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(note how the Discluding Element has been centered over the mandibular midline) |
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| In an excursive movement on the day of delivery, not the separation of posterior teeth... |
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| Two weeks later, a left excursive movement (above) reveals an occlusal interference with a maxillary palatal cusp and a mandibular distal-lingual cusp. This may not be evident upon original delivery. The NTI may allow a condyle to seat more posteriorly/superiorly in the fossa, thereby allowing the patient to eventually "find" this mandibular position and continue clenching activity, possibly resulting in an increase in symptoms. THEY MAY ALSO REPORT THAT THEIR LOWER INCISORS ARE SUDDENLY SORE. This is due to the increased clenching intensity that the posterior contact has allowed. In this example, the right condyle is strained (it is translated) due to the chronic contraction of its lateral pterygoid with resistance, while clenching intensity of the left temporalis persists. (the above photo was digitally altered for demonstration purposes). |
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| The
indicated remedy
is to reduce the cusp tip(s) of the interfering teeth.
Increasing the vertical dimension of the DE to discluded the interfering teeth is contra-indicated. Doing so would simply further translate the right condyle (in this example), placing it under an even greater strain when the patient continues excursive clenching behavior. |