15 Day Basic Curriculum
Intensive Training in Occlusal Medicine
Hands On + Lecture
Clinical Instrumental Analysis
Clinical Instrumental Analysis is a proven part of the diagnostic approach in interdisciplinary dentistry. Instrumentation provides additional information which is critical to a complete diagnosis. The instrumentation taught includes semi and fully adjustable articulation, anatomic and kinematic facebow, MPV, CPM and Electronic Condylography. Condylography is a non-invasive method of monitoring the patient’s individual movements of their mandible within 6 degrees of freedom. At the centre of of these studies are the translational and rotational components of hinge-axis movement of the mandible. These movements are related to a standardized craniomandibular coordinate system (hinge-axis-orbital coordinate system) based on a zero starting point called Reference Point (RP)
Condylography recordings are useful to program condylar housings of semi- and fully-adjustable articulators according to the patient-individual movement patterns. The data may also be used to judge the mobility and motility of the TMJs. Based on standardized border movements (Protrusion, Mediotrusion right and left and Open/Close) preliminary assessment of the functional status can be performed. Functional movements (Bruxing, Speech, Swallow, etc.) can be analyzed and integrated where indicated into the treatment planning.
Professor Dr. Rudolph Slavicek
VieSID: Professor Slavicek, what does your concept of Interdisciplinary Dentistry mean?
Prof. R. Slavicek: At university dental studies and general medicine are two separate studies.
Nevertheless I consider all stages of the dental education and formation as well as practical work integrated in general medicine, whereby interdisciplinary issues must not be neglected in any of these areas.
Interdisciplinary dentistry means the cooperation and coordination between different medical specialist areas and dentistry. In dentistry we include for instance orthodontics, prosthodontics, periodontology and all the others, and not to forget prosthetic dentistry. But for a responsible approach in interdisciplinary dentistry other medical fields have to be called in.
The interdisciplinary approach should be a concept which can be used in a standardized way for all patient cases. Problems can be identified already at an early stage without taking the risk that health problems settle or become chronic.
VieSID: Will there be a team of different doctors for each patient?
Prof. R. Slavicek: With due regard being paid to the patient’s requirements and wishes an exact diagnosis and hence a detailed case planning has to be made. This gives the necessary evidence if a specialist of another medical field has to be called in.
In any case, the patient always is the centre of attention.
VieSID: Does the patient deal with different doctors? Who will be the reference person?
Prof. R. Slavicek: To guarantee a successful and a frictionless procedure, the main contact person will be the dentist responsible for the restoration. In the final therapy plan he /she will involve other specialists, e.g. orthopaedics, physiotherapists, ENT physician, eye specialists or psychotherapists.
VieSID: You just mentioned the domain of psychotherapy.
Prof. R. Slavicek: For patients with psychic or psychiatrical problems it is necessary to be very sensitive and empathic. In these cases psychologists, psychiatrists and psychotherapists play an important role to support both the patient and the dentist. This team should consist of a well matched group of very experienced specialists.
VieSID: Diseases caused by false posture are increasing drastically. How would you describe the role of the dentist in cooperation with other disciplines?
Prof. R. Slavicek: The various and increasingly occuring problems due to bad posture are mainly caused and intensified by our sedentary way of life. Our upright posture is one of the risk factors which we have to owe to evolution and our becoming two-legs.
Posture problems, backache, headaches and tension are caused by shortened and weakened muscles. A large part of the problems and of the pain can be put down to a lack of mobility. For these cases we call into action the parallel disciplines of manual medicine, first of all physiotherapy for a physical treatment of muscle problems.
The treatment of posture problems with pain resulting out of it and other symptoms has to be done in consultation with the dentist
VieSID: communication within the interdisciplinary team – a difficult subject?
Prof. R. Slavicek: During treatment of complex cases the dentist, as the main contact person, should in any case be informed by all other attending physicians about diagnosis, therapy plans and medication.
Well performed communication with the regular exchange of medical findings can make it easier to establish a good therapy plan and to get optimal and satisfying results.
VieSID: you are developing special concepts for the treatment of youths and children.
Prof. R. Slavicek: Especially during childhood and youth it is important to focus on dental prophylaxis. Early disorders can lead to serious consequences if not noticed in time. Regular checks in all stages from primary dentition to mature dentition must also be seen from an interdisciplinary aspect and are therefore a definite must.
The articulator is a device used for simulating jaw movements. Plaster models of the upper and the lower jaw are mounted to the articulator to simulate the natural chewing movements and the dental status, so that he dentist can identify occlusal problems and can initiate the necessary treatment steps for a perfect function of the masticatory organ.
The use of an articulator is especially necessary for making partial or complete dentures and during functional analysis.
Axiography means recording of movement traces of the lower jaw respectively the condyles (hinge axis). see Condylography
Bite splint (occlusal splint)
The bite splint is an individually adjusted, removable and temporary synthetic splint which is used for a lack of contact between the chewing surfaces of the jaws. Bite splints mostly are applied to the lower jaw. The aim of the bite splint therapy is the elimination and relief of wrong or overload of the teeth or jaw joints.
Bruxism is the grinding of teeth or clenching of teeth. It usually occurs unconsciously at night while sleeping or during the day. The main causes of bruxism are psychological and emotional stress and tension, but triggers can also be sleep-related breathing disorders, nicotine, alcohol consumption or medication. This overload can lead to destruction of the hard tooth substance, which will make the teeth sensitive to pain. Bruxism can be diagnosed with the help of the BruxChecker, a simple diagnostic tool. The result is an overload of the teeth, the tooth holder and / or excessive wear and damage to the tooth structure. These processes can make your teeth sensitive and painful. A gnash splint can help
Bennett – movement
(Bennet, London Oral Surgeon, 1870-1947); this means lateral, spatial displacement of the lower jaw during lateral movement (so-called lateral movement or laterotrusion). The laterotursion condyle is laterally displaced during a laterotrusion movement. The temporomandibular joint head (condyle) on the laterotrusion side (“working joint”, “working condyle”, functional joint, “resting condyle”, see illustration) can – due to the anatomy of the temporomandibular joint – experience the following movements: to the side and to the front = lateroprotrusion to the side and back = latero retrusion to the side and up = laterostrusion to the side and down = laterodetrusion This Bennett movement can start immediately and at the same time at the beginning of the sideways movement.
Mediotrusion angle, angle between the pro and mediotrusion path of the vibrating condyle, projected onto the horizontal plane (= horizontal mediotrusion path), English: Bennett’s angle; (London oral surgeon Bennet, 1870-1947). This angle, which is described as “difficult” by definition, is based on a peculiarity of the temporomandibular joint during the chewing act: In the case of pure feed movements, the two condyle centers describe, among other things, a uniform path running in the ventral direction (towards the abdomen). With a sideways movement (laterotrusion, eg for chewing) the condyle on the mediotrusion side (“balance side”) moves ventrally and medially (so-called swinging condyle). The other condyle is the movement center (work side, so-called resting condyle) the movement center. The Bennet angle is now the angle measured on a horizontal plane between the recording of a pure feed movement in the sagittal direction (protrusion movement) and a lateral (lateral) movement of the “oscillating condyle” on the balance side. The path of this condyle is described by a straight line that connects the beginning and end of the condyle path recording. This angle is approximately 10 – 15 degrees on average. (Source: zahnlexikon-online.de) that connects the beginning and end of the condyle path recording. This angle is approximately 10 – 15 degrees on average. (Source: zahnlexikon-online.de) that connects the beginning and end of the condyle path recording. This angle is approximately 10 – 15 degrees on average. (Source: zahnlexikon-online.de)
dental procedure to exactly duplicate parts of jaw and teeth for a so-called model which displays the situation outside the mouth.
Condylography is necessary for the extensive diagnosis and diagnosis of craniomandibular dysfunctions. In condylography, the movements of the temporomandibular joints are recorded three-dimensionally.
three-dimensional motion of the condyle in the skull-related coordinate system with division into: horizontal condylar : movement path of the condyle to the horizontal plane projected frontal condylar : movement path of the condyle on the frontal plane.
Condylar position (centric)
Term for the position of the temporomandibular heads in the terminal, that is, the most distant hinge axis position. The TMJ heads are located in the zenith of the joint pit.
mandible, condyle, capitulum mandibulae, joint head, joint head, temporomandibular joint head, movable, roller-shaped part of the temporomandibular joint, which sits at the tip of the condylar process of the lower jaw. Articulates directly with the intermediate disc (disc) and indirectly with the socket (fossa mandibularis). When subjected to violence, its approach to the lower jaw (collum mandibulae) is one of the fragile parts of the lower jaw (“collum fracture”). A “swinging condyle” means the joint head on the balance side; the “resting condyle” is that of the working side (Bennet angle, mediotrusion side (source: zahnlexikon-online.de)
CMD (craniomandibular dysfunction)
(Dysfunction; cranio = derived word part for skull or head, mandibular = lower jaw),
Malfunction in the area of all structures that determine and control the position of the lower jaw to the upper jaw; Collective name for a diverse complex of diseases of the chewing system that relate to symptoms in the head and neck area, such as:
- migraine-like possibly chronic headache
- Trigeminal pain / facial pain
- Pain and / or tension in the area of the neck and shoulder girdle muscles
- stiff neck
- Myalgia in the entire course of the back muscles
- Disc problems
- Static problems in the loin, hips or knees
Competitive athletes prone to injury
In addition to clinical and instrumental functional analysis, imaging methods (based on X-ray technology, magnetic resonance methods, ultrasound methods (sonography), endoscopic methods (arthroscopy)) and consultative methods (for clarifying psychological and orthopedic factors (especially the cervical spine)) are used for diagnosis.
Two therapeutic approaches are under discussion: a somatic and a psychological. The somatic approach focuses on changes in occlusion, splint therapy, medication and surgical measures, the psychological approach focuses on home exercises, stress management, education, biofeedback, hypnosis and behavioural therapy. In a controlled, randomized study (Journal of Orofacial Orthopaedics / Progress in Orthodontics, 04/2002: 259-260), 124 patients with CMD between 18 and 70 years were divided into two groups. One half was treated with patient education, physiotherapy, splint therapy and medication, the other with three three-hour information sessions, instructions for stress management, relaxation procedures and an individually developed home exercise program. The success of the therapies was compared after six weeks and six and twelve months. It was shown that the patients from the home exercise group performed significantly better in almost all parameters at all times. (Source: zahnlexikon-online.de)
The Craniomandibular System (CMS) encompasses all organs, muscles and nerves of the head and shoulder area that work closely together. Incorrect strain on the masticatory muscles and the temporomandibular joints, but also incorrect posture of the support and holding apparatus can lead to painful symptoms.
Organs of the head and shoulders:
- Tooth retention device (periodontium)
- Chewing organ (teeth, temporomandibular joints, chewing muscles)
- Swallowing organs (swallowing muscles)
- Speech organs (speech muscles)
- Facial expressions and contact organs (facial muscles)
- Hearing organs (ears)
- Visual organs (eyes)
- Olfactory organs (nose)
Central switching organ (brain, pulse networking via sensors and nerves)
Dysgnathia is a summary of the malformations of the teeth, jaws and / or the chewing system. The anomalies can affect the position of the teeth, the teeth, the shape of the jaw, the position of the jaws in relation to each other or the installation of the jaws in the skull and, as a result, can cause aesthetic and functional impairments
Functional analysis / functional dentition analysis
Examination to determine or exclude malfunctions in the chewing organ
Teaching of the jaw, in particular its functions; Treatments from a gnathological point of view take into account the teeth, but also the structures surrounding them, the muscles, ligaments and bony parts, such as the temporomandibular joint. The structures and functions are examined. (Source: gzfa.de)
If the teeth are not correctly connected to each other, the lower jaw automatically shifts to a new position when closing to compensate for the misalignment of the teeth. This results in the state of malocclusion.
The contact of the teeth of the upper jaw with those of the lower jaw. The contact points form the occlusal plane.
A distinction is made between: Static occlusion – tooth contacts without movement of the lower jaw. The static occlusion is divided into habitual, centric and maximum occlusion. Dynamic occlusion – tooth contacts that result from movement of the lower jaw. The dynamic occlusion is divided into anterior guidance, canine guidance and group guidance
The field of dentistry that deals with the treatment of misaligned teeth.
The human temporomandibular joint lies in a hollow at the base of the skull just in front of the bony ear canal. It is a rotating sliding joint that is surrounded by a joint capsule. The temporomandibular joint is the only joint in the body that can move in 3 axial directions. (Source: cmd-zahaerzte.com)
are considered the most common cause of atypical and unexplained symptoms. The following symptoms occur as a result of temporomandibular disorders: Neck complaints, migraines, tinnitus, fibromyalgia or psychosomatic disorders