501741 - GNATHOLOGY

The determinants of the stomatognathic apparatus:
The anterior determinant:
• Occlusal table (terminology, characteristics and morphological-functional aspects)
• Occlusal patterns of classical and modern gnathology (P. Thomas, Lundeen, Abjean-Korbendau, Ramfjord-Ash, Wiskott)
• Compensation curves (Spee, Wilson) and their biomechanical meaning
•Craniomandibular relationships (conventional planes and reference axes, reference skeletal-occlusal lines and planes, vertical occlusion dimension, free way space and speaking space, horizontal mandibular-cranial ratios, maximum intercuspation, habitual occlusion, myocentric position, rest position, centric occlusion and centric relation, reference position)
• Dynamics of the stomatognathic system (Gothic arch and Posselt diagram, mediotrusion, laterotrusion, protrusion, retrusion, transtrusion, surtrusion, lateroprotrusion)
• Angle and movement of Bennet, angle of eminence (H.C.I.) and Christensen phenomenon
The posterior determinants:
• Temporo-mandibular articulation (descriptive, topographic and functional anatomy of the glenoid fossa, condyle, disc and joint capsule)
• Ligaments of the TMJ (l collateral, capsular l, temporo-mandibular l., spheno-mandibular l, etc.)
Physiology and biomechanics of the stomatognathic system and in particular of the TMJ
Basic elements of pathophysiology of the TMJ.
Neuromuscular determinant
• Functional anatomy of masticatory muscles
Psycho-affective and behavioral influences

Relationship between occlusion and temporomandibular joint

Dental guides, types of occlusion and disclusion, pro, medio- and latero-trusive interferences, precontacts, parafunctions

Gnathological-instrumental aspects:
• Occluders, medium-value articulators, semi-adaptable articulators, fully adaptable articulators, anatomical and kinematic facial arches, articulator assembly
• Tools, materials and methods for interocclusal recordings
Condylar positions: maximum intercuspation, habitual occlusion, rest physiological position, centric occlusion and centric relation, reference position and reference position.
Instruments for the analysis and registration of mandibular movements.
The centric or therapeutic reference position: how, when and why to take the centric, comparison and discussion on the different techniques, materials and methods of interocclusal registration.
Assembly of the models in the articulator (split-cast technique and checks).

Epidemiology, nomenclature and classification, etiopathogenesis, signs and symptoms of temporomandibular disorders (TMD)
Etiology, prevalence / incidence, history, diagnosis, clinical features and treatment of the following disorders:
• Congenital or developmental disorders
• TMJ diseases.
• Intracapsular dysfunctions of the ATM.
• Extra-capsular dysfunction

From the Research Diagnostic Criteria for Temporomandibular Disorders to the Diagnostic Criteria for Temporomandibular Disorders.
Axis I and II of the DC / TMD.
Diagnostic protocol in the different subgroups of the extended classification.

TEMPOROMANDIBULAR JOINT DISORDERS
1. Joint pain A. Arthralgia B. Arthritis
2. Joint disorders
A. Disc-condyle complex disorders 1. Disc displacement without reduction 2. Disc displacement without reduction with limited opening
B. Hypomobility disorders 1. Adhesions / Adherence 2. Ankylosis a. Fibrous b. osseous
C. Hypermobility disorders / dislocation 1. Subluxation 2. Luxation
3. Joint diseases A. Degenerative joint disease 1. Osteoarthritis 2. Osteoarthrosis B. Condylar resorption / condylysis C. TMD attributed to systemic arthritis D. Neoplasm E. Chondromatosis
4. Fractures
5. Congenital / developmental disorders A. Aplasia B. Hypoplasia C. Hyperplasia

II. MASTICATORY MUSCLE DISORDERS
1. Muscle pain: A. Myalgia 1. Local myalgia 2. Myofascial pain 3. Myofascial pain with referral B. Tendonitis C. Spasm D. Myositis
2. Contracture
3. Hypertrophy
4. Neoplasm
5. Movement Disorders: A. Dyskinesia B. Dystonia
6. Masticatory muscle pain to systemic / central pain disorders A. Fibromyalgia / widespread pain B. Centrally mediated regional myalgia
III. Headache 1. Headache assigned to TMD
IV. Associated structures 1. Coronoid hyperplasia
Static and dynamic gnathological instrumental investigations (classification, advantages, disadvantages and indications of use)
TMJ imaging (indications and contraindications, advantages and disadvantages, costs and availability of different methods): OPT, transcranial projections, US, RM, CT, etc.
Orofacial pain and headaches: differential diagnosis

Gnathological clinical record
Clinical examination of the gnathological patient
• History
• Static and dynamic objective examination
• Static and dynamic tests
• Psychological tests and structured clinical interviews for the evaluation of psychoaffective factors
• Cervical and / or postural correlations
• Prognosis and recalls

Therapy and management of temporomandibular disorders:
• Counseling and cognitive behavioral therapy.
• Preterapy and supporting secondary therapies.
• Physiatric rehabilitative therapy
• Psychotherapy.

Occlusal therapy using splint / bites and other occlusal aids
Characteristics of the main occlusal devices: bite or stabilization splint, protection bite, MORA, Michigan bite, repositioning bites.
• Michigan bite and its modifications (historical outline, objectives, characteristics, occlusal constructive details).
• Theoretical-practical part on the preparation of the upper or lower Michigan bite.
 Surveying and impression. Inter-occlusal registration. Constructive position wax.
 Anatomical transfer bow. Control and disinfection of fingerprints.
 Casting impressions, materials used and their characteristics.
 Control and analysis of models and waxes.
 Articulators, features, use and assembly in the articulator.
 Materials used in relation to the construction techniques of splint
 Verifications and controls. Delivery and balancing of the bite;
 Instructions and advice for correct use and maintenance of the bite.

Outline of therapy of minimally invasive surgical therapy of the Temporomandibular Joints.
The multidisciplinary rehabilitative treatment plan of the dysfunctional patient: orthodontics, prosthetics, maxillofacial surgery, etc.
Prosthetic finalization in simple and complex cases.
• Reorganization rehabilitation in simple and complex cases