Joint Vibration Analysis in Routine Restorative Dentistry

[Drsumitra]

The urgency for taking the temporomandibular joint (TMJ) condition into account is the pervasiveness of occlusion-related disease and the recent advances in restorative and prosthetic systems. Clinical best practices would include the screening and diagnosis of the temporomandibular condition in the evaluation and treatment of the occlusion-related diseases such as abfractions, wear, mobility, periodontal damage, fractured teeth, and abnormal parafunctional muscle activity.
During routine dentistry, in the vast majority of dental practices, 2 oversimplified assumptions are made that then determine the course of occlusion, mastication, and dental anatomy decisions for the patient. These assumptions are: (1) that the asymptomatic TMJ is either healthy, or as healthy as can be expected for this patient, and (2) that maximum intercuspal position (MIP) is the most stable position in which to reference the patient’s dental care.

These 2 assumptions are commonly adopted as the default scenario for dental care for several reasons. Namely, the clinical manifestations of TMJ derangements are often encountered at a later or more chronic stage that does not lend itself easily to diagnosis and/or treatment. Many of these later-stage, chronic disc derangements are often asymptomatic before and after routine dental care. Furthermore, most of these later-stage TMJ derangements are not correctable with routine dentistry.
Also, the MIP is seemingly the most easily determined position of the interface between the maxilla and mandible due to patient accommodation and preference of interdigitated teeth. Additionally, the facet-to-facet interdigitation of the teeth is routinely utilized to relate the maxillary teeth to the mandibular teeth on laboratory models of the patient’s dentition.
Relying on either or both of these assumptions creates or perpetuates the existing conditions, pathologies, and the position of the mandibular condyles and their respective disc and ligament apparatus. This perpetuation of the current status puts even the most limited restoration in jeopardy of early failure or worsening of the patient’s condition.
While the majority of patients without reported symptoms will accommodate or continue to accommodate to this condition/position of the condyles, the glaring signs of occlusal disease and pathology are staring the practitioner in the face. These signs are primarily being treated symptomatically or ignored, rather than systematically evaluated and treated at the source of the problem.
This situation is frustrating for dentists, as they often feel that they don’t have the opportunity or urgency of symptoms to be able to take control of the problems. Additionally, there has been a challenge to integrate the concepts of occlusion with the condylar position. Many dentists have studied with various occlusion “camps” only to become confused regarding the relevance of the condylar position or which condylar position is “correct.” This debate has continued for years as to the best way to define and establish what a “normal” condylar position is. As a result, the only established norms for occlusion have relied on the systems created to produce successful clinical results and idealistic concepts that are perpetuated in texts and academia.
Consequently, dentists end up discussing their “philosophy” of occlusion without regard to routine objective measurements that could establish the relative health or normality of the stomatognathic system.
This situation is also frustrating for patients, as they are at a loss as to what is normal for them. How much deterioration of their dentition is acceptable? Why, when they return to the dentist year after year, is “something wrong,” every time? And which of their symptoms are important enough to report to their dentist? They often end up years down the road with thousands of dollars of dentistry done only to discover that their wear and/or pain continues, and their condition is never truly under control, despite their best intentions and investment.

Fortunately, we currently are in a new place of discussion regarding the diagnosis and possible therapies for occlusal, masticatory, and temporomandibular care. With an objective test for TMJ condition, better treatment plans can be devised for occlusal disease.
This new place where we are is directly related to the development and usage of biometric technology that gives the doctor objective data from which to make decisions and measured documented treatment results.
The past attempts to record and/or measure the condylar position and condition included axiopath recordings of joint position and border movements, transcranial and tomographic radiography with objective and subjective interpretation, comparison of condylar position on articulators with multiple jaw position “bite” recordings, magnetic resonance imaging (MRI) and functional MRI scans, computed tomography (CT) and cone beam CT scans, contrast arthrography, computerized mandibular positions based on transcutaneous electrical nerve stimulation pulsed muscle contractions irrespective of the condylar position, face-bow mounted casts on various articulators referenced to numerous closure paths from speech to swallowing, from controlled manipulation to deprogrammed patient closure. At best, these methods were expensive and time consuming; and at worst, these techniques were dependent on the clinician’s experience and subjective analysis.
The current biometric standard with the Joint Vibration Analysis (JVA), a system of equipment and software manufactured by BioRESEARCH (bioresearchinc.com), allows the dentist to easily and objectively measure the condition of the condyles quickly, affordably, and irrespective of treatment “philosophy.” The mandate from the ADA, as stated in 1990 and 1992, calls upon the dentist “to document, assess, note, describe, evaluate, and record the presence, location, loudness, timing, consistency, and quality” of joint vibrations. This mandate then encourages us to consider biometrics that will accomplish this effectively and affordably with high levels of sensitivity and specificity. The JVA system achieves this standard and creates a 21st-century documentation of objective information that will afford the treating dentist the ability to diagnose the patient’s condition and monitor the patient throughout preventive or therapeutic care. By establishing objective measurements of the condylar condition, the dentist can evaluate the effect of future events such as injury, accident, or therapy. The doctor can also begin to correlate the condylar condition with other data, such as bite force analysis (with T-Scan) and/or electromyography (BioPAK [BioRESEARCH]) measurements of the muscles of mastication. In addition this JVA system can be overlaid on data regarding mastication analysis (BioPAK), range of motion, and mandibular position.

        

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