Compendium Supplement Bite Tech July/August 2009 : Page 1
Dear Readers, In 1961, I had a sound reason to become involved with the understanding and treatment modalities of a TMD (temporomandibular dysfunction). I was the patient! A doctor gains additional understanding of a disease or illness when the pa- tient is oneself. The associated physiologic manifestations brought about by temporomandibular joint (TMJ) problems are difficult to understand. How can the articulation of two bones cause such problems? While localized joint pain makes intuitive sense, associated anatomic pain away from the joint space and violent bouts of vertigo are harder to rationalize. I desperately needed to engage in a commonsense self-evaluation and splint design to solve my prob- lem. That is why over 40 years ago I began the lifelong process of understand- ing mandibular positioning through occlusal interception. My journey began with a three-unit gold onlay bridge replacing tooth No. 19. The bridge fit the teeth but the occlusion caused problems, and my TMD started then. I sought the advice of dentists and medical doctors, but no one could give me relief. In their defense, they were working with TMJ treat- ment modalities that were in their genesis back then. Many different man- dibular positioning devices were created for my problem, including upper and lower appliances of all shapes and sizes. Some were made from acrylic and others from cast metal. Every conceivable functioning design was fab- ricated until the condylar pressure that led to inflammation and pain in the joint, surrounding tissues, and structures could be eliminated. The knowledge gained from personal evaluation of mandibular repositioning devices led to the creation of what is today known as “the reverse wedge”— a simple yet effective device through which a predictable increase in the distal portion of the posterior teeth and a lesser dimension in the premolar area positions the mandible to bring the head of the condyle slightly out of the fossa. By relieving abnormal and/or over-pressures in the TMJ, I be- came pain-free. I could not predict 40 years ago that my suffering would lead to performance- enhancing mouth wear. I invite you to enjoy this very special supplement to Compendium of Continuing Education in Dentistry introducing this new field of dentistry. Respectfully, Paul Belvedere, DDS Private Practice Minneapolis, Minnesota “While localized joint pain makes intuitive sense, associated anatomic pain away from the joint space and violent bouts of vertigo are harder to rationalize. I desperately needed to engage in a common sense self-evaluation and splint design to solve my problem.” Compendium—Volume 30 (Special Issue 2) 1
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