FUNCTIONAL DIAGNOSIS AND TREATMENTA

Functional Diagnosis and Treatment is a branch of medical science that deals with the functioning of the chewing system as a whole, as well as diagnosing and treating its dysfunctions. It also analyses the impact of the dysfunction of the chewing system on other systems in the body, especially the musculoskeletal system (also known as the locomotor system), because it has the greatest influence on it.

Functional Diagnosis and Treatment is an integral part of all the other dental disciplines and in some ways is the most important dental science that coordinates and fine-tunes all parts of a very complex chewing system.   

At Dental Esthetic Center, we always strive to apply the rules of function to all dental procedures in our everyday work with patients - from the simplest procedures, such as dental filling, to the most complex ones - such as implant, crowns and bridges placements, orthodontics and complex oral rehabilitations.

To this end, we employ specially trained specialists and staff, and possess most advance equipment and devices for diagnostics and treatment of dysfunctional chewing system disorders. Only an approach so advanced and dedicated can guarantee our patients a long-term success of dental treatment.                                                                                                                          

Today we know that a beautiful smile, aesthetics and the function of the teeth are deeply intertwined with the rest of the masticatory system and the body. Having mastered all the most advanced methods of modern dentistry, we are able to tackle the treatment of any aesthetic and functional problem of our patients’ chewing system.
 

Dental procedures from functional aspect

There are exact, scientifically proven rules, confirmed by experts, how a particular part of the chewing system must function and how it should be structured anatomically, in order to be functional. Without exemption, we apply these rules in every and each treatment our patients.

Due to dedicated application of the rule of function, our treatment will never cause our patients any functional disorders.
Only one, several microns elevated nodules on one tooth can cause major chewing system disfunctions in sensitive patients. More complex dental procedures can cause far more severe functional disorders.

Unfortunately, this is still relatively common in clinics where rules of function are not applied during dental procedures. Furthermore, the doctors are usually unaware of them.

Fortunately, a large number of patients are not responding to certain functional impairments if they are not advanced. However, not such a small number of highly sensitive people (around 15%) most commonly responds to the smallest functional disturbances and experience severe pain. 

The application of the rule of function for dental procedures is extremely important. Even those patients who have functional disorders, but are not aware of them due to lack of symptoms, when triggered can respond with symptoms of dysfunction. Most commonly, the symptom is a strong pain in the area of the head and neck, but the patient cannot determine its source.

The most common trigger for the onset of the symptoms is stress. It causes the development of the right conjunctival dysfunction (CMD) with the onset of pain, often accompanied by reduced mouth opening and other symptoms.  

Dental clinics that apply the rule of function in their work throughout the world are, unfortunately, still in the minority.
At global level, dental scientists are making the utmost efforts to bring function into everyday work in as many clinics as possible. The ultimate goal of these efforts is that in the near future functional diagnosis and treatment become an integral part of everyday work with patients in all dental offices.

Prerequisites for function-based clinics are physicians who, in addition to their specialisations, are additionally educated in the field of functional diagnostics and treatment. Such a dental clinic must also have adequate equipment that enables the application of functional dentistry in everyday work with patients.
Dental offices and clinics that apply functional dentistry in everyday work with patients, are most often the most appreciated, in Europe and worldwide. They represent the very top of dental science and dental profession.                

Craniomandibular dysfunction

The chewing system consists of the upper jaw, the lower jaw, the teeth, the chewing muscles, the jaw joints, and the nerves and centres of the brain that control the chewing system. Psychosomatics or stress also have a strong impact on the condition and function of the chewing system.

The loss of an individual tooth which is not immediately replaced, the irregular position of existing teeth, the irregular position of the lower jaw in relation to the upper, oversized or overlapping crowns and bridges, dysfunctionally placed implants, and inadequate orthodontic treatment may cause functional disorders in the chewing system.

These disorders most often present themselves with the appearance of abrasion on the teeth (wear and tear of the tooth). The appearance of tilting and increased movement of the teeth due to bone loss around the tooth root is a result of excessive harmful pressures acting on them. In many cases, pain in the area of ​​the head, neck and shoulder comes from increased activity in the chewing musculature, and pain of the jaw joint is a result of its irregular function and pathological changes in the joints. These pains are often wrongly attributed to migraines, neuralgia and toothache, and are usually permanently misdiagnosed, and the pain does not stop. Swallowing problems and decreased mouth opening, dizziness, and ear murmurs may occur.

We are all aware that when we are stressed, when we are tense, we often squeeze our teeth or scrape them together, to release it. Unfortunately, this bad habit has a dreadful effect on teeth, chewing muscles and jaw joint in terms of wear and tear and the occurrence of periodontitis, as well as disorders and pain in the jaw joint and chewing muscles.

The collective term for all these symptoms and disorders is craniomandibular dysfunction.

Functional Diagnostics

Medical History – When diagnosing functional disorders, we always start by interviewing the patient, taking a detailed medical history that alongside their general health must also be focused on symptoms of craniomandibular dysfunctions.

Manual Diagnostics – Using manual diagnostics, we test chewing musculature and the condition of the jaw joint, which gives us important guidelines for the direction of further diagnosis and treatment.

Only physicians educated and trained in the field of manual diagnostics may apply this diagnostic procedure. Improper and rough manual diagnosis can lead to worsening of the patient's dysfunctions.

Dental Esthetic Center physicians are graduates of diagnostic and therapeutic procedures in craniomandibular dysfunctions, with a specialisation in functional diagnostics and treatment.

Instrumental Diagnostics – The analysis of a tooth model in the articulator gives us information about the position and anatomical appearance of each tooth and about the occlusion status (mutual contact between the upper and lower jaw teeth). This diagnostic method also determines the position of the lower jaw relative to the upper jaw, which is very important for the correct function of the chewing musculature and the jaw joints and the position of the joint capsule in the jaw joints.

    

The articulator model analysis helps us define the basic parameters for the articulator programming in the process of producing crowns and bridges as well as other therapeutic aids for the oral cavity.
This further helps us to set proper contact between the upper and lower jaw and establish unhindered lower jaw movements, which enables the patient to speak and swallow properly and gives him/her a beautiful new appearance after our surgery.
Hence, in Dental Esthetic Center, the articulator model analysis is always done before any major prosthetic implants in the oral cavity (crowns, bridges, veneers, dentures), before dental implant placements, and before orthodontic treatment to ensure proper function of the chewing system after our surgeries and top-of-the-notch aesthetics which is always closely connected to proper function.

Articulator is a device that simulates the jaw joints and the upper and lower jaw. It is used for functional diagnosis and analysis of the jaw model of the patient. The device is also used for the planning and producing of prosthetic replacements such as crowns, bridges and veneers. With the articulator we can reproduce, almost identically, the movements of the lower jaw and the movements occurring in a patient's jaw joint. The modern articulators we use in Dental Esthetic Center can be individually programmed for each patient based on electronic diagnostic data, which allows us to create the finest crowns, bridges and veneers of top quality aesthetics. 

Electronic diagnostics enables us to precisely determine the condition of the jaw joint, the position of the jaw capsule in the jaw joint and its movements. Furthermore, it allows us to determine the position of the lower jaw relative to the upper jaw in all three dimensions, the movement of the lower jaw (upper jaw is fixed, unmovable) and chewing muscles activity, along with their impact on the jaw joint and the movements of the lower jaw.
In addition to the model analysis in the articulator, electronic diagnosis gives us complete and precise data for the individual articulator programming, which enables us to produce the most accurate, maximally aesthetic and functional crowns, bridges, veneers and implants.
At Dental Esthetic Center, for this purpose, we use the most accurate condilograph in the world – Condylocomp.
Using this machine, we can accurately measure all the deviations of the mentioned positions and movements and make precise corrections. Based on these measurements, we create therapeutic devices (crowns, bridges, veneers, implants, orthodontics, retainers/aligners) that will correct the functional impairments, establish a harmonic occlusion and provide proper function of the chewing system and top-quality aesthetics.

Condylocomp is an optoelectronic device that monitors the movements of the lower jaw and the movement of the joint capsule in both jaw joints simultaneously, in all three dimensions, in real time. This diagnostic procedure is called condilography. Condylocomp is the most accurate condilograph in the world. It measures motion with a precision of one hundredth of a millimetre.

Functional Therapy

Craniomandibular dysfunction treatment is most often multidisciplinary, so physicians, orthopaedics, otorhinolaryngologists, psychotherapists, and physiotherapists can also participate in it, alongside the dentist. The dentist treats disorders related to the chewing system, and other problems are treated by other specialists in coordination with the dentist.
Chewing system dysfunction treatment depends on the part of the system that is affected - which is often all of them because they are all dependent on each other.

Treatment can range from the simplest muscle relaxation and relieving of the teeth and the jaw joint to the most complicated procedures correcting the position of the lower jaw and jaw joint in a proper physiological position.

Retainers – Usually, the basic functional treatment begins with the use of tight-fitting custom-made aligners that slip over the teeth, commonly known as retainers. We use them to slightly increase the gap between the upper and lower jaws (lifting the bite) and annul the harmful non-physiological contacts between the upper and lower jaw, resulting in the relaxation of the chewing muscles and the unburdening of the teeth and the jaw joint.
They are made of transparent plastic material and can be worn on both jaws, but they are more frequently worn on the upper one, always during sleep, and preferably as long as possible during the day, when they do not obstruct the usual daily activities of the patient.
Today there are a number of ready-made retainers available at many dental offices. They may have certain positive effects.

Being one of only a few clinics in Europe that employs educated doctors and possesses full equipment for such endeavours, at Dental Esthetic Center the initial functional treatment is conducted exclusively by individually tailored retainers, based on electronic diagnosis.
Such individually made retainers offer the best results in functional treatment, because of their maximum precision.

Oral Rehabilitation – In the case of severe functional disorders, we usually have to correct the position of the lower jaw relative to the upper, with the precise positioning of the joint capsule in the proper physiological position in the oral cavity and the joined teeth. We also need to establish proper movements of the joint capsule of the jaw joint and proper movement of the lower jaw without obstruction.

In order to achieve this and maintain the stability of the system, more often than not we need to reconstruct the tooth crowns of all teeth to obtain physiological chewing surfaces and contacts between the upper and lower jaws by function rules or harmonic occlusions.
The collective term for all of these therapeutic procedures of the chewing system is oral rehabilitation. For this purpose, we use practically all knowledge and branches of the dental profession. Prosthesis for crowns, bridges and veneers, implantology for the replacement of lost teeth roots, endodontics and periodontology for the treatment of existing teeth roots, and orthodontics for the alignment of teeth..

Impact of the chewing system function on body statics

It has been a well-known fact in the medical profession for a long time now, that healthy teeth and proper function of the chewing system play an important role in the health of the whole organism. However, newer findings reveal the strong influence of the function of the chewing system on the function of the movement system i.e. the spine, bones, muscles and joints of the whole body.

Today, we know a "bad bite" or incorrect lower jaw position relative to the above causes a static disorder of the entire body, resulting in pain and dysfunction in various parts of the movement system.

This can cause pain in the elbows, back, hips, knees and feet. Tingles can also appear in the hands and feet. It also leads to an incorrect head position, which is usually tilted to one side and forward. The shoulders are also in an irregular position, most often one is elevated, the other is lowered which, furthermore, leads to differences in arm length. The pelvis may also be distorted and pelvic torsion may occur, resulting in one shorter leg, which makes walking difficult.

If these symptoms and movement system pain occurs, aside from an orthopaedist and physician, you should also see a dentist specialising in craniomandibular dysfunction that will perform a functional diagnosis of the chewing system.

If irregularities in the function of the chewing system are found, the dentist's functional disturbance treatment of the bite must be implemented in cooperation with the physician, physiotherapist, orthopaedist, otorhinolaryngologist and neurologist. A psychiatrist might be a needed part of the team, quite often, as long-lasting pain also causes psychosomatic changes in the body and vice versa.

Using such a multidisciplinary approach to the treatment of movement system problems caused by craniomandibular dysfunction can lead to positive results.

Long-term usage of painkillers only temporarily reduces pain that will not stop until the basic problem is resolved - a bite disorder.

Recent studies suggest that as much as 80% of spine scoliosis and pelvic torsion are caused by irregular bites. All the data on this subject lead to the conclusion that a correct bite is of utmost importance for body statics and normal functioning of the movement system.