Fig. 14 Facial symptoms b Any pain or discomfort when palpating the masseter, temporalis or Pterygoid (medial or lateral) venter suggests TMD? b Is the mouth opening too small? b Is the mouth opening asymmetrical? b Any joint sounds? (Pain is more serious problem than clicking!) b Any occlusal traumas? b Facial asymmetry position of the condyle in the fossa while others assume a neuromuscular approach often by placing a patient on a transcutaneous electrical nerve stimulation (TENS) machine. Both models are seriously flawed. (Fig. 14) Every dentist learns to assess occlusion from a semi-adjustable articulator in dental school. Yet almost nobody continues doing this within days of being in private prac-tice. It is not because dentists are lazy! Dentists are among the hardest working of all professionals. If they believed getting a facebow and mounting casts resulted in better dentistry for their patients they would do it. Because of inferior dental results it doesn’t take long for dentists to discard this approach! Many don’t fully understand why cases mounted in CR turn out so disas-trously. There are many problems with semi-adjustable articulators and assumption that CR is the “correct” TMJ position. The numerous faulty assumptions about models mounted in CR include but are not limited to (Fig. 15): ᕡ There is a faulty assumption that the occlusal plane determined with a facebow is “correct” and is a baseline for building the occlusion. Even the weight of the facebow device alters replication of the patient’s occlusal plane. ᕢ There is a faulty assumption that the upper occlusal plane is level and aesthetic. Facebow mounting of the upper arch is level while in clini-cal reality the occlusal plane frequently is canted. This is an incorrect starting point! ᕣ There is a false assumption that healthy patients occlusioN: WhERE Do WE builD ThE biTE? There are serious problems in the current and tradi-tional models of occlusion. Most focus on establishing centric relation (CR) defined as a superior and anterior Fig. 15 18 Summer 2017 JAOS
Journal of the American Orthodontic Society Summer 2017/Buyer's Guide: Page 18
