Specialist Orthodontist, LSUMC , USA | Specialised in Craniomandibular Orthodontics and Occlusion Medicine, IDEA -SAN FRANCISCO , USA | Visiting lecturer, LSUSD- USA, Postgraduate program in Orthodontics.

Effective approach for stable resolution of locked joints

INTRODUCTION:
Locked joints have always been one of the most challenging conditions in dentistry. As a result, different treatment approaches have been recommended to confront this issue in the last century. In most cases, a resolution of the locking is attempted based on empirical knowledge or using approaches guided by simple diagnostic tools.

METHOD:
A series of cases collectively presenting all possible types of locked joints (i.e.,acute, closed, chronic, reciprocal clicking with intermittent lock, ligamentous lock) were differentially diagnosed by clinical examination and condylography (using CADIAX 4, Gammadental, Austria). The therapeutic position (ThP) of the condyle was identified and transferred to the mounted models of the patient on the variator. Occlusal composite repositioning overlays were fabricated in this position with the appropriate anatomy which guided the condyles in the ThP. The overlays and the brackets were bonded at the same appointment, and anterior vertical elastics were initiated in order to produce a class A lever to decompress and reposition the condyles within the joints. Initial, progress and final condylography were performed to assess the effectiveness of this treatment.

RESULTS:
Immediately or soon after the initiation of the treatment, all cases showed a dramatic improvement of the condyle translation within the joints. Stability of the improvement was demonstrated on follow up examination. CONCLUSIONS: Clinical evidence shows that patients with locked joints can benefit from a treatment approach using condylar reposition informed by condylography, a monitoring tool aiding diagnostics by accurately estimating the ThP of the condyles in the joints and in combination with orthodontic treatment with occlusal composite repositioning overlays on the posterior teeth and anterior vertical elastics.

A stable Condylar Position - why should the orthodontist care?

In my presentation I will discuss why a stable condylar position is an important orthodontic treatment goal. I will use clinical cases to demonstrate, that both internal derangements, and an unstable condylar position can either lead to misdiagnoses and therefore wrong treatment plans or jeopardize the stability of the achieved orthodontic result.

As orthodontists we are moving all teeth in the mouth. We are basically doing a full mouth reconstruction in enamel (Ron Roth). Independent of our tools, weather we use fixed appliances or Aligners, the orthodontist must not only respect the teeth, but also the temporomandibular joints and the whole masticatory system for long-term healthy and stabile results.

I will illustrate the effects of progressive condylar resorption, of degenerative or inflammatory joint disease in adults and in growing children, and the effect of growth modification in children with healthy TM joints.

“Functional disorders – CMD – immediate effects of oral acupuncture: the sensitivity of muscles and oral acupuncture system for diagnosis and therapies.”

An increasing number of medical disciplines begin to appreciate that acupuncture enlarges their therapy spectrum. This applies to functional disorders, and particularly to those of the craniomandibular complex.CMD and functional disorders have become very important and are also of relevance to various other medical disciplines, amongst which dentistry plays a key role as teeth occlusion, muscles, Temporo Mandibular Joint (TMJ), cervical spine, form indeed a functional unit and all these structures have a very important role of stress relief and stress control.
TMJ disorders refer to a complex set of conditions (from childhood to adults), manifested not only in local pain but also referred pain from trigger points for instance headache. Myofunction and swallowing pattern are very important for functional development and biocybernetic strategies.

In screening tests functional parameters are evaluated with muscle palpation (Krogh Poulsen) systematically diagnosed including the palpation of specific tender points and oral acupuncture areas with patient’s feedback of sensitivity and rating on a 4-point scale.
A system of very effective oral acupuncture points is to be found in the oral mucosa opposite teeth and in the retromolar region. Specific reflex points in a state of irritation have a high degree of sensitivity.
Oral Acupuncture is a form of Western microsystem reflex-therapy. In CMD, an immediate reduction of pain and muscle tension and re-organisation of normal functions could be shown.These points react immediately by exact hitting the “Very-Point” and establish the well-known benefits of acupuncture.

Our results indicate that acupuncture therapy has an immediate effect on pain, muscle relaxation, CMD and cervical spine mobility disorders and is approved effective for more than 40 years’ experience.