Wednesday, December 16, 2009

Treating Craniomandibular Dysfunctional Patients Implementing Gnathological or Neuromuscular Concepts

Clayton A. Chan, DDS, FICCMO: Treating Craniomandibular Dysfunctional Patients Implementing Gnathological or Neuromuscular Concepts. International College of Craniomandibular Orthopedics, ICCMO Anthology VI, 2003.

Treating craniomandibular disorders (CMD or TMD), is an area of dentistry that has often times frustrated the clinician due to its multi-faceted musculoskeletal occlusal signs and symptoms. An aspect that should be considered in this arena of treatment is the study of occlusion that relates the maxillary and mandibular teeth as well as the temporomandibular joints and the mandible to the cranium. Investigating even further into this arena of occlusion, one discovers that it also involves physiologic dynamics of muscle activity and muscle rest that drives the masticatory element of occlusion. It is the supporting element that is often overlooked in the health care field that allows the human body to posture and optimally function as a complete healthy system. It is apparent after a more thorough understanding, diagnosis and evaluation by the dentist that musculoskeletal, postural, emotional, biochemical and/or functional issues may be part of the suffering patients complaints. Many of the symptoms that accompany this disorder continue to challenge the great minds of the dental profession who may not be aware that the signs and symptoms which are presented go beyond the occlusal perspective of how teeth articulate and where the centricity of condyle to glenoid fossa relationship exists.  Traditionally it was believed that these disorders can be treated through gnathological occlusal principles. However, there are fundamental differences between gnathological and neuromuscular approaches in therapy when addressing the needs of patients who present with the numerous signs and symptoms that compromise the craniomandibular dysfunctional patient. These differences will be presented in this paper. A clinical case report will be presented and reviewed which has been treated gnathologically and later treated neuromuscularly implementing computerized electro-diagnostic and treatment instrumentation validating the often unrecognized differences.

Applying the Neuromuscular Principles in TMD and Orthodontics

Chan, C.A., “Applying the Neuromuscular Principles in TMD and Orthodontics”, J. Am. Orthodontic Soc., pp. 20-29, Spring, 2004.

Neuromuscular dentistry goes beyond traditional dentistry in that it includes consideration of the “physiologic posture” of the mandible. Determining habitual posture vs. physiologic posture requires evaluation of the muscles, joints and nerves involved in mandibular posture and function in addition to the teeth. Today’s computerized measuring and recording instrumentation, together with an understanding of neuromuscular principles, give dentists the ability to be true “physicians of the mouth.” Muscles cannot be evaluated by radiographic analysis alone. With bioinstrumentation it is possible to determine a proper resting jaw position that positively affects the facial, head, and neck muscles and the teeth as well as the joints. A case study is presented in great detail describing how a severe TMD case had failed to respond to long and frustrating traditional dental therapy, but was then resolved through the application of neuromuscular principles and evaluation. Following provisional treatment that proved a symptom-free mandibular position, the case was permanently finished to that position with orthodontic treatment.

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