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Special Issues
July/August 2017
Volume 38, Issue 2
Peer-Reviewed

Achieving Biofunctional Dynamic Occlusion

Javier Vasquez, DMD, MICCMO, MDT

The integration of tridimensional data through CBCT technology along with high-resolution impressioning with CEREC® Omnicam (Dentsply Sirona, sirona.com) combined with new capabilities of jaw motion tracking allow clinicians to visualize actual functions of the patient. The case presented describes the principles of biofunctional dynamic occlusion, a concept in which craniocervical stability is the main component. Occlusion has long been described as only the terminal position of the teeth; however, the most important events occur before the dentitions come together and immediately after they part. This mechanism creates adaptation between the cervical spine, muscles, and temporomandibular joint (TMJ), all dictated by the occlusion. This 15-year follow-up case shows the importance of establishing the proper jaw dynamics and balancing muscles starting from a homeostatic position.

Key Takeaways

• It is important to understand the concept of studying muscles as muscles and joints as joints and establishing proper occlusion based on homeostasis of the stomatognathic system.

• The principles of biofunctional dynamic occlusion are crucial to oral health.

• A workflow to achieve proper diagnostics can be created with the latest technology from Dentsply Sirona and advancements that introduce data into a CAD/CAM system to fabricate preadjusted restorations.

About the Author

Javier Vasquez, DMD, MICCMO, MDT
Owner
Oral Design Miami
TMJ Research Foundation
Biofunctional Dynamic Academy

Fig 1 and Fig 2. December 2002: Jaw tracking system and instrumentation implemented. Note the occlusal conditions and the integrity of the incisal borders before degeneration.

Figure 1

Fig 1 and Fig 2. December 2002: Jaw tracking system and instrumentation implemented. Note the occlusal conditions and the integrity of the incisal borders before degeneration.

Figure 2

Fig 3. June 2006: Wear facets in the anterior teeth revealed dysfunction (ie, unstable TMJ, dyskinetic movements, muscles in parafunction, cervical spine instability, teeth breakage; all postural and stomatognathic components were altered). Various tools were used to observe function under the principle of muscle relaxation.

Figure 3

Fig 4. October 2011: Teeth were moving and breaking more in the incisal area. In phonetics and dynamics anterior teeth were hitting and the mandible tended to shift to one side. Orthopedic treatment was implemented to develop the premaxilla, facilitate expansion, and move the teeth away from the complex zone in the anterior segment.

Figure 4

Fig 5. October 2011: Kinesiographic trace showed apparent anterior displacement of the disc, which created dyskinetic patterns without repositioning the disc, confirming articular joint problems.

Figure 5

Fig 6. January 2013: A transcutaneous electrical nerve stimulation (TENS) bite was taken to neutralize the muscles.

Figure 6

Fig 7. April 2014: Based on kinesiographic studies of the patient’s functional movement, it was determined that the breakage occurred in phonetics and postural movements, continuing more in the anterior teeth from the lingual area, confirming a dysfunctional pattern.

Figure 7

Fig 8. 2016: Using SICAT Function™ (Dentsply Sirona) in conjunction with Galileos CBCT (Dentsply Sirona) and Omnicam, the author studied the different patterns, to incorporate principles of biofunctional dynamic occlusion and analyze the various ranges of motion based on mandibular head position and postural changes. Simultaneously, the author took a TENS bite to relax the muscles and different centric relation (CR) bites to analyze condyle stability and reproducibility of the CR position. CR bites varied among operators and techniques, because the forces when squeezing the synovial compartments changed between operators.

Figure 8

Fig 9. At that time, the patient decided to get treatment. The neuromuscular concept was used to try to decompress the joints, but, still, she had some dysfunctional movement.

Figure 9

Fig 10. As a result of the use of TENS, a change in the bite in a more decompressed position was evident that was close to the functional position in phonetics, swallowing patterns, and head reaction position.

Figure 10

Fig 11. Based on this observation, different manipulation techniques were used to induce breakage of fibrous tissue. Then, a bite registration was taken. After breakage of the tissue and relaxation of the muscle, about 2 mm of mobility was gained in the joint that had restriction.

Figure 11

Fig 12. March 2017: After a biofunctional dynamic orthotic appliance was placed into the patient’s mouth for 6 months to develop stability, the author created pivots in teeth Nos. 18 and 31 to generate a larger distraction in the joint. Then, three feldspathic veneers (shown) were fabricated to perform the smile design.

Figure 12

Fig 13. The author then used the SICAT Function traces with the pivots in place and the new bite registration to manufacture two temporary onlay bridges. Integration into the Inlab software (Dentsply Sirona) allowed the restorations to be preadjusted in function. These restorations were subsequently milled in PMMA material and cemented, and records were obtained for stability.

Figure 13

Fig 14. The final result of the case demonstrated the importance of understanding the physiology of the stomatognathic system and how in some pathological conditions, as in this case, one of the condylar heads may be reabsorbed, causing loss in its height and shifting the mandible. The treatment objectives were (1) to decompress the joint and distract the condyle that was reabsorbed to create more space and stabilize the good occlusion, and (2) to follow the concept of stabilizing the occlusion in a better position that created more harmony with the muscles, facilitated decompression of the joint, and enabled stability of the craniocervical structures.

Figure 14

Fig 15. The patient’s current smile. Presently, the patient is functioning well and waiting for the next phase, which will entail closing the bite slightly, following the current trajectory after joint distraction, and finalizing the restorations with no-preparation ceramic occlusal onlays. As a result of the treatment objectives being met, the patient’s cervical vertebrae is now better aligned and the airway is improved through the proper alignment of the cervical spine.

Figure 15

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