TMJ radiology and occlusion: vertical dimension, intra-articular disorders, centric relation

Category: Orthodontics

Instructor(s): Lukas Lassmann

Course structure: Lessons: 4 lessons | Duration: 6 h 15 min

Course overview

On the Lucas Lassman course, you will study in detail effective and accurate methods for diagnosing TMJ pathology.
During the training, you will learn:
– how does the vertical dimension of occlusion affect the development of TMJ pathologies
– radiological aspects of TMJ anatomy
– protocols for the diagnosis of TMJ pathologies by CBCT and MRI
– the role of the central ratio in the total rehabilitation of the oral cavity.

Curriculum

Lesson 1. Vertical dimension of occlusion

• – How do we know when should we increase VDO and how much?
• – Vertical dimension of occlusion (VDO)
• – Increasing VOD in excessive tooth wear
• – Full mouth reconstruction and TMD
• – 1-1,3-2-3 relation in increasing VDO
• – What is the dentoalveolar compensation
• – The effect of raising VDO on the cervical spine and pain in the trigeminal nerve nuclei
• – Cephalometric analysis of the cervical spine (analysis of intervertebral spaces and the cranio-cervical angle) and the position of the hyoid bone
• – crucial for achieving muscle balance and making it possible to raise occlusion successfully
• – Basic photo protocol for aesthetic planning
• – Establishing the height of the deprogrammer platform using a modified DSD protocol
• – DSD in patients with significant tooth abrasion (teeth not visible when patient smiles). How to establish the right aesthetics at the preliminary stage
• – VDO checklist – if you follow this you can increase the VDO as much as you need.

Lesson 2. TMJ radiology. Basic

• – Anamnesis vitae and morbie
• – Two important steps before deciding to order radiographs
• – Analysis of pantomographic images
• – are 2D images suitable for the assessment of the temporomandibular joint?
• – Analysis of condyle hypermobility on the basis of radiographs
• – Structure of the temporomandibular joint in the context of radiology
• – Assessment of the condyle position in the joint based on CBCT.

Lesson 3. TMJ radiology. Advanced

• – Why position 4/7 did not fulfill its role?
• – Cortical bone erosion on CBCT
• – what is it and how to assess it?
• – Joint degeneration in the CBCT image – arthritis vs arthrosis – a key difference from a clinical point of view
• – Idiopathic condyle resorption – why does an open bite suddenly appear?
• – Subcortical cysts, ankyloses and developmental defects in the CBCT image
• – What to look for when analyzing cephalometry for respiratory disorders?
• – What is the hyoid triangle and how to assess the pathology of the cervical vertebrae on cephalometry?
• – Magnetic resonance imaging (MRI) – normal anatomy important from the point of view of TMD
• – Displacement of the disc with and without reduction, lateral and posterior displacement of the disc – detailed analysis of MRI images
• – Analysis of mobility in the joint based on MRI
• – Joint effusion and double disc image – detailed MRI analysis
• – Three words about ultrasound – why MRI is much better
• – Stabilization of the condyle as seen by magnetic resonance imaging.

Lesson 4. Clinical application of CR in prosthodontics and orthodontics

• – MRI and CBCT positioning of the condyle – when does it make sense?
• – 4/7 position and rearmost position – why they were used and why they were stopped
• – Centric slide – a physiological phenomenon or a big mistake?
• – Constricted Chewing Pattern (CCP) and the “long centric”– Compression and decompression in TMJ – is the joint space important for us?
• – Rotation / translation – are we actually separating these two movements?
• – Defining the Central Relation – dental cabaret
• – Adapted centric posture. How do I know when an intervention is needed?
• – Muscle vectors of the stomatognathic system
• – Establishing a centric relation (deprogrammers and maneuvers)
• – Triple centric relation and determining the position of the articular fossa
• – Forward position – splint reposition, functional orthodontics, apnea treatment
• – Neuromuscular position – main principles and doubts
• – What position should we choose and when should we look for it?
• – Does an incorrect position in the joint guarantee TMD?