Tag: Concept

Instrumental dental functional analysis and jaw relation determination

Reliable DIR® diagnostics: Tracking down the functional disorder through intraoral
measurement!

If a functional disorder is suspected – especially after a clinical functional analysis – dentists obtain definitive clarity about the individual situation of the craniomandibular system through further instrumental analysis. The centric condylar position, which is considered ideal for smooth functioning of the temporomandibular joint, is also determined.

Definition of centric condylar position

The cranioventral, not laterally displaced position of both condyles with physiologic condyle-discus relation and physiologic loading of the involved tissue structures (DGZMK and DGFDT)

“In the centric condylar position, both condyles are not laterally displaced in the cranioventral section of the eminentia if the vertical dimension of the mandible to the maxilla is correct. In this circumscribed area, the tissues involved are not subjected to excessive pressure or tension.
There is freedom of movement in all three spatial directions. The centric condylar position can be controlled and maintained neuromuscularly with minimal energetic effort.”

DIR® (DYNAMIC INTRAORAL REGISTRATION)

An intraoral measurement of the patient with the DIR® system enables the function of the craniomandibular system to be assessed.

A support pin register is used here, whereby the recording of the lower jaw movements is transferred to a medical PC in real time at any time via the DIR® System software and the dentist can observe the movements of the lower jaw. Recording and bite encoding take place under a defined chewing force. (ACTUAL POSITION)

The DIR® System software supports the dentist in converting the ACTUAL to TARGET position.

The physiological condyle position is the focus of the bite adjustment.

After evaluating the results, misalignments can be corrected and secured as part of the DIR® treatment concept, using the DIR® splint, among other things. It also serves to retrain the masticatory muscles. Only after correction and freedom from pain should dental treatment be continued and the TARGET POSITION reconstructed (e.g. with dentures).

Instrumental functional analysis with the DIR® system is used for

  • Suspicion of CMD
  • Setting the physiologically optimal bite position
  • Fabrication of new dentures
  • Orthodontic treatment
  • Patients who were not treated according to the DIR® concept (e.g. with dentures) and now have complaints
  • Bruxism, abrasive dentition, joint noises and other complaints

The high quality and safety of DIR® diagnostics is also guaranteed by regular training courses (refresher seminars, acquisition of current DIR® quality seals).

The DIR® concept

A really good concept as a supporting framework for a strong partner network is the result of years of development work. Good and coherent, a
concept that makes it possible to use the DIR® system as a therapeutic link between dentistry and dental technology as well as complete planning
from the first impression to the finished restoration (planning reliability).

The range of indications for the DIR® concept includes both the prosthetic restoration of patients with CMD syndrome and the fabrication of new dentures for functionally healthy patients.

Diagnostics

As part of the DIR® concept, the FunktioCheck Pro® software documents the preliminary dental findings.

The type of complaints and previous visits to the dentist from other specialist disciplines are recorded as part of the functional dental history. In the brief dental findings, missing canine guidance, non-age-appropriate abrasion of the teeth in the sense of grinding facets and abrasions or The brief dental findings record missing canine guidance in the sense of grinding facets and abrasions or wedge-shaped incisions, tooth loosening, tilting and migration, gingival recessions with Still-man clefts and McCall’s garlands, pain during muscle palpation, temporomandibular joint noises as well as restrictions and asymmetrical mouth opening movements, resulting in a three-grade probability statement for the presence of a functional disorder and a recommendation for further findings.

Axis 2 diagnostics

The special functional analysis carried out in the case of a high probability of CMD, the so-called Axis 2 diagnostics, is highly relevant for the success of the subsequent therapy and is objectively assessed using a Graded Chronic Pain Scale and a pain perception scale, whereby an evaluation of the patient’s degree of psychological stress is possible in an evaluation form.

Manual-clinical diagnostics

The subsequent manual-clinical diagnostics allow an assessment of a manifest arthropathy with examination of the temporomandibular joint function to exclude or confirm the presence of a disc perforation or a disc displacement, condylar osteoarthrosis, hypermobility, capsulitis or inflammation of the bilaminar zone. The morphological or structural remodeling processes in the hard tissues should of course be confirmed radiologically (MRI). Manifest myopathy is assessed by performing standardized masticatory muscle examinations using the isometric tension test and muscle palpation.

Instrumental functional analysis

The manual functional analysis is followed by the instrumental functional analysis with the DIR® system, which is also carried out on functionally healthy patients as part of prosthetic planning. The electronic measuring method is based on the arrow angle or support pin registration according to Gerber with recording of the marginal movements of the mandible under physiological masticatory pressure and without reference to occlusion.

Centric position as target bite

Once the DIR® measurement has been completed, the centric position determined is encoded in the patient’s mouth as a so-called target bite by guiding the support pin into a fixation plate under defined chewing pressure. This is followed by transfer to the articulator. In the following model analysis, an occlusion analysis is performed, whereby the deviation of the habitual occlusion or the current actual state from the centric occlusion or the target bite is documented.

The appropriate therapy is planned on the basis of these results.

The DIR® concept for the treatment of functional disorders (CMD) is scientifically validated and follows a closed anamnesis and therapy principle.