Some advocates consider the MRI to be the gold standard as to determine what is going on with the disc and condyles. They readily admit that they can not help at least 35% of their patients. Many clinicians believe that you cannot stop someone from bruxing and clenching. However, in the end, some TMJ experts believe after doing everything they can do and the problems still remain they say that the disc doesn’t matter anyway because it will eventually “flatten” out and not be a problem. And if it fails to flatten out or otherwise cooperate, then surgery is indicated.
It has been well noted that the K7 kineseograph instrumentation is the Gold Standard in assessing mandibular to maxillary jaw relationships based on real time functional measurements while the patient is in an upright position. It removes the guess work, saves time and is precise. Naturally as with all instrumentation training is required by the dentist to properly operate and use this highly sophisticated instrument.
Electrosonography (ESG) has been also used in this study to evaluate more finely to what extent discal tissue damage is present and at what position during the opening and closing cycles disc damage is present if any. MRI’s were also used to visualize and evaluate both temporomandibular joints for disc positioning before and after GNM orthotic treatment.
If damage is evident in the TMJs and dysfunction is present in the masticatory system,
How is the clinician (or YOU) going to treat this?
How does the jaw position determine in order to assure that the intra oral splint appliance matches the physiology of the muscles, your bite/occlusion and jaw joints? (We recognize most TMD experts begin their treatment with some form of an intra oral appliance)?
Case History and Data: (Female age 27, over 2 years stable. Previous left and right disc medial anterior disc displacement now reduced/ recaptured):
Electrosonographic (ESG) TM joint analysis was also used to record joint sound patterns of both left and right joints during dynamic opening and closing cycles. TMJ joint sounds can be correlated to mandibular movements using finely balanced vibration transducers that are interfaced with a computer
ESG indicates high frequency low and high amplitude signature patterns (repeated) indicating severe joint damage to the discal tissue (bone on bone, scraping, grating patterns) during late opening and early closing mandibular movements (condyle at height of articular eminence) rubbing abnormally on bone. (K7 joint sound filtering is from 0-300 showing degenerative joint disease (DJD) is present on both joints. (When you see blue and red filtered graph lines patterns not returning to baseline in the fast fourier analysis graph below it is indicative of DJD).
Before Treatment: K7 computerized jaw tracking data shows mandible is posterior displaced 7.0 mm posterior to the optimal myo-trajectory (antero-posterior) and 0.8 mm to the left of midsagittal plane.
Muscle relaxation and temporomandibular joint decompression protocols are implemented using objective K7 jaw tracking measurements to locate an optimized mandibular and joint position in 3 dimensions. Data below demonstrates and validates disc recapture (both left and right TM Joints) with support of GNM orthotic in “optimized” mandibular position.
Note: Arrow is pointing to space where the disc is not seen in the CO position (without GNM orthotic) vs. disc seen over condyle AFTER (with GNM orthotic) for both left and right joints.
Data below demonstrates and validates disc recapture of unreduced disc (both left and right TM Joints) when in “functional” Maximum Mouth Opening (condyles with disc move to height of articular eminence) with support of GNM orthotic in “optimized” mandibular position. Without support of GNM orthotic disc is not present in maximum opening (not reduced) for both left and right TM joints.
Note: Disc is not seen in the maximum opening position (without GNM orthotic) vs. disc is seen over condyle (with GNM orthotic – After) for both left and right joints.
Myotronics K7 Electronsonography (ESG 2) was used to record functional temporomandibular joint sounds during functional open and closing movements before and after GNM orthotic treatment.
ESG recordings shows in left screen significant mid to late opening high frequency TM Joint sound signature patterns on left joint (red) and right joint (blue) before orthotic treatment. Right screen shows shows quiet and improved ESG patterns after optimized GNM orthotic treatment for both left and right TMJ joints.
This validates that the Optimizing GNM protocols are able to recapture (reduce) non reducing disc using the orthotic based on muscle relaxation and proper jaw positioning protocols using K7 measurements.
MICRO OCCLUSION principles and protocols are applied to the gnathic and neuromuscular conditions to help bring precision and accuracy to the muscle systems. Objective confirmation that one has truly achieve the neuromuscular objectives to is re-measure and re-evaluate to see if the antero-posterior relationship of the mandibular closing path is now coincident with the myo-trajectory closure path. (The habitual path of closure is on one and the same with the optimized myo-trajectory path of closure). It is in this 3 dimensional relationship that a pathologic jaw joint and disc relationship that was formerly displaced and restricted has not become physiogically functional and recaptured (reduced) with these specific and detailed GNM protocols.
After Treatment: Patient’s mandible, condyle and discs are now proven to open and close coincident with the optimized myo-trajectory both laterally and frontally. Confirmed with K7 jaw tracking combined with involuntary TENS objectively measured.
Patient is now pain free (over 2 years since initial orthotic delivery) and now wants to move forward with Phase II orthodontic treatment. Patient is comfortable and pleased.
ADDITIONAL THOUGHTS TO CONSIDER:
Some claim MRI is the gold standard to diagnosing TMD….is it really? What about the diagnosing of the muscle dysfunctions that contribute to joint derangements?
When TMJ experts don’t measure muscle activity and or properly understand how to implement an anatomical orthotic, they naturally relegate the TMD problems to something else (excuses), thus they commonly use common (generic) splints and they turn to looking at the TM joints!
Bones, discal tissue reduction (recapture) becomes the focus using MRI’s as if that is the tool to find and remedy the over all problem. They fail to pay attention to how the muscles of the head, neck and masticatory system (jaw, joints, disc and muscles), move and functioning, not realizing if one implements the right tool and understanding in how to find the bite and manage it in order to reduce the disc, whether it is displaced, perforated, etc., perhaps another perspective of TMD would evolve.
Before progress can be made the dental profession has to understand how the intricacies of how the masticatory and K7 system works and what the data means properly.
One can have a K7 and learn NM…but miss the whole process eventually they turn to flat plane splints because of misunderstandings…because it seems simpler but the patient continues to suffer without any logical explanation to why the dental profession is failing them. GNM focuses on what matters!