The following Magnetic Imaging Resonance (MRI) images are of a 34 year old male, TMD patient who had 4 bicuspid extraction retraction orthodontics previously. Skeletal Class II retrognathic mandible was noted prior to treatment. Using K7 jaw tracking and TENS Optimized Bite protocols (as per Dr. Clayton A. Chan) the “optimized mandibular and bite” position was determined. MRI confirms both left and right disc are optimized and functional.
Enlarged MRI View of the Right Temporomandibular Joint.
Using a 1.5 Tesla MR Imager images through the TMJs were obtained without contrast. Left image is right TMJ in the closed position (“normal”). Right image shows condyle in open position. “There is no disc dislocation”.
- Right and Left TMJ: condyle is small with normal joint position with the disc on closed mouth imaging.
- Right and Left TMJ: On open-mouth imaging it moves anterior with disc. There is not dislocation.
Does the Optimized Bite Protocol Bring the Condyles Too Far Down the Eminence?
Only the doctor who is taking the “optimized bite” can bring the condyle “too far down the eminence”. It is not the optimized bite protocol that brings the condyle too far forward…it’s the clinicians understanding or misunderstanding of where to identify the optimized myo-trajectory.
Secondly, some may say that when using the optimized bite protocols the condyles are “too far forward”. We have to ask, relative to what? This is the question I would ask.
Is to too far forward relative to what we are use to seeing radiographically when a condyle has no bend in the neck? Or when the condyle has a bend in the neck and the condyle is down the eminence more than you typically see ask yourself if this bend is contributing to the body of the mandible to be too far forward (abnormal pathologic or normal physiologic)? Are the teeth too far back (maxillary teeth tipped back) or maxillary pre maxilla too retrognathic contributing one’s perception and understanding that a condyle is “too far down and forward” within the fossa. Think of all the structures involved. Don’t just think of joints. Think teeth, mandible body, muscles and also joints as a whole unit. Look at the face profile as well.
If the patient is functioning with good open and close velocity, no slow downs, no bradykinesia, or dyskinetic movement (Scan 7) with round velocity patterns… is the seemingly “too far forward” position on tomography of the joint a bad thing?
If it is too far forward you will have functional occlusal problems, postural head, neck and overall body instability as well as patient complaints of ringing in the ears, the patients habitual trajectory will not be coincident with the TENS optimized pulse myo-trajectory. Those would be some of the objective measured features that would indicate a condyle is too far down and forward.
The doctors should NOT be going by what the condyle looks like by radiographs within the glenoid fossa only, but more importantly how is the unit of the body including the masticatory system and body structuring functioning as a whole (healthy or pathologic function)…and we can see the function with our K7 scans.
I think we doctors have been strongly influenced by traditional joint imaged based thinking more than an appreciation and understanding of physiology and K7 (functional data ). We never really learned what is actually healthy patterns nor understood what health or pathologic K7 scan were portraying and telling us in a dynamic and real time manner. That is why Scan Interpretation is key to diagnostic understanding. The K7 operator should understand the K7 data better before concluding and promoting certain concepts wrongly or not completely.
– Clayton A. Chan, D.D.S. – Las Vegas, NV