TMJ Disorders and Orofacial Pain. Axel Bumann

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Occlusal Reshaping of the Occlusion on the Casts

       Diagnostic Tooth Setup

       Diagnostic Waxup

       Condylar Position Analysis Using Mounted Casts

       Instrumented Analysis of Jaw Movements

       Mechanical Registration of the Hinge Axis Movements (Axiography)

       Evaluating the Axiograms and Programming the Articulator

       Hinge Axis Tracings (Axiograms) as Projection Phenomena

       Effect of an Incorrectly Located Hinge Axis on the Axiograms

       Electronic Paraocclusal Axiography

       Diagnoses and Classifications

       Classification of Primary Joint Diseases

       Classification of Secondary Joint Diseases

       Hyperplasia, Hypoplasia, and Aplasia of the Condylar Process

       Hyperplasia of the Coronoid Process

       Congenital Malformations and Syndromes

       Acute Arthritis

       Rheumatoid Arthritis

       Juvenile Chronic Arthritis

       Free Bodies within the Joints

       Styloid or Eagle Syndrome

       Fractures of the Neck and Head of the Condyle

       Disk Displacement with Condylar Neck Fractures

       Fibrosis and Bony Ankylosis

       Tumors in the Temporomandibular Joint Region

       Joint Disorders–Articular Surfaces

       Joint Disorders–Articular Disk

       Joint Disorders–Bilaminar Zone and Joint Capsule

       Joint Disorders–Ligaments

       Muscle Disorders

       Principles of Treatment

       Specific or Nonspecific Treatment?

       Nonspecific Treatment

       Elimination of Musculoskeletal Impediments

       Occlusal Splints

       Splint Adjustment for Vertical Disocclusion and Posterior Protection

       Relationship between Joint Surface Loading and the Occlusal Scheme

       Relaxation Splint

       Stabilization Splint

       Decompression Splint

       Repositioning Splint

       Verticalization Splint

       Definitive Modification of the Dynamic Occlusion

       Definitive Alteration of the Static Occlusion

       Examination Methods and Their Therapeutic Relevance

       Illustration Credits

       References

       Index

      Introduction

      The dental functional diagnostic procedure determines the functional condition of the structures of the masticatory system. For patients with functional disturbances it serves to arrive at a specific diagnosis. For medical and legal reasons, it is necessary for all patients who are facing dental restorative or orthodontic treatment, even for those who are assumed to have no malfunction. Often no connection can be established between the clinical findings discovered through conventional methods (testing of active movements and muscle palpation) and the symptoms reported by the patient. For that reason, specific manual examination methods for the masticatory system have gained prevalence during the past 15 years. These focus on the so-called loading vector and recognize the capacity of biological systems for adaptation and compensation. A cause-targeted treatment is then indicated only when the caregiver knows which structures are damaged (loading vector) and the cause of the damage (the harmful influences).

       1 Possible causes and consequences of an altered occlusion

      Idiopathic or iatrogenic alterations of the static or dynamic occlusion can influence the neuromuscular programming, and thereby affect other structures of the masticatory system. The same sequence of events can also be precipitated by intrinsic factors or other extrinsic factors. Usually during a clinical examination the changes listed in the right-hand column receive the most attention. But to plan a cause-targeted therapy it is necessary to determine what the specific causes of the altered neuromuscular programming are. A differentiated investigation protocol could set aside the old superficial philosophical discussion of the causes of functional disturbances within the masticatory system (“occlusion versus psyche”) in favor of an individualized patient analysis.

      Every biological system, from a single cell to an entire organism, is continuously exposed to many influences. It overcomes these through two mechanisms:

      • adaptation as a reaction of the connective tissues;

      • compensation as a muscular response to an influence (Hinton and Carlson 1997).

      Influences on the one hand and the capacity for progressive adaptation on the other may achieve a physiologic state of equilibrium. If, however, the sum of harmful influences during a given period of time exceeds an individually variable threshold, or if the adaptability of a system becomes generally diminished, the system will fall out of equilibrium. This condition has been referred to as decompensation or regressive adaptation (Moffet et al. 1964) and is accompanied by more or

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