Sidekick - Summer 2011 - (Page 20)

A Case Study of Acute Changes in Dental Occlusion: Digital CBCT Analysis DeWitt C. Wilkerson D.M.D. Every day brings new challenges to the Dentist who embraces the role of “Physician of the Masticatory System.” Fortunately, new advances in diagnostic imaging, such as Digital Cone Beam 3-D Technology, make it virtually impossible for pathology to escape diagnosis. To illustrate, let’s explore a challenging case to diagnose, beautifully exposed by digital CBCT technology. A 62-year-old Caucasian female presented with a chief complaint of progressive bite changes. Previously, all her teeth touched uniformly, but over the past 18 months this had gradually changed. The result was an open bite that extended from teeth #2–13, and a facial asymmetry with the mandibular plane of occlusion visibly canted significantly downward on the right side (Figure 1.). She reported no pain; the left TM Joint felt normal but the right TM Joint felt restricted, as if something was in the way of normal movement. Her previous dentist had told her that she would need restorative dentistry to correct the new malocclusion; but was concerned as to why these changes had occurred. We also discussed the possibility that changes were still progressing. Clinical evaluation revealed an absence of masticatory muscle tenderness. Mandibular range of movement was limited to a maximum opening of 29 mm (normal 40–50 mm) with a marked deviation toward the right side. Right excursion was 7 mm, left excursion was 2 mm, and protrusive movement was 4 mm with a noticeable deviation toward the right (normal for each 7–13 mm). Palpation of the left and right TM Joint capsules and ligaments were negative for reported tenderness. Orthopedic load testing of the TM Joints via Dawson’s bimanual manipulation was negative bilaterally. Doppler auscultation was negative for clicking or boney crepitus bilaterally. Joint Vibration Analysis-JVA (Bioresearch Associates technology) revealed no indications of joint clicking or condylar breakdown bilaterally. Occlusal evaluation, using articulating ribbon and TScan computerized bite analysis Figure 1 revealed the only teeth that touched with seated TM Joints were the left side first and second molars. The occlusion was increasingly open from left to right with the right molars open by 4–5 mm. Swallowing did not reveal a notable tongue thrust between the teeth that were out of contact. Movement of the mandible in lateral and protrusive excursions with the teeth in contact revealed exclusive contact on the left molars. The first impression upon observing our patient’s facial asymmetry and open bite was the probability of an internal derangement in the left TM Joint; but the reported history did not fit that diagnosis. When observing the range of mandibular movement, it became evident that the right TM Joint was not translating normally. Joint assessment did not imply any obvious discal displacement or internal derangement in the left TM Joint. The concern shifted toward the right TM Joint region. To develop the bite changes observed would require an enlargement of tissues in the right TM Joint. Specifically, the concern became focused on the probability of some type of expanding pathosis. Due to the absence of pain and the inability to properly translate on opening, we became suspicious of extra capsular hard-tissue expansion. SIDEKICK 20 Summer 2011 Sidekick

Table of Contents for the Digital Edition of Sidekick - Summer 2011

Sidekick - Summer 2011
Table of Contents
Hoekwater Family Dentistry
Traveling With an Old Friend
A Case Study of Acute Changes in Dental Occlusion: Digital CBCT Analysis
We Do That!
Improving Periodontal Treatment Acceptance
Henry Schein Financial Services
Fiscally Fit in 2011
Featured Designs
Smile Design Esthetics
Arkansas Family Dental
Privileges
Distinctive Advantage
Clay Center Family Dental Care
TechCentral
New Tools From i-CAT
Better Hiring Techniques for Dental Practices
Tips From the Top
Exploring the Use of QR Codes in Dental Practice Marketing
Gendex–Past Legacy and Future Innovation
iPad? Xoom? Making Heads or Tails of Tablet Computing
Gearhart Dentistry–Dr. Stephanie White
Professional Practice Transitions

Sidekick - Summer 2011