Discussions and explanations of important principles regarding diagnostic measurement of occlusomuscular TMD, DTR treatment, TMJ imaging, and more from leaders in the field of digital occlusal analysis.
Drs. Robert Kerstein and Nick Yiannios discuss FAQs of Disclusion Time Reduction (DTR) Therapy for occlusomuscular TMD patients. Dr. Kerstein is the leading author and researcher in the field of Computerized Occlusal Analysis, with over 30 years of work including 45 peer-reviewed publications. Cited literature indicates that ~15% of TMD patients have maladapted and unstable joints. DTR therapy is less predictable when damage to the medial pole of the cartilaginous TM meniscus compromises its reduction between condylar head and articular eminence. In addition to objective Joint Vibration Analysis, Neural Occlusion screening protocols such as MRI and CBCT are significant diagnostic aides in identifying those patients who are NOT candidates for DTR. Dr. Yiannios includes cited literature for further reference.
Dr. Ben Sutter explains the treatment process known as DTR therapy, giving patient examples and a brief description of the software used by the T-scan digital bite sensor alongside EMG for measurement of occlusion synchronized with muscle activity. He describes DTR as a form of splintless TMD therapy which addresses concerns like bite force and timing, defining occlusion as one of the most influential concepts in all of dentistry.
Drs. Nick Yiannios and Tom Coleman are co-authors of literature in the Handbook of Research on Computerized Occlusal Analysis Technology Applications in Dental Medicine (Kerstein, DMD). Dr. Yiannios is founder of the Center for Neural Occlusion which emphasizes the multidisciplinary nature of orofacial pain and TMD. Topics discussed include limitations of analog methods, traditional bite "equilibration" vs. DTR therapy, force outlier contacts in periodontal considerations such as PDL attachment loss and mobility, condylar positioning (CR, FSCP, adapted / non-adapted centric posture), occlusomuscular dystonia, and the prevalence of iatrogenic malocclusion in chronic TMJ microtrauma.
Drs. Mark Piper and Nick Yiannios consider TMD splint design and the priority of imaging for condylar positioning. Dr. Piper is founder of the Piper Education and Research Center whose work includes surgical repair of TMJ internal derangements to reverse childhood osteochondral growth defects and subsequent malocclusion. His peer-reviewed publications focus on TMJ microsurgery, avascular necrosis of the mandibular condyle, MR diagnosis of TMJ internal derangements, and the relationship of malocclusion to damaged TMJs.
Drs. Mark Piper and Nick Yiannios discuss variables involved in adjusting a bite to "treat" symptomatic occlusomuscular TMD. For complex orofacial pain patients, improving the bite is only one part of a bigger puzzle. Although DTR therapy can fix dental malocclusion, an interdisciplinary approach may be necessary if compounding symptoms stem from other causes in addition to the dental component.