Jan 25, 2014 - that each pathology of the Temporomandibular joint creates a ... of TMJ vibrations in newtons per square meter and displays this information in a numeric integral that can be used to aid in more accurate diagnosis of the.
Original Article: January 25th 2014 Asnan Portal Dental Online College www.asnanportal.com
Role of Digital Technology in dentistry for improved treatment outcome
Dr. Sarah Qadeer, BDS, MSD, International Lecturer & Researcher, Dept. of Prosthodontics Faculty of Dentistry, Thammasat University, Rangsit Campus Thailand.
Introduction: Digital technologies available to dentists today can enhance the clinician’s ability to deliver better treatment and improved patient care in current dental scenario as discussed in details in the previous four articles. T-Scan Digital Occlusal Analysis Technology can be used in various dental clinical scenarios to achieve improved treatment results such as: Initial patient exam To identify areas of occlusal overload, To pin-point excessive contact locations in the arch For achieving bilateral simultaneity, In Implant cases for bringing about a measurable time delay Post orthodontic occlusal balancing procedure Case finishing after any kind of restorative and prosthetic procedures. T-Scan Technology not only improves treatment outcome but also enhances patient education whereby patient can see the recording of the ongoing occlusal balancing procedure and have an interactive communication with the dentist during the procedure. The clinician is well able to explain the ongoing treatment procedure through comprehensive vibrant 2-D and 3-D images on the computer screen that keeps the patient more engaged and helps the clinician to achieve the desired occlusal treatment outcome through patient compliance (Fig.1).
Technological advancement in the field of clinical dentistry gave way to more accurate diagnostic aids to explore and analyse the masticatory system. While T-Scan Digital Occlusal Analysis Technology can help the clinician to accurately analyse the occlusal discrepancies, excessive contact location in the arch and provide tooth contact time and force data, Joint Vibration Analysis by BioJVA™ Milwaukee Wisconsin USA (Fig 2) explains the movement of the condyle as it simultaneously rotates and translates down the articular eminence during mandibular movement. The TemporoMandibular joints are the skeletal foundation of the stomatognathic system and dentists must know if this joint is functioning properly or if a pathology exists and it is critical to know if the pathology is progressive in nature or if it has stabilized. Temporomandibular dysfunction (TMD) not only impacts the health of the joints but can also create secondary pathologies of the craniofacial muscles and dental occlusion. Joint Vibration Analysis works on the simple principle that when surfaces rub together, they produce a vibration. When the TMJ is in harmony, it is an incredibly smooth system that creates very little friction as the disk remains between the condyle and eminence to protect and cushion the bony structure, this movement creates very little friction/vibration (Fig 3). Greater the friction, greater the vibration produced in the temporomandibular joint, as different pathologies of the TMJ such as inflammation, edema, partial and complete displacements of the disk, degeneration and perforations of the disk as well as degeneration of the condyle itself which will then produce a different kind of vibration that can be objectively diagnosed using the JVA.
The vibrations recorded by the JVA can help the clinician to identify the wave-pattern of the vibrations produced during the mandibular movement to make more accurate and objective diagnosis of the TMD. JVA uses these vibration-recording accelerometers over the Temporomandibular joints to record the amplitude duration and frequency of the vibrations that emanate from the Temporomandibular joints during opening and closing. Research has shown that each pathology of the Temporomandibular joint creates a unique vibration pattern that can be used as an aid in the diagnosis and monitoring of joint function (Fig.4).
Synovial fluid, the fibrocartilage disk, the bony condyle and eminence all have different densities. The differences in these densities determine the frequency of the vibrations produced by their movement. Softer tissues create different frequency vibrations than harder tissues. Researchers and clinicians can use the vibration profile of a patient’s joint vibration analysis trace to aid in the diagnosis of joint condition, and to test the impact of treatments both immediately and long-term. BioJVA™ records the amplitude of TMJ vibrations in newtons per square meter and displays this information in a numeric integral that can be used to aid in more accurate diagnosis of the temporomandibular disorders. A normal functioning temporomandibular joint will have a normal range of motion, a total integral below 20, and a high frequency integral below 3. Pathologies of the joint will either show a reduced range of motion, or higher total integrals and/or increased high (bone) frequencies that can lead to an accurate diagnosis following the numerics provided in the chart that comes with the system to interpret the JVA traces (Fig. 5).
In the past diagnosis of Temporomandibular joint function has been restricted to the subjective techniques such as auscultation, palpation, Doppler, visual analogue pain scales, and patient’s complaints of pain. These subjective techniques are not adequate to reach a credible diagnosis of an individual’s Temporomandibular joint function, and they are all plagued by poor interobserver agreement even among experienced clinicians. JVA provides an accurate, noninvasive, reliable way to objectively measure joint function. Conclusion: Digital technology now available for dentists worldwide aids in better treatment planning, treatment outcome and followup records. T-Scan Digital Occlusal Analysis enables the clinician to explore the occlusion as the patient bites on the occlusal sensor to analyse precise time and force measurement from the first point of contact to maximum intercuspation. T-Scan occlusal analysis leaves the guesswork out of dental practice as this evidence based, repeatable, non-subjectice occlusal insight enhances the clinician’s ability to make precise targeted occlusal adjustments based on measurable data through objective, comprehensive recording of the patient’s occlusion. BioJVA™ enables the clinician in accurately diagnosing the temporomandibular joint disorders by recording the vibrations as the condyle rotates and translates against the articular eminence and transforms the numeric measurements of the vibrations produced in the TMJ into an indication of the pathology that could be the cause of the signature vibration produced due different pathologies. Digital Analysis such as T-Scan Occlusal Analysis System (T-Scan III™,Tekscan Inc. South Boston, MA, USA.) and Joint Vibration Analysis (BioJVA™ Milwaukee Wisconsin USA) have revolutionized the way dentistry is practiced by providing the clinicians with objective, quantifiable, accurate data for better treatment planning and clinical outcome.
