TMJ Disorders and Orofacial.pdf - E-Lib FK UWKS

Adaptation, Compensation, Decompensation
Progressive/Regressive Adaptation and Compensation/Decompensation
The patient population of a dental or orthodontic practice
can be divided into three groups:
• "Green" group: The masticatory structures are either
physiological or have undergone complete progressive
adaptation. These patients have no history of problems,
nor do they experience symptoms during the specific clin
ical examination.
• "Yellow" group: These patients have compensated func
tional disturbances and no history of problems. However,
symptoms can be repeatedly provoked by specific manip
ulation techniques.
Physiological
structures
or
progressive
adaptation
Compensation
Decompensation
or
regressive
adaptation
Dental treatment, including
functional prophylactic measures
No definitive measures that
affect the occlusion without
further diagnostic clarification
Dental treatment that will not upset
the fragile equilibrium
Cause-related functional therapy prior
to definitive dental treatment
Functional therapy prior to
definitive dental treatment
No occlusal functional therapy if there
are no occlusal etiological influences
Symptomatic functional therapy for the
transition to a compensated status
• "Red" group: Patients with complaints whose symptoms
can be repeatedly provoked through specific examination
methods suffer from a decompensated or regressively
adapted functional disturbance.
In young patients, adaptation is based upon growth, modeling,
and remodeling (Hinton and Carlson 1997). Modeling (=
progressive adaptation) is the shaping of tissues by apposition
and results in a net increase of mass. Remodeling (=
regressive adaptation) is usually accompanied by a net
decrease of mass. In adults adaptation depends primarily
upon remodeling processes (de Bont et al. 1992).
4 Functional status of biological
systems
A functional analysis should always
be carried out before any dental
restorative or orthodontic treatment
is initiated. The patient's
most urgent needs are determined
by which group of the patient population
he/she is classified under.
For patients with complaints (red
group) a functional analysis should
be performed to arrive at a specific
diagnosis and to determine whether
or not treatment is indicated and
possible, and if so whether it should
be cause-related or symptomatic.
All other patients (green and yellow
groups) have no history of complaints.
If during a specific functional
analysis with passive manual
examination techniques, compensated
symptoms can be repeatedly
provoked in an otherwise symptom-free
patient, the patient is
classified in the yellow (caution!)
group. Identification of these "yellow"
patients is extremely important
because of the therapeutic and
legal implications. They make up
between 10% and 30% of the patients
in an orthodontic practice.
Patients with compensated functional
disturbances are also of special
interest because tooth movement
or repositioning of the
mandible is always accompanied by
stresses which increase the harmful
influences on the system. When
faced with a compensated
functional disturbance, the clinician
has three basic options:
1. Referral of the patient because of
the complexity of the problem.
2. Dental treatment without pro
voking decompensation. Here the
dentist must be aware of the load
ing vector acting upon the system.
3. Treatment directed at the cause
with subsequent definitive dental
treatment monitored through on
going functional analysis.