CATEGORY AUSTRALASIAN DENTIST83 CLINICAL suggest that MG/AG was more critical for these Group C patients to achieve a good outcome. Additionally, the results show that each additional treatment stage completed produces additional reduction in self-reported symptoms. Discussion The author has come to the realisation that prosthodontists and dentists only have a cursory interest in ‘full occlusal therapy’ and suffer technical challenges with implementation. Murphy 2006, a past instructor for Seminars for Occlusal Studies, wrote on being perplexed when approached by recently graduated prosthodontists after a lecture, claiming ‘unfamiliarity with this ‘stuff’ (occlusion)’. Murphy questioned how they could manage TMD patients without knowledge on occlusion (Murphy 2006). This author’s view following university graduate teaching experience and interaction with dentists and prosthodontists attempting to deliver ‘full occlusal therapy’ calls out for a speciality stream in ‘OcclusoProsthodontics’ for TMD management. The laxity of supporting TMJ ligaments and their relationship with disc displacement was methodically evaluated by De Coster et al. 2005 and they concluded that a positive relationship existed between generalised joint hypermobility and disc displacement (De Coster, Van den Berghe; et al. 2005). Along with hypermobility and trauma cases, it is this author’s opinion that stretched TMJ ligaments (Shore 1970) are common and occur because of unprotected damaging mandibular vectors and hyperfunction (Parker 1990). These factors result in what could be termed lax TMJs as reinforced by the author’s experiences in Pantronic readings showing TMD bruxers with immediate side shifts of 2.2 mm in each TMJ instead of the regular 0.1-0.3 mm shifts. Lax TMJs with time and hyperfunction create an opportune environment for disc displacement. The author believes disc derangement starts with a minor disc displacement in the form of a joint noise like a click, then develops into a moderate disc displacement like a clunk or pop where the disc reduces, and finally no noise when a major displacement becomes non-reducing. The three groups of TMD patients reacted differently to each of the three occlusal therapies offered and the author noted from the statistics the presence of a ‘TMD/Occlusal profile’ which indicated that each patient found an occlusal therapy more suited to their TMD. The three profile types of ‘occlusal therapy affected’ TMD patients were identified: (1) Type 1 TMD/ Occlusal profile patients only required OST to feel satisfied to complete the management of their TMD. These patients were identified from Group A which had a marked 84% improvement from OST and ‘full counselling’, with 56% of these patients scoring a 100% improvement in symptoms and did not feel the need proceed to further occlusal therapies; (2) Type 2 TMD/Occlusal profile patients required OST and OE to feel satisfied to complete the management of their TMD. These patients were from Group B and had only a 70% improvement with OST and needed to advance to OE to get their desired acceptable outcome of 91% improvement, with 53% of this group achieving a 100% improvement. These Type 2 TMD/Occlusal profile patients did not feel the need to proceed to the last occlusal therapy of MG/ AG; and (3) Type 3 TMD/Occlusal profile patients required OST, OE and MG/AG occlusal therapies to feel comfortable for management of their TMD. These patients were from Group C patients who could only get a 58% improvement with OST and 81% with OE but needed to advance to MG/ AG to get a desired 96% improvement, with 71% of this group attaining 100% improvement. These Type 3 TMD/Occlusal profile patients were only content after all three occlusal therapies for management of their TMD. These results show three distinct ‘occlusal therapy affected’ TMD patient profiles exist, as not all patients needed to advance through all three stages of occlusal therapy to get their desired outcome. However, the author believes that the ‘full occlusal therapy’ sequential regime should be proposed to all patients from the outset to comprehensively address their individual TMD. The author believes that these three types of ‘occlusal therapy affected’ TMD patient profiles exist because of four major intertwined aetiological factors that run in parallel with the ‘musculoskeletal biopsychosocial disorder’ model described by Bhat (Bhat 2010). These four major aetiological factors include: (1) the patients’ individual unprotected occlusal schemes according to Darveniza (Darveniza 2001); (2) their prominent destructive mandibular habits detailed by Darveniza (Darveniza 2023, Darveniza 2023); (3) their personality types; and (4) life stressors as described in the ‘dynamic etiological TMD model’ by Parker (Parker 1990). Three possible aetiological scenarios may explain the existence of these Type 1, 2 and 3 ‘occlusal therapy affected’ TMD patients: For a Type 1 TMD/Occlusal profile patient with a casual personality type, minimal stress, a marginally unprotected occlusal scheme but with an extreme but easily reversible habit, like yawning to 68 mm (Darveniza 2023), then OST with targeted counselling (Darveniza 2023, Darveniza 2023) may be sufficient treatment. This could be because following splint therapy the re-centred discs remain stable while the targeted counselling arrested the damaging habit. As well, with the patient’s casual attitude towards their minor occlusal interferences this did not act as a parafunctional occlusal trigger. Thus, with a mean improvement of 84%, the perceived need for this Type 1 TMD/ Occlusal profile patient to move onto occlusal equilibration was absent. For a Type 2 TMD/Occlusal profile patient with a demanding personality type with moderate stress levels, who knowingly identifies that ‘only one tooth contacts’ demanded an additional therapy to improve their bite. This type of patient was not happy with a 70% improvement following OST and affirmed the need for occlusal equilibration to allow the other teeth to touch. This resulted in the repositioned discs from OST remaining in a stable state, as all teeth now touch in hinge occlusion. This patient was rewarded with a 91% improvement and did not find the need to proceed to MG/AG. For a Type 3 TMD/Occlusal profile patient with a precise and exacting personality type who freely admits to being severely stressed and aware that grinding on their worn down lower canines needs to be addressed. This patient not only clenches but grinds in broad excursive mandibular movements and required lateral guidance/ restriction (example a crown) to stabilize the re-centred discs following OST and OE. That is, after completing OST (58% improvement) and OE (81% improvement), with too many symptoms remaining goes on to MG/AG to achieve satisfaction with a 96% improvement in symptoms. This bio-designed crown (Darveniza 2001) restricts the patient’s ability to continue stretching the TMJ ligaments by preventing the mandible moving into a destructive vector. Now with the absence of destructive mandibular vectors and the TMJ ligaments tightening following addressing the grinding habit, future disc displacement is minimized, and the TMD symptoms largely resolved. The author has observed clinicians who perform a functional occlusal analysis often erroneously consider that if canines contact during lateral movement this will be a protective lateral occlusion and this has contributed to negative clinical outcomes (Darveniza 2001). The concept of canine guidance starts with the contemporary definition used by Roberts et al. (Roberts et al. 1987) and followed by the Academy of Prosthodontists (The Academy of Prosthodontics 1999). Namely, ‘cuspid guidance was defined as no multiple tooth contacts in lateral excursions.’ This
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