T-Scan as an Education Tool

The T-Scan is an effective patient and doctor education tool for illustrating existing occlusal pathology, as it presents complex occlusal force and timing information in a visual format that is easily understood. The T-Scan applies to all stages of the teaching/learning process because its recorded data forms the framework upon which a doctor/patient discussion can begin regarding the patient's occlusal disease manifestations, the potential benefit of treatments, and the risks of not undergoing corrective treatment. When used as part of an educational strategy, the T-Scan can lead the patient to accept procedures that would benefit their long-term dental health. Chapter 19 outlines the four stages of creating optimum dental health, the steps required to perform effective teaching and learning, the differing styles of teaching and learning utilized in educational forums, and how to best employ the technique of Feature, Function, and Benefit. A few case examples illustrate how T-Scan data can educate a patient about their own occlusal problems, while describing both normal and abnormal occlusal function to a dentist.

Understanding Posturo-Occlusal Interrelationships by Combining Digital Occlusal and Posture Diagnostic Technologies

The nature of the interrelationship between whole body posture and the quality of the dental occlusion has not yet to date been clearly documented within the dental or posture literature, as the findings of published studies within both fields have been scarce and inconclusive. The combined use of digital diagnostic occlusal and postural assessment technologies has not been widely employed in these research projects, which has mired both fields' ability to study, to understand, and to clearly ascertain how posture and dental occlusion affect each other physiologically. As such, the specific aims of this chapter are to outline how posture and dental occlusion interrelate through the stomatognathic system's afferent neural inputs into the central nervous system (CNS), which communicate important occlusal contact force distribution information, and equally as important, mandibular spatial positional information within the posture and balance regions of the brain. The concept that the dental occlusion is a capteur for posture (which in English means, a sensor of posture health), is further explored with the inclusion of three differing clinical posturo-occlusal cases, diagnosed and treated with the combined use of the T-Scan 9 computerized occlusal analysis technology, the MatScan/MobileMat foot pressure mapping technology, and the Footmat Research software version 7.10. These presented clinical cases illustrate that improved right-to-left occlusal contact force balance, and improved center of force location within the dental arches, improve a number of measurable sway parameters. Together, the implementation of the T-Scan and the MatScan exquisitely demonstrate to the clinician the significance of the physiologic interrelationship between body posture and the dental occlusion. The presented cases emphasize there exists a whole-body concept that depends upon a variety of differing systems, whereby changes in the dental occlusion produce a phenomenon of bio-functional neuro-reprogramming for the stomatognathic system and the whole body.

Periodontal and Implant Treatment With Computerized Occlusal Analysis

The role of occlusion in the progression of periodontal disease remains a controversial subject. Occlusal force, which is a mechanical stress applied to tissues, has always been considered to not initiate, nor accelerate, periodontal attachment loss resultant from inflammatory periodontal disease. This chapter outlines this controversy in great detail, from the perspective that the absence of a validated occlusal force and timing measuring device that can quantify the occlusion, has contributed to the confusion and questions that exist in the scientific community about the relationship between both periodontal disease and peri-implantitis, and the occlusion. The development of a new occlusal measurement technology that records and analyzes precise and reproducible relative occlusal contact force levels in real-time, independent of a clinician's subjectivity, is helping to change the scientific opinion regarding occlusion's role in periodontal and peri-implant supporting tissue loss. The T-Scan 10 system is particularly adapted for treating patients who demonstrate tissue loss combined with occlusal issues. Indeed, after having controlled the major etiologic and risk factors of periodontal disease and peri-implantitis, adjusting the occlusion after active tissue and implant therapy favors healing. The outcome of periodontal treatment aimed at compromised teeth and dental implants, combined with occlusal force excess control from computer-guided targeted occlusal adjustments, is highly predictable, and is characterized by less inflammation, a decrease of probing depths, and the stabilization of bone levels around teeth and dental implants.

Combining the Air Indexing Method With the T-Scan System to Detect and Quantify Cervical Dentin Hypersensitivity

This chapter introduces the air indexing method for detecting and quantifying cervical dentin hypersensitivity (CDH) as a companion to the T-Scan Occlusal Analysis System which evaluates force and timing values for occlusal contacts of teeth. This chapter will also highlight an evidence-based retrospective investigation undertaken between 1979 and 1996 that evaluated associations and/or correlations between diagnosed CDH and its resolution following occlusal adjustment. This retrospective's method described the detection, diagnosis, and treatment of the signs and/or symptoms of the common clinical finding amongst patients with CDH. Stress physics will illustrate how small occlusal contacts magnify the impact that applied occlusal contact force has on the cervical regions of teeth. This resultant cervical stress is etiologic for how non-carious cervical lesions (NCCLs) form and degrade tooth roots. This chapter also explains how biocorrosion from endogenous and exogenous sources produces loss of dentin's protective proteins, glycoproteins, and cementum, which add to the effects of applied occlusal force, thereby creating CDH symptoms and NCCLs. CDH appears resultant from the co-factors of occlusal forces that produce cervical stress, along with biocorrosion, that are both modified by occlusal surface friction. The air indexing method of CDH diagnosis is an objective diagnostic means to detect and quantify CDH symptoms during the formation of cervical lesions. This chapter presents the clinical benefits of melding the T-Scan Occlusal Analysis System with the Air Indexing Method when clinically assessing and treating cervical hard tissue pathologies. The clinician gains significantly more occlusal insight as opposed to using either methodology alone, when air indexing is combined with T-Scan's occlusal contact force and timing data. Lastly, this chapter introduces two case reports of how T-Scan guided occlusal adjustments can be effective at reducing CDH and prohibiting the progression of gingival recession.

The Occlusal, Neurological, and Orthopedic Origins and Implications of the Hypersensitive Dentition

In the dental literature, the association between the occlusion and hypersensitive teeth is poorly explained. Quantified occlusal contact force and timing parameters have been largely ignored in studies assessing hypersensitive teeth. This chapter introduces a novel occlusal concept, frictional dental hypersensitivity (FDH), after systemically simplifying the existing and often confusing terminology used in the literature to describe the variant clinical presentations of the hypersensitive dentition. Clinical evidence from combining computerized occlusal analysis and electromyography is presented linking opposing posterior tooth friction and muscular hyperactivity to FDH. This chapter will outline how occlusion, many muscular TMD symptoms, and FDH are all interrelated. Both a pilot study and a 100 subject cold ice water swish follow-up study are presented and used a numerical visual analog scale (NS/VAS) to quantify cold response dental hypersensitivity resolution observed in occlusally symptomatic patients that underwent the immediate complete anterior guidance development coronoplasty (ICAGD). This computer-guided occlusal adjustment procedure eliminated pretreatment FDH symptomatology, further supporting that dental hypersensitivity often has an occlusally-based, frictional etiology. Additionally, consideration for the orthopedic influences that may directly affect the occlusion and neurology of the system are outlined, as well as the medical concept of tooth allodynia. Furthermore, trigeminal neurological influences are compared and contrasted to autonomic sympathetic inputs in relation to the influence that they each have upon the hypersensitive dentition. Lastly, the greater auricular diagnostic nerve block is discussed, as is the influence that this nerve may have upon the hypersensitive mandibular posterior dentition.

Temporomandibular Joint Imaging

Computerized tomography (CT) and magnetic resonance (MR) imaging of the temporomandibular joint are often not a routine part of a dental patient's pain and clinical evaluation. As a result, the most poorly understood region within the masticatory system is the temporomandibular joint foundation. Unfortunately, patient care and occlusal management are often compromised because of a lack of insight into the relationship between the anatomy of the temporomandibular joints and the occlusion. This chapter's four distinct sections review the key concepts about the temporomandibular joint foundation anatomical structures, detail structurally intact and structurally altered temporomandibular joint anatomy, clarify how structurally altered temporomandibular joints influence occlusal function, and classify the stages of temporomandibular joint structural degeneration. The concept of joint-based malocclusion is explored with numerous temporomandibular joint foundation anomalous software renderings, and sample CT and MR images, which together illustrate in detail how soft tissue and bony abnormalities in a structurally altered temporomandibular joint can create distortions in the occlusion. Lastly, the chapter addresses the specific requirements a clinician must technically master to perform a comprehensive CT or MR examination.

Employing the T-Scan/BioEMG III Synchronized Technologies to Diagnose and Treat Chronic Occluso-Muscle Disorder

This chapter discusses chronic occluso-muscle disorder, which is a myogenous subset of temporomandibular disorder (TMD) symptoms resultant from occlusally activated muscle hyperactivity. It also describes the computer-guided occluso-muscle disorder treatment known as disclusion time reduction (DTR), that studies repeatedly show reduces many common muscular temporomandibular disorder symptoms. T-Scan-based research since 1991 has determined that a significant etiologic component of occluso-muscle disorder is prolonged (in time) occlusal surface friction shared between opposing posterior teeth during mandibular excursions, that occurs in both normal chewing function and during parafunction. This friction results in prolonged compressions of the periodontal ligament (PDL) fibers of the involved teeth, which when in excursive opposing occlusal contact, also experience pulpal flexure that leads to pulpal neural activation, which together with the periodontal ligament compressions, trigger excess muscle contractions within the masticatory muscles. It is this unique neuroanatomy that incites and perpetuates many chronic muscular TMD symptomatology, that can be readily resolved in patients that meet the diagnostic criteria for DTR candidacy, using the ICAGD coronoplasty that is performed in the maximum intercuspal position (MIP), without employing treatment splints, deprogrammers, appliances, orthotics, or mandibular repositioning. Additionally, this chapter will highlight the newest disclusion time reduction therapy (DTR) studies that support the clinical implementation of this highly effective measured occlusal treatment for occluso-muscle disorder.

Adding Technology to Diagnostic Methods

Adding modern technology to clinical diagnostic methods instead of replacing them, represents an improvement in patient care, because objective bio-physiologic measurements enhance the information obtained from the patient report of symptoms and the clinical observations made during a patient examination. Combining multiple tests has universally been acknowledged to enhance diagnostic sensitivity and specificity. The increased objectivity of bio-physiologic measurements that represent quantifiable data for diagnostic purposes also adds value to treatment monitoring and/or outcome assessments. The most recent evidence suggests that the emotional aspects of temporomandibular disorders (TMD), are more the result of pain and dysfunction than the cause. This chapter discusses several dental technologies that are now available that provide objective bio-physiologic measurements of masticatory functions. Bio-physiologic measurements have the capacity to provide detailed, objective analysis. Each diagnostic technology is illustrated with an example of its output data, recorded from both an asymptomatic subject, as well as a patient with masticatory dysfunction. Of significance when considering employing these instruments is that a dentist can use these technologies to improve the initial diagnostic accuracy, and also to verify the degree of success after rendered treatment. Finally, recommendations are provided that dental medicine should accept the use of modern digital technology as an indispensable part of modern clinical practice, and that resistance to its implementation should no longer inhibit its widespread clinical use.

Joint Vibration Analysis (JVA) and the Diagnostic Process in TMD

This chapter describes joint vibration analysis technology (JVA), that assesses pathological changes that can occur within the temporomandibular joints. The diagnostic process and a simplified approach to better understand and efficiently treat temporomandibular dysfunction (TMD), will be overviewed. With over 38 different etiologies under the umbrella term “TMD,” the need to streamline and effectively determine an accurate definitive diagnosis and potential treatment options becomes apparent. Joint vibration analysis (JVA) uses tissue accelerometers to objectively capture vibrations given off by structurally compromised, internal TM joint anatomy. This structural breakdown leads to altered mandibular movement patterns during chewing function. Different attributes of representative JVA vibrations have been shown to indicate the presence of various disease states, often seen within the temporomandibular joint complex. After being recorded, the JVA software displays the various vibration waveforms for clinician analysis, to determine the specific internal derangement present. This chapter provides an overview of the various vibratory waveforms that indicate TM Joint pathology is present, and illustrates the utility of joint vibration analysis as a temporomandibular joint diagnostic adjunct. When this information is combined with a thorough clinical exam and medical history, a clinician can then begin to efficiently present the information to the patient. Significantly, proper communication begins with presenting information that is easily understood and familiar to the patient. A simplified approach utilizing a JVA-based diagnostic process, will be overviewed in detail.

Precision and Reliability of the T-Scan III System

Precise analysis of occlusal contacts and occlusal force is a problem in functional diagnostics that has not yet been satisfactorily resolved, despite the fact that the deleterious consequences of an unbalanced occlusion are widespread, and can be severe. In clinical practice, the present-day analysis of the occlusion is reduced to depicting force with color-marking foils that leave ink marks upon the teeth. However, these foils only indicate the localization of contacts, but do not describe reliably the occlusal force relationships. Precise analysis that incorporates time resolution, and plots the distribution of forces within the occlusion, is not possible when employing the traditional occlusal indicator methods. A detailed occlusal force and timing analysis can only be provided by performing a computer-assisted analysis, using the T-Scan III system (Tekscan, Inc. S. Boston, MA, USA), which records changing relative occlusal force levels and real-time occlusal contact sequence data, with high definition (HD) recording sensors. The following chapter demonstrates the accuracy and reliability of this computer-based occlusal measurement method that reliably describes the time-dependent distribution of occlusal force evolution.