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Difference between revisions of "4° Clinical case: Temporomandibular disorders"
4° Clinical case: Temporomandibular disorders (view source)
Revision as of 09:14, 4 August 2023
, 1 year ago→Functional Neuro Gnatologic Detail
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File:Clicker 3.jpg|'''Figure 8a:''' Mechanical silent period recorded on the masseter and temporal muscles before the Neuro | File:Clicker 3.jpg|'''Figure 8a:''' Mechanical silent period recorded on the masseter and temporal muscles before the Neuro Gantholgic Functional treatment | ||
File:Clicker SP post.jpg|'''Figure 8b:''' Mechanical silent period recorded on the masseter and temporal muscles after Neuro | File:Clicker SP post.jpg|'''Figure 8b:''' Mechanical silent period recorded on the masseter and temporal muscles after Neuro Gantholgic Functional treatment. | ||
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Figures 8a and 8b show the extraordinary differences in the trigeminal neuromotor response due, being of a functional type, to a mandibular spatial change and an accurate neurognathological occlusal balancing. In fact, one can see a symmetrization of the jaw jerk on the right masseter, a decrease in the duration of the mechanical silent period and above all an optimal motoneural reactivation after the silent period (rebound effect) which means safety in the total and immediate reactivation of the motoneural discharge. Once this trigeminal neuromotor re-symmetrization has been documented with irrefutable data, it is possible to move on to finalizing the clinical case. | Figures 8a and 8b show the extraordinary differences in the trigeminal neuromotor response due, being of a functional type, to a mandibular spatial change and an accurate neurognathological occlusal balancing. In fact, one can see a symmetrization of the jaw jerk on the right masseter, a decrease in the duration of the mechanical silent period and above all an optimal motoneural reactivation after the silent period (rebound effect) which means safety in the total and immediate reactivation of the motoneural discharge. Once this trigeminal neuromotor re-symmetrization has been documented with irrefutable data, it is possible to move on to finalizing the clinical case. | ||
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File:Clicker end1.jpg|'''Figure 9a:''' Frontal view of functional neuro-evoked rehabilitation<br>and incisal normocclusal restoration<br>with two crowns in Empress<br>(performed in 1992) | File:Clicker end1.jpg|'''Figure 9a:''' Frontal view of functional neuro-evoked rehabilitation<br>and incisal normocclusal restoration<br>with two crowns in Empress<br>(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 | File:Clicker end2 .jpg|'''Figure 9b:''' Occlusal view of functional neuro-evoked rehabilitation and incisal normocclusal restoration with two crowns in Empress. | ||
File:Clicker end3.jpg|'''Figure 9c:''' Peculiarities of neurognathological parameters. Occlusal view of the left mediotrusive detail. | File:Clicker end3.jpg|'''Figure 9c:''' Peculiarities of neurognathological parameters. Occlusal view of the left mediotrusive detail. | ||
File:Clicker end4.jpg|'''Figure 9d:''' Peculiarities of neurognathological parameters. Occlusal view of the right mediotrusive detail. | File:Clicker end4.jpg|'''Figure 9d:''' Peculiarities of neurognathological parameters. Occlusal view of the right mediotrusive detail. | ||
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In figure 9c and 9d, we can see not only the well balanced centric contacts but above all the mediotrusive excursions. A few more words should be spent on this subject. Benedikt Sagl et al.<ref>Sagl B, Schmid-Schwap M, Piehslinger E, Rausch-Fan X, Stavness I. The effect of tooth cusp morphology and grinding direction on TMJ loading during bruxism. Front Physiol. 2022 Sep 15;13:964930. doi: 10.3389/fphys.2022.964930. eCollection 2022.PMID: 36187792 </ref> state, in their study in which the contribution of tooth inclination, medio-otrusive and laterotrusive excursion and von Mises stresses on the articular disc was analysed, that mediotrusive bruxing generates higher loads than laterotrusive simulations. In this sense it is not clear whether the mediotrusive contacts are a protective or a pejorative element in the generation of temporomandibular joint disorders. So much so that an article by Walton TR and Layton DM<ref>Walton TR, Layton DM. Mediotrusive Occlusal Contacts: Best Evidence Consensus Statement. J Prosthodont. 2021 Apr;30(S1):43-51. doi: 10.1111/jopr.13328.PMID: 33783093</ref> increases the confusion as they first state that the presence of TM interference in patient populations is large and varies from 0% to 77% and then conclude that TM interference should be avoided in any occlusal treatment regimen to minimize pulpal, periodontal, structural and mechanical complications or exacerbation of temporomandibular disorders (TMD). The confusion increases when he concludes that natural molar MT interferences should only be eliminated if signs and symptoms of TMD are present. The question that arises is the following | In figure 9c and 9d, we can see not only the well balanced centric contacts but above all the mediotrusive excursions. A few more words should be spent on this subject. Benedikt Sagl et al.<ref>Sagl B, Schmid-Schwap M, Piehslinger E, Rausch-Fan X, Stavness I. The effect of tooth cusp morphology and grinding direction on TMJ loading during bruxism. Front Physiol. 2022 Sep 15;13:964930. doi: 10.3389/fphys.2022.964930. eCollection 2022.PMID: 36187792 </ref> state, in their study in which the contribution of tooth inclination, medio-otrusive and laterotrusive excursion and von Mises stresses on the articular disc was analysed, that mediotrusive bruxing generates higher loads than laterotrusive simulations. In this sense it is not clear whether the mediotrusive contacts are a protective or a pejorative element in the generation of temporomandibular joint disorders. So much so that an article by Walton TR and Layton DM<ref>Walton TR, Layton DM. Mediotrusive Occlusal Contacts: Best Evidence Consensus Statement. J Prosthodont. 2021 Apr;30(S1):43-51. doi: 10.1111/jopr.13328.PMID: 33783093</ref> increases the confusion as they first state that the presence of TM interference in patient populations is large and varies from 0% to 77% and then conclude that TM interference should be avoided in any occlusal treatment regimen to minimize pulpal, periodontal, structural and mechanical complications or exacerbation of temporomandibular disorders (TMD). The confusion increases when he concludes that natural molar MT interferences should only be eliminated if signs and symptoms of TMD are present. The question that arises is the following | ||