BODY SYMMETRY AND OCCLUSION

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1 BODY SYMMETRY AND OCCLUSION Do the occlusion anomalies appear because of the body asymmetry or is the irregular bite the main cause for body asymmetry Prof. Prof. h.c. (VRC) Dr. med. Harald Gumbiller 2017

2 Where is the hen, where is the egg????

3 TMJ- Dysfunctions one of the most important causes of chronic spine problems

4 History of Prof. H. Gumbiller Orthopedic, 50 years old, from time to time loosing my nerves seeing the same patients coming back with the same complaints after apparent short term recovery following an initial treatment of lumbar or cervical spine problems. I am speaking of the 20-30% of chronic or recurrent spinal pain patients which are booking another treatment all too early

5 Why? wrong diagnosis? symptomatic treatment? awkward patient? psycholocical problem? hidden primary cause?

6 Temporomandibular Joint (TMJ) The TMJ has a primary controlling function over the entire musculosceletal System

7 Temporomandibular Joint (TMJ) vice versa: disorders of the musculosceletal system are themselves affecting the TMJ (cause effect - concept)

8 Temporomandibular Joint (TMJ) What are the reasons for the increasing importance of TMJ referring to the musculosceletal system

9 Reason for the increasing Importance of TMJ Better treatment of dental problems by dentists and orthodontics are leading to a high effectivness of the primary goal, but also to an increase of sideffects.

10 Reasons for the increasing Importance of TMJ These sideffects are affecting especially the musculosceletal system (evidence by manuel medicine)

11 1988 Study by Tore Hansson and Y. Kobayashi The installation of a 0,1 mm high barriere of occlusion leads to: muscle- and joint pain changes of lab parameters ( increasing of white blood cells and GGT) within a few days changes in psychological behaviour

12 The way in which the cranio-mandibular system is affecting the entire body has not been proved so far. Today the following hypothesis are made: Musculary Joint influence Neurologic Neurophysiologic Cause effect concept Dura concept Psychological influence

13 Clinical signs of TMJ dysfunctions History (no pain in the region of TMJ, maybe the dentist tells me that I am gnashing my teeth) Inspection (horizontal eye axis and horizontal masticatory axis, shoulder level, pelvic level) Palpation: functional palpation of TMJ (activ, passiv) Functional tests (variable difference of the leg length, Priener abduction test, Leg turn in test, thorax-rotation-test) Muscletests in Applied Kinesiology (AK)

14 TMJ-Dysfunction Diagnosis: Muscular TMJ-Dysfunction some years ago Referral to the dentist to adjust a orthodontic splint

15 Frequent signs when controlling the orthodontic splint Only minimal improvement of leglength difference (e.g.: 3 cm - 1,5 cm) incompatibility of the used material (plastic, steel) Worsening of signs and symptoms (e.g: leglength difference 2 cm - 3 cm)

16 Why The patient comes to the dentist or orthodontic in a total wrong posture

17 Why? Atlas dysfunction Torsion of the pelvic with leglength difference Distorsion of the entire spine Ancle joint dysfunction Major difficulties in adapting the orthodontic bite

18 Taking a bite In the second of taking a bite the dentist or orthodontic is fixing the incorrect posture of the patient. ATTENTION: in a study in my office in 2006 with 53 patients, we could show that the occlusion was changing before and after manual/osteopathic treatment of the posture in the average of mm.

19 Conclusion The posture of the patient will be treated by manual medicine or Osteopathy first Now we have the posibility to measure the occlusion problem with µ-paper Now it is the time to take the bite by the dentist Problem: the way from Osteopath to the dentist. Please in stop floating position

20 New Treatment Strategy for TMJ-Dysfunction Introducing a new point in earacupuncture to influence the TMJ function Dr. med. H. Gumbiller

21 Prerequisite for the indication of earacupuncture for treating a TMJ- Dysfunction? Changing leglength differnce when biting The Priener Abduktionstest changes to positive when biting positive Leg turn in Test when introducing the bite positive Thorax-Rotations-Test when introducing the bite positive therapy localizing (muscles are getting weak) in Applied Kinesiology when introducing the bite

22 Lokalisation of the earpoint for TMJ- Dysfunctions: TMJ-Muscle Point by Gumbiller Essential: Permanent needle for at least 10 days otherwise danger of relaps

23 Prerequisite for the correct localisation is the immediate improvement of the following signs: Changing leglength differnce when introducing the bite The Priener Abduktionstest changes to positive when introducing the bite positive Leg turn in Test when introducing the bite positive Thorax-Rotations-Test when introducing the bite positive therapy localizing (muscles are getting weak) in AK when introducing the bite

25 In a follow up study on 1100patients over a period of 5 years we received the following results: In 40% of the patients we obtained a permanent elimination of the TMJ Dysfunction with a single treatment with ear acupuncture In 60 % of the cases we obtained a elimination of TMJ Dysfunction only for the period with the inserted needle. Referral to the dentist to adjust a orthodontic splint or direct construction of plastic on the teeth as a temporarily treatment

26 TMJ Dysfunction Hypothesis: The acupuncture point is changing the neurological control of TMJ muscles, which in its turn, will lead to a change in the occlusion of the jaws

27 High importance in cooperation of dentist and physician: If there is no long term effect of acupuncture treatment Orthodontic specialist and dentist has the possibility to adapt a orthodontic splint or a direct construction of plastic on the teeth as a temporarily treatment while the permanent needle is inserted to put the body in correct posture

28 How do we proceed in our medical clinic if we find a TMJ Dysfunction In the first appointment no treatment by dentist or orthodontic Ear acupuncture (TMJ ear point by Gumbiller)

29 If the patient has a recurrence of the TMJ Dysfunction: Again: osteopathic treatment of the posture Check frontal teeth contact (Coxathritis!) Measurement of the vertical fault in occlusion Again: earacupuncture Referral to dentist/orthodontic with the results of measurement Check the patient 14 days and 6 weeks after treatment by dentist/orthodontic

30 Conclusion In 80-90% of chronic recurrent cervical und lumbar spine problems the TMJ- Dysfunction is a essential cofactor With four reliable tests from manual medicine it is possible to prove if there is a chronic dysfunction of the body caused by the TMJ- Dysfunction

31 Thank you for your attention

32 Powerpoint Presentation Aktuelle Infos

Total Prosthetic Replacement of the Temporomandibular Joint (TMJ)

Total Prosthetic Replacement of the Temporomandibular Joint (TMJ) VERSION CONTROL Version: 2.0 Ratified by: Governing Body Date ratified: 13 November 2013 Name of originator/author: Name of responsible