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Sunday, April 3, 2016

Full Mouth Neuromuscular Reconstruction: Planning and Execution is essential for success.

This was originally a Google +  Post.  Due to an incredible response from viewers of that post I decided to repost with comments on the I Hate Headaches site.

A full mouth reconstruction is the ultimate in dentistry but it can also be a patient's worst nightmare.

The relation of the jaw to the head affects and is affected by the entire body. Ideally a full mouth reconstruction is done to physiologically healthy muscles joints breathing and function.

This video is of a patient who started with a single quadrant of crowns that morphed into a non-physiologic reconstruction. I saw him after three reconstructions of his entire mouth to treat his symptoms. The first was a Centric Relation Reconstruction and the second two were Neuromuscular Reconstruction. His final reconstruction was done well but failed to resolve many issues.
I did not do any of these reconstructions but worked to idealize his current restorations. These two videos describe a small part of the difficult journey this patient has travelled.

Correcting physiological issues should be done at the start of a case. This patient did not go looking for a full mouth reconstruction but fell into it.

It is unfortunate that a fabulous person and excellent physician fell into a trap not of his making.



Additional patient videos:  https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos

The reason there are so many issues with full mouth reconstruction is that many dentists, even etremely wel educated and proficient dentists do not understand the importance of head posture on their treatment.  Many take bites and do adjustments with the patient reclined in the dental chair.

The Quadrant Theorem of Guzay is extremely important to dentists because it explains in engineering terms how the center of jaw rotation is not in the TMJoint.  Rather, it is on the Dens process of the second vertebrae (Axis) that passes thru the first cervical vertebrae (atlas).
This is because the TMJoints acting together go thru two distinct movements rotation and translation.  These movements alwys happen simultaneously and there is no time during normal function in which pure rotation occurs.
The concepts of Centric Relation's approach to occlusion is that it is found by the dentist moving the patients jaw in a pure rotation at a border position of the joint.

The usefulness is that it is easy to transfer this information to the dental laboratory.  The problem is it is not a physiologic position and in fact the most dangerous position for all joints is in border positions.   Patients don't funtion there.

The use of TENS in  Neuromuscular Dentistry is to take the muscles to a healthy relaxed state.  This creates a three dimensional relation between the cranium (head) and mandible (lower jaw).

This relation changes when the head position changes.  It is vital to evaluate the bite in upright sitting and standing positions.  This also means that you cannot ignore the rest of the body when doing a full mouth reconstruction without risk of long term instability.

Chair, Alliance of TMD Organizations
Diplomat, American Academy of Pain Management
Diplomat, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health Journal
Member, American Equilibration Society
Member, Academy of Applied Myofunctional Sciences
Member, Academy of Cosmetic Dentistry

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#CentricRelationReconstruction #fullmouthreconstructiondisaster
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posted by Dr Shapira at 5:51 AM

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