DISCLUSION TIME REDUCTION AND TSCAN APPLICATION, DTR, TEK SCAN

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2. DISCLUSION TIME
REDUCTION & T-SCAN
APPLICATION
PRESENTED BY : ILA YADAV
PG STUDENT, DEPT. OF PROSTHODONTICS
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3. DISCLUSION TIME
The Disclusion Time is defined as the duration of
time that working and non-working molars and
premolars are in contact during a mandibular
excursive movement, that is commenced from
complete habitual intercuspation, and extends
through to the contact of solely anterior guiding
surfaces (canines, and/or lateral and central
incisors).
Kerstein R. Disclusion time measurement studies: stability of
disclusion time: a 1 year follow up. J Prosth Dent. 1994;72:164–8
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4. Eccentric Relation – GPT 9
eccentric relation ĭk-sĕn΄trik rĭ-la΄shun n: any
relationship of the mandible to the maxillae other
than centric relation.
functional
movements
Parafunctional
movements
MUSCLES OF MASTCATION
FUNCTION
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5. Chewing movements
(eccentric)5

6. Parafunctional movements
(eccentric)
 American academy of orofacial pain
Bruxism is defined as “diurnal or nocturnal
parafunctional activity including clenching, bracing,
gnashing, and grinding of the teeth.”
 According to glossary of prosthodontic terms
(GPT)-8
It is defined as the “parafunctional grinding of the teeth
(or). An oral habit consisting of involuntary rhythmic or
spasmodic nonfunctional gnashing, grinding or clenching
of teeth, in non-chewing movements of the mandible,
that can lead to occlusal trauma.” It is also called tooth
grinding, or occlusal neurosis
Lobbezoo F, Hamburger HL, Naeije M. Etiology of bruxism. In: Paesani
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7. Harmful contacts
Parafunctional contacts
Non-working occlusal contacts
Interferences (abnormal contacts that may occur
in either functional or parafunctional activity)
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8. What does harmful occlusion
do?
Occlusal interferences can induce
 tooth pain,
 mobility,
 masticatory muscle hyperactivity.
 Damaged restorations
 Fractured teeth
 Receding gums or loose teeth
 Pain in the muscles, teeth and jaw joint
 Night time teeth grinding
 Headache and neck pain
 Greater tooth wear and sensitivity
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10. TMD / MPDS
1934 - James costen- group of symptoms centering
around the ear and TMJ - Costen syndrome
1959 - Shore – TMJ Dysfunction Syndrome
Terms like – pain dysfunction syndrome, TM pain
dysfunction syndrome, myofacial pain dysfunction
syndrome, craniomandibular disorders
Bell suggested the term- TM Disorders
American Dental Association adopted the term –
TEMPOROMANDIBULAR DISORDERS
TM Disorders are used to include all functional
disturbances of the masticatory system
Griffiths RH. Report of the president’s conference on examination, diagnosis
and management of temporomandibular disorders. J Am Dent assoc, 106:75-
77,1983
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11. TMD
symptoms
headache
Grinding
and
clenching
Clicking/
popping
Tooth
sensitivity
Depressionanxiety
Muscle
tension
Neck
tension
Shoulder
tension
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12. Current Treatments Only Targeting
Symptoms
Splint therapy,
Orthodontic brackets
Botox injections
Muscle relaxants
Massage
trigger point injections
Chiropractor / osteopathy
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13. Current Treatments Only Targeting
Symptoms
diet
Drugs or pain killers
Psycotherapy
TENS therapy
Reducing stress
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14. Hope for
TMD
Hope for
headaches
Hope for
bruxism
Hope foe
clenching
Hope for
grinding
DTR
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15. How Neural Occlusion Screening Works
Neural Occlusion screening involves a
combination of hi-tech objective technologies
and knowledge to ascertain whether or not a
patient possesses a proper bite and stable and
adapted TMJ's, and/or if their problem(s) arise
from other sources.
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16. What we measure
Force and time
EMG
X Rays
Ice water swish
JVA
CBCT
MRI
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17.  In patients in whom the diagnostic and
biometric assesment reveal that the overriding
condition is a muscular based problem with
normal vertical dimension, no internal
derangements, and near normal occlusal
relations, the quality of the occlusal contacts
can be a significant contributory factor to the
chronic nature of patients condition.
 Then occlusal corrections can be considered
as a treatment.
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18. Digitally Directed
“Alignment”,
 Disclusion Time Reduction (DTR) therapy is a
bite/occlusal adjustment procedure used in patients
that possess stable and adapted temporomandibular
joints (TMJ’s). Objective confirmation of stable &
adapted TMJ's leads to predictable outcomes
regarding restorative dentistry &/or TMD therapy!
 When back teeth contact/touch too long in TIME
during function, research has shown repeatedly for
decades that this neurologically overstimulates
muscular contraction within the chewing complex.
Many of these muscles, when overworked, become
very fatigued and painful, resulting in unexplained
headaches and tension within the head and neck. In
a practical sense, muscles that overwork chronically
can lead to not only broken teeth, but failing dental
work as well!
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20.  A precise and objective, digitally directed
“alignment” of the way the teeth relate to one
another over TIME, can reduce this
overstimulation of the muscles, leading to not only
a reduction in painful symptoms, but the likelihood
that dental work will not fail over time as well!
 Based upon three decades of evidence-based
research , DTR therapy does not involve the
usage of splints, medications, injections, lasers,
chiropractic therapy or other temporary adjuncts.
DTR addresses the genesis of the problem that
causes the chewing muscles to overwork, excess
contact of posterior teeth, in TIME.
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21.  T-Scan™ is dentistry's only clinically
recognized and research validated digital
occlusion analysis system. T-Scan system
provides dynamic occlusal measurement -
revealing the level and timing of force on
individual teeth and the occlusal stability of the
overall bite - bringing articulation paper marks
to life.
 With T-Scan, we can visualize and treat
destructive forces before they become a
problem, yielding better patient outcomes.
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22.  With T-Scan, we are able to see where you
couldn't before using traditional occlusal
indicator methods. Our state-of-the-art, digital
software helps clinicians to identify premature
contacts, high forces, and interrelationship of
occlusal surfaces.
 Whether eliminating destructive forces on a
new restoration, or performing an occlusal
analysis and adjustment procedure, T-Scan
helps to balance patients’ occlusions with
precision and accuracy.
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23. Indications / Contraindications
 Indicated for use in patients with TMD that
exhibit primarily muscular contraction
symptomatology and whole anterior teeth
couple or near couple.
 ICAGD is contraindicated in patients with class
II Div II, patients with severe open occlusion
and people who demonstrate primary internal
derangements such as locking, dislocating,
avascular necrosis of the condyle or tumours
of the TMJ.
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24. Technique
 Phase I
After analyzing the pretreatment Disclusion Time
data of each subject, either the ICAGD
enameloplasty (reduction) is performed, or
composite additions are placed on the lingual
surfaces of the maxillary canine teeth, so both
established immediate posterior disclusion of ,0.5
seconds per excursion. At this point, post-treatment
T-Scan records are taken, and if the Disclusion Time
was not ,0.5 seconds in duration in either excursion,
further ICAGD corrections were made to the
occlusion where required.
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25.  Phase 2
On the eighth day, 1-week post-treatment
excursive T-Scan recordings are made, and any
T-Scan detected occlusal interferences are
cleared from within the new habitual self-
intercuspated position. And, any prolonged
Disclusion Time that is found on involved
posterior teeth, is then corrected to once again
bring the Disclusion Time per excursion below
0.5-second duration.
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28. T-Scan™ Benefits:
 Educate patients on their occlusion
 Gain commitment to treatment
 Differentiate your practice
 Precise occlusal data; stop chasing the bite
 Locate premature contacts
 Preserve your dental artistry by eliminating
destructive forces
 Minimize adjustments and repeat visits
 Monitor changes in the occlusion over time
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29. Applications
 When used in conjunction with articulating paper, T-Scan™'s
precise, actionable data gives you the ability to diagnose and
treat occlusion accurately and with confidence.
 The following are just some examples of the many ways T-Scan
can be used in dental offices today.
 Initial Comprehensive Exam
 Occlusal Analysis & Adjustment
 TMD/TMJ & Headaches
 Splint/Orthotic Therapy
 Implants
 Crowns & Bridges
 Dentures
 Veneers
 Full Mouth Restorations
 Orthodontics
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30. Initial Comprehensive Exam
Educate New and Existing Patients and
Increase Case Acceptance
 Many dental practices include T-Scan™ as a
screening tool during new patient exams and
hygiene recare appointments as a way to
identify occlusal issues and treat them before
they become a problem. Showing patients 2D
and 3D representations of their bite with T-
Scan software helps them to visualize the
occlusion and feel more confident in your
treatment plan.
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Use T-Scan™ during initial exam and hygiene
recare screenings to:
 Visualize high forces and early interferences
instead of relying simply on what the patient feels
 Uncover imbalances before the patient notices
any symptoms
 Document occlusal data and track changes in the
bite over time
 Position yourself as a progressive doctor with
digital technologies that enhance patient care
 Gain commitment to treatment

32. Occlusal Analysis and Adjustment
Better Treatment Outcomes
 When used during occlusal analysis and
adjustments, T-Scan™’s digital bite force data
brings paper marks to life. Take guesswork out
of the occlusal picture and start using objective
data to interpret and treat occlusion disorders.
 T-Scan identifies early and high forces
during occlusal analysis
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Benefits:
 Bite force readings display the timing and
force of individual teeth coming together
 2D and 3D mapping allow dentists to pinpoint
early interferences accurately
 T-Scan data helps the dentist make
adjustments quickly, reducing the need for
follow-up appointments
 Educate your patients on their occlusion with
digital data they can see

34. TMD/TMJ & Headaches
 Pinpoint the Source of TMD Issues with
Accurate, Digital Data
 Patients who suffer from TMD and the
debilitating side effects it causes are some of
the most complex cases in dentistry. With T-
Scan™'s digital bite force data; you will feel
more prepared than ever to treat (and even
cure) TMD patients of the pain and suffering
they endure.
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T-Scan is used by dentists to identify
occlusal forces that are contributing to TMD
symptoms
 T-Scan helps to identify early interferences in
the bite sequence so you can remove them,
giving your patients relief from myofascial
pain, headaches, earaches etc. For further
analysis of muscle function as it related to
TMD, link T-Scan with EMG systems.

36. Splint /Orthotic therapy
 Splint therapy and orthotic devices are
commonly used to treat occlusal disorders,
which are often difficult to diagnose.
Digital occlusal analysis helps dentists
identify occlusal imbalances in patients
being fitted for splints
 T-Scan™’s real-time bite force and
measurement data can help the dentist
analyze the patient’s occlusion before, during
and after splint therapy. Digital
information makes it easier identify areas that
need adjustment in order to ensure patient
comfort, a balanced appliance, and a
harmonized occlusal scheme.
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37. Implants
 Achieve Optimal Occlusal Loading with T-
Scan™
 Dentists use T-Scan to ensure proper implant
loading
 It is concerning when a dental implant takes the
brunt of the bite force. T-Scan™ allows dentists to
use timing and relative force measurement data to
determine when and how the pressure is being
distributed per-tooth. Implant loading alerts in the
new 9.0 software warn users if the implant is
sustaining a large percentage of occlusal force or
hitting early in the bite sequence. This means you
can protect implants from damaging occlusal
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Implant Warning in T-Scan 9.0 Software
Using T-Scan in a mixed implant-natural tooth
dentition prevents:
 Ceramic fracture
 Screw loosening
 Cementation compromise
 Destruction of soft tissue
 Loss of alveolar bone

39. Crown & Bridges
T-Scan™ Helps Create a Harmonized
Occlusion Scheme to Preserve Crowns and
Bridges
 Fitting crowns and bridges requires skill and
precision to ensure a balanced, functional, and
esthetically pleasing bite. T-Scan™ provides
dentists with digital bite force data, helping to
analyze the occlusion of a patient undergoing
restoration procedures. Computerized occlusal
analysis aids in identifying regions of
excessive or non-uniform force, giving the
dentist knowledgeable control over the
adjustment process.
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T-Scan is used to give dentists data that reveals
the occlusal dynamics of the bite to ensure the
longevity of prosthetic work. Use T-Scan to
ensure dental prostheses are loaded in harmony
with the rest of the natural occlusal surfaces to
minimize:
 Fractured porcelain
 Broken prostheses
 Bruxing
 Interferences
 Uncomfortable high spots

41. Dentures
 T-Scan™ Helps Dentists Achieve Denture
Stability, Retention, and Fit
 When a patient is being fitted for dentures,
analyzing occlusal forces becomes necessary
for successful treatment outcomes. T-Scan™
provides dentists with digital bite force data
that shows when and how teeth come into
contact, which helps identify premature
contacts, stability issues, and causes of sore
spots. Digital occlusal analysis gives dentists
an edge with a comprehensive approach to
treatment.
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 Associate the patient’s "feel" with objective
data
 See occlusal timing data that shows contact
points
 Identify early interferences that may cause the
dentures to rock
 Adjust with precision
 Eliminate sore spots
 Reduce the need for post-op adjustments

43. Veneers
 Whether using composite or porcelain, veneer
artistry is critical to the function and form of a
patient's bite. T-Scan™ allows dentists to see
timing and levels of force across the dentition.
This helps reduce fracture potential and
preserves dental artistry.
 2D and 3D maps help dentist and patient
visualize which contacts are problematic
 Bite force data helps put identify extreme
forces that may chip or dislodge veneers
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44. FMR
 T-Scan™ Data Provides Context to Bite
Discrepancies in Full Mouth Restoration
Cases
 Among the most complex procedures in dentistry,
full mouth reconstructions require a treatment plan
that revolves around teeth, periodontal
tissues, temporomandibular joints and muscles,
and esthetics. T-Scan™ is a computerized
occlusal analysis system that allows dentists to
see when and how each tooth makes contact.
This is critical to achieving a balanced, functional
bite during and after a full mouth reconstruction.
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 Use T-Scan During Full Mouth Restorations
to:
 See digital timing and force data related to the
patient's bite
 Identify early and high forces that cause
fractures and breakages
 Minimize lateral interferences
 Preserve your dental artistry

46. Orthodontics
T-Scan and Orthodontics
 While most patients seek ortho for cosmetic reasons, it is
important for you to maintain a healthy occlusion so these
patients will remain satisfied with the results of orthodontia for
years to come. T-Scan™ gives you accurate, digital data
related to the patients occlusion so you can balance bite
forces properly throughout orthodontic treatment. This
means, possibly preventing chronic side-effects such as:
 Idiopathic Condylar Resorption (ICR)
 Temporomandibular Disorders (TMD)
 Chronic Myofascial Pain (CMP)
 Apical Root Resorption (ARR)
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47. SUMMARY
Muscles of mastication
Masticatory/parafunctional movements
Eccentric movements / interferences in
occlusion
Disclusion in eccentric movements should be
< 0.4 sec
DTR – disclusion Time Reduction - reducing
contacts/interferences that delay disclusion
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ICAGD- immediate complete Anterior Guidance
Development – method for occlusal adjustment
Make the occlusion canine guided
Reducing/ eliminating posterior interferences
Lesser muscle tension
Reduction in symptoms of MPDS

49. References
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 Dawson PE. Evaluation, diagnosis, and treatment of occlusal problems.
2nd ed. St Louis, MO: CV Mosby Co.; 1988
 Okeson JP. Management of temporomandibular disorders and occlusion.
5th ed. St. Louis , MO, Mosby &Co.
 Thumati P. The influence of immediate complete anterior guidance
development technique on subjective symptoms in myofascial pain
patients: Verified using digital analysis of occlusion
(Tekscan) for analyzing occlusion: A 3
year’s clinical observation. J idian Prosthet Soc
2015;3:218-23.
 Kerstein R. Disclusion time measurement studies: stability of disclusion
time: a 1 year follow up. J Prosth Dent. 1994;72:164–8
 Lobbezoo F, Hamburger HL, Naeije M. Etiology of bruxism. In: Paesani
DA, editor. Bruxism- Theory and Practice. London: Quintessence; 2010.
pp. 53–65.

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 Thumati P. The effect of reduced disclusion time in the treatment of
myofascial pain dysfunction syndrome using immediate complete
anterior guidance development protocol monitored by digital
analysis of occlusion. J Craniomandib Pract 2014;32:289-99.
 Kerstein RB, Farrell S. Treatment of myofascial pain-dysfunction
syndrome with occlusal equilibration. J Prosthet Dent
1990;63:695-700.
 Kerstein RB. Reducing chronic massetter and temporalis muscular
hyperactivity with computer guided occlusal adjustments. Compend
Contin Educ Dent. 2010;31:530–43
 Kerstein RB, Farrell S. Treatment of myofascial pain dysfunction
with occlusal equilibration. J Prosth Dent. 1990;63:695–700.

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