Description: This course will cover concepts of joint injury leading to alteration of the occlusion. Drawing from a database of 20,000 CT and MR imaged temporomandibular joints, Dr. Piper will explain how finite distortions of articular space soft tissue and bony dimensions can create dramatic changes in the occlusion. Mechanisms of injury to the temporomandibular joint foundation will be reviewed. The distinction between malocclusion that leads to internal derangements versus internal derangements that creates the malocclusion will be clarified. The clinical correlation between mechanically injured temporomandibular joints and Class II molar occlusion, apertognathia, occlusal asymmetry, and posterior dental working and balancing interferences will be demonstrated. Attendees will be given specific guidelines for diagnosing joint-based foundational malocclusion through the examination of both the static and the dynamic occlusion. Cone beam CT (CBCT) and the magnetic resonance imaging (MRI) scan findings will be related to projected future stability or instability of the occlusion and facial skeleton. Mechanisms of masticatory system pain relating to foundational instability shall be discussed. Scans in adult patients with joint-based foundational injuries will be referenced to explain why orthodontics, restorative dentistry, and orthognathic surgery cases may remain unstable. Special attention will be dedicated to mandibular condylar growth injury in children and the resulting development of severe malocclusion and skeletal distortion. This is a two-part lecture (C10 and C23) that is best attended as a full day. However, participants may take either the morning or the afternoon session.
Learning Objectives: • Understand how joint structures support the occlusion. • Learn how mechanical injuries within the temporomandibular joints can profoundly alter the occlusion in both children and adults. • Understand the clinical signs of joint-based foundational malocclusion through direct examination of the static and dynamic occlusion. • Integrate CBCT scanning and MRI to diagnose temporomandibular joint injuries, alteration of articular dimensions and resulting distortions of the occlusion.