Practitioners should aim to diagnose as early as possible the development of malfunction of the masticatory system, or temporomandibular disorder (TMD), that causes pain, discomfort and a decrease in functional efficiency, especially in those patients whose occlusion is being rehabilitated in the course of orthodontic treatment. This is particularly true for the segment of the patient population who are characterized by certain risk factors.

Armed with a good understanding of the diagnostic classification of TMD, orthodontists will be better prepared to pinpoint and diagnose TMD and, if necessary, adopt the most appropriate mode of therapy for treating it.

Thanks to a good understanding of TMD nosology, orthodontists will be able to distinguish between muscular and joint disorders and then manage patients in accordance with specific diagnostic criteria.

By definition, orthodontists take special care in achieving a high quality occlusion when finishing cases, believing good contacts are essential to maintain dental health, function, and insure stable long-term of results. The T-scan III system provides a real-time digitized analysis of occlusion, in both static and dynamic modes, and records the distribution of occlusal forces within the dental arches in different clinical situations. While the first T-Scan generations versions showed weaknesses, recent technical improvements have made T-scan a reliable and reproducible tool, whose findings are independent of the operator. It is now possible to calibrate the sensitivity of the sensor for individual patients, and to evaluate the quality of records so that comparisons can be made between various stages of a patient’s treatment, as well as between patients. In addition to the accuracy of occlusal diagnosis, that often exceed clinical requirements, the T-scan III also can help understanding better each patient’s functional pattern. This article describes the T-scan III occlusal analysis system, reviews current literature that evaluated its clinical use, and outlines its principal indications in dentofacial orthopedics. Four clinical cases treated with full bonded lingual appliance will illustrate how the Tscan III influences orthodontic case finishing : one case of “occlusal discomfort” after completion of surgical and orthodontic treatments, a case of cervical abfraction lesions, a case of anterior deep bite restored with an implant-supported prosthesis, and a case of severe facial hemiatrophy treated with a complex protocol.

Dentists often use occlusal splints in the management of occlusodontic problems. Because they are considered to provide non-invasive and reversible treatment they are therapeutic devices that conform well to the current philosophy governing protocols for therapy of the masticatory system. Proper design and placement of occlusal splints requires that they respond to precise indications and that practitioners fabricate and maintain them with scrupulous care to assure that patients benefit from them. Splints help practitioners adjust the relationship between the jaws either by suppressing blockage of teeth to relax muscles or by repositioning the condyles in the articular fossas to recapture discs or to reduce painful excess intra-articular pressure derived from degenerative diseases.

Occlusal splints are also suitable as diagnostic tools to validate and evaluate contributions of behavioral, postural, and psychosocial factors to the multifactorial etiology of malfunctions of the masticatory apparatus. The simple introduction into a patient’s mouth of an appliance whose benefits have been well described to that patient will serve as a forward step in the psychological management of a TMD problem, especially if bruxism is one of its components.

At one time or another all orthodontists have to deal with a patient in their daily practice who sufferers from a temporo-mandibular disorder. Usually not well trained in this area they avoid the problem by referring the patient to an ‘‘occlusodontist’’ even though the majority of these TMD problems can be resolved by simple non-invasive techniques that any dentist can readily perform.

In this article I describe the therapeutic sequence of events. When pain is present, practitioners devote the initial appointment to establishing a diagnosis of ‘‘painful disorder.’’ At the same time they must explain to their patients what the different psychosocial components of the TMD are. While the clinical examination practitioners conduct next is simple and speedily completed, its correct execution requires a certain apprenticeship. The result of properly concluded procedures is a precise diagnosis of the functional TMD problem.

Then I review the wide range of therapeutic possibilities that are currently available, which are comparable to those employed in medical rheumatology.

Finally, I present the treatment of a patient with TMD to illustrate the clinical application of this up-to-date approach.

Behavioral therapy (or myofunctional re-education) acts on the central nervous system and not directly on facial tissues like other orthodontic treatment. This therapy was developed in two stages: first, orthodontists identified the role played by muscular pressure on the shape of dental arches (Blandin4, 1836), then by the elaboration of remedial treatment of malfunctions as well as the elimination of parafunctions (Johnston20, 1938). The School of Stomatology introduced these treatment methods in France in 1950.