Recapturing the Articular Disc or Repositioning the Mandibular Condyle? What about Rethinking the Concept as the Recovery of the Physiological Relationship of the Head of the Mandible with the Articular Disc. Patients with a long history of pain. Case series. First Section.

Recapture the articular disc, repositioning the mandibular condyle?

What about rethinking the concept as the recovery of the physiological relationship of the mandible head with the articular disc ,WHEN IT IS POSSIBLE.

And when is it not possible? What is the differential diagnosis? WHAT CAN WE OFFER TO OUR PATIENTS?

What type of orthotic or intraoral device to use? What is the purpose of an orthotic  in a TMJ Pathology treatment? Repositioning the jaw, recapturing the articular discs? Is this always possible? DEPEND ON THE DIFFERENTIAL DIAGNOSIS!

Does it have changes in the articular structures of the temporomandibular joint?

Does it have distortions in the horizontal, vertical and transverse posture of the craniomandibular complex?

How are the bones?

How’s the cartilage?

How’s the articular disk?

How are the muscles in this system?

How is the cervical spine in relation to the whole system?

How is the relation of the vertebral column with the other parts of the system?

The teeth, the two temporomandibular joints and the postural musculature are parts of the same bone, the mandible. They are deeply interrelated and interdependent in growth, form, and function. An abnormality in one, profoundly affects the others.

1 frente

A 30-year-old female patient presents at the clinic with a history of headache, pain in the forehead, pain and stiffness in the nape of the neck, left eyebrow pain, pain behind the right eye, and pain in the right shoulder. The patient reports TMJ pain (temporomandibular joint) on the right side.

The patient reports bilateral crackling, non-specific facial pain, and muscle tremor, difficulty opening the mouth, difficulty in chewing and mandibular locking.

Summary report written by the patient:

I do not remember a sudden drop where there might have been some kind of injury.
At 6 years of age I was a gymnast. I always had falls, front, back and head. But there were protections on the floor.

Near 8 years old, I extract a molar from the lower left side. I think that from this I have always forced more chewing on the right side.

At approximately 13/14 years of age, I remember starting the cracks on the right side. On this side I had a cross bite and a deciduous canine that “bit” behind the lower tooth.

At this stage, the crackling became more frequent, causing a bit of difficulty to fully open the mouth.  When trying to open the mouth without the snap, the opening becomes smaller than after the click. That is, if I do not play with the jaw, the mouth does not open completely.

In 2004 I had the first “lockup”. I remember being in winter and cold. I tried to do the “game” of the jaw and I could not open the mouth. Then I forced myself to open my mouth and I felt a strong crack, followed by pain in the ear / nose. The impression was that it had displaced some bone / nerve.

From this episode, whenever I force more the region, the locking happens. Ex: when I eat meats, candy, peanuts. Things that I need to force when chewing.

In 2008 I put orthodontic appliance to make the corrections. In the treatment, I made a process of spacing the teeth, with a device in the roof of the mouth to open the arch. I kept my teeth apart for a while.

After finishing the treatment, corrected the teeth, the clicks returned lighter. Approximately 1 year later, the locking returned as well. I started with headaches and cervical pain. I felt slight tingling in the head.

In 2015 I started to hear some kind of “sand” on the left side. Then I got pregnant and in this period began the crackling also on the left side. In February 2017 I had the first “lock” on the left side.

Now when I feel the locking, I try to relax the muscles well, leaving the jaw loose for a few minutes. Sometimes it returns to normal anyway, other times I have to force it with the opening of the mouth, causing a strong crack.

2 foto inicial perfil

Current information:

When I close my mouth, I feel my jaw line back slightly, to “marry” the bite. To keep my mouth “loose” and comfortable, I have to snap both sides, and let the jaw loose.

When I try to open my mouth without the snaps, the opening becomes smaller than after the click. That is, if I do not play with the jaw, the mouth does not open completely.

Crashes usually occur:

– Yawning;

– In the morning (awake with the jaw locked);

– Eating meats.

2 tomo

CT: Part of the initial study of the patient sent before the consultation requested by another professional.

Anamnesis and clinical examination are a key part in the diagnosis of patients with TMJ pathology.

Computed tomography is an excellent image, but when we treat a synovial joint in a patient with TMJ pathologies, CT does NOT PROVIDE THE INFORMATION OF THE SOFT TISSUES.

Magnetic Nuclear Resonance (NMR) can give a lot of information and not just the position of the disk. It is essential to have the knowledge to KNOW WHAT TO DO WITH THIS INFORMATION.

We cannot treat a patient with mandible head necrosis or with medullary edema or arthrosis or rheumatoid arthritis or lupus in the same way that we treat another patient with only a wrong position of the jaw.

The temporomandibular joints of all these patients need to be decompressed, but that is only part of the problem.

3 dentes inicHabitual occlusion of the patient on the day of the consultation.

4 oclusaisUpper and lower occlusal views of the patient prior to treatment.

Orthodontic treatment contention wire is observed between the right and left lower canines.

5 panoramica

Initial panoramic radiograph of the patient before treatment.

Orthodontic treatment contention wire is observed between the right and left lower canines.

6 laminografia

The laminography of the temporomandibular joints shows a modification of the growth axis of the mandibular condyles in both the left and right caused by a traumatism in the early childhood, (fracture in green stick).

Retro position of both mandibular heads in the articular fossae.

TMJ laminography in habitual occlusion and open mouth.

cicatriz do queixoThree-dimensional asymmetries in the head of the condyle may have been caused by different etiologies and cause morphofunctional pathologies.

Changes in the orientation of the mandible head occur in patients who have suffered blows in the chin region, either anteroposterior, vertical or lateral. We can observe in these cases a deformation of the head of the mandible in the form of curvature, with an anterior concavity, which in some cases may be so important which produces a compression of the retrodiscal region, causing severe symptoms.

7 frontal

Frontal radiography of the patient in habitual occlusion before treatment.

Orthodontic treatment contention wire is observed between the right and left lower canines.

8 teleperfil

Lateral radiograph of the patient in habitual occlusion before treatment.

9 c 7Lateral and cervical radiograph of the patient in habitual occlusion before treatment. Note the loss of cervical lordosis and rectification of the cervical spine.

16 rnm inicial 1

MRI: sagittal slices of the left TMJ in the closed mouth before treatment. There is an anteroversion of the mandibular condyle. The mandibular head is in retro position.

The articular disc is displaced anteriorly, with reduction in maneuvers in open mouth.

Important retrodiscal compression.

17 rnm inicial 2

MRI: sagittal slices of the left TMJ in the closed mouth before treatment. There is an anteroversion of the mandibular condyle. The mandibular head is in retro position.

The articular disc is displaced anteriorly, with reduction in maneuvers in open mouth.

Important retrodiscal compression.

19 rnm inicial4

MRI: sagittal slices of the right TMJ in the closed mouth before treatment. There is an anteroversion of the mandibular condyle. The mandibular head is in retro position.

The articular disc is displaced anteriorly, with reduction in maneuvers in open mouth.

Important retrodiscal compression.

20 rnm dir inicial5

MRI: sagittal slices of the right TMJ in the closed mouth before treatment. There is an anteroversion of the mandibular condyle. The mandibular head is in retro position.

The articular disc is displaced anteriorly, with reduction in maneuvers in open mouth.

Important retrodiscal compression.

21 rnm inicial 6

MRI: sagittal slices of the right TMJ in the closed mouth before treatment. There is an anteroversion of the mandibular condyle. The mandibular head is in retro position.

The articular disc is displaced anteriorly, with reduction in maneuvers in open mouth.

Important retrodiscal compression.

22 frontal rnm inicial 7MRI: frontal slices of the right and the left temporomandibular joints, closed mouth in habitual occlusion before treatment.

The frontal slice of the right and left temporomandibular joint evidences a severe loss of joint space.

24 atm aberta24a eletromiografia dinãmica habitual rolos de algodão

Dynamic electromyography record of the patient in habitual occlusion and with cotton rolls on the right side (second column), left side (third column) and both right and left sides (fourth column).

Note the improvement in recruitment of motor units in the fourth column.

25 registro cineciografico inicial

Patient’s initial record for the construction of the DIO ( intraoral device)

To correctly evaluate the Maxilomandibular relationship we should begin to consider the physiological rest mandible position.

Physiological rest is a concept applicable to all the muscles of the body.

The stomatognathic musculature is no exception.

The patient’s masticatory muscles were deprogrammed electronically and a new physiological neuromuscular position at rest was recorded.

The patient has in this first record a pathological free space of 6,4 mm. 

The patient also presented a 0.4 mm  of mandibular retro position.

26 recalibraÇÃo da orteseRecalibration of the physiological neuromuscular position of the DIO (intraoral device)

In the first phase the intraoral devices are recalibrated and / or changed according to each specific case as the jaw, muscles and TMJ improve.

28 ortoseOcclusion of the patient with the DIO (intraoral device)

With the record obtained with the jaw tracker an intraoral device (DIO) was made to reposition the mandible three-dimensionally.

The PHYSIOLOGICAL NEUROMUSCULAR position was recorded in the form of an occlusal bite record, which was later used to make a DIO (intraoral device)

In the first phase the intraoral devices are recalibrated and / or changed according to each specific case as the jaw, muscles and TMJ improve.

29 controle da orteseAnother cinecigraphic record to control the DIO (intraoral device) in a physiological neuromuscular position as the device is changed or recalibrated.

The patient did not report any more symptomatology. The electromyography and kinesiography records objectively showed improvement of the neuromuscular function.

I asked for the second MRI (nuclear magnetic resonance) to objectively evaluate the physiological relationship between the mandibular condyles and the articular disc.

35 rnm comparativas 1RNM: Comparison of the sagittal slice of the left TMJ, closed mouth, before the physiological neuromuscular treatment, and of the same left TMJ, closed mouth, after the FIRST PHASE of the treatment.

Recovery of the physiological relation of the head of the mandible with the articular disc.

35b rnm comparativas 1RNM: Comparison of the sagittal slice of the left TMJ, closed mouth, before the physiological neuromuscular treatment, and of the same left TMJ, closed mouth, after the FIRST PHASE of the treatment.

Recovery of the physiological relation of the head of the mandible with the articular disc.

36 rnm comparativas 2RNM: Comparison of the sagittal slice of the left TMJ, closed mouth, before the physiological neuromuscular treatment, and of the same left TMJ, closed mouth, after the FIRST PHASE of the treatment.

Recovery of the physiological relation of the head of the mandible with the articular disc.

38 rnm comparativas 4RNM: Comparison of the sagittal slice of the left TMJ, closed mouth, before the physiological neuromuscular treatment, and of the same left TMJ, closed mouth, after the FIRST PHASE of the treatment.

Recovery of the physiological relation of the head of the mandible with the articular disc.

39 rnm comparativas 5

RNM: Comparison of the sagittal slice of the rigt TMJ, closed mouth, before the physiological neuromuscular treatment, and of the same right TMJ, closed mouth, after the FIRST PHASE of the treatment.

Recovery of the physiological relation of the head of the mandible with the articular disc.

40 rnm comparativas 6RNM: Comparison of the sagittal slice of the rigt TMJ, closed mouth, before the physiological neuromuscular treatment, and of the same right TMJ, closed mouth, after the FIRST PHASE of the treatment.

Recovery of the physiological relation of the head of the mandible with the articular disc.

41 rnm comparativas7RNM: Comparison of the sagittal slice of the rigt TMJ, closed mouth, before the physiological neuromuscular treatment, and of the same right TMJ, closed mouth, after the FIRST PHASE of the treatment.

Recovery of the physiological relation of the head of the mandible with the articular disc.

42 rnm comparativas 8RNM: Comparison of the sagittal slice of the rigt TMJ, closed mouth, before the physiological neuromuscular treatment, and of the same right TMJ,  closed mouth, after the FIRST PHASE of the treatment.

Recovery of the physiological relation of the head of the mandible with the articular disc.

43 frontal rnm comparativas 8

RNM: Comparison of the frontal slice of the left TMJ, closed mouth, before the physiological neuromuscular treatment, and of the same left TMJ, closed mouth, after the FIRST PHASE of the treatment.

Recovery of the physiological refrontallation of the head of the mandible with the articular disc.

44 frontal rnm comparativas 8

RNM: Comparison of the frontal slice of the rigt TMJ, closed mouth, before the physiological neuromuscular treatment, and of the same right TMJ, closed mouth, after the FIRST PHASE of the treatment.

Recovery of the physiological refrontallation of the head of the mandible with the articular disc.

45 imagens

The patient did not report any more symptomatology. The comparative MRI showed the recovery of the physiological relationship of the mandible head with the articular disc.

The electromyographic and kinesiographic records objectively showed improvement of the neuromuscular function.

It was decided to start the SECOND PHASE of the treatment to remove the DIO (intraoral device), maintaining the neuromuscular physiological occlusion.

For this we use a three-dimensional orthodontic, where the teeth are erupted to the new physiological neuromuscular position.

46 depoimento 1Patient Testimony:

My first memory of locking joints was at age 15 or so.

I looked for orthodontic specialists; I made the necessary “adjustments”, but the locking and the pain still continued.

I looked for Dr. Lidia now at the age of 30, since other experts told me that only surgery would be possible in my case. And yet, without knowing exactly whether we would succeed.

After starting the first phase of treatment with the device, the pain ceased and never again I had the jaw locking that so frighten me.

47 depoimento 2

I adapted very easily to the treatment, I was and I am being much disciplined with the use of the device.

Now, as Dr. Lidia explained to me, with the discs already in the right place, we will pass for the second phase, for withdrawal of the device.

Today I’m having a routine without worry that I can “lock” at any time.

I’m very grateful to Dr. Lidia.

TMJ Study and Investigation Page. Three years of publication.

Dear friends,

At December 2014 I started the project TMJ Study and Investigation Page. At first, all its content was offered in three languages: Portuguese, English and Spanish. Due to the analysis of the webpage access statistics, at March 2015 I decided to offer the content solely in Portuguese and English.

Anyway, access to the contents of the page is still available to other researchers, professionals in the field and to those interested in the research that I develop.

Three years of publication

Nowadays, the medicine based on evidence is hierarchically stratified from top to bottom, where in the base of the pyramid we find the clinic cases, which are rarely seen as evidence.

The TMJ Study and Investigation Page had in its conception, the purpose of posting the clinic cases, which were carefully published with the documentation related to each of the patients treated at Clinica MY with pain complaints, dysfunction and TMJ pathology.

The proposition was of presenting these clinic cases and concepts in order share them, offering free access to the content along images, surface electromyographies, computerized kinesiography, scanned before and after the therapeutic process. Cases of tridimentional orthodontics and neuromuscular phisiologic reabilitation of the second phase of treatment, after the TMJ treatment, were also included.

FINAL

The TMJ Study and Investigation Page completed in the month of December, three years of life.

I remembered to celebrate on the first anniversary of the Page.

In the middle of the work with patients, teaching and publications I did not remember to celebrate the second year.

I want to celebrate these three years with you.

With this project, we have a place in the Internet that presents a line of work known as neuromuscular physiologic dentistry, which takes into account the whole body system. It is an area which acts on posture, mandibular functioning and considers the entire body system.

In order to do that, the neuromuscular physiologic dentistry aims to establish, in the patient, a position that is based on a harmonious relation between the muscles, the teeth, and the temporomandibular joints.

MARCUS LAZARI frontal E SAGITAL

In the publication of this year’s end I have chosen the most significant images of all these years of publications, with direct links to each of the original publications.

At the end of this publication I placed the links of the publications of the first year of this page.

3 ANOS DE PUBLICAÇÕES 2

The TMJ Study and Investigation Page  has grown tremendously and continues to receive visitors from all over the world.

Thank you!

Lidia Yavich

Temporomandibular Joint Pathology in a Patient with Congenital Fusion of two Cervical Vertebrae. First and Second Phase. Case Report.

33 FINAL

Postural Improvement in a Patient after Neuromuscular Physiological Mandible Repositioning Treatment. Patient with Scoliosis Surgery and Craniomandibular Symptomatology.

24

TMJ Pathologies Treatment: Patient with Severe Headaches and Temporomandibular Joint Pain with Significant Contour Irregularities in the Mandibular Condyle and Mouth Opening Limitation.

27 CEF COMPARATIVAS ingles

Reestablishment of the Bone Marrow Signal in a case of Avascular Necrosis of the Mandibular Head. Monitoring two years after treatment.

FRONTAL COMPARATIVAS ESQUERDA 2016

Neuromuscular Physiological Treatment in a Patient with Headache and Pain in the Temporomandibular Joints. Case report without possibility of Disc Recapture: first and second phase.

10 abre e fecha inicial

FINALE FINALE

TMJ Pathologies Treatment: Patient with Pain in the Back of the Head, Bilateral Tinnitus and Constant Teeth and Prosthesis Fracture. First and second phase. Case Report.

ITACIR COMBINADA

TMJ Pathologies Treatment: Patient with headache for 30 years. Neuromuscular Physiological Rehabilitation. First and second phase. Case Report.

1 FOTOS FRENTE

TMJ Pathology in Professional Musicians: A look beyond the risk factors. Physiological Neuromuscular Rehabilitation. First and second phase. Case Report.

HELLA

TMJ Study and Investigation Page. One year of publication

INITIAL

2

The TMJ Study and Investigation Page  has grown tremendously and continues to receive visitors from all over the world.

Thank you!

Lidia Yavich

TMJ Pathology in Professional Musicians: A look beyond the risk factors. Physiological Neuromuscular Rehabilitation. First and second phase. Case Report.

Several articles and studies cite the prevalence of TMJ dysfunction in violinists and violists, especially by prolonged flexion of the head and shoulder, posture necessary to keep the violin in position. Studies also report that the incidence of TMJ dysfunction in musicians is similar to the general population.

Professional musicians require many hours of training and improvement that involve complicated movements, fast and repetitive actions with over use of the hands, fingers, arms and head.

Most articles report anxiety about professional performance and increased muscle tension, but few do a particular study of the state of the anatomical structures of the cases studied.

1 postura inicial frontalA 45-year-old female patient referred by her physiotherapist consults with complaints of headache, pain in the cervical and scapular region, muscular contractures in the mandible.

The patient also reports mandibular displacement when playing the violin and pain in both temporomandibular joints.

2 postura inicial lateralThe patient also reports clicks in both temporomandibular joints and occasionally the sensation of clogged ears.

Frequent pain in the spine and both shoulders.

At that time the patient had already consulted physiotherapists, rheumatologists, psychiatrists and psychologists.

2 bpontos de dorMarking chart of pain points.

3 OCLUSÃO INICIALImage of the patient’s habitual occlusion on the day of the appointment.

4 OCLUSAIS INICIAISUpper and lower occlusal views of the patient on the day of the consultation.

5 PANORAMICA 1Initial panoramic radiograph of the patient before treatment.

Teeth 18, 28 included.

Wear on the incisal and occlusal faces of the teeth present.

Prosthetic device 25 to 27 (26 pontic)

Horizontal resorption of alveolar ridges.

6 LAMINOGRAFIA INICIALPatient’s TMJ initial laminography before treatment

In the maximum opening position, observe the anterior angulation of the articular processes. Structural modification of the mandibular condylar process as one of the sequels of traumatism in infancy.

The patient reports a trauma in early childhood, a knock on the head while playing on a slide.

7 TELEPERFILLateral radiograph and patient profile before treatment. Patient in habitual occlusion.

8 FRONTALFrontal radiography of the patient in habitual occlusion before treatment.

9 C7Lateral and cervical radiograph of the patient in habitual occlusion before treatment.

At this time, the patient performed a CT scan of the cervical spine

In the report there is rectification of cervical lordosis.

Degenerative discopathy in C5-C6, observing reduction of the height of the disc space and osteophytic proliferations reactional. At this level the disc-osteophyte bar is identified that touches and distorts the ventral face of the dural sac.

There is no stenosis of the central vertebral canal.

Neural foramina with amplitude within the limits of normality.

Mild signs of uncovertebral arthrosis C5 and C6.

Relationship C1-C2 maintained.

Symmetric paravertebral regions.

10 eletromiog dinamica inicialDynamic electromyographic record in patient’s habitual occlusion before treatment. Note the minimal activation of the right and left masseter muscles in maximal intercuspation and the high activation of the right and left temporal muscles.

The masseter muscles are the most powerful muscles of the stomatognathic system, the temporal muscles even being elevating muscles have to have an equal and preferably smaller activation than the masseter muscles.

11 cineciog 1Initial cineciographic record of the patient.

Three-dimensional view of the mandibular displacement.

The record shows mandible opening, closing and speed when the patient makes these movements. The patient shows a 47 mm opening and a right deflection of 3.9 mm

Note a significant  loss of velocity in the middle of the mandibular closure.

13 ress esq fechMRI: sagittal slice of the left TMJ, closed mouth, anteversion of the mandibular condyle can be observed.

14 ress esq fechMRI: Another sagittal slice of the left TMJ in the closed mouth, the anteversion of the mandibular condyle can be observed.

Important area of retrodiscal compression at the level of mandibular condyle deflection. Primary objective has to be the three-dimensional decompression of the mandibular condyle.

15 ress esq fechMRI: Another sagittal slice of the left TMJ in the closed mouth, the anteversion of the mandibular condyle can be observed.

Important area of retrodiscal compression at the level of mandibular condyle deflection. Primary objective has to be the three-dimensional decompression of the mandibular condyle.

16 ress esq fechMRI: internal sagittal slice of the left TMJ, closed mouth.

17ress dir fechMRI: internal sagittal slice of the right TMJ, closed mouth.

18ress dir fechMRI: another sagittal slice of the right TMJ, closed mouth, the anteversion of the mandibular condyle can be observed.

The articular disc is displaced anteriorly, with reduction in open-mouth maneuvers. (open mouth images not included in the post)

Important area of retrodiscal compression at the level of mandibular condyle deflection. Primary objective has to be the three-dimensional decompression of the mandibular condyle.

19 ress dir fechMRI: another sagittal slice of the right TMJ, closed mouth, the anteversion of the mandibular condyle can be observed.

The articular disc is displaced anteriorly, with reduction in open-mouth maneuvers. (open mouth images not included in the post)

Important area of retrodiscal compression at the level of mandibular condyle deflection. Primary objective has to be the three-dimensional decompression of the mandibular condyle.

20 ress dir fech

MRI: another sagittal slice of the right TMJ, closed mouth, the anteversion of the mandibular condyle can be observed.

The articular disc is displaced anteriorly, with reduction in open-mouth maneuvers. (open mouth images not included in the post)

Note the posterior compression in this section.

Primary objective has to be the three-dimensional decompression of the mandibular condyle.

21 FRONT DIR E ESQMRI: frontal slice of right and left temporomandibular joints, closed mouth in habitual occlusion before treatment.

The frontal slice of the right temporomandibular joint shows a loss of joint space, especially in the region of the external lateral pole of the joint. Both frontal images show a decrease in joint space.

Slight medial disc deviation.

21A registro inicial para o DIOTo correctly evaluate the maxillomandibular relationship we should begin to consider the physiological rest mandible position.

Physiological rest is a concept applicable to all the muscles of the body.

The stomatognathic musculature is no exception.

The patient’s masticatory muscles were deprogrammed electronically and a new physiological neuromuscular position at rest was recorded.

The patient has a pathological free space of 5.8 mm, already discounting the two physiological mm of a healthy free space.

The patient also presented a 2.1 mm mandibular retroposition

22 oclussao com o DIOWith these data we constructed a DIO (intraoral device), to maintain the three-dimensional recorded position. This device must be electromyographically tested to objectively measure the patient.

It is logical that the report of the patient’s symptomatology is important, but the surface electromyography shows in an objective way if the muscular function improved, worsened or did not modify.

22A eletromiografia com o DIOElectromyographic record with DIO (intraoral device) in physiological neuromuscular position.

Note the higher recruitment of motor units in the masseter muscles that previously showed very little activity.

22A Registro cinesiográfico para controlar o DIO em posição neurofisiológicaCineciographic record for the DIO (intraoral device) control in physiological neuromuscular position as the device is changed or recalibrated.

In the first phase the intraoral devices are recalibrated and / or changed according to each specific case as the jaw, muscles and TMJ improve.

Each case IS UNIQUE. There are cases where the TMJ structures are so damaged that the objectives outlined will have limitations dictated by the initial diagnosis.

These limitations refer not only to the structures of the temporomandibular joint, but also to the patient’s systemic condition.

22B 2 Registro cinesiográfico para controlar o DIO em posição neurofisiológicaAnother cineciographical record to control the Dio in a physiological neuromuscular position as the device is changed or recalibrated.

23 laminografias comparativas com dioComparison of left and right temporomandibular joint laminography, closed and open mouth: in habitual occlusion before treatment and with the DIO (intraoral device), in a physiological neuromuscular position.

24 ct comparativas com dioComparison of lateral radiographs and cervical spine of the patient: in habitual occlusion before treatment and with the DIO (intraoral device), in a physiological neuromuscular position.

With the jaw in a physiological neuromuscular position the physiotherapist colleague worked the rest of the muscle chains, using global manual techniques, always taking into account the individuality of the patient. This work in a patient with degenerative discopathies should be maintained

25 rad lateral e perfilComparison of lateral radiographs of the patient: in habitual occlusion before the treatment and with the DIO (intraoral device), in a physiological neuromuscular position.

Improvement of the profile and recovery of the vertical dimension.

26TELEFRONTAIS COMPARATIVASComparative frontal radiographs of the patient: at the beginning of treatment in habitual occlusion, during treatment with DIO (intraoral device) in physiological neuromuscular occlusion.

27 PANORAMICA com o DIOPanoramic radiograph of the patient with the DIO constructed in a physiological neuromuscular position.

47 ress esqu comparativa 1MRI: comparative sagittal slices of the left TMJ, closed mouth, before and after the physiological neuromuscular treatment.

Three-dimensional joint decompression is noted. Primordial objective in this specific case.

48 ress esqu comparativa 1MRI: comparative sagittal slices of the left TMJ, closed mouth, before and after the physiological neuromuscular treatment.

Three-dimensional joint decompression is noted. Primordial objective in this specific case.

49 ress esqu comparativa 1MRI: comparative sagittal slices of the left TMJ, closed mouth, before and after the physiological neuromuscular treatment.

Three-dimensional joint decompression is noted. Primordial objective in this specific case.

50 ress esqu comparativa 1MRI: comparative sagittal slices of the left TMJ, closed mouth, before and after the physiological neuromuscular treatment.

Three-dimensional joint decompression is noted. Primordial objective in this specific case.

51 ress direita comparativa 1MRI: comparative sagittal slices of the right TMJ, closed mouth, before and after the physiological neuromuscular treatment. In this section we can see the improvement in the discal condylar relationship obtained.

Three-dimensional joint decompression is noted. Primordial objective in this specific case.

51a ress direita comparativa 1MRI: comparative sagittal slices of the right TMJ, closed mouth, before and after the physiological neuromuscular treatment. In this section we can see the improvement in the discal condylar relationship obtained.

Three-dimensional joint decompression is noted. Primordial objective in this specific case.

52 ress direita comparativa 1MRI: comparative sagittal slices of the right TMJ, closed mouth, before and after the physiological neuromuscular treatment. In this section we can see the improvement in the discal condylar relationship obtained.

Three-dimensional joint decompression is noted. Primordial objective in this specific case.

53 ress esquerda frontal comparativa 1

MRI: Comparison of the frontal slice of the LEFT TMJ, closed mouth, before the physiological neuromuscular treatment, and of the same LEFT TMJ after the FIRST PHASE.

Note the decompression of the temporomandibular joint, especially in the lateral pole.

54 ress direita frontal comparativa 1

MRI: Comparison of the frontal slice of the RIGHT TMJ, closed mouth, before the physiological neuromuscular treatment, and of the same RIGHT TMJ after the FIRST PHASE.

Note the decompression of the temporomandibular joint, especially in the lateral pole.

The patient did not report any more symptomatology related to the TMJ. Bioinstrumentation also objectively showed an improvement in neuromuscular function.

It was decided to start the SECOND PHASE of the treatment to remove the DIO (intraoral device), maintaining the physiological neuromuscular occlusion.

For this we used a three-dimensional orthodontic, where the teeth are erupted to the new neurophysiological position.

55 ORTO 1In the second phase, in this case the three-dimensional orthodontics the patient is monitored and deprogrammed electronically, and often the device is recalibrated, to maintain the position obtained in the first phase.

Part of the sequence of the second phase (in this specific clinical case).

56 PANORAMICA COM O IMPLANTEPatient’s panoramic radiograph after the installation of the implant and the removal of the retained upper third molars.

57 ORTO 2Part of the sequence of the second phase (in this specific clinical case).

58 ORTO 3Part of the sequence of the second phase (in this specific clinical case).

59 ORTO 4Part of the sequence of the second phase (in this specific clinical case).

60 ORTO 5

Part of the sequence of the second phase (in this specific clinical case). Photograph of orthodontic wire before cutting from the right side for didactic purposes.

61 ORTO 6Part of the sequence of the second phase (in this specific clinical case). Photograph of orthodontic wire before cutting from the right side for didactic purposes.

62 ORTO 7Part of the sequence of the second phase (in this specific clinical case).

63 ORTO 8Part of the sequence of the second phase (in this specific clinical case).

64 ORTO 9Part of the sequence of the second phase (in this specific clinical case).

65 ORTO10Part of the sequence of the second phase (in this specific clinical case).

66 ORTO101Part of the sequence of the second phase (in this specific clinical case).

67 ORTO102Part of the sequence of the second phase (in this specific clinical case).

68 ORTO103Part of the sequence of the second phase (in this specific clinical case).

68 RETIRADA DO DIORemoval of the DIO (intraoral device)

69 ORTO104Part of the sequence of the second phase (in this specific clinical case).

70 ORTO105Finalization of the second phase.

71 OCLUSAL FINALPatient’s upper and lower occlusal view after the finalization of the second phase.

72 b panoramicas comparativasPatient’s comparative panoramic radiographs before and after the end of the second phase of the treatment using a three-dimensional orthodontics.

72 comparação OCLUSAIS FINAISPatient’s comparative superior and inferior occlusal view, before and after, the end of the second phase of the treatment by a three-dimensional orthodontic.

72 OCLUSÃO IcomparativasComparative occlusion of the patient before and after the end of the second phase of the treatment using a three-dimensional orthodontics.

77 registro controle após a ortodontiaKinesiographic control record after the completion of the three-dimensional orthodontics in a physiological neuromuscular position.

Coincident neuromuscular trajectories.

73 laminografias finalLaminography of the patient in physiological neuromuscular occlusion after the finalization of the second phase of the treatment.

74 3 laminografias comparativasComparative laminography of the patient: before the treatment, during the first phase of the treatment and after the finalization by the three-dimensional orthodontics.

75 TELEFRONTAIS COMPARATIVASPatient’s comparative frontal radiographs: before the treatment, during the first phase of the treatment and after the finalization by the three-dimensional orthodontics.

76 rad lateral e perfil comparativas 3Patient’s comparative lateral radiograph and profile: before the treatment, during the first phase of the treatment and after the finalization by the three-dimensional orthodontics.

78 DEPOIMENTO 1

Patient testimony:

What made me look for the treatment were recurrent headaches, frequent

(weekly) and intense, which lasted, on average, 2 days, affecting my productivity

at work as well as leisure hours.

The pain did not subside with common analgesics, requiring strong medication, which, in turn, only softened the pain a little.

Today, after the treatment, I can say that only very rarely do I suffer from these pains, greatly improving the quality of life, besides the posture.

TMJ Study and Investigation Page. One year of publication

Dear friends,

At December 2014 I started the Project TMJ Study and Investigation Page. At first, all its content was offered in three languages: Portuguese, English and Spanish. Due to the analysis of the webpage access statistics, at March 2015 I decided to offer the content solely in Portuguese and English.

Nowadays, the medicine based on evidence is hierarchically stratified from top to bottom where in the base of the pyramid we find the clinic cases, which are rarely seen as evidence. The TMJ Study and Investigation Page had, in its conception, the purpose of posting the clinic cases, which were carefully published with the documentation related to each of the patients treated at Clínica MY with pain complaints, dysfunction and TMJ pathology.

INITIAL

The proposition was of presenting these clinic cases and concepts in order share them, offering free access to the content along images, surface electromyographies, computerized kinesiography, scanned before and after the therapeutic process. Cases of tridimentional orthodontics and neurophisiologic reabilitation of the second phase of treatment, after the TMJ treatment, were also included.

site em portugues nova ingles

The TMJ Study and Investigation Page is completing, in this month of December, one year since it started, and I want to celebrate its anniversary with you. With this project, we have a place in the Internet that presents a line of work known as neurophysiologic dentistry, which takes into account the whole body system. It is an area that also operates regarding the posture and the mandibular functioning. In order to do that, the physiologic dentistry aims to establish, in the patient, a position that is based on a harmonious relation between the muscles, the teeth, and the temporolandibular joints.

site em ingles novaIn the publication of the end of this year I have chosen the most significant images of the whole year of publications, with their direct links to each one of the originals publications.

31

Joint Decompression in a Neurophysiological Mandibular Rest Position Promotes a Positive Remodeling in a Degenerative Process of a Teenager Temporomandibular Joint

english 1-1

Anatomy is the platform on which physiology functions

Sem Título-1

Structural modifications of the mandibular condylar process as one of the sequels of traumatism in infancy.

26

Articular discs recapture with mandibular neurophysiological repositioning

26

Cervical Dystonia or Spasmodic Torticollis: Positive evolution after Neurophysiological Treatment

2

Recapture of articular disc displacement with reduction. Recapture or not recapture that is the question.

17 COLUNA E PERFIL COMP

Inter relation of Craniomandibular disorders and vertebral spine. Case report

24

Tridimensional Orthodontics in the Second Phase of TMJ Pathologies

FINAL

Neurophysiological Combined Orthodontics and Rehabilitation: patient with degenerative conditions in several body joints

FINAL

TMJ Pathologies Treatment: first and second phase (tridimensional orthodontics) in a hypermobile joint patient with low signal in the head of the mandible bone marrow. Case report.

33

Articular Disc Recapture: patient with significant mandibular heads asymmetry and unilateral reducible luxation. Case report

Sem Título-1

Osteonecrosis of the Mandibular Head: recovery of condylar bone marrow alteration

6 BASAL ANTES E APOS O DEM

TMJ ( temporomandibular joint) Pathologies: Patient with severe pain in the region of the face, neck and temporomandibular joint. First and second phase.

18 comparativas

Patient with Ankylosing Spondylitis and non inflammatory TMJ pathology

15 3D comparativas

Mandible Condyle Fracture Consolidation by Neurophysiological Alignment of the Segments, Four Months after Unsuccessful Surgery. Case report

37 poster

The importance of Mandibular Rest Position by Electronic Deprogramming in the Treatment of Temporomandibular Joint Pathologies, Orthodontic Diagnosis and Oral Rehabilitation. Case report.

41 RNM AFTER TREATMENT cor

TMJ Pathologies in Children and Teenagers the Overlooked Diagnosis

evento 4

Training in Diagnosis and Treatment of TMJ Pathologies

31

The Postural Position of the Mandible and its Complexity in the Maxillomandibular Tridimensional Relation: first and second phase in a patient with severe symptoms with subtle information on the images.

e images.

26B LATERAIS COMPARATIVAS LINHA

The Tridimensional Neurophysiological Position of the Mandible in Implant Prosthesis Protocol

I want to thank my family that is always at my side in each one of the projects, I also want to thank my friends, that from Brazil and from many places of the world, supported and support this project. Last, but not least, I want to thank my colleagues and patients that often write, encouraging and thanking the existence of this virtual place.

By closing, in this moment, the annual analysis and the perspective for the year that follows, I therefore thank the readers of all places in the world that follow the TMJ Study and Investigation Page. It is a privilege to count with your visits.

With the best votes for 2016, and wishing for a year of peace, health, love and happiness for all.

Dr. Lidia Yavich

 

Patient with Ankylosing Spondylitis and non inflammatory TMJ pathology

Female patient, 40 years old comes to consultation referred by her rheumatologist WITH STRONG PAIN IN the TMJ (temporomandibular joint), TWINGES IN THE HEAD AND MOUTH OPENING LIMITATION.

The patient had a diagnosis of seronegative spondyloarthropathy until then nonspecific.Later diagnosed as Ankylosing Spondylitis

Seronegative spondyloarthropathies refers to a group of diseases that share common characteristics, including the occurrence of inflammation in the spine, peripheral joints and in various peri-articular tissues, in particular entheses.

Seronegative spondyloarthropathies laboratory outstanding feature is the absence of rheumatoid factor and auto antibodies. They have strong association with human leukocyte antigen HLA-B27.

1  The patient reports clicking on the right TMJ, difficulty to open the mouth, difficulty and paint in chewing. She also reports bruxism.2She reports feeling headache, neck pain, pain in the right eyebrow, pain behind the eyes, pain in the right shoulder. She also reports pain in both temporomandibular joints which is stronger  in the right joint.

Points where the patient reports pain

The patient marks on the record the most important points of pain.3  In the first consultation, during the anamnesis the patient reported that she had initiated a treatment for the bruxism problem, and that at one point with the device change she  began to feel a very strong pain and her mouth locked.

4The occlusal view shows the superior anterior sector wear and the anterior lower sector wear.5Patient’s panoramic radiograph.6The joints radiographic image shows the superior and posterior positioning of the articular process on the left side in the joint cavity when the jaw is in maximal intercuspal position.

In the maximum opening position, there is flattening of the posterior and anterior surface of the left mandibular condyle process and a flattening of the superior and anterior surface of the right mandibular condyle process. The right side also presents an alteration of the growth axis of the mandibular condyle.

6BPatient’s lateral and profile radiograph before treatment.7Patient’s lateral radiograph and cervical spine before treatment.7BPatient’s frontal radiograph in habitual occlusion before treatment.8 abre e fecha inicOpening and closing computerized kinesiographic record, the patient can open only 32 mm feeling strong pain, which shows an important limitation.

The patient also has a deflection of 2.7 mm to the right.8 B COMP abre e fecha inic Note in the skull graph, the left condyle moves more than the right condyle where the deviation is.

9The surface electromyography exam evaluates the superior anterior temporal right and left, the right and left masseter, the right and left digastrics and the right and left upper trapezius.

In this electromyography record the patient could not generate a good activity when we asked to bite hard (keeping the teeth in maximum intercuspation) and clench.

At the beginning of the record when we asked the patient to open the mouth it is important to note the different activity between right and left digastrics.

The left digastric activates double than the right digastric.

9

Image enlargement showing the difference in translation of the mandibular condyles. Patient in maximum mouth opening.

It is important to be able to understand and connect all the information, the surface electromyography and the computerized kinesiograph. These data still does NOT PROVIDE A DIAGNOSIS, However they are tools to help us in the diagnosis.

I asked the patient for an MRI-(magnetic resonance imaging) of the temporomandibular joints.

When the patient filled out the clinical record for the MRI she reported that she did a tattoo a month before, that prevented the realization of the MRI until completing the time of three months after the realization of the tattoo.

Remember that the resonator is a large magnet and tattoos have pigments which may contain metal and could heat up and cause burns.

We kept the patient with a temporary splint until we had the MRI information, as explained in previous posts; WE MUST NOT TREAT A PATIENT WITHOUT  A DEFINED DIAGNOSIS.

We could easily assume that as the patient had a systemic nonspecific inflammatory arthritis attacking various joints of her body also the TMJ could be involved.

It is fundamental to rethink something which SOMETIMES could be ONLY A CONJECTURE, even if the patient is a carrier of an inflammatory autoimmune disease.

In the systemic part it is the rheumatologist who will decide the therapy.

Our part is to promote a non-compressive position of the TMJ where the masticatory muscles may perform without loading the joint, and where the patient can fulfill all the functions of the stomatognathic system.

9APatient’s inflamed elbow after synovectomy with the disease still not controlled

9A  MRI: sagittal sections selected. Left TMJ closed mouth: articular disc anteriorly displaced. Change in the growth axis of the mandibular condyle.

Left TMJ open mouth: limitation in mouth opening.

The images here are in T1, all images analyzed including T2 and STIR DOES NOT SHOW inflammatory signs.

It is relevant to remember that in the first consultation, during the anamnesis the patient reported that she had initiated a treatment for the bruxism problem, and that at one point with the device change she began to feel a very strong pain and the mouth locked.

The patient remembers that the device change aimed to align the median line of the upper incisors to the median line of the lower incisors.

This has to be a warning to all of us in dentistry which were taught to carry out all our treatments without knowing the condition of the TMJ.  

9B  MRI: sagittal sections selected. Right TMJ closed mouth: articular disc anteriorly displaced. Change in the growth axis of the mandibular condyle.

Right TMJ open mouth: limitation in mouth opening.

After conducting the analysis of the MRI images, studying all the slices and all required parameters (not included in the post), we can proceed to carry out a neurophysiologic record.
10The masticatory muscles of the patient were electronically deprogrammed and the rest position was recorded with a computerized kinesiograph.

This record has been difficult to achieve. The patient was limited and in great pain. A very low DIO was made, leaving an interocclusal free space of one mm which would normally be too little.

11DIO (intraoral device constructed in neurophysiologic position)11A  Patient’s frontal image on the same day, before and after installing the intraoral device in neurophysiologic position.

11B  Patient’s lateral image on the same Day, before and after installing the intraoral device in neurophysiologic position.

11cPatient’s electromyography record in neurophysiologic occlusion wearing the device (DIO), even the muscles activation is low the difference with the initial record is remarkable.11DComparative EMG records: the upper in habitual occlusion and lower in neurophysiological occlusion with the DIO (intraoral device).12 abre e fecha com DIO  Patient’s kinesiographic record with the DIO (intraoral device) constructed in neurophysiological position.Improvement in mouth opening. 13 recalibração  DIO recalibration to improve the patient’s neurophysiological position. The condition of the patient now allows best records because the significant decrease in pain.14Control of the intraoral device, habitual and neuromuscular trajectory are coincident.15 REGISTROS DE AB COMPARATIVOSPatient’s comparative kinesiographic records before and during treatment. Improvement of the patient mandibular opening.16 abre e fecha inicNote on the skull graphic, both condyles right and left move symmetrically.16 A abre e fecha inicImage enlargement showing both condyles right and left moving symmetrically. Patient in maximum mouth opening.17 comparativosPatient’s kinesiographic records comparison with the skull 3D model before and after treatment.

17B comparativosSkull models in 3 D, graphic animation from patient’s kinesiographic record before and after treatment comparison. Patient in maximum mouth opening.

17A 2008MRI: Right TMJ, closed and open mouth before and after treatment. Articular disc in habitual position,(the disc was dislocated before treatment) Resolution of the opening limitation.

17B 2008MRI: Leftt TMJ, closed and open mouth before and after treatment. Articular disc in habitual position. Resolution of the opening limitation.

18 comparativasMRI: TMJ sagittal comparative images, open and closed mouth before and after treatment.

19 bThe patient without pain, decided to continue with the DIO and not perform the phase 2 to eliminate de DIO, with a tridimensional orthodontics. She decided only to restore the teeth that were worn. Restorations made by Dr. Luis Daniel Yavich Mattos.

20

When I was 39 years old I was diagnosed by my rheumatologist with arthritis.

All major joints of my left side were suddenly and without warning, very swollen, such as knee and elbow, preventing me from performing my simplier movements such as standing and stretching my arm.

I had swelling, redness and intense pain. Then I started to feel pain in the TMJ. I ended up in the clinic of an orthodontist and facial orthopedist  who told me that I had ‘bruxism’ and that I needed to use a device to place the tongue in the right position.

I wore the appliance for a month or two, my TMJ locked, I could not open my mouth and I felt an absurd pain in my entire head, I no longer knew what hurted more, if it were the joints of the body or my head and mouth.

My rheumatologist, apprehensive that I could have arthritis also in the TMJ immediately referred me to Dr. Lidia Yavich, who received me in the office and managed to relieve my pain completely .

I HAVE TO STRESS THAT, THERE WAS NO MEDICATION THAT COULD CEASE THE PAIN that I felt in the TMJ and in the cervical spine, NOTHING!

After the imaging studies performed by indication of Dr. Lidia, we came to the conclusion that I was not suffering from arthritis in both TMJ, but from a dislocation  of my right condyle  after using for a short time a mistaken device to place my bite and tongue in the ” RIGHT POSITION”

That treatment did not considered important assumptions as the asymmetry of my condyles, or their position, or the disc status in relation to the condyles, causing much suffering.

It took me a long time to understand what was happening to me in my TMJ; I suffered from absurd pain in the head in the middle of a very difficult treatment for arthritis. I was disfigured, terrified and unsure after using the first device with the previous professional because he did not know how to end the pain and even seemed, not to know what was actually happening with me.

I had panic to imagine that I had arthritis in my TMJ, but only after the MRI and the Dr. Lidia interpretation it was possible to exclude the possibility of rheumatic disease in the TMJ in that moment, and from then on to make an efficient treatment.

In a few weeks Dr. Lidia not only took out ALL THE PAIN of the TMJ, but also led me to a treatment that repositioned my disc and  stopped the pain, even being a carrier of a severe autoimmune disease.

I have been using the DIO for seven years without any pain, I have full understanding of the meaning of bruxism in my case and correct approach to the problem, including the options that I could have for a more permanent solution instead the use of the DIO.

I am very grateful to my rheumatologist  today for indicating me a treatment that saved me, because I certainly would have gone crazy with those TMJ pains.

I am very grateful to Dr. Lidia who took me from the rock bottom in which I found myself, ignorant from all  that was happening in a joint so unknown from most of us:.the TMJ.

Cervical Dystonia or Spasmodic Torticollis: Positive evolution after Neurophysiological Treatment

The patient of this post contacted me through a derivation from a colleague from abroad.

Soon after he sent an email where he explained the motif for his consultation on Cervical Dystonia or Spasmodic Torticollis, I answered that it was not my

knowledge  area, that I treated TMJ Pathologies , Orthodontics and Facial Orthopedics.

The patient insisted, commenting that the colleague that recommended me and knew me from the AACP meeting where I was invited as a lecturer explained to him that he didn´t know if I treated Distonia, but he thought that considering  what he had  watched  I could help him.

I began to study more on  published articles of this field. One of the articles that impacted me was: Spasmodic Torticollis: The Dental Connection. Anthony b. Sims, D.D.S.; Brendan C> Stack, D>D>S> ;MS.;Gary Demererjian, D.D.S.

1

Dystonia is a  neurological movement disorder, which sustained muscle contractions causing twisting and repetitive movements or abnormal postures. The movements may resemble a tremor. Dystonia is often initiated or worsened by voluntary movements, and symptoms may “overflow” into adjacent muscles.There are multiple types of dystonia, and numerous diseases and conditions may cause dystonia.

Focal   dystonia:  affects a muscle or group of muscles in a specific part of the body causing involuntary muscular contractions and abnormal postures, like eyes, neck or hands.The precise cause of primary dystonia is unknown .It is suspected to be caused by a pathology of the central nervous system, likely originating in those parts of the brain concerned with motor function, such as the basal ganglia.

2

Main common dystonia denomination are :

blepharospasm (from Greek: blepharon, eyelid, and spasm, an uncontrolled muscle contraction), is any abnormal contraction or twitch of the eyelid.

Oromandibular dystonia is a form of focal dystonia affecting the mouth, jaw and tongue, and in this disease it is hard to speak.

Cervical dystonia (spasmodic torticollis ) affects the muscles of the neck. Causes the head to rotate to one side, to pull down towards the chest, or back, or a combination of these postures.

Spasmodic dysphonia (or laryngeal dystonia) is a voice disorder characterized by involuntary movements or spasms of one or more muscles of the larynx(vocal folds or voice box) during speech.

2

Patient Testimony

Everything began approximately after the placement of the  lower implants.

One year after that, I began to feel uncomfortable.

I felt a back and neck stiffness, a strong weight in the back of the head and pain.

I began to make a lot of examination tests with neurologists, physical therapists, rheumatologists, orthopedists.
All of them followed the same line, saying that it could be a stress problem and fatigue.

Later I began to feel a twist movement in my neck towards the left. It was not so strong  but I felt I had no  control on my neck.

My neck always tried to rotate to the left, especially  when I walked and when I tried to hold an object.

After doing physical therapy, chiropractic’s, acupuncture and all those techniques I began to research and finally consulted another neurologist who told me that  I had CERVICAL DYSTONIA.

He asked for many exams to eliminate the possibility of being  a trauma or other problem related to Wilson disease. That hypothesis was soon discarded.

I consulted another neurologist that confirmed the same diagnosis: CERVICAL DYSTONIA.

The neurologist initiated a treatment with Botox, to alleviate, and to relax some muscles, trapeziums, sternocleidomastoids and splenius. I was also oriented to have three applications of miorelaxants.

I began to investigate more on the subject and I found some videos about TMJ and some treatments with dental appliances.

4

Habitual patient’s occlusion

Patient Testimony

The situation is very bad because doctors say: “is neurological”,  we don’t know the etiology and it has no cure until today.

I believe all of this must have a relation with the implants, because I passed more than 30 years without these teeth, maybe  the position of my mouth could have provoked some slow alteration that end up in this situation.

I’m not an specialist to affirm that this is the real situation, but I believe that it is worthy to investigate because there is the existence of written articles.

Moreover Dr. Anthony Sims, and other doctors in the dentistry field point for possible head and neck disturbance, motor coordination, Tourette disease or something like that, so many things connected with TMJ (temporomandibular joints) disorders.

3

Patient’s occlusal superior and inferior view

1

Patient report: Detail of principal symptoms

Impossibility of head stabilization

Ringing ears

Ear compression sensation

Muscle spasm when I want to move the head down and to the right.

Noises in the vertebras in the back of the neck region, may be C1 and C2, but I am not sure and noises in the spine.

Noises in the TMJ, specially when yawn.

5

Patient’s panoramic radiograph before treatment.

6

Patient’s frontal radiograph where it is clearly seen the impossibility for straight posture of the head.

7

Patient’s initial laminography, in habitual occlusion where we can observe the retro position of both mandibular heads.

9

Patient’s initial lateral radiograph in habitual occlusion before treatment.

10

We can observe in this lateral radiograph and cervical spine radiograph the total lack of space between the ATLAS posterior arc and the Occipital base. I suspected adherences so I solicited a lateral radiograph in flexion.

11

In the Cervical Spine radiograph in flexion we can observe a REDUCED space between the ATLAS posterior arc and the base of the occipital. THE SPACE IS REDUCED, BUT EXISTS.

12

The MRI in closed mouth shows a small disc, superior facets in both mandibular condyles and bilateral retro discal compression. The patient has no limitation in opening the mouth and the discs are well situated on the mandibular heads when opening. I didn´t judge important to include the image of open mouth for this clinic case.

tHE 13

The Semg dynamic record shows an important asymmetry between anterior right and left temporalis, low activity of both masseters muscles. The trapezius doesn’t show activity during mandibular closing, which is physiologically correct. Important activity from the digastrics muscles in closing movement, which is not physiologically correct.

14

The Semg dynamic record shows an important asymmetry between anterior right and left temporalis, low activity of both masseters muscles. The sternocleidomastoid muscles show activity during mandibular closing, which is NOT physiologically correct (the sternocleidomastoid muscle is not a masticatory muscle). Important activity from the digastrics muscles in closing movement, which is NOT physiologically correct.

15

His masticatory muscles were electronically deprogrammed with TENS (Transcutaneal Electronic Neural Stimula­tion). A jaw tracker then registered a neurophysiologic position from where an intraoral appliance was constructed and tested with SEMG (Surface Electromyography.) For this record we used the neurophysiologic technique.

16-comparativa-frontal-1-dio

Patient’s frontal comparative images: initial and four months after DIO (Intra Oral Device) wear. Notice the important improvement of head and shoulder posture.

17-a-comparativa-perfil-diio

Patient’s right profile comparative images: initial and four months after DIO (Intra Oral Device) wear. Notice the important improvement of head and shoulder posture.

17-b-comparativa-perfil-2-diio

Patient’s left profile comparative images: initial and four months after DIO (Intra Oral Device) wear. Notice the important improvement of head and shoulder posture.

19

Patient’s lateral radiograph with the device in neurophysiological position. Notice the space between the posterior arc of the atlas and the occipital base that didn´t exist before.

20

Patient’s frontal comparative radiograph: before the treatment and with the DIO (Intra Oral Device), the patient manages now to have a straight posture of the head.

21

Patient’s lateral and cervical spine comparative radiograph: before the treatment and with the DIO. Notice the space between the posterior arc of the Atlas and the occipital base that did not exist before.

22

Patient’s comparative laminographies: initial in habitual occlusion where we can observe the retro position of the mandibular heads and with the intraoral device with retrodiscal decompression.

23-comparativa-frontal-3-dio

Patient’s frontal comparative images: initial, four months and nine months after DIO wear. The patient had a physiological posture recovery.

24-comparativa-perfil-3-diio

Patient’s right profile comparative images: initial, four months and nine months after DIO wear. The patient had a physiological posture recovery.

25-comparativa-perfil-2-diio-3

Patient’s left profile comparative images: initial, four months and nine months after DIO wear. The patient had a physiological posture recovery.

artigo

Spasmodic Torticollis: The Dental Connection. Anthony b. Sims, D.D.S.; Brendan C> Stack, D>D>S> ;MS.;Gary Demererjian, D.D.S.

 

26

 

The patient also sent videos where he shows his initial incapacity to rotate the head and also comparative videos where he could do that again. The videos are not in the post to preserve patient’s identity.