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Instrumental functional analysis  / /certified fixed orthodontic courses by Indian dental academy
 

Instrumental functional analysis / /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078

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    Instrumental functional analysis  / /certified fixed orthodontic courses by Indian dental academy Instrumental functional analysis / /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

    • Instrumental Functional Analysis www.indiandentalacademy.com
    • INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    • What is Instrumental Analysis   Mounted casts Mandibular position     RCP – Hinge axis – Centric relation ICP Mandibular movements Condyle/disc complex www.indiandentalacademy.com
    • Why do an Instrumental Analysis  The mouth is the worst articulator    Morphology of the occlusal surfaces of the teeth. Neuromuscular adaptation to the occlusion (proprioception) The morphology of the hard and soft structures of the TMJ www.indiandentalacademy.com
    • Why do an Instrumental Analysis    Ligaments attached to the mandible. Compromises necessitated by various skeletal patterns. Head posture and total body posture. www.indiandentalacademy.com
    • Why do an Instrumental Analysis   Hand held casts  ICP Articulator mounting  functioning of mandible www.indiandentalacademy.com
    • Why do an Instrumental Analysis  Once the casts are mounted on the articulator  Compare RCP and ICP.  Accurately see max-mand relation.  3 dimensional determination of position of condyles in fossa. www.indiandentalacademy.com
    • The SAM 2 Articulator  Made for diagnosis  Semi-adjustable  MPI and Axiograph www.indiandentalacademy.com
    • Mandibular Position Indicator   Measures deviation from RCP to ICP 3-dimensional measurements www.indiandentalacademy.com
    • Axiograph    Records mandibular movements Dynamic record Takes into account PDL, Muscles, Soft tissues etc. www.indiandentalacademy.com
    • Mounting casts on the SAM 2   Accurate impressions Stone casts www.indiandentalacademy.com
    • Mounting casts on the SAM 2  Base of casts – Split cast former www.indiandentalacademy.com
    • Mounting casts on the SAM 2  Face bow record  Oriented to soft tissue Po and Orbitale. www.indiandentalacademy.com
    • Mounting casts on the SAM 2  Face bow record transferred to acticulator www.indiandentalacademy.com
    • Mounting casts on the SAM 2   Obtaining interocclusal record Deprogramming www.indiandentalacademy.com
    • Mounting casts on the SAM 2  Mandible guided into retral position by the operator www.indiandentalacademy.com
    • Mounting casts on the SAM 2  Roth power centric technique.    Delar wax Ant – 6 thicknesses Post – 2 thicknesses www.indiandentalacademy.com
    • Mounting casts on the SAM 2    Orient upper and lower casts with wax bite. Mount lower 3 wax bites – to confirm accuracy www.indiandentalacademy.com
    • Use of the MPI     Adhesive grid on incisal table Grid mark Incisal pin reading Articulator programmed with 3 co-ordinates www.indiandentalacademy.com
    • Use of the MPI   Transfer max. cast to MPI Exactly same relation as to upper member. www.indiandentalacademy.com
    • Use of the MPI    Max. cast interdigitated with mand. Cast. Incisal pin reading (Delta H). Mark on incisal table grid (Delta L). www.indiandentalacademy.com
    • Use of the MPI   Adhesive grid on black cubes of MPI Mark position of condylar spheres with blue articulating paper. www.indiandentalacademy.com
    • Use of the MPI    Pin of the dial placed into cube. Cube slid against condylar sphere. Dial gauge reading (Delta Y) www.indiandentalacademy.com
    • Use of the MPI   Cubes slid medially to perforate grid. Point of perforation indicates hinge axis. www.indiandentalacademy.com
    • Use of the MPI  Data obtained from MPI:   3 grids Incisal pin reading Dial gauge reading www.indiandentalacademy.com
    • Use of the MPI  Results obtained –      Delta H = vertical increase or decrease Delta L = protrusive or retrusive movement Delta X = protrusive ( + ) or retrusive ( – ) Delta Z = compression ( + ) or distraction ( – ) Delta Y = right or left transverse movement www.indiandentalacademy.com
    • Use of the MPI  Interpreting the results   RCP and ICP correspond. ICP is displaced below RCP - distraction www.indiandentalacademy.com
    • Use of the MPI ICP is above RCP compression Plus or minus Delta Y values - the condyle is being repositioned medially or laterally by the maximum intercuspation of teeth www.indiandentalacademy.com
    • Axiography  Records mandibular movements in all 3 planes of space.  Diagnosis of subclinical discopathies.  Similar data from MPI – more dynamic. www.indiandentalacademy.com
    • Axiography  Facebow – on cranium.    2 vertical bars (parasaggital flag bows) 2 grids. 2nd part anchored to mandible. www.indiandentalacademy.com
    • Axiography  Tray or  Para-occlusal clutch www.indiandentalacademy.com
    • Axiography     Locate hinge position – as reference position. Open and close mandible – teeth don’t touch. Stylus should purely rotate at one point. May be difficult to locate in some patients. www.indiandentalacademy.com
    • Axiography    All mandibular movements related to this. Adolescents – 1 mm anterior. Reference position marked on the graph. www.indiandentalacademy.com
    • Axiography   Stylus replaced by a dial gauge. Three dimensional recording. www.indiandentalacademy.com
    • Axiography  Step 1 - Movements   Protrusion-retrusion;  opening-closing;  unguided mediotrusion  guided mediotrusion www.indiandentalacademy.com
    • Axiography  Step 2 – Joint resiliency test.   Upward pressure Condyle displaced superiorly & anteriorly. www.indiandentalacademy.com
    • Axiography     Child  1 mm Young adult  0.5mm Middle age /Elderly  0.3 mm Less = no protection against strong forces. www.indiandentalacademy.com
    • Axiography  No resiliency     Flattening of codylar head Disc derrangements Splint therapy indicated www.indiandentalacademy.com
    • Axiography    Step 3 - Maximum intercuspation mark the position. Step 4 - Habitual occlusion - mark the position. Step 5 - Phonation, mastication, rest position, swallowing –record the border positions. www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings Sagittal movements  Coincide for first 10-12mm  Bilaterally identical  No Bennett movement. (0.2-0.3 mm acceptable) www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings Sagittal movements  Muscle in-coordination    Bilat. not symmetrical Unable to repeat movement smoothly. Co-relate with clinical findings. www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings  Protrusion & Retrusion – coincide in pattern and timing  Loose ligaments – alter position of disc  Superior line for prot.  Inferior line for ret.  No Bennett mov. – check Pteryoids www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings  Mediotursive movement     Condyle rotates in the inf. Concavity of disc Disc translates along the eminence Tracing = morphology of the eminence Tracings of movt. should coincide www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings  Causes for not coinciding –     loose ligaments subluxation luxation reduction www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings Fischer Angle Normal movement Movement due to displaced disc www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings    Positive Bennett movt. should be seen. If not – avoidance of prematurities Negative Bennett movt. = displaced disc. www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings  Mediotrusive tracings    Unguided Guided Helps in differential diagnosis -muscles or ligaments (?) www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings Opening and closing   Translatory movements  upper compartment Rotational movements  lower compartment www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings     Opening and closing should coincide Flattening of condylar head  don’t coincide. Radiographic evaluation. Degenerative bone disease? Pain? www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings – Special Situations  Over rotation of mandible at end of full mouth opening www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings – Special Situations  Muscle distraction   Pain of muscles Correlate findings of palpation. www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings – Special Situations  Condyle ant. to reference position   Loose ligaments Hyperactive muscles www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings – Special Situations  During ICP   Prematurities Functional distraction www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings – Special Situations Reciprocal Click Disk is pulled anteriorly (on protrusion) Condyle is repositioned in the disc Normal movement Condyle slips away from the disc www.indiandentalacademy.com
    • Interpretation of Axiograpic Tracings – Special Situations  Hyperactive temporalis muscle. www.indiandentalacademy.com
    • Computer Aided Axiography  Advantage –    Mand. movements in X, Z and Y (Bennett) planes are recorded directly into the computer. Timing of movement is also measured Accuracy www.indiandentalacademy.com
    • Computer Aided Axiography www.indiandentalacademy.com
    • Computer Aided Axiography www.indiandentalacademy.com
    • Computer Aided Axiography   Location of hinge axis Repeated movements can be superimposed www.indiandentalacademy.com
    • CADIAS  History,  Clinical examination,  Muscle palpation,  Instrumental analysis,  Model analysis and  Cephalometric analysis,  Growth predictions,  Skeletal and dental VTO and  Different cephalometric analyses. www.indiandentalacademy.com
    • A Comparison Of Mandibular Condylar Location Between Unstrained Retral Position And Maximum Intercuspal Position In Temporomandibular Dysfunction Cases And In Asymptomatic Subjects, Using A Mandibular Position Indicator Dr. Divakar H. S. MDS Dissertation – Feb 1995 www.indiandentalacademy.com
    • Introduction    Is condylar position important in etiology of TMD? – Inconclusive evidence If ‘Yes’ then how much. Comparison between patients with TMD and Asymptomatic patients. www.indiandentalacademy.com
    • Introduction Methods of assessing condylar position  Radiographic      Transcranial Laminography (CT Scan) MRI Sonography Clinical Methods   Axiograph MPI www.indiandentalacademy.com
    • Materials and Methods  40 patients      25 with TMD symptoms 15 asypmptomatic No h/o arthritis, trauma or ortho. treatment. History, photographs – Rest position & ICP Procedure for SAM and MPI www.indiandentalacademy.com
    • Results  All MPI readings found to be very similar  Range and means very close  No statistical significance even at 10% www.indiandentalacademy.com
    • Discussion Symptomatic Asymptomatic (25) No Anteroposterior displacement No Vertical displacement (15) 3 (12%) None 5 (20%) 2 (13%) www.indiandentalacademy.com
    • Discussion  Range of movements   Greater than suggested by Roth (both groups) Asymmetric movements  25% subjects in both groups www.indiandentalacademy.com
    • Summary and Conclusions  Condylar shift occurred in both groups  No significant difference in amount of shift  Asymmetric movements in both groups  TMD cannot be predicted using condylar position www.indiandentalacademy.com
    • An Evaluation Of Condylar Position In Class II Div. 2 Malocclusion Using The Mandibular Position Indicator Dr. Sonali M. MDS Dissertation – Feb 1998 www.indiandentalacademy.com
    • Introduction     Posterior position of condyle in Class II div 2 patients – often used to advantage. Is it true? Correlation with overjet, overbite jaw sizes, incisor inclinations? Cause of TMD? www.indiandentalacademy.com
    • Materials and Methods  30 subjects      14 male, 16 female 10-30 yrs Upright or lingually inclined incisors 50% or more of overbite Overjet upto 4 mm www.indiandentalacademy.com
    • Materials and Methods     History – including symptoms of TMD Clinical examination Study models, lateral ceph Mounted casts of SAM 2 articulator, and use of MPI to assess condylar position. www.indiandentalacademy.com
    • Results  Results were tabulated       Condylar position at ICP – both sides seperately Overjet Overbite Size of both jaws Incisor inclinations and relationship Other MPI readings (Vertical pin reading, Dial gauge reading, incisal table reading www.indiandentalacademy.com
    • Results   18 of the 30 – retrusion of at least 1 condyle Correlation of retrusion with other features     No correlation with overjet No correlation with overbite Size of mandible – large mandible in pts with retrusive condyles Maxilla was small in most cases www.indiandentalacademy.com
    • Results      Amount of max. incisor retroclination did not affect posterior placement. No correlation with inclination of lower incisors. No correlation with inter incisal angle. Retrusion of condyle may be associated with TMD – Asymmetric placement more prone. TMD symptoms – seen more in adult pts. www.indiandentalacademy.com
    • Clinical implications   Pts with retrusion may develop TMD later in life. Anterior relocation seen in pts with retrusion of condyle – not if condyle is normally placed. www.indiandentalacademy.com
    • References   JCO Interviews : Dr. Slavicek on clinical and instrumental functional analysis for diagnosis and treatment planning. July 1988 Clinical and instrumental functional analysis for diagnosis and treatment planning Parts 4 – 7. JCO Sept – Dec 1988  MDS Dissertation – Feb 1995 – Dr. Divakar H.S.  MDS Dissertation – Feb 1998 – Dr. Sonali M  Concepts in functional occlusion and management of functional disorder of TMJ - Dr. N. R. Krishnaswamy Manual of the 7th IOS PG Convention www.indiandentalacademy.com
    • Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com