TMJ and musculoskeletal system diagnostics

Introduction

The physiological position of the lower jaw is crucial for successful orthodontic treatment. A possible discrepancy between the maximum intercuspidation and the occlusion in the physiological mandibular position should be carefully examined. An unrecognized craniomandibular dysfunction (TMD) can significantly impair the success of orthodontic treatment. If the "Short Clinical Screening Test" provides indications of a disorder, further functional diagnostics are required, which may also include the musculoskeletal system.

Examination of the temporomandibular joint and muscles

The diagnosis begins with a detailed medical history, which not only records dental complaints, but also muscular and orthopaedic symptoms. In the event of positive findings in the screening test, a detailed examination of the craniomandibular system (TMS) is carried out. This includes

- Manual functional testing of the temporomandibular joint

- Documentation of occlusal contacts in maximum intercuspidation and in the physiological condylar position

- Examination of mandibular mobility (lateral movements, protrusion, mouth opening)

- Palpation of the masticatory muscles to detect pain points and muscular trigger points

Connection between TMS and MSS

The temporomandibular joint interacts closely with the musculoskeletal system (MSS). Chronic incorrect loading of the temporomandibular joint can cause complaints in the cervical spine, in the shoulder/neck area and even in the lower back. The following tests should therefore also be carried out:

- Rotation of the cervical spine

- Torso rotation

- Testing the leg length difference

- Examination of hip mobility (Prien abduction test)

Therapeutic measures and diagnostic procedures

Falls eine funktionelle Störung festgestellt wird, kann eine reversible Vorbehandlung mit einer Okklusionsschiene erforderlich sein. Zur weiteren Diagnostik können digitale oder physische Modellanalysen in einer physiologischen Kondylenposition sowie bildgebende Verfahren wie die digitale Volumentomographie (DVT) oder eine Magnetresonanztomographie (MRT) herangezogen werden.

Conclusion

Precise diagnostics of the craniomandibular and musculoskeletal system is essential in order to detect malocclusions at an early stage and initiate targeted therapy. The functional examination should always be carried out before the start of orthodontic treatment in order to ensure optimal therapeutic planning.

 

Source:

Schupp, W., Funke, J., Boisserée, W., Heller, R., & Haubrich, J. (2018). Continuing diagnostics of the temporomandibular and musculoskeletal system (TMS/MSS). Journal of Aligner Orthodontics, 2(3), 199-213.