The four dimensions of orthodontic diagnosis--Part II

There are three traditional dimensions of orthodontic diagnosis--transverse, vertical, and anterior-posterior of the maxilla and mandible. However, there is a "fourth dimension"--proper condylar position. The condyles, at the other end of the teeth, can be influenced by orthodontic treatment. The chief problem in 90% of my patients referred for TMJ dysfunction is posteriorly and/or superiorly displaced condyles. Whether these patients have had a problem for 2 months or 10-20 years, most of them will have major relief (50-70%) of their symptoms within 2 weeks to 2 months. They frequently report 50-70% relief of their symptoms. This is accomplished by placing the condyles in the proper position in the glenoid fossae with an appliance worn full time. This article will discuss how to determine proper condylar position and the construction of a mandibular appliance (VG) to correctly reposition the condyles in the glenoid fossae. After 3-4 months, when symptoms are relieved, an upper inclined biteplane appliance (VMI) is added for nighttime wear and the lower appliance is "shortened" to allow eruption of posterior teeth. Spacers are used to encourage eruption of posterior teeth. Several patient examples are included and the results achieved are written in the patients own words on a progress report form.