Cutting Temporomandibular Joints

Tags

Asymmetry, condylar asymmetry recognition, Dentistry, Implantology, Occlusion, Orthodontics, Preprosthetic occlusal adjustment, Prosthodontics, Radiography, Temporomandibular joint, Temporomandibular joint disorder, Temporomandibular joint pain, Treatment planning

occurs in surgery. Thank God it does not happen too often, as responsible, well trained and experienced oral / maxillofacial surgeons are utmost cautious. They know it is involved with major draw backs. However, under certain circumstances and with the correct indications it is  necessary. I do not mind that at all, but what I do mind is all the cutting of temporomandibular joints in the panoramic x-rays we are exposed to in the literature and thus unconsciously gives us the message that the joints are not so very important.

It does not matter whether it is in a professional journal of prosthodontics, orthodontics, implantology, periodontics or even in a presentation at a congress it could be estimated that 8-9 out of 10 panoramic x-ray photos presented do not show the entire picture of the two temporomandibular joint condyles. The majority of condyles are cut totally  or at least partially while all the teeth are nicely depicted and aligned in the perfect occlusal plane  often before as well as always after treatment.  Is a vertical condylar asymmetry present in such a patient most likely the teeth are not aligned in the shown or anticipated correct occlusal plane. With a high probability the smile of that patient is tilted which is observed in the clinical situation and which often also might be the reason for the complaint of  the not satisfied patient.

In rehabilitation priority is supposed to be given to the whole stomatognathic system and not only to one third of it. As the other two thirds of the system ( the masticatory muscles and the two temporomandibular joints ) are dependent on the teeth it is my advice that the teeth must be aligned in such a way that they vertically compensate for what is missing in the vertical dimension of the shorter condyle when present. Addressing the vertical condylar asymmetry, when present, is of utmost importance and  in my opinion it should be done already at the time of treatment planning regardless specialty of the therapist. To incorporate an index, preferably via Maaxloc, between the models already at the initial analysis of the ” study ” models instead of just manually having the models to occlude will definitely contribute to a bigger certainty in reaching the goal of treatment. It makes the whole planning easier and it decreases the risk of unnecessary difficulties during treatment. In not accepting cut temporomandibular joint condyles in the panoramic x-ray and instead  only accepting  the picture when it is  complete i.e. picturing  both the temporomandibular joint condyles we most probably will be  expanding our clinical success and consequently patient satisfaction.