What means a MRI that comes back normal ?

Very bad quality xray showed condylar anteposition/subluxation.

Hi there : just to be sure.. My MRI comes back all normal, says bones structures are ok, location of the condyles is central, blabla, all good. However, I still have major pain (could be muscular, ok) and moreover, my previous (one year old) showed condylar flattening as showed on the image attached + another VERY BAD QUALITY xray showed condylar anteposition/subluxation. If I understand well, I would need to do a scanner to know exactly what’s going on in the bones and condyles, right? So, overall, what means a MRI that comes back normal…? And other question: any dentist here/radiologist would have the kindness to read my MRI (willing to pay for a normal consult!) ?
Thank you very much.

Discussion

Mark Usher
The images you’ve posted to not appear to be an MRI?

Amelie Giraud
no, these images as said in y post are not my MRI, they are previus scans and xays.

Jeffrey Brown
Hello Amelie Giraud- I’m always glad to review an MRI – no cost at all- as long as we can share the results so people can learn.

Amelie Giraud
dear Jeffrey Brown, that’s so kind of you… I am sending you a pm now just to know how I pass it on to you.

Luis Redinha
Amelie I don’t see anything wrong with the rxs that you’ve posted… on adult, mild assimtetry of condyles might be related IMO with different guidance a in your teeth . Canine guidance in one side and group function in the other will do that

Eva Willer-andersen

do you mean that canine guidance is not necessary on the other side ? what exactly is group function ? trying to understand 🙂 Thanks Luis Redinha

Luis Redinha
When moving sideways you can get separation of all the teeth except the canine that slides or you can get canine, bicusps and eventually first molar sliding together

Luis Redinha
Canine guidance vs group function

Luis Redinha
Studies show higher masseteres and temporal activity on group function compared to canine guidance

Luis Redinha
Also angle of disclusion is usually higher on canine guidance compared to group function thus “shaping” côndyles on a different manner

Thelma Louise Davis
great info! what happens if a patient naturally has one type of function be it group or canine and dental restoration creates the other type of function? can patients easily be switched from one to the other without negative affects?

Luis Redinha
no general answer… if done within good clinical judgment it usually works ok. Best aproach is to try it with provisional restoration , adjust if needed and then replicat ewhat you´ve achieved on finals

Tatiana Gelfand
I had different ones on each side. I am not sure if this was naturally because the dental work which I had very long ago made my jaw skew to one side and ground down one canine turning this side into group function. However, when for a short time, I managed to have canine guidance on both sides, it felt so good! Yet, the dentist who messed me up last and who ruined my canine guidance, said, “canine guidance is very difficult to achieve, I will make you group function”. I guess what they make can also depend on their skills and not specially on what would be best for the patient.

Luis Redinha
Rule of thumb – canine guidance is easier to create than group function unless upper and lower canine relation is off and it would need teeth that are not acceptabke shape wise…

Tatiana Gelfand
Luis Redinha, what is ICP? What does this teeth mobility mean? Is it that the teeth are not in bridges?
I like that 10 micron clearance! This is exactly what I need! It was not easy to achieve in my case. I am not sure any dentist or lab can do it in finals 🙂
Why a flat occlusal plane? What about the curve of Spee? I couldn’t do without it on one side. On the other it was fine.

Tatiana Gelfand
Luis Redinha , they could have just asked me. LOL. I had both (at different times) so I know how much better canine guidance is for the muscles. 🙂

Luis Redinha
ICP – inter cuspal position, same as MI. Yes keep teeth standing ,alone if possible. IMO 10micron is usually not enough, we need a little more, adjusted in a individual basis. I assure you that this is possible in a predictable, repetitive way, with all the patients that undergo FMR. It just takes time and patience…Flat OP will make it easier to disclude posterior teeth. Spee curve will need more disclusion heights on anterior teeth to separate posterior teeth on excentric movements.

Lidia Yavich
Amelie Giraud this is not an MRI, this is a CT

Lidia Yavich
Sorry, I see now that you said that. CT and MRI, give different informations

Amelie Giraud
yes, I know they do. I have been fighting to get an MRI as I have no referent dentist anymore. I’ll ask for a CT now, but here in Germany dentist tell me “you are too young to be irradiated, let’s do a MRI instead”. Grrr.. Going with a GNM dentist soon, maybe he will recommend to do a scan.

Tara Vanessa Michelle Parker
I have been watching a youtube video on DTR…Disclusion Reduction Time…i am not a candidate as my issues are post surgical but would have tried this first!! I am going for a lidocaine injection today…

Eva Willer-andersen
please do not recommend this procedure esp as you have not even tried it Tara Vanessa Michelle Parker people here have got substantially worse from irreversible occlusal equilibration

Jeffrey Brown
Much agree with Eva Willer-andersen – shaving down the teeth is the wrong direction- it will push the condyle deeper into the joint and compress the discs more over time. Granted- it might feel ok for a while due to changes in proprioception, but not a good direction in general.

Rodney Baier
What if the equilibration only removes lateral interferences and doesnt reduce VDO?

Amelie Giraud
i was wondering the same!

Amelie Giraud
I did have a griding of a temporary crown that my dentist has just put in place to replace a missing tooth. What I can see is that : at the beginning, I had interferences (lateral, quite imporant) on these crown, so he grinded it. Felt ok for a 2 weeks but now I have again crazy days of pain AND the interference is back! So IMHO it just means that griding is like not erasing the issue, but putting it away for a while. If the body is attracted by the problem, it will just stretch further (or applied to joints, push more backwards the condyles) to get to it.

Jeffrey Brown
Rodney Baier- the lateral changes may affect the lateral positioning of the articular disc- i.e. vdo is not the total solution. I personally use turbos on every single case I do- and sometimes I really jack them up – it gives space for the discs.

Rodney Baier
Jeffrey Brown then restore them at an increases VDO?

Amelie Giraud
what’s a turbo ?!

Jeffrey Brown
YES- for sure- I have done orthodontics with turbos that are one inch tall in severe cases.

Rodney Baier
Do you ever use removable appliances to “decompress” the joints? And do you ever do turbos without ortho?

Jeffrey Brown
OK – one more comment before signing off for the holiday. I ALWAYS use appliances to decompress the TM joints, I do not do braces in the beginning

Jeffrey Brown
And yes to turbos for acute cases and apnea cases on young children- it works remarkably well !

Rodney Baier
Cool. Have a wonderful Thanksgiving. And thanks for sharing tour knowledge

Tatiana Gelfand
Jeffrey Brown, do you ever need to place a turbo towards the anterior teeth, on canines for example? I badly need one on my right canine. 🙂
BTW, are these turbos made from composite?

Luis Redinha
If mock up oclusal equilibration reveals that for achieving occlusal stability you’re closing down vertical then occlusal adjustments should not be performed . But we should not be doing occlusal equilibration in MI… if it is done in centric relation we will have in a lot of patients a possibility of adjusting occlusion to a proper muttualy protected occlusion maintaining or slightly increasing vertical dimension on occlusion thus not increasing joint loading

Jeffrey Brown
Signing off now- have a great holiday everyone

Amelie Giraud
thanks a lot for your information.

John Veloso
right condyle posteriorly positioned