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Difference between revisions of "4° Clinical case: Temporomandibular disorders"
4° Clinical case: Temporomandibular disorders (view source)
Revision as of 08:56, 9 August 2023
, 1 year ago→Mandibular spatial analysis
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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 <sub>b</sub>Root-MEPs as previously mentioned which has an indication of the 'state' integrity of the <sub>t</sub>CNS 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) | 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 <sub>b</sub>Root-MEPs as previously mentioned which has an indication of the 'state' integrity of the <sub>t</sub>CNS 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: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 | 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 | ||
File:Barberini2.jpg|'''Figure 5c:''' Result of mandibular elevation from resting position to Centric Neuro Evoked Functional via bRoot-MEPs | File:Barberini2.jpg|'''Figure 5c:''' Result of mandibular elevation from resting position to Centric Neuro Evoked Functional via bRoot-MEPs | ||
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File:IMG0010.jpg|'''Figure 6a:''' Positioning of frameworks in Empress to accommodate the wax for Functional Neuro Evoked Centric | 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. | 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. | ||
File:IMG0006.jpg|'''Figure 6c:''' Frozen Functional Neuro Evoked Centric Registration by placing crown structures in Empress with wax and brought back into the articular. | File:IMG0006.jpg|'''Figure 6c:''' Frozen Functional Neuro Evoked Centric Registration by placing crown structures in Empress with wax and brought back into the articular. | ||
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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) | 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 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. | 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. | ||
File:Clicker NGF3.jpg|'''Figure 7c:''' view of the crowns with active centric cusps in the right-sided mouth. | File:Clicker NGF3.jpg|'''Figure 7c:''' view of the crowns with active centric cusps in the right-sided mouth. | ||
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