functional analysis

In the case of problems with the temporomandibular joints and the chewing muscles or with therapy-resistant tension and pain in the musculoskeletal system, a functional analysis can be the first step to a pain-free life. The function analysis is a complex diagnostic procedure with which we can detect malalignment of the temporomandibular joint as well as other functional disorders of the chewing apparatus in detail.

A missing tooth or a tooth crown that is too high can lead to malfunctions and displacements in the temporomandibular joints. This results in jaw and TMJ pain as well as muscular tension in the chewing, facial and auxiliary muscles. These misregulations of joint and muscle function are summarized under the term "craniomandibular dysfunction (short: CMD)". “Craniomandibular” refers to the area between the skull (cranium) and lower jaw (mandible).

The temporomandibular joints as well as the chewing, facial and auxiliary muscles are connected to the other joints and muscles of the body via functional chains. Therefore, TMJ problems can result in a whole cascade of physical complaints. Accordingly, treatment of CMD can only be successful if the dentist has an eye on the health of people as a whole.

What is the role of functional analysis??

The functional analysis shows the exact positional relationship between the skull and jaw.
It shows the movements of the jaw joints and
analyzes the position of the teeth to each other.

Benefits of functional analysis

enables targeted treatment of the dysfunctional chewing system
represents the functional connection between the complaints in the temporomandibular joints and the complaints in other parts of the body,
reveals hidden compensated inflammation in the pain areas,
forms the basis for the development of a holistic therapy concept, which in addition to the treatment of TMJ pain
consequential damage or problems with the spine are taken into account.

The functional analysis has no disadvantages.

When does a functional analysis make sense??

The main area of application for functional analysis is in the area of the mentioned CMD diagnostics. However, it has also proven itself in the run-up to tooth restorations and prosthetic restorations as well as orthodontic treatments. It makes sense for

Patients who have clinical signs of craniomandibular dysfunction (including temporomandibular dysfunction) on CMD screening,
Patients with pain in the facial and neck muscles,
Patients with recurrent headaches or migraine attacks,
Patients with bruxism (gnashing of teeth)
Patients with larger tooth gaps,
Patients for whom extensive dental restoration measures are pending,
Patients who are in the process of restoring a tooth that is the first contact in the centric occlusion (centric occlusion = teeth of the upper and lower teeth in the rest position),
Patients with an open bite,
Patients who subjectively find their bite uncomfortable,
Patients who have only a limited number of tooth contacts when gritting,
Patients with missing anterior tooth guidance (= tooth contact of the anterior teeth of the upper and lower jaw during lower jaw movements)
Patients with deep, tightly closed tooth relationships in the anterior region,
Patients whose upper and lower front teeth touch when gritting.

Functional analysis as the basis of CMD diagnostics

The diagnostic instrument of the functional analysis is divided into the clinical and the instrumental functional analysis based on it.

Clinical functional analysis

Clinical functional analysis is a sequence of various manual examinations. The mouth opening, the chewing, facial and head muscles as well as the jaw joints are examined. Of particular interest are TMJ noises and restrictions on opening the mouth and chewing movements. By scanning certain areas, the dentist will find out exactly where it “hooks” and hurts.

With CMD, certain muscle areas on the jaw, face and head are often hardened. The painful areas are localized by pressure on these pressure-sensitive “trigger points”. The pressure sensitivity of the temporomandibular joints is also examined. An in-depth check of the posture is also very important. Improper posture, such as an inclined head, can provide very important information about a possible CMD disease.

If the result is positive, further radiological examinations are carried out, which can support the diagnosis. An MRI, CT or DVT may also be necessary. The subsequent instrumental functional analysis specifies the findings of the clinical functional analysis.

Instrumental functional analysis (occlusion analysis)

The instrumental functional analysis is based on the clinical functional analysis. It allows an insight into the “microcosm” of functional disorders in the chewing system. The skull-jaw axis, the jaw joint movements and the contact points of the teeth are analyzed with certain instruments. Even the smallest movements of the lower jaw as well as minimal disturbances in the movement can be recorded.

Process of instrumental functional analysis

For the exact measurement of the temporomandibular joints, first impressions of the upper and lower jaw are taken. The impressions form the basis for the production of high-quality jaw models, which are required for the analysis. Then the exact jaw joint positions and the movement paths of the jaw (axiography) on the patient are recorded. For this you use the so-called "face bow".

The facebow has a nose support and is attached to the two outer ear canals on the patient’s head. Then the patient bites on the integrated bite fork with the slightly warmed reference mass. This bite fork is firmly screwed to the facebow via a joint.

The measurement data obtained with the facebow are then transferred to the connected "articulator" (chewing simulator). The articulator is a device in which the previously made plaster models of the two jaws are installed in occlusion (in a "bite"). In this way, the situation of the natural jaw is shifted to an external model, which makes it possible to precisely simulate the movements of the jaw in relation to each other outside the mouth. In addition to conventional articulator devices, there are also "virtual articulators". These are additional modules from CAD / CAM programs.

CAD / CAM is a computer-aided procedure with which the dentist can construct dentures directly on the computer screen. The planning data are fed into state-of-the-art dental milling systems via computer interfaces, in which inlays, onlays, veneers, crown frameworks and crowns can be milled from a block.

Measurement of the temporomandibular joints

What is the additional instrumental functional analysis good for??

The aim of the jaw movement simulation is to change the positional relationship between teeth and jaws until the optimal position for the patient is reached. An individual treatment plan is then created on the basis of the result data. The type of treatment depends on the nature of the malfunctions identified. In some cases, wearing a functional splint made for the patient is sufficient. However, comprehensive treatment approaches are often necessary in cooperation with orthodontists (for jaw / tooth misalignments), orthopedists, or physiotherapists. Physiotherapeutic measures are useful if the incorrect regulation in the temporomandibular joints has already led to complications such as shoulder and back pain. If poorly fitting dentures are the cause of TMJ disorders, an appropriate adjustment of the dentures can bring the TMJs back into balance.

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