Dr. Aladin Sabbagh & Dr. Derek Mahony.
Temporomandibular joint screening prior to orthodontic rehabilitation is indispensable for preventive, therapeutic, and forensic reasons. Daily practice calls for a simple and effective concept in order to treat TMD patients, and to avoid iatrogenic mishaps during orthodontic therapy. Furthermore, planning and prognosis may be improved in many cases.
Most diagnostic methods, from expensive axiographic and electromyographic measurement, through to sophisticated imaging techniques (MRI, ct) entail considerable costs in terms of time and expense. As these techniques mostly focus on the examination of special parts and structures, they cannot be considered as universal standard examination methods. The Manual Functional Analysis according to the Kiel concept (Bumann et al. 1989) provided the first substantial progress towards a practice-oriented concept .
The previous hypothesis implying that temporomandibular joint disorders / TMD originate from the stomatognathic area is only partially correct. Opinions in the current literature widely differ on this topic. We believe that malocclusion may be among the causes of certain TMJ disorders, however rarely appears to be the only one. As generally known, there are patients who, despite extreme malocclusion, show hardly any, or no TMJ discomfort, while other patients are sometimes severely affected despite minor occlusal discrepancies. Craniomandibular disorders (TMD) result from an interplay of multiple factors:
- malocclusion, overloading of the temporomandibular joint (compression, forced position)
- hyperactivity of masticatory muscles (bruxism/ clenching)
- psychosomatic disorders, stress syndrome
- joint hypermobility, particularly in combination with general connective tissue weakness