CATEGORY AUSTRALASIAN DENTIST77 CLINICAL protective anterior guidance (Darveniza 2001). For a dolichofacial patient, the author first used molar guidance in 1992 to bio-design a lateral and protrusive occlusion (Darveniza 2024). ‘Full Occlusal Therapy’ was be defined in 2023 by Darveniza (Darveniza 2023) as ‘sequential treatment performed in three stages, as needed: Stage 1, a ‘Fully Protective Occlusal Splint’ with a minimum of four splint adjustments over a minimum three-month period and collectively termed ‘Formal Fully Protective Occlusal Splint Therapy’; Stage 2, major and fine tune occlusal equilibration appointments; and Stage 3, bio-designing molar (Darveniza 2024) or anterior guidance (Darveniza 2001) with concurrent ‘Full Counselling’ (Darveniza 2023, Darveniza 2023)’. ‘Full Counselling’ of TMD patients was defined by Darveniza as ‘targeting and modification of head, neck and occlusomandibular habits and improving sleep posture, and general body posture as required’ (Darveniza 2023). This paper details the use of ‘Full Occlusal Therapy’ in the treatment of 200 TMD patients. Materials and methods Examination, occluso-mandibular analysis and full counselling was performed with the following salient features: 1. complete oral examination of TMD patients was carried out in parallel with two occlusal orientated papers by Egan 1982 (Egan 1982) and Rieder 1975 (Rieder 1975), 2. initial radiographic evaluation of TMJ’s, jaws and teeth with an orthopantomogram followed by lateral transcranial radiographs, arthrograms, and MRI at a later date, as indicated, 3. recording all comments, including colloquial ones, made by the patient, 4. examination and palpation of muscles and joints including digital verification externally and or via the external auditory canal by the patient and/or operator, 5. occluso-mandibular analysis (Darveniza 2023, Darveniza 2023, Darveniza 2022) was performed involved identifying the occluso-mandibular vectors (Darveniza 2023) in hinge, protrusive and lateral occlusion according to Darveniza (Darveniza 2001) and then charting the vectors (Darveniza 2023) (Figs. 1, 2, 3 and 4), 6. occluso-mandibular counselling followed by showing the patient their inherent unprotected occlusal scheme with a brief explanation of the perceived effects on TMJ and muscle pain, and joint noises (Darveniza 2023, Darveniza 2022). This was followed by an occlusoFig. 1 Occluso-mandibular vectors charted for the patient in figures 2, 3 and 4. The abbreviations of the vectors are VL= vertico-lateral, HL= horizonto-lateral, DH= disto-horizontal and for RCR= right canine rise, LCR= left canine rise, BI= bilateral and UNI= unilateral. After formal fully protective occlusal splint therapy and occlusal equilibration appointments crowns (C) for 23 and 33 were recommended to convert a disto-horizontal vector to a vertico-lateral mandibular vector. Several years later crowns were required on all canine teeth to bio-design protective left and right bites. Fig. 2 The left view shows centric occlusion of a TMD patient with disc displacement and left TMJ pain, clicking, tinnitus and hyperacusis. The 43 is opposite the 12 in an Angle’s Class 3 relationship while the 33 is occluding with the 23 and 22 in Class 1 and 2 relationships. The right view illustrates an unprotected unilateral guided protrusive movement with 41 on 21 with a non–sagittal vector. Fig. 3 The left view illustrates an unprotected right lateral occlusion, guided horizonto-laterally by 42 on 12. The right view illustrates extreme right lateral cross-over with 41 now on 12 and 11 with a perceived concomitant stretching of the contralateral left TMJ ligaments. Fig. 4 The left view illustrates an unprotected left lateral occlusion guided horizonto-laterally with 33 on 23, 32 on 22 and 41 and 42 on 21. The right view illustrates a now extreme left lateral mandibular cross-over resulting in 33 reaching distal to 24, and with wedging of 23 against the lingual surface of 32. This produced a disto-horizontal mandibular vector resulting in the left condyle retruding into the disc and towards the ear with concomitant ear and disc displacement symptoms. This included left TMJ pain, clicking, tinnitus and hyperacusis.
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