Temporomandibular Joint First Orthodontics
Orthodontic closure problems are classified as Class 1, Class 2, Class 3. The aim of classical orthodontic treatment plan is always obtaining the Class 1 dental occlusion and observing this only intra orally is enough.
But, even the treatments are finalized with Class 1 occlusion, if temporomandibular joint is not stabile and the location of the joint and dental occlusion is not matching:
- Recurrence of orthodontic treatment,
- Pain on chewing muscles, temporomandibular joint and head and neck region
- Fracture or cracks on teeth
- Severe teeth abrasions and gum recessions can be observed.
Not facing the problems like those, Mandibular joint should be stabile and move in compatible with teeth during opening and closing the jaw. For diagnosing this compatibility, in the beginning of the treatment jaw relations should be transferred in centric relation to a device which is called articulator and simulates jaw movements.
In some situations, if joint pain is present, before starting the orthodontic treatment splint usage should be required for an accurate diagnosis (for mandibular joint treatment). The most important part of joint priority treatment is records which are obtained before the treatment. Those records consist of: face photographs and intra oral photographs, plaster models obtained from inta oral impressions and 2 dimension panoramic and cephalometric x-rays, besides 3 dimension Computer Tomography and/or MR images and transferring the patients jaw movements to simulating devices which we called articulators. Transferring mandibular joint by orientating it to the correct position provides diagnosing the difference between habitual occlusion and the correct position. Upper jaw is transferred by bars positioned to the ears of the patient and supported by the nose (facebow) and fixing it by intra oral part (bite fork). Lower jaw is transferred to articulators by centric relation waxes which are obtained from the patient by orientating the joint to the correct position. Transferring to articulator demonstrates the first tooth contact when the patients mandibular joint is at the correct position and where is the skeletal position.
Treatment principle of this transfer and joint priority treatment:
- Determines our treatment limits,
- Provides making a proper treatment plan,
- Determining the skeletal and dental limits provides identifying the expectations of the patient and considering what can be done for the doctor.
- Reduces the treatment related complications to minimum level,
- Contributes durability of the treatment.