The second author would like to thank the International Bureau of
the German Federal Ministry of Education and Research for a
grant for a short-term visit to Tokyo Dental College in the first
days of February 2006.
13. Goessi D. On the relationship between functional properties and
anatomical structure of the temporomandibular joint. PhD Thesis,
Swiss Fed Inst Tech Zurich, Switzerland, 2004.
14. Musgrave MT, Westesson P-L, Tallents RH, Manzione JV, Katzberg
RW. Improved magnetic resonance imaging of the temporomandib-
ular joint by oblique scanning planes. Oral Surg Oral Med Oral
Pathol 1991; 71: 525 –528.
15. Stalling D, Westerhoff M, Hege H-C. Amira: A highly interactive
system for visual data analysis. In: Hansen CD, Johnson CR (eds).
The visualization handbook. Amsterdam, The Netherlands: Elsevier,
2005, 38: pp 749 –767.
16. Kober C, Sader R, Zeilhofer H-F. 3D-reconstruction and visualization
of bone mineral density of the ethmoid bone. In: Buzug TM, Lueth
TC (eds). Perspective in image-guided surgery. Singapore: World
Scientific, 2004, pp 490 – 496.
17. Erickson SJ, Cox IH, Hyde JS, Carrera GF, Strandt JA, Estkowski
LD. Effect of tendon orientation on MR imaging signal intensity: a
manifestation of the “Magic Angle” phenomenon. Radiology 1991;
181: 389 – 392.
18. Sano T, Westesson P-L, Yamamoto M, Okano T. Differences in
temporomandibular joint pain and age distribution between marrow
edema and osteonecrosis in the mandibular condyle. Cranio 2004; 22:
283 – 288.
19. Kober C, Erdmann B, Lang J, Sader R, Zeilhofer H-F. Sensitivity of
the temporomandibular joint capsule for the structural behaviour of
the human mandible. Biomed Eng 2004; 49: 372 – 373.
20. Kober C, Erdmann B, Hellmich C, Sader R, Zeilhofer H-F.
Consideration of anisotropic elasticity minimizes volumetric rather
than shear deformation in human mandible. Computer Methods
Biomechanics Biomed Eng 2006; 9: 91 –101.
21. Kober C, Erdmann B, Lang J, Sader R, Zeilhofer H-F. Adaptive finite
element simulation of the human mandible using a new physiological
model of the masticatory muscles. PAMM 2004; 4: 332 –333.
Dentomaxillofacial Radiology