CMD functional analysis by the dentist

In case of problems with the jaw joints and the masticatory muscles or in case of therapy-resistant tensions and pain in the musculoskeletal system, a functional analysis can be the first step towards a pain-free life. The functional analysis is an elaborate diagnostic procedure with which we can detect jaw joint malpositions and other functional disorders of the masticatory system in detail.

Even a missing tooth or a crown that is too high can lead to malfunctions and shifts in the jaw joints. The result is pain in the jaw and jaw joints as well as muscular tension in the masticatory, facial and auxiliary muscles. These misregulations of joint and muscle function are summarized under the term “craniomandibular dysfunction (CMD)”. “Craniomandibular” refers to the area between the skull (cranium) and lower jaw (mandible).

The temporomandibular joints as well as the masticatory, facial and auxiliary muscles are connected to the other joints and muscles of the body via functional chains. Therefore, jaw joint problems can lead to a whole cascade of physical complaints. Accordingly, CMD treatment can only be successful if the dentist has the health of the individual as a whole in mind.

What is the task of the functional analysis?

  • The functional analysis represents the exact positional relationship between skull and jaw.
  • It shows the movement sequences of the temporomandibular joints and
  • analyzes the position of the teeth in relation to each other.

Advantages Functional Analysis

  • enables targeted treatment of the dysfunctional masticatory system
  • represents the functional connection between the complaints in the temporomandibular joints and the complaints in other body regions,
  • reveals hidden compensated inflammations in the pain areas,
  • forms the basis for the development of a holistic therapy concept, which, in addition to the treatment of temporomandibular joint pain, also already includes
  • the consequences or problems with the spinal column are taken into account.

The functional analysis has no disadvantages.

When does a functional analysis make sense?

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

  • Patients who show clinical signs of craniomandibular dysfunction (also temporomandibular dysfunction) during CMD screening,
  • Patients with pain in the facial and neck muscles,
  • Patients with recurrent headaches or migraine attacks,
  • Patients with bruxism (grinding of teeth)
  • Patients with larger tooth gaps,
  • Patients who require comprehensive dental restorative measures,
  • Patients in whom the restoration of a tooth is pending that represents the first contact in the centric occlusion (centric occlusion = interlocking of the maxillary and mandibular teeth in rest position),
  • Patients with open bite,
  • Patients who subjectively perceive their bite as not pleasant,
  • Patients who have only a limited number of tooth contacts when they bite together,
  • Patients with missing front tooth guidance (= tooth contact of the front teeth of upper and lower jaw with lower jaw movements)
  • Patients with deep, densely closed tooth relationships in the anterior region,
  • Patients whose maxillary and mandibular front teeth touch when they bite together.

Functional analysis as the basis of CMD diagnostics

The diagnostic instrument of functional analysis is divided into clinical and instrumental functional analysis.

Clinical functional analysis

Clinical functional analysis is a sequence of different manual examinations. The mouth opening, chewing, facial and head muscles as well as the temporomandibular joints are examined. Of particular interest are jaw joint noises as well as restrictions in opening the mouth and chewing movements. By palpating certain areas, the dentist finds out exactly where it “hooks” and hurts.

In CMD, certain muscle areas on the jaw, face and head often harden. The painful areas are localised by applying pressure to these pressure-sensitive “trigger points”. The pressure sensitivity of the temporomandibular joints is also examined. A detailed check of the posture is also very important. Incorrect postures such as a sloping head can provide very important indications of a possible CMD disease.

If the findings are positive, further radiological examinations are carried out to support the diagnosis. 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)

Instrumental functional analysis is based on clinical functional analysis. It provides an insight into the “microcosm” of functional disorders of the masticatory system. Certain instruments are used to analyze the skull-jaw axis, temporomandibular joint movements and contact points of the teeth. Even the smallest lower jaw movements and minimal disturbances in the movement sequence can be recorded.

Process Instrumental Functional Analysis

For the exact measurement of the temporomandibular joints, impressions of the upper and lower jaw are taken first. The impressions form the basis for the production of high-quality jaw models, which are required for the analysis. The exact jaw joint positions as well as the trajectories of the jaw (axiography) are then recorded on the patient. The so-called “face bow” is used for this purpose.

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

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

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

Measurement of the temporomandibular joints

What is the purpose of the additional instrumental functional analysis?

The aim of jaw movement simulation is to change the positional relationship between teeth and jaw until the optimal position for the patient is achieved. An individual treatment plan is then created on the basis of the result data. The type of treatment depends on the severity of the malfunctions detected. In some cases it is sufficient to wear a custom-made functional splint for the patient. However, comprehensive treatment approaches are often necessary in cooperation with orthodontists (in case of jaw/tooth malpositions), orthopedists or physiotherapists. Physiotherapeutic measures make sense if the misregulations in the temporomandibular joints have already led to subsequent complaints such as shoulder and back pain. If a poorly fitting prosthesis is the cause of temporomandibular joint disorders, a corresponding adjustment of the prosthesis can bring the temporomandibular joints back into alignment.

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Christina Cherry
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