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

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

  1. 1. Instrumental Functional Analysis www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. What is Instrumental Analysis   Mounted casts Mandibular position     RCP – Hinge axis – Centric relation ICP Mandibular movements Condyle/disc complex www.indiandentalacademy.com
  4. 4. 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
  5. 5. 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
  6. 6. Why do an Instrumental Analysis   Hand held casts  ICP Articulator mounting  functioning of mandible www.indiandentalacademy.com
  7. 7. 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
  8. 8. The SAM 2 Articulator  Made for diagnosis  Semi-adjustable  MPI and Axiograph www.indiandentalacademy.com
  9. 9. Mandibular Position Indicator   Measures deviation from RCP to ICP 3-dimensional measurements www.indiandentalacademy.com
  10. 10. Axiograph    Records mandibular movements Dynamic record Takes into account PDL, Muscles, Soft tissues etc. www.indiandentalacademy.com
  11. 11. Mounting casts on the SAM 2   Accurate impressions Stone casts www.indiandentalacademy.com
  12. 12. Mounting casts on the SAM 2  Base of casts – Split cast former www.indiandentalacademy.com
  13. 13. Mounting casts on the SAM 2  Face bow record  Oriented to soft tissue Po and Orbitale. www.indiandentalacademy.com
  14. 14. Mounting casts on the SAM 2  Face bow record transferred to acticulator www.indiandentalacademy.com
  15. 15. Mounting casts on the SAM 2   Obtaining interocclusal record Deprogramming www.indiandentalacademy.com
  16. 16. Mounting casts on the SAM 2  Mandible guided into retral position by the operator www.indiandentalacademy.com
  17. 17. Mounting casts on the SAM 2  Roth power centric technique.    Delar wax Ant – 6 thicknesses Post – 2 thicknesses www.indiandentalacademy.com
  18. 18. 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
  19. 19. Use of the MPI     Adhesive grid on incisal table Grid mark Incisal pin reading Articulator programmed with 3 co-ordinates www.indiandentalacademy.com
  20. 20. Use of the MPI   Transfer max. cast to MPI Exactly same relation as to upper member. www.indiandentalacademy.com
  21. 21. 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
  22. 22. Use of the MPI   Adhesive grid on black cubes of MPI Mark position of condylar spheres with blue articulating paper. www.indiandentalacademy.com
  23. 23. Use of the MPI    Pin of the dial placed into cube. Cube slid against condylar sphere. Dial gauge reading (Delta Y) www.indiandentalacademy.com
  24. 24. Use of the MPI   Cubes slid medially to perforate grid. Point of perforation indicates hinge axis. www.indiandentalacademy.com
  25. 25. Use of the MPI  Data obtained from MPI:   3 grids Incisal pin reading Dial gauge reading www.indiandentalacademy.com
  26. 26. 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
  27. 27. Use of the MPI  Interpreting the results   RCP and ICP correspond. ICP is displaced below RCP - distraction www.indiandentalacademy.com
  28. 28. 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
  29. 29. Axiography  Records mandibular movements in all 3 planes of space.  Diagnosis of subclinical discopathies.  Similar data from MPI – more dynamic. www.indiandentalacademy.com
  30. 30. Axiography  Facebow – on cranium.    2 vertical bars (parasaggital flag bows) 2 grids. 2nd part anchored to mandible. www.indiandentalacademy.com
  31. 31. Axiography  Tray or  Para-occlusal clutch www.indiandentalacademy.com
  32. 32. 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
  33. 33. Axiography    All mandibular movements related to this. Adolescents – 1 mm anterior. Reference position marked on the graph. www.indiandentalacademy.com
  34. 34. Axiography   Stylus replaced by a dial gauge. Three dimensional recording. www.indiandentalacademy.com
  35. 35. Axiography  Step 1 - Movements   Protrusion-retrusion;  opening-closing;  unguided mediotrusion  guided mediotrusion www.indiandentalacademy.com
  36. 36. Axiography  Step 2 – Joint resiliency test.   Upward pressure Condyle displaced superiorly & anteriorly. www.indiandentalacademy.com
  37. 37. Axiography     Child  1 mm Young adult  0.5mm Middle age /Elderly  0.3 mm Less = no protection against strong forces. www.indiandentalacademy.com
  38. 38. Axiography  No resiliency     Flattening of codylar head Disc derrangements Splint therapy indicated www.indiandentalacademy.com
  39. 39. 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
  40. 40. 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
  41. 41. 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
  42. 42. 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
  43. 43. 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
  44. 44. Interpretation of Axiograpic Tracings  Causes for not coinciding –     loose ligaments subluxation luxation reduction www.indiandentalacademy.com
  45. 45. Interpretation of Axiograpic Tracings Fischer Angle Normal movement Movement due to displaced disc www.indiandentalacademy.com
  46. 46. Interpretation of Axiograpic Tracings    Positive Bennett movt. should be seen. If not – avoidance of prematurities Negative Bennett movt. = displaced disc. www.indiandentalacademy.com
  47. 47. Interpretation of Axiograpic Tracings  Mediotrusive tracings    Unguided Guided Helps in differential diagnosis -muscles or ligaments (?) www.indiandentalacademy.com
  48. 48. Interpretation of Axiograpic Tracings Opening and closing   Translatory movements  upper compartment Rotational movements  lower compartment www.indiandentalacademy.com
  49. 49. 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
  50. 50. Interpretation of Axiograpic Tracings – Special Situations  Over rotation of mandible at end of full mouth opening www.indiandentalacademy.com
  51. 51. Interpretation of Axiograpic Tracings – Special Situations  Muscle distraction   Pain of muscles Correlate findings of palpation. www.indiandentalacademy.com
  52. 52. Interpretation of Axiograpic Tracings – Special Situations  Condyle ant. to reference position   Loose ligaments Hyperactive muscles www.indiandentalacademy.com
  53. 53. Interpretation of Axiograpic Tracings – Special Situations  During ICP   Prematurities Functional distraction www.indiandentalacademy.com
  54. 54. 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
  55. 55. Interpretation of Axiograpic Tracings – Special Situations  Hyperactive temporalis muscle. www.indiandentalacademy.com
  56. 56. 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
  57. 57. Computer Aided Axiography www.indiandentalacademy.com
  58. 58. Computer Aided Axiography www.indiandentalacademy.com
  59. 59. Computer Aided Axiography   Location of hinge axis Repeated movements can be superimposed www.indiandentalacademy.com
  60. 60. 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
  61. 61. 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
  62. 62. 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
  63. 63. Introduction Methods of assessing condylar position  Radiographic      Transcranial Laminography (CT Scan) MRI Sonography Clinical Methods   Axiograph MPI www.indiandentalacademy.com
  64. 64. 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
  65. 65. Results  All MPI readings found to be very similar  Range and means very close  No statistical significance even at 10% www.indiandentalacademy.com
  66. 66. Discussion Symptomatic Asymptomatic (25) No Anteroposterior displacement No Vertical displacement (15) 3 (12%) None 5 (20%) 2 (13%) www.indiandentalacademy.com
  67. 67. Discussion  Range of movements   Greater than suggested by Roth (both groups) Asymmetric movements  25% subjects in both groups www.indiandentalacademy.com
  68. 68. 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
  69. 69. 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
  70. 70. 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
  71. 71. 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
  72. 72. 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
  73. 73. 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
  74. 74. 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
  75. 75. 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
  76. 76. 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
  77. 77. 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
  78. 78. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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