Parafunctional Analysis & Diagnostic~Restorative Application

14 Rating(s).


Posted on By michael melkers In Occlusion

I have been wanting to share some of my practical 'research'~clinical retrospective and its application on XP.

This is the work that my wife, Dr. Jeanine McDonald and I did from about 2002-2012, and how we applied it to diagnostic and clinical dentistry.

Over the course of about 10 years, Jeanine and I colored orthotics/appliances/nigtguards and analyzed the patterns that were created by noctural bruxing, as well as any changes.

Long story short-the patterns never changed. Pre-ortho, post-ortho, pre-restorative, post-restorative, pre-equilibration, post equilibration...

I broke the patterns down into three groups. Of the 300+ cases we analyzed, here are the breakdowns that we saw.

Parafunctional analysis statistical breakdown
Laterotrusive-a combination of protrusive and lateral movements.

Pure protrusive. There was also a group that had wear but the type of pattern could not be discerned or agreed upon
Just to be clear, the devices we analyzed were not limited to NTI's but inlcuded NTI's, Tanners, Universals, Michigans, anterior only, dual arch~DAASA designs...


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10 Comments

At delivery, the patient was intsructed to move their jaw to the sides and as far back as they could and the ranges of voluntary motion were measured.

At 10 days to 2 weeks-in this case 17, the patient returned and the parafunctional ranges were noted and measured. The parafunctional ranges were visible as the black marker had been worn away by nocturnal bruxing.

The patient was also instructed to go through the voluntary ranges with red film in place.

The protocol gives a metric to analyze if the patient can comfortably move at least as far as their parafunctional ranges. This is representative of the 'physical therapy' aspect of orthotic therapy.

This is especially significant in analyzing and comparing the voluntary vs parafunctional ranges of seating as well as excursive movements. If the patient seats of moves parafunctionally beyond what we can observe and record, our restorative design and materials can be at great risk, without us even being aware.

At delivery
17 post delivery


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For pre-restorative application, the PA (parafunctional analysis) can provide a metric if the patient can voluntarily seat and be recorded/restored at teh most seated position (sometimes referred to as "CR").

An issue with relying on if 'the patient is comfortable' is that it is subjective. There may be extended patrafunctional ranges which occur at night which exceed what we can observe during the day. The differences between teh apex of teh chevrons tell us that additional time and 'physical orthotc therapy' is required.

Parafunctional wear vs voluntary movement (red)
Voluntary ranges are not equal or coincident to parafunctional ranges


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In application, if we restore at the apex of the voluntary position and the patient is still parafunctioning to the apex of the green chevron, they can 'get behind' the dentistry and apply all of the load to the 7's or even continue to seat and develope an anterior open bite.

**Special thank you to Dr. Frank Spear for allowing me to use his skull graphics

Progression of seating
Progression of seating


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I think that I have everything cleaned up! Thank you for letting me share Dr. Salama!


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This is a critical process in occlusal evaluation. Great post. Regards Maurice


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Thank you Maurice!


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Thank you for sharing! How did you apply this research to the restorative stage? Gregory


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Hey Greg-I am glad you found it interesting.

I find it invaluable in extensive restorative cases. I don't want to get into a CR discussion but I would like to find the most seated point in parafunction (the apex of the green chevron) and also the parafunctional ranges in excursions-the lateral extension of the green lines.

When you look at the red like-the voluntary ranges, you can see that they don't match. These sometimes do not match even when the patient feels fine. They may even repeatably close to the apex of the red chevron.

The issue is that when the parafunctional seating or parafunctional range exceed the patient voluntary movements, they may get 'behind' the dentistry we design..and just parafunction onto the 2nd molars.

If they parafunctional in excursions beyond what they cans how us chairside, then we are not able to evaluate and adjust our new provisionals or final restorations.

I hope I explained that OK...the subject is a lecture or webinar unto itself...or you are so close we could meet and discuss it over a scotch!


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I agree with the analysis. John Kois always said if it is "brain" mediated occlusion we can always reduce the risk but do not eliminate.
Do you have any cases to share? And BTW always ready for the scotch!!!Gregory


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Greg-all occlusion~occluding is brain mediated. The brain tells muscles to move.

I have a nice Japanese collection-come on up and visit!


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