Joint Vibration Analysis in Routine Restorative Dentistry

 Consequently, we now pay very close attention to any joint vibration that occurs during the time that the teeth are sliding into MIP, or in the timeframe just before closure. These are the early, subclinical vibrations that can be easily treated by elimination of the closure interferences and/or re-establishing the normal vertical dimension of occlusion. Certainly, the treatment plan does not have to include a change in vertical dimension or a full-mouth rehabilitation; however, it must ensure that the closure interferences (slides) are eliminated and that any hyperactivity of the lateral pterygoid muscles related to working or nonworking interferences be controlled with appropriate occlusal therapy. This occlusal therapy can include subtractive coronoplasty on the interferences, but more frequently depends on appropriate additive coronal enhancement of the anterior and canine teeth.
     The use of the JVA during treatment design and provisionalization as well as postoperatively gives us the assurance that we are not only aware of any pretreatment problems or red flags, but most importantly, that in the course of any dentistry that influences tooth contact or occlusion patterns, we have not made changes that result in a more unstable TMJ apparatus than we noted before treatment. We would always like the patient to finish our care better off than when we first started (Figures 6a to 7).

DISCUSSION
Regardless of other biometrics or treatment philosophy, the JVA provides objective information to the treating doctor as to the stability or instability of the TMJ condylar apparatus. This information can be easily utilized in the decision as to whether (or not) MIP would be the best choice in making dental treatment plans for the best long-term patient prognosis. Certainly, an unstable condyle being present in the attempt to treat occlusal disease would necessitate the treating doctor to consider and document the effect of his or her treatment of the dentition on the stomatognathic system, including the TMJs. In the author’s experience, in utilizing the JVA system in literally hundreds of full-mouth rehabilitations during the last 11 years, several conditions of the patient bring this technology to bear.
     The most enlightening finding from JVA recordings has been the diagnosis of subclinical problems that represent “early” or “unstable” condyle-disc problems that are not perceptible with any other technology, especially palpation or auscultation. This condition shows up as disc movement, joint laxity, and/or TMJ inflammation. The ability to diagnose this subclinical condition has revealed that appropriate treatment of the dentition can result in stabilizing or correcting the problem in the condyle disc apparatus. This is the missing link in the conversation of the connection between the occlusion and the TMJ condition.
If problems can be detected before they become permanent ligament or disc damage, then stabilization through effective occlusal therapy will afford the patient the best possibility for long-term health and function.

CLOSING COMMENTS
The benefit of having baseline JVA recordings on all of our patients gives the patient the assurance that we will have something to compare to should an injury or jaw trauma occur. It also allows the patient to know that he or she is in the right place for care should any signs or symptoms occur. Many patients are considering snoring or sleep apnea appliances that modify the position of the jaw and joints at night. The JVA allows us to follow their therapy with appropriate care giving and monitoring.
     Only by having appropriate biometrics with the JVA we can ensure that we are in control of the TMJ condition for our patients. Screening, diagnosing, recording, and monitoring with JVA provide affordable, noninvasive, and objective data that we have needed for effective routine TMJ management, even for our asymptomatic patients.