With interest, I read the Point/Counterpoint discussion on articulator mounting of dental casts in the January 2012 issue of the AJO-DO . Some statements by Drs Rinchuse and Kandasamy raise many questions.
I do not understand why “articulators can play a role in prosthodontics, restorative dentistry, and orthognathic surgery to maintain a certain vertical dimension,” and yet they do not play a role in orthodontics. The vertical dimension is an important factor in orthodontic treatment, especially in patients where we try to control growth or close open bites. Aren’t we as orthodontists doing a full-mouth reconstruction in enamel, as Ron Roth used to say?
Even if occlusion is not the primary cause of a temporomandibular disorder, what is the justification not to respect all possible causes of temporomandibular disorders, including those that might not be the primary cause? Would Dr Rinchuse prefer to have his own or his children’s condyles seated, as described by Okeson, or does he not care? What is the argument against having condyles seated in their fossae? Why so much emotion about adding 1 additional tool in diagnosing orthodontic patients?
It is great to have “exciting future research topics for temporomandibular disorders,” but we are here to treat patients now and as diligently as possible. We as clinicians cannot wait for future research when we treat our patients today. I do understand, as Rinchuse stated, that “conservative and reversible forms of temporomandibular disorder treatments are preferred . . . over aggressive and irreversible forms.” Is it not conservative to strive to seat the condyles and allow articulators to help us do so?
“The amelioration of gross occlusal interferences that cause tooth mobility, fremitus, and deviation or deflection on mandibular closure and movement are within the scope of the evidence-based paradigm.” Does Dr Rinchuse mean that we should not care about details? Where is the border between gross and minor interferences? Are all patients as sensitive as others? How can we be certain that gross interferences do matter, but smaller ones do not? Maybe the authors are correct that the majority of patients can adapt. But who are those who cannot?
Rinchuse quoted Johnston: “I know of no convincing evidence that condyles of patients with intact dentitions should be placed in CR.” I ask the question: is there convincing evidence that it will harm, if we place condyles in centric relation? Why are so many clinicians (prosthodontists and orthodontists) who try to treat to centric relation very successful in helping their pain patients?
Rinchuse stated, that “in growing children, the temporomandibular joint condyle-glenoid fossa complex changes location with growth.” We should consider that the joints in growing patients have many years to adapt to the developing dentition. But orthodontists change the occlusion in a 2-year treatment time. Can the joints adapt that fast, if we put the condyles in a different position? As long as we don’t know, I would rather respect nature and condylar position in my patients.