by Dr. Lee Ann Brady
I believe in working with the provisionals on a patient I
believe has a restricted envelope of function, particularly when patient mentions that he
reported waking with a headache the first few mornings after we placed
the provisionals. I believe he needs more freedom in the anterior, and
breaking the provisionals and the morning headaches support this theory.
Patients who need more anterior freedom can present with signs and
symptoms that affect their teeth, muscles, joints or all three. I find
it helpful to puzzle through what is happening anatomically as a way to
make sense of signs and symptoms I see.
Patients who are trapped
or locked in the anterior can either spend significant time in this
position with their posterior teeth touching, try to create more space,
or move their mandible forward and rest in a forward position. Each of
these adaptive strategies and the amount of time the person does each
one create the patient’s presentation. The next question to ask yourself
is what is the position of the condyle , is it being pushed
posteriorly, and what are the muscles doing to protect the joint and the
teeth? Each patient presents with a unique combination of signs and
symptoms, but their combination can be overlaid on their occlusion and
what they do with their teeth. There are common signs
& symptoms with a restricted envelope of
function and here is a list of some of them.
Dentition:
- Upper Anterior lingual wear
- Lower Anterior incisal edge and labial wear
- Upper anterior lingual ledging
- Anterior fremitus/mobility
- Anterior diastema opening
- Upper anterior flaring
- Loosening or fracturing anterior provisionals/restorations
Joints/Muscles:
- Retrodiscal tenderness/pain
- Digastric tenderness/pain
- Posterior Temporalis tenderness/pain
- Elevator Muscle tenderness/pain
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