The majority of the patients we help have already received prior treatment, usually orthodontic care.

Orthodontics is the branch of dentistry dealing with the prevention and correction of irregular teeth, as by means of appliances or braces. TMJ Orthodontics involves finding the best upper quadrant functional relationship and approximating the teeth to support and maintain these anatomic and physiologic stable associations.

Orthodontic and TMJ Orthodontic corrections are not the same. Orthodontics developed over thousands of years from the time of ancient Egyptians, Greeks and Romans who were concerned about how the teeth fit together and had means to move the teeth to improve the bite. Orthodontic care moves the teeth at the habitual bite or how the teeth fit together when you close. Initial examination records are taken at this bite position and this bite is where a diagnosis is made and where treatment alternatives are formed.

TMJ Orthodontics was developed by Dr. Duane Keller over the last 40 years. TMJ Orthodontics established the best functional anatomic and physiologic position of the lower jaw to the upper jaw so the joints, muscles and associated structures function harmoniously and the best functional relationship of the head to the cervical spine.

A diagnostic phase is initiated at this association to evaluate function over time to ensure optimal joint, muscle, head and neck associations are obtained and maintained. The diagnostic functional association is maintained over time as the patient’s signs and symptoms are monitored to ensure optimal function is attained. When this diagnostic phase is effective in overcoming patient’s signs and symptoms of dysfunction, a permanent maintenance of this association is proposed so the bite is made to function, support and maintain the best upper quadrant structural and functional association.

A relationship exists between how the teeth fit together, how the joints, muscles and other associated structures relate. When this system is in balance the components function harmoniously. When this system is out of balance compromises occur. One or more of the components will suffer structural and postural dysfunction and breakdown. The following is an example of this type of compensation.

This patient had received first bicuspid and wisdom teeth removal orthodontic corrections at the habitual bite relationship. The orthodontic results do not support the best functional relationship of the joints, muscles or head and cervical alignment. As a result the lower anterior teeth have worn so there is almost no facial enamel left on the teeth. The muscles and joints are not as compromised.

The orthodontic results completed at the habitual bite position also demonstrate a lack of symmetry in the final orthodontic corrected position. The mandible is shifted to the right as is evident from the deprogrammed position and the occlusal plane is canted down on the right and up on the left. The anterior teeth were worn through the facial and incisal edge and canine cusp tips were worn off.

This photograph also demonstrates complications when the orthodontic corrections focus on how the teeth fit together. This patient bites on his posterior cheek structures so he does not have to fully occlude his dentition. This can be observed in the linea alba (white line) in the cheek. The bite plane is also canted down right and up left as the camera is maintained at a true horizontal reference. There are multiple muscle trigger points and occasionally the patient is aware of headaches and upper neck and back pain. Some early opening clicking occurs when he brings his teeth together at the completed orthodontic association, but not when he bites into this functional bite position (below).

The patient is able to function without compromise to the joints and muscles at this association, but this also demonstrates how far the initial orthodontic results missed the functional joint, muscle, head and neck association. The best functional position should be supported by the teeth or something has to give. In this case the joints, muscles and dentition have been compromised by the initial orthodontic treatments. The problems started with the original examination and diagnosis.

This case demonstrates the difference in the habitual bite position on the left and the functional bite position on the right. The left diagnosis demonstrates the upper arch to be too far forward and extraction mechanics maybe appropriate. The diagnosis on the right demonstrates the mandible is too far back and treatments here would not involve extractions but treatment to a mandibular advanced position. A diagnostic phase with an intraoral orthotic would be needed to determine which position is appropriate and where the patient is best able to function free of compromise or compensation.

The following patient is observed at the end of orthodontics that was not completed at the best upper quadrant functional position. The patient experienced clicking in her right joint as the orthodontic results cause the mandible to shift to the right, thus compromising the function of the right joint with associated muscle pain (headaches).

The best functional association is established with an orthotic and physical therapy and is observed here. The patient’s signs and symptoms disappeared and she could function without pain or noise.

This functional association is maintained with the TMJ Orthodontic Method and the teeth are approximated to support the best functional upper quadrant relationship.

Segmental arch mechanics which are a part of the TMJ Orthodontic Method allow a leveling of the occlusal plane and an approximation of the teeth to support the best functional joint, muscle, and upper quadrant association.

Photographs of the bite association 22 years later demonstrate the stability of treating the dentition to the best functional upper quadrant position with TMJ Orthodontics. There are no TMJ signs or symptoms.

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