Difference between revisions of "4° Clinical case: Temporomandibular disorders"

Sebastian Silva Ulloa, Ana Lucía Cordero Ordóñez, Vinicio Egidio Barzallo Sardi  }}Therefore, it is essential to operate in synergy with the trigeminal neuromotor content in order to have an 'Observable' more indicative of the masticatory reality and in this case of the real spatial position that the jaw wants to reach beyond the dental interference. To achieve this target we have developed a method of simultaneous Transcranial Electrical Stimulation of the trigeminal roots which evokes a direct response of all the masticatory muscles which we call _bRoot-MEPs as previously mentioned which has an indication of the 'state' integrity of the _tCNS and at the same time it determines an elevation of the mandible from the rest position to the Occlusal Centric. This Centric has been named by us Functional Neuro Evoked Centric. (Figure 5)  

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File:Clicker 00.jpg|'''Figure 5a:''' Presumably pathological usual occlusal position, with anterior crossbite and wear of the central incisors

File:Barberini21.jpg|'''Figure 5b:''' Positioning of the recording electrodes on the masseters on both sides and of the electrodes to evoke the direct response from the trigeminal roots

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File:IMG0010.jpg|'''Figure 6a:''' Positioning of frameworks in Empress to accommodate the wax for Functional Neuro Evoked Centric

File:Clicker CR .jpg|'''Figure 6b:''' Frozen Functional Neuro Evoked Centric Registration by placing crown structures in Empress with interdigitating wax. Note the slight increase in the vertical dimension purposely wanted.

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For Neuro Gnatologic Functional detail, rehabilitation model called 'NGF Index' from which a whole scientific process will be initiated which will lead to a diagnostic paradigmatic model called 'NGF Index' in the 'Extraordinary Science' section, means an occlusal adjustment normalized to trigeminal neuromotor symmetry . To achieve this goal, gnathological replicates (articulated) and above all the ability to read the evoked and reflex responses of the tCNS in different occlusal situations are fundamental. For this reason, only the active centrics of the Empress crowns were stratified on the four lower molars. (figure 7)

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File:Clicker NGF2 .jpg|'''Figure 7a:''' View of the Empress framework in the laboratory phase where only the active centric cusps of the molars were layered.

File:Clicker NGF1.jpg|'''Figure 7b:''' View of the Empress structure in the clinical phase in the mouth on which to perform trigeminal electrophysiological tests.

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The finalization of the definitively diagnosed clinical case of DTMs resulted in a restoration of the masticatory function, disappearance of the symptoms as well as an aesthetic improvement. The various phases of the rehabilitation can be followed in the gallery of images in figure 9. In particular, the Functional Neuro-Evoked Centric position is not only centered having moved slightly to the right but also retruded. It is interesting to make a comparison with figure 5a to understand the spatial differences. Element 22, in fact, is no longer in crossbite but in a head-to-head position while element 23 has a much more incisal centric contact with respect to the previous clinical situation, so as to note the occlusal space in the medial area of element 24 which it was generated with the current mandibular spatial position determined with the Functional Neuro Evoked Centric. This new occlusal arrangement was only possible because the stable and mainly frozen centric position in the molar sector. The molars through the previously exposed neuromotor balance on the centric cusp stabilize the occlusion and generate a bilateral balance in the mandibular movements as will be shortly described.

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File:Clicker end1.jpg|'''Figure 9a:''' Frontal view of functional neuro-evoked rehabilitation and incisal normocclusal restoration with two crowns in Empress (work performed in 1992)

File:Clicker end2 .jpg|'''Figure 9b:''' Occlusal view of functional neuro-evoked rehabilitation and incisal normocclusal restoration with two crowns in Empress (work performed in 1992)

File:Clicker end3.jpg|'''Figure 9c:''' Peculiarities of neurognathological parameters. Occlusal view of the left mediotrusive detail. (work done in 1992)

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