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
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
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
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.
The Masticatory System as a Biological System
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
