Functional Analysis
The number of patients experiencing maxillofacial pain (pain in the jaw and face) has increased significantly.
The common causes are dysfunction or incorrect alignment of the jaw, which over time can lead to headaches or painful muscle tension in the face and neck areas, as well as impairment of dental function and damage to the masticatory system. To prevent or treat this condition, functional analysis is recommended to determine the correct and efficient treatment.
There are scientific rules established and confirmed by experts in the field regarding how the masticatory system should function and be structured to be functional. Functional analysis of the masticatory system is a dental method for evaluating the individual characteristics of the patient’s jaw. This procedure analyzes the masticatory muscles, the jaw, teeth, and periodontium. The chewing process and the movements of the upper and lower jaw are recorded, and the functionality of the masticatory muscle is observed.
Functional analysis is part of the dental branch called Occlusology. It is the pathway to diagnosing a cranio-mandibular dysfunction and is specifically performed in cases involving superior aesthetics, such as dental veneers. It is considered to be the first step in conducting prosthetic or aesthetic treatments.
What does functional analysis include?
- Facial analysis – it determines facial symmetry, diversity of shapes, proportions, and profile.
- Dento-labial analysis – it examines how the lips move, the appearance of the smile line and the oral corridor.
- Phonetic analysis – which is crucial for determining the correct rehabilitation of front teeth.
- Dental analysis – it evaluates the shape and size of the teeth, their color and texture.
- Gingival analysis – it assesses gingival health, zenith line (the highest point of the free gingival margin in the front teeth), interdental papillae (helps create the framework for the dental contour).
Functional analysis complements aesthetic analysis to create a correct and efficient treatment plan that integrates both aesthetic and functional values, both dynamic and static.
Moreover, this analysis involves an interdisciplinary approach across multiple directions, providing a comprehensive overview. To achieve the desired comprehensive picture, visits to osteopaths and physiotherapists, for example, are necessary. Why? Because there are situations when muscle contractions, scars, can pose problems beyond the dental context.
Functional analysis for diagnosing temporomandibular joint (TMJ) disorders
Functional analysis for diagnosing temporomandibular joint (TMJ) disorders is crucial as it can prevent or eliminate early structural problems of the TMJ. It includes the analysis of guided or unguided, conscious or unconscious dynamics of mandibular movements.
In the case of unconscious movements, several tools are used, such as myorelaxant splints and bruxcheckers. The latter are extremely thin splints made of colored films worn at night on the upper and lower jaw. They determine areas where extremely high pressure is exerted, caused by teeth grinding during the night. Areas where the color is worn indicate maximum pressure zones, helping identify unconscious, nocturnal muscle contractions.
Dynamic examination for diagnosing temporomandibular disorders involves condylography. This analysis focuses on conscious movements guided by the dentist and digitally recorded using a condylograph. Through this dental analysis, we can largely determine the position of the condyles and assess whether there is pressure on the temporomandibular joint.
The position of the condyles is influenced by posterior support (the position where the teeth come into contact). Sometimes, the body can compensate for compression. In cases where it cannot, pain may occur in the TMJ (or elsewhere). Additionally, incorrect posture – head position in flexion, extension, rotation, a scar – can cause skeletal changes in the TMJ and occlusion.
Incorrect occlusion or malocclusion - a major cause of temporomandibular joint (TMJ) disorders.
Addressing malocclusion often involves orthodontic interventions, such as braces or other dental appliances, to correct the alignment of the teeth and improve the bite. In some cases, additional treatments, including physical therapy, bite splints, or surgery, may be recommended to manage TMJ disorders associated with incorrect occlusion. Early diagnosis and intervention are crucial to preventing the progression of TMJ-related issues.
Incorrect occlusion or malocclusion means that the teeth do not come together correctly when the jaw is closed. Additionally, when the jaw is closed, the muscles responsible for jaw closure should be at rest, but in the case of malocclusion, these muscles are tense and hyperactive, exerting more pressure on the TMJ disc and jaw than necessary. Prolonged periods (in terms of years) with this extra pressure lead to stretching of the ligaments holding the TMJ disc behind the condyle, resulting in the repositioning of the jaw’s end connected to the TMJ disc, ultimately causing pain.
Over time, the ligaments can perforate, leading to direct bone-to-bone rubbing. Additionally, the TMJ disc may become displaced, causing difficulty in opening the jaw. At this stage, pain may decrease as the sensitive tissue is no longer exposed to such high pressure. The shape of the condyle may change due to excessive bone rubbing (something that can be observed by the dentist on an X-ray). Arthritis in the TMJ can also occur due to bone-to-bone friction.
If these irregularities are detected in time, the dentist can correct and prevent these major deteriorations. There is also the possibility of recovery for patients with TMJ disorders. However, the more advanced the condition, the more likely the patient will need the attention of a TMJ specialist.
The Importance of Functional Analysis
- Assessment of dysfunction impact. It evaluates how a dysfunction contributes to the creation and/or exacerbation of malocclusion. Correcting the dysfunction is directly proportional to correcting malocclusion.
- Prognostic evaluation. It helps assess the prognosis of treatment. Not all functional problems can be corrected, and in such cases, the orthodontist must design the occlusion around the existing functional situation.
- Treatment plan selection. It aids in selecting the treatment plan. For example, it corrects deep bites.
- Impact on overall health. Disorders in the masticatory system can lead to serious health issues, as the masticatory system, being one of the most complex systems in the human body, is closely connected to the head, spine, brain, and other organs. By determining the problem and treating it with functional analysis, complications in general health, not just dental health, are prevented.
How is functional analysis conducted in the dental office?
The first step is to ask the patient a series of detailed medical history questions, focusing on their overall health and symptoms of cranio-mandibular dysfunctions.
The second step involves manual diagnosing to test the muscles used for chewing and the condition of the jaw joint, providing important guidelines for subsequent diagnosis and treatment.
The third step includes analyzing information about the position and anatomical appearance of each tooth and the occlusal state. In this step, we also determine the position of the lower jaw relative to the upper one, crucial information for the proper functioning of the chewing muscles and jaw joints, as well as the position of the joint capsule in the jaw joints.
This diagnostic method also determines the position of the lower jaw relative to the upper jaw, which is essential for the proper functioning of the chewing muscles and jaw joints, as well as the position of the joint capsule in the jaw joints.
As mentioned earlier, the patient may also need a physiotherapist or osteopath to further analyze and more effectively treat the issue.