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Biomedical subjects

R B Kerstein

Publications and source records attributed to R B Kerstein.

15 recordsLinked to original sources
PubMed2001

Locating the centric relation prematurity with a computerized occlusal analysis system.

Locating the first tooth contact that interferes with freedom of movement in and out of centric relation has been the diagnostic and treatment objective of most occlusal therapies. The centric relation prematurity can be located by various methods, which involve operator-guided mandibular positioning combined with the patient's subjective assessment of his or her perceived first tooth contact. The method known as bimanual manipulation has been widely recognized and accepted as a predictable method of determining and verifying the centric relation position. The first occlusal contact that results when the mandible is closed on a correct centric relation axis is known as the centric relation prematurity. An alternative procedure combines bimanual manipulation with the simultaneous recording of the sequence of resultant tooth contacts using a computerized occlusal analysis system. This alternative offers a significant improvement in the precision of locating the first tooth contact. This article describes a method of identifying the first tooth contact while not relying on the patient's subjective assessment of his or her perceived occlusal feel.

Adult↗
PubMed2000

Ideal gingival form with computer-generated permanent healing abutments.

Implant fixture positioning and inclination problems that result from poor osseous height, width, and ridge configuration have created difficult prosthetic tooth replacement scenarios. Options for ameliorating poor angulation are limited to the use of preangled and custom abutments. Overcoming poor angulation has been simplified by using custom vs preangled abutments because preangled abutments are limited by their standardization to a few random angles. Custom abutments can be more predictably formed to re-create the desired supporting preparation orientation and morphology. This facilitates the formation of anatomical gingival topography and coronal contours for prosthetic replacement. Cast, ceramic, and machine-milled titanium abutments have several advantages and disadvantages. A new custom abutment system that uses computer-guided manufacturing technology to machine mill custom abutments from commercially pure titanium is described. These abutments are anatomically correct, have the proper emergence anatomy, proper spatial design at the cervical margins, necessary occlusal reduction, and the proper axial angulation of ideal tooth preparations. A clinical case that illustrates implementation, with respect to the principle of stage 2 guided tissue healing, is presented.

Anodontia↗
PubMed1999

Improving the delivery of a fixed bridge.

Force loading of dental prosthesis is generally a guessing game played by the operator with the patient. Relying on a patient is comfort level to adjust occlusion is now being replaced by sound force information provided by the T Scan II. Proper use of the T Scan II when installing a segmental fixed prosthesis gives a more precise, comprehensive occlusion. Porcelain surfaces, solder joints, and the underlying abutment teeth can now be loaded with low-to-moderate forces because the operator can fine-tune the occlusal forces precisely. With proper force loading, greater material and prosthesis longevity is significantly enhanced.

Dental Stress Analysis↗
PubMed1997

A comparison of ICAGD (immediate complete anterior guidance development) to mock ICAGD for symptom reductions in chronic myofascial pain dysfunction patients.

The purpose of this study is to assess what impact shortening disclusion time to less than .5 seconds during right and left mandibular excursions has on myofascial pain(s) symptoms present in a dental student population. Twenty-five dental students, who exhibited symptomatology consistent with myofascial pains patient, were divided into a treatment, control, and an untreated group. They participated in an occlusal adjustment study which measured changes in disclusion time, as well as, myofascial pains muscular symptom remissions resultant from treatment. The treated group of ten subjects received ICAGD occlusal adjustments to shorten their disclusion time to less than .5 seconds per mandibular excursion. The goal of this therapy was to totally disclude the posterior teeth in a measurable time frame of .5 seconds or less. The control group of eight subjects received mock ICAGD with tooth polishing. The goal of this therapy was to simulate ICAGD adjustments for possible placebo effect on symptom remissions. The untreated group had their disclusion times measured but received no treatment to adjust, or to simulate adjustment to their occlusion. The goal of analyzing an untreated group was to attempt to show that mock treatment (performed on the control subjects), or no treatment (performed on the untreated subjects), resulted in no measurable change in the disclusion time in either of these two subject groups. Each subject was recalled for disclusion time measurement four to five times in a one-year period of observation, at which time, they were required to report their myofascial pains symptom status by answering an ordinal scale questionnaire. The results suggest that shortening disclusion time to less than .5 seconds per mandibular excursion can induce remissions of many muscular myofascial pains symptoms. Additionally, mock ICAGD occlusal adjustments did not appear to be a factor in the control subjects treatment response, as this group showed no statistically significant symptom remissions.

Adult↗
PubMed1995

Treatment of myofascial pain dysfunction syndrome with occlusal therapy to reduce lengthy disclusion time--a recall evaluation.

A recall study of 102 myofascial pain dysfunction syndrome-temporomandibular disorder (MPDS-TMD) patients, treated with disclusion time reduction therapy from 1983 to 1991, was undertaken to determine the long-term results of this treatment on symptom reductions. The patients were asked to fill out a symptom questionnaire which used ordinal number scales to determine their disease status (frequency and intensity of muscular, joint and dysfunctional symptoms; frequency of medication and appliance use) before and after they were treated with disclusion time reduction. The statistical results indicate that discluson time reduction therapy is a highly effective treatment regimen for MPDS and that it has lasting effects on symptom reduction. In addition, the results of this recall study indicate that occlusion, and more specifically, lengthy pretreatment disclusion time, does play a primary role in the symptomatology, and most probably, in the etiology of MPDS and TMD.

Adult↗
PubMed1994

Disclusion time measurement studies: a comparison of disclusion time between chronic myofascial pain dysfunction patients and nonpatients: a population analysis.

From a pool of 89 patients, 49 patients were classified as having chronic myofascial pain dysfunction syndrome (MPDS), and 40 were classified as asymptomatic or non-MPDS patients designated as the control group for the study. To achieve balanced sample size in both groups, 40 patients were arbitrarily selected from the MPDS group. All patients from each of the two primary groups were then categorized and assigned to one or more subgroups according to the following criteria: (1) jaw classification, (2) open occlusion, (3) previous orthodontic therapy, or (4) no previous orthodontic therapy. A fifth subgroup composed of only MPDS patients and equally divided into those who had or had not experienced orthodontic therapy was established to determine whether mean disclusion time differences occur between orthodontic and nonorthodontic MPDS patients. All 80 patients were evaluated for disclusion time of their right and left mandibular excursions to determine statistical population comparisons. Statistical assessment of right and left disclusion times for women and men in the MPDS and non-MPDS groups was performed separately for each of the five subgroups. Analysis of the comparisons revealed that in all except two of the subgroups, mean disclusion time was significantly longer in the MPDS patient group than in the non-MPDS group. The two subgroups in which this was not apparent were those with open occlusion and orthodontic patients compared with nonorthodontic patients. These findings suggest that lengthy posterior disclusion time may be of diagnostic importance when the differing etiologic factors of chronic MPDS patients are evaluated.

Adolescent↗
PubMed1993

A comparison of traditional occlusal equilibration and immediate complete anterior guidance development.

Traditional occlusal equilibration has been advocated by numerous authors as a treatment modality for chronic myofascial pain dysfunction syndrome. However, treatment predictability and reliable clinical success has not been reported by all authors. Some report no correlation between occlusal contacts and chronic myofascial pain dysfunction syndrome. Recent publications and manuscripts have described a new occlusal adjustment technique which is aimed at reducing lengthy pretreatment disclusion time in mandibular excursions. This reduction in disclusion time physiologically and rapidly reduces contractile muscle activity in the masseter and temporalis muscles, which leads to the resolution of numerous chronic myofascial pain dysfunction syndrome (MPDS) symptoms. This new occlusal adjustment process is known as Immediate Complete Anterior Guidance Development (ICAGD). The purpose of this article is to describe the important differences in focus, sequence, and theory between traditional occlusal equilibration and ICAGD.

Dental Occlusion, Balanced↗
PubMed1992

Disocclusion time-reduction therapy with immediate complete anterior guidance development to treat chronic myofascial pain-dysfunction syndrome.

Successful treatment of chronic myofascial pain-dysfunction syndrome by disocclusion time-reduction therapy has been shown to be effective in 1 to 3 months, with the major muscular changes occurring in the first 30 to 40 days following initial therapy. Disocclusion time reductions have been previously reported to quickly reduce or eliminate numerous symptoms of chronic myofascial pain-dysfunction syndrome. Proper modification of an existing occlusal scheme from one that contains lengthy disocclusion time to one with short disocclusion time can be accomplished by implementing the method of occlusal adjustment known as immediate complete anterior guidance development. This paper describes the proper clinical occlusal adjustment methodology using a computerized device that shows the measurement and subsequent reduction of excessive disocclusion time. This directly lessens elevated contractile muscle activity, which leads to rapid muscular recovery of the involved dysfunctional muscle groups.

Bicuspid↗
PubMed1991

Electromyographic and computer analyses of patients suffering from chronic myofascial pain-dysfunction syndrome: before and after treatment with immediate complete anterior guidance development.

Seven women patients at Tufts University School of Dental Medicine were evaluated for the subjective symptoms of a myofascial pain dysfunction. Each patient was evaluated by an occlusal analysis of the T-Scan computer to determine posterior disclusion time during excursive movements, and EMG analysis of the masseter and temporalis muscles. Each patient was then treated occlusally by developing immediate complete anterior guidance. This adjustment process involved the removal of all lateral and protrusive interferences prior to habitual closure adjustments. No attempt was made to retrude the mandible in centric relation, and splints were not used to deprogram the musculature before adjustment. In this study, protrusive movements and interferences were not examined, and there was no control group. Posttreatment EMG and T-Scan computer analyses revealed that by shortening disclusion times to less than 0.5 second in any lateral excursions, muscle function returned to normal in all seven patients in approximately 1 month's time. A direct correlation seemed to exist between contractile muscle activity and disclusion time. Lengthy disclusion time leads to excessive muscle activity that introduces spasm and fatigue of the masseter and temporal muscles. These results indicated that a partial explanation of the etiology of MPDS may be the time the molars and nonworking premolars remain in contact during excursive movements--a phenomenon termed "disclusion time."

Adult↗
PubMed1990

Treatment of myofascial pain-dysfunction syndrome with occlusal equilibration.

Fifty-three patients with a diagnosis of chronic myofascial pain-dysfunction syndrome were treated with occlusal equilibration to establish complete anterior guidance. In approximately 5 to 7 days after treatment, most myofascial pain dysfunction symptoms disappeared and complete symptom resolution was usually attained within 3 weeks. The common symptoms all patients had were (1) pain and fatigue in the masseter and temporal muscles, (2) nocturnal bruxism, (3) jaw tension on waking up, and (4) difficulty chewing some foods. All patients had an absence of true anterior guidance with molar interferences in all excursive movements. Many patients had previously undergone orthodontic therapy and had "ideal" vertical tooth relationships. Treatment consisted of occlusal equilibration to remove all posterior interferences and establish anterior guidance. Three appointments, 1 week apart, were alloted for treatment. Major symptom reduction occurred after the first appointment. Four-year follow-ups reveal no recurrence of chronic symptoms after treatment completion.

Adolescent↗
PubMedDate not supplied

Computerized occlusal management of a fixed/detachable implant prosthesis.

The long-term success of an implant-supported prosthesis is related to the management of occlusal forces upon the restoration. Since implants are not anchored in bone with periodontal ligament proprioceptors, subjective confirmation by the patient is not always an accurate means of determining occlusion. A computerized occlusal analysis system has been developed to determine the timing and nature of the occlusal forces on tooth contacts. This article details the implementation of this system as an aid in the occlusal adjustment procedure of an implant-supported fixed/detachable prosthesis.

Computer-Aided Design↗
PubMedDate not supplied

Current applications of computerized occlusal analysis in dental medicine.

A computer system has been developed that can accurately record occlusal contact events in real time in a dynamic "movie" form. The literature regarding this computer technology and the currently understood clinical applications in which measurable precise occlusal endpoints can be obtained is reviewed.

Bite Force↗