researchers even suggested that these conditions are not a dental problem at all. Many clinicians, however, recognize that there can be a dental component with some craniomandibular disorders and when this exists the dentists can offer a unique form of management that is not provided by any other health professional. Dentists therefore need to understand when dental therapy is useful for a craniomandibular disorder and when it is not. This understanding is basic to selecting proper treatment and ultimately achieving clinical success. This is the greatest challenge faced by all dentists who manage patients with craniomandibular disorders.
The purpose of this atlas is to bring together information that will help the practitioner better understand the patient’s problem thereby allowing the establishment of the proper diagnosis. A proper diagnosis can only be determined after the practitioner listens carefully to the patient’s description of the problem and past experiences (the History) followed by the collection of relative clinical data (the Examination). The interpretation of the history and examination findings by the astute practitioner is fundamental in establishing the proper diagnosis. Determining the proper diagnosis is the most critical factor in selecting treatment that will prove to be successful. In the complex field of craniomandibular disorders misdiagnosis is common and likely the foremost reason for treatment failure.
Dr. Alex Bumann and Dr. Ulrich Lotzmann have brought together a wealth of information that will help the practicing dentist interested in craniomandibular disorders. This atlas provides the reader with techniques that assist in the collection of data needed to establish the proper diagnosis. This atlas brings together both new and old concepts that should be considered when evaluating a patient for craniomandibular disorders. Some of the old techniques are well established and proven to be successful. Some of the newer techniques are insightful and intuitive, and will need to be further validated with scientific data.
In this atlas the authors introduce the term “manual functional analysis” as a useful method of gaining additional information regarding mandibular function. They have developed these techniques to more precisely evaluate the sources of pain and dysfunction in the craniomandibular structures. Each technique is well illustrated using clinical photographs, drawings and, in some instances, anatomical specimens. Elaborate, well thought out, algorithms also help the reader interpret the results of the mandibular function analysis techniques. Although these techniques are not fully documented, they are conservative, logical, and will likely contribute to establishing the proper diagnosis. The authors also provide a wide variety of methods, techniques and instrumentations for the reader to consider.
This atlas provides an excellent overview of the many aspects that must be considered when evaluating a patient with a craniomandibular disorder. Appreciating the wealth of information presented in this atlas will certainly assist the dentist in gaining a more complete understanding of craniomandibular disorders. It will also guide the practitioner to the proper diagnosis. I am sure that the efforts of Dr. Bumann and Dr. Lotzmann will not only improve the skills of the dentists, but also improve the care of patients suffering with craniomandibular disorders. My congratulations to these authors for this fine work.
Jeffrey P Okeson, DMD
Professor and Director
Orofacial Pain Center
University of Kentucky College of Dentistry
Lexington, Kentucky, USA 40536-0297
Preface
Medicine and dentistry are continuously evolving, due largely to the influences and interactions of new methods, technologies, and materials. Partly because of outdated testing requirements, our students can no longer adequately meet the increasing demands these changes have placed on a patient-oriented education. With limited classroom and clinic time and an unfavorable ratio of teachers to students, the complex interrelations within the area of dental functional diagnosis and treatment planning are precisely the type of subject matter that usually receives only perfunctory explanation and demonstration in dental school. Consequently, recent dental school graduates are obliged to compensate for deficiencies of knowledge in all areas of dentistry through constant continuing education. And so the primary purpose of this atlas is to provide the motivated reader with detailed information in the field of dental functional diagnosis by means of sequences of illustrations accompanied by related passages of text. The therapeutic aspects are dealt with here only in general principles. Diagnosis-based treatment will be the subject of a future book.
The method of clinical functional analysis described in detail in this atlas is based largely on the orthopedic examination techniques described earlier by Cyriax, Maitland, Mennell, Kalternborn, Wolff, and Frisch. Hansson and coworkers were the first to promote the application of these techniques to the temporomandibular joint in the late seventies and early eighties. In cooperation with the physical therapist G. Groot Landeweer this knowledge was taken up and developed further into a practical examination concept during the late eighties. Because the clinical procedures differ from those of classic functional analysis, the term “manual functional analysis” was introduced.
The objective of manual functional analysts is to test for adaptation of soft-tissue structures and evidence of any loading vectors that might be present. This is not possible through instrumented methods alone. The so-called “instrumented functional analysis” (such as occlusal analysis on mounted casts or through axiography) is helpful nevertheless for disclosing different etiological factors such as malocclusion, bruxism, and dysfunction. Thus the clinical and instrumented subdivisions of functional diagnostics complement one another to create a meaningful whole.
In recent years the controversy over “occlusion versus psyche” as the primary etiological element has become more heated and has led to polarization of opinions among teachers. But in the view of most practitioners, this seems to be of little significance. In an actual clinical case one is dealing with an individualized search for causes, during which both occlusal and psychological factors are considered.
Within the framework of a cause-oriented treatment of functional disorders one must consider that while the elimination of occlusal disturbances may represent a reduction of potential etiological factors, it may not necessarily lead to the elimination of symptoms. The reason for this is that there can be other etiological factors that lie outside the dentist’s area of expertise.
Some readers may object to the fact that the chapters “Mounting of Casts and Occlusal Analysis” and “Instrumented Analysis of Jaw Movements” do not reflect the multitude of articulators and registration systems currently available. We believe that for teaching purposes it makes sense to present the procedural steps explained in these chapters by using examples of an articulator and registration system that have been commercially established for several years. This should not be interpreted as an endorsement of these instruments over other precision systems for tracing and simulating mandibular movements.
Fall 2002
Axel Bumann
Ulrich Lotzmann
Acknowledgments
The physical therapist Gert Groot Landeweer deserves our special thanks for the many years of friendly and fruitful collaboration. Before his withdrawal from the team of authors he made a great impact on the contents of this atlas through numerous instructive professional discussions.
Furthermore we owe a debt of gratitude to the Prüner Gang General Radiology Practice in Kiel, especially to Dr. J. Hezel and Dr. C. Schröder for 10 years of excellent cooperation and their friendly support in the preparation of special images beyond the clinical routine. Almost all the magnetic resonance images shown in this atlas were produced by this clinic.
We thank Prof. B. Hoffmeister, Berlin, and Dr. B. Fleiner, Augsburg for
