Occlusal Adjustment at a TMJ Condylar Asymmetry?

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Asymmetry, Centric relation, condylar asymmetry recognition, Dental treatment, Dentistry, Occlusal adjustment, Occlusion, Preprosthetic occlusal adjustment, Retruded Position of the Mandible, TMJ rehabilitation, Treatment planning

Be careful! The tooth contacts which seem to be occlusal interferences at the first sight when the conventional retruded contact position of the mandible is being executed may not be disturbing tooth contacts at all. If they are located on the higher condyle side they may denote the vertical dimension of the inter maxillary relationship and should in my opinion not be removed. Only precontacts on the shorter condyle side are to be looked upon as true interferences and can be removed to such an extent that tooth contacts are established on the higher condyle side.

With the risk of repeating myself I  do want to advise the clinician to build up the occlusion on the shorter condyle side instead of adjusting the teeth through occlusal adjustment on the higher condyle side.In this way we will secure a correct vertical dimension between the two jaws in occlusion and thereby rescue the patient from a too low vertical dimension of the occlusion after completed dental work often jeopardising the function the temporomandibular joints.

Developing TMJ arthrosis at a condylar asymmetry

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Dental treatment

is likely to occur when bruxism is present.It seems to be the result on the shorter condyle side at unilateral bruxism as most often the shorter condyle side is being used as the mediotrusive side. The bird beak formation of the antero-lateral part of the condyle in combination with the flattened surfaces of the articular joint components is easy to recognize in any panoramic X-ray.

Dental treatment in patients with the radiological signs of a developing TMJ arthrosis should therefore routinely not be executed in the “normal” intercuspal position. The dental treatment must be guided by the normally developed, higher and healthy condyle. This approach often entitles a more extended treatment. The vertical dimension of the occlusion of the shorter condyle side needs to be increased as the treatment  is aiming at a symmetrical temporomandibular joint function. The treatment thereby is compensating at the occlusal level  what is missing vertically intraarticularly.avoiding or reducing the effects unilateral bruxism.