Indices for jaw registrations

Tags

Bruxism, Centric relation, condylar asymmetry recognition, Dentistry, Mounting casts, Occlusal device, Occlusal splint, Occlusion, Retruded Position of the Mandible, TMJ rehabilitation

Sometimes it can be difficult to get a relaxed mandible in the process of jaw registration in the retruded position of the mandible in as well the diagnostic phase as in the steps of treatment. It happens mostly when the patient is a heavy bruxer or when the patient seems to defend him/herself against the pressure from the hands of the dentist in the clinical situation. A condylar asymmetry may add to the clinical difficulty in getting the registration right.
With the measurements of the vertical dimensions of the temporomandibular joint condyles and the Maaxloc device at hands the above mentioned problems can definitely be reduced.It is my opinion, which to a great extent I have achieved from the dental technicians, that the registrations made in the Maaxloc system get into a more retruded position of the mandible in comparison with the manually taken clinical indices which often are protruded.This conclusion is based upon several years of cooperation with Ines Selimanovic T.I.C. laboratory, Malmoe ,Sweden, an experienced dental technician, with whom I have made comparisons of by me taken clinical indices and by her made registrations in the Maaxloc device.
In conc;usion: To avoid unnecessary and time consuming adjustments despite quality of the dental work in the ” difficult mouth “it might be worth while to become critical to the manually taken clinical registration and consider the advantage of the Maaxloc device.

Response to Jamie’s problem ( question )

Thanks for your question. It is my opinion that your left side tmj condyle is higher ( evaluated on your attached panoramic X-ray ). This side therefore needs to be the guide in finding the correct mandibular position for your treatment.Your splint should therefore be somewhat thicker on your right side. From the clinical pictures it seems as if your left side teeth meet prior to your right side teeth on closing ( in the retruded position of your mandible ).Your splint probably needs to be redone in order to compensate for the condylar height that is missing on your right side. In addition, it seems as if you are bruxing in a left side laterotrusion (predominantly mandibular movements to the left ), a thought based upon the flattening of the right side condyle visible on the X-ray.
Sincerely,
Tore L. Hansson

x-ray analysis of vertical tmj Condylar Asymmetry

Tore L. Hansson

Dental students are normally taught about the necessity of an overview radiograph in the screening for and in the early detection of undiagnosed hard tissue changes of the maxilla and of the mandible (neoplasms, tumors or any strange lesions). Most dental students have also been told the questionable value of the panoramic radiograph because of the superimposition of the structures due to the construction of the X-ray machine with its two axes of rotation ( focus and film in opposite directions). On the other hand the panoramic radiograph is the only routinely used radiograph in the dental practice in which comparisons between the right and the left sides of the jaws can be made, as both side are projected in the same film without any change of head position.
However,comparisons of horizontal dimensions are not possible due to the superimposition of structures.Vertical dimensions can be compared as the focus of…

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