OCCLUSION
Figure 13. Immediately after correction of the
amalgam filling, there occurred a relaxation of
the muscles. Within a few days an unrestricted
oral opening was possible
Figure 14. Massive centric
and eccentric series contacts
on a ceramic restoration
Findings
1. Mouth opening asymmetrical
Yes No
2. Mouth opening restricted
3. Traumatic excentric movements
4. TMJ noises, pain
5. Muscle palpation (M. masseter/temporalis) asymmetrically
positive finding
Evaluation
max. 1 pos. finding: health probable
3 or more pos. findings: disease probable
Supplemental finding
Yes No
6. Physiological centric position unequal max. intercupation
“Cotton-Roll-Test” (early contacts, occlusal gliding, enamel
chipping, grinding facettes, wedge-shaped defects, tooth
mobility, tongue impressions etc.)
Evaluation
With pos. finding: disease probable
Figure 15. Correction of these
ceramic restorations gave the patient
a balanced-fit-feeling
General medical and neurological examinations
were unsuccessful and ultimately relaxation
therapies were recommended. A mere-chanceconversation lead to an inspection that showed a
single occlusal risk factor: distinct wear facets on
an amalgam filling at a lower molar. At the same
consultation this filling was corrected by grinding
using magnifying spectacles and using 10-micron
thin occlusal foil. These fissures were so engrossed
and moved that the maximum intercuspation and all
eccentric movements were possible (Fig. 9, 10, 11).
Spontaneously releasing the patient, he would now
have an even bite together, and he felt much more
relaxed. The muscle irritations were now no longer
on.
Second Case
This patient came to our clinic because of restricted
mouth opening of about 25 mm interincisal distance
(IID). As a risk factor, an amalgam filling was found on
an upper molar, which had a massive abrasionfacet.
120
mod.n Ahlers / Jakstat
Figure 16. The Ahlers and Jakstat clinical summary
report for CMD risk identification was extended by
a test of physiological centric position
The amalgam filling was remodeled according to
the natural model. The patient was spontaneously
changed to a pleasant- fit-feeling.
Because of photo documentation the session took
a total of about 45 minutes. In the end, the patient
was able to achieve an opening of 38 mm IID, which
was apparently due to a spontaneous relaxation of
the muscles. Within a few days they then reached an
unrestricted mouth opening of about 40 millimeters
IID (Fig. 12, 13).
Third case
This patient was referred by a neurologist due
to severe tension headaches of unknown origin. It
had to be clarified whether dental risk factors may
be identified that could causally contribute to this
disease. In clinical occlusion diagnostics centric
and eccentric premature contacts were found
on a ceramic restoration in a mandibular molar.
Immediately after correction the patient showed
a balanced-fit-feeling of all the teeth of the maxilla
STOMA.EDUJ (2014) 1 (2)