Step 1: Consultation
During the initial consultation, we conduct a comprehensive examination of the oral cavity and teeth using magnification tools—microscope/binoculars, as well as palpation of the masticatory muscles. This allows us to determine:
- Which muscles are involved,
- Whether there are painful areas,
- Whether there is asymmetry between the right and left sides.
- We also collect a detailed medical history, including both dental and general medical records.
A photographic record of the teeth and face is made for further analysis. Based on these data, we discuss a preliminary diagnosis with the patient and explain the upcoming treatment stages.
On average, the consultation lasts from one to one and a half hours.
Step 2: Condylography Appointment (Takes up to 2 Hours)
Advanced Diagnostic Stages
After the initial consultation, the next crucial diagnostic step is condylography.
1. Condylography
Condylography is a method for recording lower jaw movements using a specialized condylograph developed by the German-Austrian school of gnathology. The device is fixed to the patient’s head.
During the study, functional tests are recorded, including:
- Opening and closing of the mouth
- Lateral and anteroposterior jaw movements
- Chewing movements
- Swallowing and other functions
As a result, we obtain a graphical representation of temporomandibular joint (TMJ) movements on both the right and left sides, allowing for detailed analysis.
2. Joint Path Analysis
Based on the collected data, the individual joint path (the trajectory of the condylar head movement) is calculated. This helps to:
- Fully individualize cranial parameters
- Identify possible structural changes in the joint
- Determine the presence and stage of arthritic processes
3. Lateral Cephalometry with Markers
After condylography, lateral cephalometry (TRG) is performed using pre-positioned markers. This step is necessary to accurately calculate the individual bite height.
4. Data Transfer to the Articulator
The obtained parameters are recorded and transferred using plaster modeling and a kinematic facebow to a specialized device—an articulator or variator. This allows us to:
- Model the position of the upper and lower jaw within the patient’s skull
- Assess their true occlusion and functional characteristics
5. Occlusogram
Additionally, an occlusogram is performed, where the patient bites onto a special diagnostic wax to identify:
- Occlusal interferences (contacts that hinder proper jaw movement)
- Possible functional chewing disorders
Step 3: Data Analysis (Without the Patient)
Functional Diagnostics
Functional diagnostics include a comprehensive analysis of all collected data to determine the optimal position of the lower jaw.
1. Data Analysis
- Photographic records of teeth and face – for visual analysis of occlusal and aesthetic parameters
- Occlusogram – to identify occlusal interferences affecting jaw movement
- Condylography – to assess condylar head trajectories and detect possible dysfunctions
2. Cephalometric Analysis
Precise calculations are performed using the Slavicek and Sato methods, allowing for the determination of the correct position of the lower jaw.
3. Additional Examinations
- Muscle palpation – to detect areas of hypertonicity, pain, and asymmetry
- CT scan analysis – to evaluate condylar head positioning, detect compression, and identify early arthritic changes
4. Conclusion Formation
Based on all collected data, the required amount of lower jaw repositioning is determined.
5. MRI Prescription (If Necessary)
If the available data is insufficient, TMJ MRI is recommended to visualize the joint disc and soft tissue structures, allowing for a more precise assessment of the joint condition.
Summary
Functional diagnostics allow for a comprehensive analysis of the dentofacial system, joints, and muscles, determining the individually correct lower jaw position for further treatment.
Step 4: Test Bites
What Are Test Bites?
Test bites are a trial fitting of the future lower jaw position using special occlusal plates.
Procedure Steps
- Custom occlusal plates are placed in the patient’s mouth to:
– Temporarily change bite height
– Assess the impact of the new jaw position on muscles and joints
– Analyze changes in facial symmetry and harmony - During the procedure, the doctor observes:
– How muscles relax and adjust
– Changes in jaw opening trajectory
– External facial changes
Duration
The test bite procedure takes 1 to 2 hours, during which occlusal plates may be changed to find the most physiological and comfortable jaw position.
Conclusion
Test bites allow for a real-time evaluation of how the new jaw position affects muscles, joints, and facial aesthetics before proceeding to the next treatment stage.
Step 5: Splint Therapy
What Is a Splint?
A splint is a repositioning appliance designed to stabilize the new lower jaw position.
How Does a Splint Work?
- The splint is worn continuously, except during meals.
- It corrects jaw position but does not move teeth (unlike aligners or braces).
- If the patient previously had subluxations or joint clicking, the splint helps eliminate these issues and relieve pain.
Splint Therapy Duration
Treatment with a splint lasts from 1 to 6 months, depending on joint damage severity and arthritic changes.
Conclusion
Splint therapy stabilizes joint function, eliminates discomfort, and prepares the jaw system for further treatment.
Step 6 Transferring the Splint Position to Positioning Overlays and Initiating Orthodontic Treatment
Securing the Result and Orthodontic Treatment
After achieving positive dynamics in temporomandibular joint (TMJ) treatment using a splint, it is crucial to fix the new position of the lower jaw.
1. Transferring the Therapeutic Position
To stabilize the result, temporary overlays are used, which are typically placed on the molar teeth. These overlays help:
- Maintain the lower jaw in its new, physiologically correct position (in the splint position).
2. Orthodontic Treatment
Once the joints are stabilized, the orthodontic phase begins:
- Metal or ceramic braces, or aligners are installed.
- The patient undergoes orthodontic treatment, which is planned from the beginning based on the correct bite height and optimal lower jaw position.
At this stage:
- The disc is fully repositioned, and the joint is relieved of arthritic changes.
- Only final tooth alignment using elastics (intermaxillary rubber bands) remains.
3. The Role of Elastics in the Final Stage
Elastics contribute to:
- Bringing the teeth together and forming a proper occlusion.
- Extrusion (gradual movement of the teeth into the correct position).
- Final bite stabilization.
Conclusion
Thanks to a step-by-step approach—from splint therapy to orthodontic treatment—it is possible to not only eliminate joint dysfunction but also create a stable, functional, and aesthetically correct bite.
If there are no indications for orthodontics, the treatment can immediately proceed to prosthetic rehabilitation.
Prosthetic Rehabilitation Without Orthodontic Treatment
In some cases, orthodontic correction may not be required. If a patient has damaged teeth but their position does not need to be changed, bite restoration is performed exclusively through prosthetic methods.
1. Temporary Rehabilitation Phase
After completing functional diagnostics, temporary restorations (crowns, overlays) are fabricated, which:
- Stabilize the jaw in the correct therapeutic position.
- Allow the patient to adapt to the new bite.
- Serve as the foundation for the final prosthetic protocol.
2. Final Stage – Ceramic Restoration
Once the patient has successfully adapted, the temporary restorations are replaced with permanent ceramic restorations, including:
- Crowns – for severely damaged teeth.
- Onlays and overlays – for minimally invasive reconstruction of molars.
- Veneers – for aesthetic correction of front teeth.
3. Complete Bite Reconstruction
This method allows for the creation of an ideal occlusion without using braces or aligners, while ensuring that:
- The jaw remains in the correct functional position.
- Joints and muscles function without overload.
- A stable and aesthetic result is achieved.
Conclusion
If orthodontic correction is not required, full bite reconstruction can be achieved through prosthetic protocols, allowing for bite restoration and occlusion stability without prolonged tooth movement.