After Vienna 2006, Krems 2008, Nice 2010 4 th meeting of the

international Academy of Advanced Interdisciplinary Dentistry

in association with Associazione Italia Gnatologia, iAAID Asia, Collge National dOcclusodontologie, iAAID East European, iAAID North American

Official language : English

Contact.iaaid@gmail.com http://www.iaaidentistry.com

VIENNA 2012
30 th November (13h-18h) 1 st December (9H_18h) 2 sd December (9h-13h)
Faculty of Dentistry Bernhard Gottlieb Universittszahnklinik Wien Sensengasse 2a A-1090 Vienna Austrian

Interdisciplinary approach of

THERAPEUTIC

POSITION
In oral rehabilitation
To a common language : R. Slavicek (Austria), JD. Orthlieb (France) Clinical implications of occlusal plane individuality in children : S. Naretto (Italy) TMJ : From anatomy to function and dysfunction : P. Carpentier (France) Reproducibility of centric relation : E. ry (Hungary) Condylar and disc position, a review : G. Slavicek (Germany) To choose the vertical dimension of occlusion : R. Slavicek (Austria), JD. Orthlieb (France) Occlusal plane and articular paths reconstructing during prosthetic treatment : E. Roshchin (Russia) Perio-Orthodontic Case report, stability of therapeutic position : Xiaohui-Rausch-Fan (Austria) Therapeutic position - decision making in dentistry : S. Kulmer (Austria) Condyle position in occlusal reconstruction : Xiao-Jiang Yang (China) Transversal displacement of the condyles (Delta (Y): decision of therapeutic position : A. Landry (Canada) Transversal Delta (Y): procedure of repositioning treatment : M. Greven (Germany) Esthetic full mouth rehabilitation of severe bruxism : a contemporary prosthetic approach : P. Simeone(Italy) Choice of therapeutic position, clinical cases discussion : N. Bassetti (Italy) Our investigation of therapeutic position and transfer to occlusal rehabilitation : G. Reichardt (Germany) Correlation of MLT in symmetrical mandibular movements in condylography and MRI examination : S. Cid Provisional restorations according to gnathological rules : R. Masnata (Italy) Full mouth prosthetic rehabilitation and rest position : F. Ravasini, N. Gondoni (Italy) Therapeutic position: from occlusal splint to final rehabilitation : E. Tanteri (Italy) Virtual articulator and simulation of therapeutic position : G. Duminil (France) Rehabilitation of patients with severe Bruxism using Full Ceramic Cad-Cam : A. Knaus (Austria) The Recent Approach to Craniomandibular Disorder by prosthodontic and orthodontic treatment : H. Yoshimi (Japan) Orthodontic trt and therapeutic position following the centric relation of disco-condylar assembly : S. Sato (Japan) Forum : R. Slavicek (Austria), S. Sato (Japan), JD. Orthlieb (France), E. Tanteri (Italy)

Interdisciplinary approach of mandibular THERAPEUTIC POSITION in oral rehabilitationEditorial

Editorial

Vienna 2012

Occlusal functions and mandibular therapeutic position

A mandibular therapeutic position claims to allow a stable mandibular position during clenching and swallowing in a stable orthopaedic position of the temporomandibular joints, thus allowing a joint position without overload and only maintained by simple muscular activities. It seems possible to propose a probably better understanding of therapeutic position through atriptych of occlusal functions: stabilizing, centering and guiding. Occlusal function: Stabylizing (no unstable ICP): Mandibular stability requires a long-term stability of every dental unit of the dental arches. The occlusal morphology, the long axis inclination of each tooth, the three-dimensional dental arches arrangement which are responsible for long-term stability of the teeth and mandibular position in maximum intercuspation (ICP). Occlusal stability in ICP is mandatory for a proper stability of a mandibular therapeutical position. Occlusal function: Centering (no deflected ICP) ICP predicts the condylar position exposed to clenching. Optimization of temporomandibular joint requires a stable disco-condylar position along the articular tubercle (orthopaedic situation) to be able to absorb the muscular constraints without damage or nociceptive reactions. Stability of a mandibular therapeutic position is probably impossible with a shifted ICP, specifically in transversal direction, which expose overloading of a small joint area (lateral pole of the condyle). Occlusal function: Guiding (no interference) Functionnal guiding or control is an easy mandibular access to ICP accommodating order and freedom. A therapeutical mandibular position established by a stable, non-deflected ICP, is not sufficient for efficient function if the access to this position is prevented or limited, by occlusal interferences. One cannot expect to create a functionnal new ICP if the occlusal guiding functions are optimized by eliminating any anterior anterior or posterior occlusal interferences, and providing an effective retrusion guidance especially in cases of mandibular anteposition (protuded position). Once defined the occlusal requirements for stabilizing and centering the mandibule, and defined a appropriate guiding function, it is necessary to establish a set of indications in order to decide an invasive treatment creating a new mandibular position called therapeutic position. This is what all this meeting is about

Jean-Daniel Orthlieb President of iAAID

12h30 13h

registration inaugural session

November, Friday 30

Chair : E. TANTERI (Italy) 13h30 To a common language R. Slavicek (Austria), JD. Orthlieb (France) 13h55 14h25 14h55 15h25 15h55 16h25 17h10 17h30 Clinical implications of occlusal plane individuality in children S. Naretto (Italy) TMJ : From anatomy to function and dysfunction P. Carpentier (France) Reproducibility of centric relation E. ry (Hungary) Break Condylar and disc position, a review G. Slavicek (Germany) To choose the vertical dimension of occlusion R. Slavicek (Austria), JD. Orthlieb (France) Synthesis of the day iAAID general assembly

Chair : G. SLAVICEK (Germany) 9H00 Occlusal plane and articular paths reconstructing during prosthetic treatment E. Roshchin, V. Panteleev, A. Roshchina (Russia) 9h20 9h50 10h20 10h50 11h20 Perio-Orthodontic Case report, stability of therapeutic position Xiaohui-Rausch-Fan (Austria) Therapeutic position - decision making in dentistry S. Kulmer (Austria) Break Condyle position in occlusal reconstruction Xiao-Jiang Yang (China) Transversal displacement of the condyles (Delta (Y): decision of therapeutic position A. Landry (Canada) Transversal Delta (Y): procedure of repositioning treatment M. Greven (Germany) Synthesis of the day Buffet

December, Saturday 1 (morning)

11h50 12h20 12h40

Chair : M. GREVEN (Germany) 14h00 Esthetic full mouth rehabilitation of severe bruxism : a contemporary minimally invasive prosthetic approach P. Simeone(Italy) 14h20 14h50 Choice of therapeutic position, clinical cases discussion N. Bassetti (Italy) Our investigation of therapeutic position and transfer to occlusal rehabilitation G. Reichardt(Germany) Break

December, Saturday 1 (afternoon)

15h20 15h50

Correlation of Mandibular Lateral Translation (MLT) in symmetrical mandibular movements in condylography and MRI examination S. Cid, C. Rijpstra, U. Labermeier, M. Vahlensieck, V. Kehl, S. Sato, A. Kolk, M. Geven (Germany, Japan) Provisional restorations according to gnathological rules R. Masnata (Italy) Full mouth prosthetic rehabilitation and rest position F. Ravasini, N. Gondoni (Italy) Synthesis of the day Bus to Schoenbrunn castle Gala dinner (Gloriette)

16h10 16h40 17h10 19h00 20h00

December, Sunday 2

Chair : S. NARETTO (Italy) 08h50 09h20 09h50 10h20 10h50 Therapeutic position: from occlusal splint to final rehabilitation E. Tanteri (Italy) Virtual articulator and simulation of therapeutic position G. Duminil (France) Rehabilitation of patients with severe Bruxism using Full Ceramic Cad-Cam A. Knaus (Austria) Break The Recent Approach to Craniomandibular Disorder by prosthodontic and orthodontic treatment H. Yoshimi (Japan) Orthodontic treatment and therapeutic position following the centric relation of disco-condylar assembly S. Sato (Japan) Therapeutic position: why ? Where ? when ? How ? Forum : R. Slavicek, (Austria), S. Sato (Japan), JD. Orthlieb (France), E. Tanteri (Italy) General synthesis C. Weber, M. Greven, JD. Orthlieb

11h20

12h10

12h40

Interdisciplinary approach of mandibular THERAPEUTIC POSITION in oral rehabilitation

Prsident of the congres : JD.Orthlieb (Marseille - France) Vice-Prsident : E.Tanteri (Torino - Italy) President of the scientific committee : R.Slavicek (Vienna - Austria) President of the organization committee : C.Weber (Vienna - Austria)

Scientific committee Rudolf Slavicek (Vienna - Austria) Sadao Sato (kanagawa- Japan) Jean-Daniel Orthlieb (Marseille - France) Marcus Greven (Bonn - Germany) Silvano Naretto (Torino - Italy) Rory O'Neil (Boston - USA) Gregor Slavicek (Stuttgart- Germany) Eva Piehslinger (Vienna - Austria) Eugenio Tanteri (Torino - Italy)

Organization committee Christiana Weber (Vienna - Austria) Georg Reichenberg (Vienna - Austria) Satoshi Aoki (Tokyo - Japan) (iAAID asia representant) Laurent Darmouni (Marseille - France) Armelle Maniere-Ezvan (Nice - France) Barbara Gsellman (Vienna - Austria) Isabel Moreno (Madrid - Spain, Lexington USA) Jean-Philippe R (Marseille - France) Mikhail Soikher (Moscow - Russia) (iAAID east-european representant)
http://www.iaaid.com / IAAID (AIG) 2012 / Friday 30 November (14h-18h) / Saturday 1 December (9h-18h) / Sunday 2 December (9h-13h) Place : Faculty of Dentistry / Bernhard Gottlieb / Universittszahnklinik Wien / Sensengasse 2a A-1090 Vienna- Austria

To a common language
Reference plane, reference position, therapeutical position, protrusion, anteposition, decompression, distraction

R. SLAVICEK (Austria) JD. ORTHLIEB (France)

Proposition of definition about the following words should be presented Reference plane Horizontal reference plane Occlusal plane Vertical reference plane and frontal aesthetic plane Mandibular asymetry Non alignement of incisal midline Mandibular positions Reference position Mandibular reference position Mandibular therapeutic position Condylar positions Compression- decompression Retroposition Anteposition (protrusion)

Rudolf SLAVICEK : Father of iAAID Jean-Daniel ORTHLIEB received his doctorat in dentistery (DDS) in 1978 in Marseille, France. He was certified in Anthropology, in fixed prosthodontic and in Occlusodontology. He received his "Doctorat d'Universit " PHD- in 1990. From 1993 he was , "Matre de confrence des Universits", Chairman of the Occlusion and Dysfunction department of Faculty of Dentistry of Marseille, University of Mediterranean. From 2007, he is Full Professor of University. From 2009, he is Vice dean of the faculty of Dentistry of Marseille in charge of education. He was President of the French National College of Occlusodontology in 1995-96,. He is member of the European Academy of Craniomandibular Disorders (EACD), member of the eduction Committee of EACD, In 2008 is was named Visiting professor of Donau University. From 2010, he is President of International Academy of Advanced Interdisciplinary Dentistry (iAAID), He published 4 books and more than 110 scientific papers about occlusion, TMD and prosthodontic.

Clinical implications individuality in children

of

occlusal

plane

S. NARETTO (Italy)
1- Which occlusal plane definition which is the more pertinent? 2- What are the relation between occlusal plane inclination and skeletal types? 3- What is the incidence of the occlusal plane inclination on the therapeutic choice?

Basic studies and researches on cranio facial growth show that occlusal plane change his position in space and time during the whole period of development and growth of the skull until the attainment of the mature dentition stage. The final position is depending by several factors related to the biomechanical behaviour during functions of the masticatory organ. Cephalometric analysis is useful to simplify the complex concept of Occlusal Planes. Observations of data indicate that the inclination is different between scheletal class I, class II and Class III, being more steep in class II and more flat in class III. Variation between the subclasses demonstrate the very high degree of individuality of the inclination of the occlusal plane in subjects during mixed dentition stage. Silvano NARETTO M.D., D.D.S., M.Sc. Doctor of Medicine Doctor of Dental Surgery Postgraduate in Oral Surgery Postgraduate in Orthodontic Master of Science in Dental Science

TMJ : From dysfunction

anatomy

to

function

and

P. CARPENTIER (France)
1- Which are the weak elements of TMJ? 2- What means TMJ compression, overloading ? 3- Is the lateral pterygoid muscle involved in the mechanism of disc displacement? The temporomandibular joints are undoubtedly one of the most sophisticated joints of the human body. Althought they have been designed to fulfill specifications of masticatory function, some of their anatomical aspects still remain difficult to elucidate. This presentation will emphasise the phylogenetic, ontogenetic and biomechanical TMJ specificities to underline why are they so different from the others synovial joints. These elements are essential to understand the uniqueness of their cartilage, their links to the middle ear, and their various masticatory muscles relationships. Anatomical and electromyographic data will be compiled to show that the lateral pterygoid muscle must definitely be considered as a three-dimensional complicated muscular entity.We will then focus on the anatomical asymmetry of the disc-condyle complex in order to explain the mechanisms of disc displacement.

Pierre Carpentier is Professor of orofacial anatomy in the department of basic dental sciences at the university of Paris 7 Denis- Diderot. He is clinically involved in the treatment of Orofacial Pain at Rothschild hospital of Assistance Publique de Paris. His research interests are concerned with salivary glands, functional anatomy and imaging of the TMJ and with surgical anatomy of the oral cavity. Dr Carpentier has published international and national articles in this research fields. He is a member of the Acadmie Nationale de Chirurgie Dentaire and of several societies

Reproducibility of centric relation E. ry (Hungary)

1- Definition, and recording of a mandibular reference position is it a key question ? 2- Reproducibility of centric relation is it a myth? 3- How to manage an unstable centric relation in initial phases of treatment? Clinical diagnostic and reconstructive procedures require a proper 3D inter-maxillary relationship. This starting point should be a reproducible, neuromuscularly stable position. Description of the spatial position, the CENTRIC is often confusing, techniques and procedures to define it are waste and have controversial results. The aim of this lecture is to present two techniques which are useful in most of the clinical situations and have excellent reproducibility. Efforts to find and capture the starting point (the where we are) makes possible to define the therapeutic position (the where we go) where our reconstruction should be finished.

El!d RY Date and place of birth:1967, Reghin 1996 Centrocc gnathology course, Budapest 1996 Centrocc gnathology course, Budapest 1996 Maxillofacial specialist degree 1997 University degree in dentistry Semmelweis University of Medicine, Budapest 1998 Brnemark surgery / prothetics course, Rgen 2000 Reality aesthetic dentistry course, London 2000 Centrocc gnathology course, Budapest 2002 Brnemark Clinical Training Course, Gteborg 2004 Condylographie Typologie und Deutung, Rheinbach 2005 Advanced Replace Select Training Course, Sopron 2005 Funktionen und Dysfunktionen des Kauorgans, (Donau Uni, Krems) 2006 Die Therapie des Funktionsgestrten Kauorgans (Donau Uni, Krems) 2007 Master of Science in Dental Sciences (MSC)

Condylar and disc position, a review G. Slavicek (Germany)

1- Which are the prevalence in different condyle-disk relations? 2- What are the pathogenic incidence of condyle-disk desunions? 3- How to analyse the condyle-disk relation? The position of the condyle and the disc are often the focus of various interpretations and hazardous speculations. A physiologic condyle disk relation is basic and ambitious goal not only in restorative-prosthodontic dentistry, but also in many other dental disciplines. The function of the disc, and from that aspect also the position of the disc, is strongly related to the anatomical incongruence between the condyle and the articular eminence. Two convex osseous structures are stabilized and equalized by a fibrous, annular structure. Additionally, this function of the disc-condyle relation is not only a static one; in fact the dynamic components of mandibular movements have to be considered as well. Three questions will be highlighted in this lecture: 1) Are there different condyle-disc relations and if yes, how often these different relations are found (prevalence)? 2) What is the incidence rate for pathogenic condyle-disc relations? 3) Which methods to be used for analyzing the condyle-disc relation?

Dr. G. Slavicek graduated 1984 from the University of Vienna and continued his education at the Dental School Vienna. He certified as specialist in Dentistry (Facharzt fr Zahn-, Mund- und Kieferheilkunde) in 1986. He graduated a postgraduate training program in Orthodontics at the Royal Dental College in Aarhus, Denmark. In 1991 he joins the Department of Maxillofacial Surgery at the Landeskrankenhaus St. Plten. In 1994 he was appointed as lecturer at the Department for Prosthodontics, University of Vienna, School of Dentistry. From 2006 to 2008 he was Head of Clinical Trials, Cancer Research Center, 1st medical Department, Wilhelminenspital Vienna, Center for Oncology and Hematology. Since 2008 he is Head of Steinbeis Transfer Institute Biotechnology Interdisciplinary Dentistry. His main interest and research activities focus on diagnostic and treatment of craniomandibular disorders of the stomatognathic system. He took part on the development of computer aided diagnostic systems for jaw joint recording and analyzing lateral cephalograms.

To choose the vertical dimension of occlusion

R. SLAVICEK (Austria) JD. ORTHLIEB (France)

1- What are the physiopathogenic incidences of vertical dimension variations? 2- In case of extended rehabilitation, what are the key determinants to choose the Vertical Dimension of Occlusion? 3- What are the interests and methods of cephalometric analysis to choose the Vertical Dimension of Occlusion? During an extensive prosthetic reconstruction, the choice of the vertical dimension of occlusion (VDO) is frequently presented as the main point to obtain a successful treatment. Probably, it is a sensible opinion to think that there is an optimal adaptative space concerning the vertical dimension (VD) rather than a magic point. The practitioner may play with the VD, if a strict rotation around the hinge axis is used, if the facial type is not worsened, and if lip closure is kept in a natural position. The decision making will be described in relation two key factors, such occlusal anterior relation and prosthetic space. Mandibular morphology, sagittal maxillary position, facial aesthetic, skelettal skeletal type are also factors to take in count. A decision making table will be proposed to visualize the trend of this different factors.

Occlusal plane and articular paths reconstructing during prosthetic treatment E. ROSHCHIN, V. PANTELEEV, A. ROSHCHINA (Russia)
Aim: to determine individual radiological parameters of orientation of occlusal plane; individualization of prosthetic treatment using electronic axiography. Purpose: 1. determine orientation of occlusion plane with cephalometric analysis during restoration of posterior teeth defects; 2. reconstruct condular movement in final prosthetic treatment. Materials and methods: One hundred and ten volunteers, age range 18-30years with natural dentition were selected for this study. All the volunteers had a CT (dental tomography I-Cat, USA) end electronic axiography (Arcus Digma II, KaVo, Germany). Using obtained data we analyzed sagittal (right and left) orientation of occlusal plane, condylar position and anatomy of articular eminence. During clinical examination we made articular analysis for individual programming the articulator (Protar 9, KaVo, Germany) and functional analysis for evaluation condylar and incisal paths. Results: analysis of TMJ on CT revealed condylar displacement (28 volunteers). Analysis of sagittal CT showed up angle 1 (tangent to eminence and occlusal plane angle) and angle SNASNP-GoGn dependency. By analyzing the difference between the two angles we discovered constant "C" which depends on ArGoMe angle. Angle size (Ar-Go-Me) Constant " (group 1) 110-115 1013 (group 2) 115-120 1033 (group 3) 120-125 1043 (group 4) 125-130 1043

With radiological analysis, individual anatomy of condylar eminence was discovered, that led to restriction of use of articulator Protar because of invariable structure of articular mechanism which are standard and not in all cases conform anatomically. We have developed electronic articulator which can reconstruct condylar and incisal paths recorded by electronic axiograph Arcus Digma II without manual intervention. Conclusions: -with the help of cephalometric analysis we worked out radiological orientation of occlusal plane -individuality of lower jaw articulation were identified in recorded articular paths in the group of volunteers with condylar displacement.

Perio-Orthodontic case report, stability of therapeutic position X. RAUSCH-FAN (Austria)

1. How to understand the role of occlusal trauma in pathogenesis of periodontal disease? 2. What is benefit or risk of orthodontic treatment for periodontally compromised cases? 3. Which therapeutic occlusion is suggested to be benefit for maintaining teeth stability in periodontium? The malocclusion has been discussed to influence the pathogenesis and progression of periodontal disease. Occlusal adjustment and correction is considered to be an important adjuvant therapy for periodontally affected teeth. A combined orthodontic, periodontic and other interdisciplinary therapy often offers the best option for resolving complex clinical problem and achieving a predictable outcome. However, orthodontic tooth movement could also accelerate occasionally periodontal destruction, in particular, under condition of periodontal inflammation. To minimize the risk and achieve the optimum treatment result, a combined periodontal-orthodontic treatment concept is required to be established. The effective non-surgical and surgical periodontal treatment provides opportunities for gaining new attachment and improved the pre-orthodontic condition for moving teeth. In other hand, orthodontic correcting malpositioned teeth can change of topography of bone tissue and further improve the results of periodontal regenerative therapy. Moreover, orthodontic approaches in treatment of periodontally compromised teeth, by mainly focusing on diagnosis and therapy for occlusal trauma and establishing functional occlusion, can obtain the outcome of long term of periodontal stability. Prof. DDr. Xiaohui RAUSCH-FAN MD, DDs, Ph.D. Professor in division of orthodontics, head of periodontal research laboratory, Bernhard Gottlieb University Clinic of Dentistry, Medical University of Vienna, Austria Xiaohui Rausch-fan@meduniwien.ac.at Education and career history 1987 Master degree of medicine, Norman Bethune University, Changchun, China 1992 PhD at Nippon medical University, Tokyo, Japan. 1993 Research associate in dental school and institute for experimental pathophysiology, Vienna University, Austria 1998 Medical Doctor (MD) in Vienna University, Austria. 1999 Intership for specialized in general dentistry, Vienna University, Austria 2002- Assistant, department of periodontology, dental school, Vienna University, Austria 2004- Orthodontic training under supervision of Prof. S Sato at department for interdisciplinary dentistry and technology, Denube University, Krems, Austria 2005- Professor, senior resident, department of periodontology, Bernhard Gottlieb University Clinic of Dentistry, Medical University Vienna, Austria 2007- Specialist in orthodontics awarded from Denube-University Krems, private orthodontic praxis in Vienna, Austria 2012- Professor in division of orthodontics and Head of periodontal research laboratory Clinic field: periodontics and orthodontics Research field: pathogenese of periodonttal diseases, periodontal tissue regeneration, biocompatibility of dental implant surface.

Therapeutic position decision making in dentistry S. KULMER (Austria)

1- Therapeutic position, is it a key question for the stability of the rehabilitation, the health of the stomatognathic system and the wellbeeing of the patient? 2- What do you need to decide? 3- What are the criteria of decision making? It is the duty of dentistry to give the patient a stomatognathic system, that has the best prerequisites for longterm stability and good function. It shall give the patient wellbeeing and keep him pain free. Diagnosis and treatment plan are based on the therapeutic position. Research and longterm followup studies have shown, that the patient positions the condyle-disc complex, when closing actively by himself, in an anterior-superior position. This proves right in a healthy joint, in a loose lower compartment of the TMJ and even when a disc displacement has occured. Longterm followup studies will show, that such a "Myostabilized centric relation", together with good parameters of function, can be stable over decades. Univ.-Prof. DDr. Siegfried KULMER 1964: Promotion to Dr.med.univ. ( MD ) Karl-Franzens-University - Graz 1964/66: Education to medical specialist for oral medicine and dentistry Leopold-Franzens-University - Innsbruck 1967/68: Assistant at the Department of Jaw and Face Surgery -Regional Hospital Salzburg 1969: University Assistant at the University Hospital for Oral Medicine and Dentistry - Innsbruck 1972: Head of the Department of Preventive and Restorative Dentistry / Innsbruck Scientific studies in the USA and Switzerland 1977: University Assistant Professor (PhD) Austrian Stomatology Award 1981: University-Professor 1981/85: Vice President of the Austrian Society of Prosthodontics and Gnathology 1982: Austrian Stomatology Award 1986/93: President of the Austrian Society of Prosthodontics and Gnathology 1987: Member of the International College of Prosthodontists Lectures and seminars in Europe, Japan and USA 2001 2005: Head of the University Clinic of Oral Medicine and Dentistry (Innsbruck) 2001 - 2006: President of the Association for Dental Health in Tyrol Since 2005: In private office in Innsnbruck Since 2005: President of the Tyrolean Dental Society Since 2006: Charter member IAAID

Condyle position in occlusal reconstruction X.-J. YANG (China)

1- Condyle position : Is it a key question about the stability of the rehabilitation, the health of stomatognathic system? 2- How to control the condyle position along the treatment? 3- What is the prognosis of condyle position in long term after treatment? Many restorations may lead to patients feel uncomfortable in occlusion, masticator muscles and temporomandibular joint (TMJ). These symptoms may not only due to the high point of the occlusion but also the unstalbe of the condyle position. However, how to evaluate condyle position during the treatment is still an open question. 3D-ultrasonic mandibular trace testing instrument (ARCUS Digma system) was use to detect the position of condyle during occlusion reconstructing since 2003 in our department. It was found that condyle position may still shift unbalance on two sides of TMJ after regular grinding of the restorations by guided with articulating paper. After grinding with the guidance of T-Scan and ARCUS Digma, the condyle could be shown in a relative stable position. Application of this technique in splint (186 cases), implant (259 cases) and fixed denture (122 cases) were discussed in this report. It indicated that grind the restorations with help of T-Scan III system, and the 3D-ultrasonic mandibular trace testing instrument (ARCUSdigrna system) explored a considerable accurate method to obtain the changes of condyle position during occlusion reconstruction treatment.

Xiaojiang Yang is the head of the 2nd Oral & Maxillofacial Surgery Department, Beijing Stomatological Hospital Capital Medical University in China. Get his PhD in Oulu University of Finland; DDS in West China Medical University in China. He is now the Vice President of Chinese National Occlusion Academy; Board Member of Chinese National TMJ Academy; Member of International Dental Collage (IDC); Member of International Association of Dentalmaxillofacial Radiology (IADR); Member of International Association of American Dental Association (ADA); American Implant Dentistry Association (AAID). His main research is TMJ, occlusion and dental implant.

Transversal displacement of the condyles (Delta Y) : decision of therapeutic position A. LANDRY (Canada)
1- How to diagnose transversal mandibular position disorders (Deranged Reference Position and unphysiologic ICP)? 2- Why Deranged Reference Position and/or unphysiologic ICP present a TMD risk factor? 3- What are the criteria of decision making to change transversely the mandibular position? Physiology of the masticatory system implies that the structures (CMS, NMS and Occlusion) work in harmony to perform normal functions under the supervision of the CNS. On dysfunctional patients, normal functions can be altered by overload (somatic or psychic) which may bring, with time, alterations to the structures of the masticatory system. Most of us have a good understanding of what may happen to the functions of an altered masticatory system on the sagittal plane. But what about the transversal plane? If we have to plan an oral rehabilitation, it is logical to consider the three planes of space, i.e. the sagittal plane (X and Z axis) and the transversal plane (Yaxis). So, if the patients masticatory system need to be reconstructed in a therapeutic position, it is a must to also consider the transversal plane.

Alain Landry : Graduated from Laval University, Qubec, Canada, general practice from 1976 to 1989. From 1990 to these days, his practice is oriented exclusively towards the treatment of Cranio-Mandibular Disorders (C.M.D.), Orthodontics and Prosthodontics. In 1994, he developed the Controlled Mandibular Repositioning method to maximize the concept of Therapeutic Position. In 2005, he obtained the degree of Master of Science in Dental Sciences (M.Sc.), from Donau University, Krems, Austria. From 2005 to 2009, he offered, in cooperation with Donau University, a Masters program, under the supervision of Professor Rudolf Slavicek. The achievement of an important breakthrough in the field of C.M.D. brought him to present the results of his work in North America and Europe.

Transversal Delta (Y) : procedure of repositioning treatment M. GREVEN (Germany)

1- How to simulate on articulator the corrected mandibular position? 2- How to control with temporaries the position transfert from the articulator to the patient? 3- How to maintain the therapeutic position during the treatment?

The respect of condylar position in any oral rehabilitation plays a major role in dentistry. The choice of condylar therapeutic position has been discussed controversially for many year and still remains a topic with many open questions. Main focus in the last couple of years was mainly given to anterior-posterior (X-axis) and cranio-caudal (Z-axis) direction of condylar control. This presentation is trying to show the significance of transversal position of the mandible and wants to discuss the procedures necessary to perform transversal control of the condyles in clinical treatment.

Markus Greven : Undergraduate at Dental School, Medical University of Aachen/Germany DDS Degree University of Aachen - Dr.med.dent. Post Graduate Education/Dental School University of Vienna Department of Prosthodontics/Prof.Slavicek Since 1996: Private Office/Bonn/Germany Post Gradaute in Periodontology Prof.Dragoo/Study Group/KarlHupl-Institute/German Board of Dentistry/Division Nordrhein Post Graduate in Function/Dysfunction of Masticatory Organ and Therapy of the functionally disturbed Masticatory Organ Danube-University Krems/Prof.Slavicek (MSc) Post Graduate in Orthodontics - Kanagawa Dental College/Yokusuka/Japan; Dept.Craniofacial Growth and Development Dentistry; Prof.Sato PhD - Education/Scientific Visiting Researcher Kanagawa Dental College/Yokusuka/Japan; Dept.Craniofacial Growth and Development Dentistry; Prof.Sato Visiting Researcher - LIFE&BRAIN-Insitute /Dept.Neurology- Med.Faculty - Medical University, Bonn/Germany (Chair: Prof.Elger; Prof.Weber) Asigned e.o.Professorship at Medical University of Vienna

Esthetic full mouth rehabilitation of severe bruxism: a contemporary minimally invasive prosthetic approach P.SIMEONE (Italy)
Restorative treatment of severely worn dentition is typically indicated to replace deficient tooth structure, limit the advancement of tooth destruction, improve oral function, and enhance the appearance of the teeth. Minimizing removal of additional tooth structure while also fulfilling the desire of patients to have higly esthetic restorations can present a prosthetic challenge when the existing tooth structure is already diminished, especially in the bruxers patients. In this particolar cases the restorations provide for a new masticatory pattern, according to the articular path and the muscolar activity, by using condylography, cephalometry and electromyography tools. This article presents the clinical and laboratory steps of a comprehensive minimally invasive prosthetic treatment approach, using a lithium disilicate allceramic material for the esthetic full mouth rehabilition of a severly worn dentition in patients diagnosed with bruxism.

Choice of therapeutic position, clinical cases discussion N. BASSETTI (Italy)

1- What is needed in order to decide to change the intercuspal position (ICP)? 2- What are the correct criteria to use in complex rehabilitation therapy involving mandibular repositioning? 3- What do you think are the main points to consider in achieving and stabilizing the correct therapeutic position? The plan for the treatment of complex dysfunctional and non dysfunctional cases requires an interdisciplinary approach that involves the most common branches of dentistry and an orthodontic, prosthetic approach respecting a functional-occlusal concept according to the philosophy of Professor Slavicek. Pre-therapy with bite or with temporary is usually required for those patients to solve the symptom of pain generally associated with the dysfunctions of the masticatory organ. Implant terapy will allow you to have the back support, the control of the vertical dimension,and to guide the mandibule in a sagittal and traversal reposition.Proceed and verify the therapeutic position by reassembling the temporary crowns in the articulator and valuate the R.P. (reference position) and any corrections to be made on the resin so as to reach the therapeutic position(TRP). We can say that the position of the implant, the consequent bone tissue management and the subsequent prosthetic reconstructions are gnathologically guided.

The final aim of the therapy is to rebuild an occlusion able to give back to the masticatory organ the function which allows it to carry out its task with the least energetic requirement and the control of the parafunctions. This type of approach is shown important for the long term stability of the therapeutic position in the complex rehabilitations. Nazzareno BASSETTI 1982 Dental technician diploma CDT 1988 Degree in dentistry and dental prosthetics with high honors university of Sapienza in Rome Italy 2002 Postgraduate University course Therapies for the functionally disturbed craniofacial ans masticatory system Prof. R. Slavicek Prof S. Sato and Noshir R. Mehta, Donau University Krems Austria 2004-2007 Master course Orthodontics in craniofacial dysfunction Prof S. Sato, Donau University Krems Austria 2007 Title of academic expert in orthodontics, Prof S. Sato, Donau University Krems Austria

Our investigation of therapeutic position and transfer to occlusal rehabilitation G. REICHARDT (Germany)
1- How to validate the mandibular therapeutic position obtained by splint? 2- How to transfert a mandibular therapeutic position from splint to fixed restorations? 3- When to decide to change mandibular position by invasive permanent reconstruction? The definition of a spatial mandibular position serving as therapeutic position (TRP) for the successful occlusal rehabilitation remains unclear and controversial. We observed the mandibular response to the elimination of occlusal influences by using a flat anterior and lateral guidance splint (FGS). The insertion of an FGS led to a change in the topographical condyle-fossa relationship with a tendency toward forward and downward movement and is likely to create an unloading condition for the temporomandibular joint (TMJ). The masticatory organ appears to self-regulate and rebalance by providing a new muscularly stabilized mandibular position which may be more physiological and we labeled as occlusion relief position (ORP). As a consequence, we present the incorporation of sequential guidance to occlusal rehabilitation using ORP as TRP.

Gerd Reichardt Year of Birth: 1965 Dental School: University of Tuebingen/Germany Private Dental Clinic in Stuttgart/Germany since 1993 Postgraduate Function und Dysfunction of Masticatory Organ- Prof. Slavicek/University of Vienna and Danube-University Krems Postgraduate Orthodontics- Prof. Sato/Kanagawa Dental University/Japan PhD Program - Prof. Sato/Kanagawa Dental College/Japan Scientific/Research Member Research Institute of Occlusion Medicine and Brain Research Center- Dept. of Craniofacial Growth and Development Dentistry/Kanagawa Dental College/Japan (Chair: Prof. S. Sato)

Correlation of mandibular lateral translation (MLT) in symmetrical mandibular movements in condylography and MRI examination S. CID, C. RIJPSTRA, U. LABERMEIER, M. VAHLENSIECK, V. KEHL, S. SATO, A. KOLK, M. GREVEN (Germany, Japan)
Hypothesis. The occurrence of Mandibular Lateral Translation (delta YMLT) in symmetrical mandibular movements is an (early-) indicator of an Internal Derangement of the TMJ. Aim(s) of the study. a) The aim of the study is to find evidence that the occurance of Mandibular Lateraler Translation (deltaY MLT) in symmetrical mandibular movments (sym. = Open/Close; Protrusion/ Retrusion) during 3 dimensional condylographic TMJ tracing is an indicator fr an Internal Derangement in the TMJ and b) the definition of a threshold value of delta-Y condylar deviation as an indicator for a pathological intra-articular finding. Material and method. A patient group of 112 TMJs (56 patients) were examined by standardized interview (anamnesis), clinical functional examination, true hinge axis condylography (incl.delta-y) and Magnetic Resonance Imaging (MRI) of the TMJ. 12 volunteers (24 TMJs) served as a control group. Results. The patients sample all showed pathological displacements oft he TMJ(s) (Internal derangement) according to Kobs classification (SHIP 2003). According to this classification the whole control group showed no pathological findings in the MRI tracings. There was a significant difference between the patients group and the control group in the evaluation of the condylographic tracings in terms of a Mandibular Lateral Translation (MLT / delta-Y) in symmetrical mandibular movements. The patients group uniformly displayed an average MLT value 0,91mm in open/close-movements and an average MLT value of 0,77mm in protrusion/retrusion-movements, whereas the control group showed significantly lower mean deviation values on Y-axis (open/close-movement: 0,51mm; protrusion/retrusion-movement: 0,49mm). This resulted in a receiver operating characteristics (ROC) curve for the open/close-movement of ROC=0,671mm and for the protrusion/retrusion-movement of ROC=0,702mm. Conclusion(s). The occurance of transversal, condylar displacement in symmetrical mandibular movements (O/C and (P/R) is a strong indicator of temporo-mandibular disorder (TMD) by the definition of articular "Internal Derangement". At minimum a loosening of the capsular and condylar ligaments is existing. The deviation of condylar movement in a quantity of 0,6 - 0,75 mm indicates limitation of the functional joint space and an Internal Derangement of the TMJ(s) and is in concordance with the values found in the recent littrature.

Provisional restorations gnathological rules

according

to

R. MASNATA (Italy)
1- What are the rules which dictate the wax-up modeling? 2- How to transfert, without distorsions, wax morphology to acrylic restorations in mouth? 3- Provisionals are a main step, for how many time may you maintain provisional reconstruction in mouth? In dysfunctional patients, the transition from pretherapy to the prosthetic restoration is always very critical and delicate. In fact, even if the pretherapy has been successful, it must be ensured that the jaw maintains the correct therapeutic position To make use of a gnathological provisional restoration, it offers the possibility of simulating the final state, with the advantage of being able to intervene again in case of need. The electronic instrumentation allows us to build a biodynamic occlusion with immediate disclusion, and sequential canine dominance with great precision. Such a provisional restoration allows us to verify that the prosthetic approach fits these requirements, offers the possibility of some corrections and guarantees greater security to reestablish a normal function at the end of the final restoration.

Roberto MASNATA : Born in Milan the 10/15/47, he took a degree in Medicine and Surgery at Pavia University (Italy) in 1974. He specialized in Prosthetic Dentistry with first class honours at the same University in 1979. He has been an active member of the International Academy of Gnathology since 1989. He is a founder member of the Italian Association of Gnathology (A.I.G.), established in 1989. He has been the secretary and vicepresident of this society since 1990. Qualified lectured at the center of Interdisciplinary Dentistry, Donau University Krems, since 2003. He practises as a free professional doctor in Stradella (Pv, Italy), devoting himself especially to complex rehabilitations and gnathological problems.

Full mouth prosthetic rehabilitation and rest position F. RAVASINI, N. GONDONI (Italy)
1- Rest position could be a reproducible mandibular reference position? 2- What is the influence of mandibular rest position in your therapeutic choices? 3- From practical point of view, what are the specific protocols used to control the therapeutic positions during the treatment? The purpose of our presentation is not an academic discussion on the position of centric relation, but the sharing of new techniques and materials available in prosthetic rehabilitation, and to see what enormous benefits not only aesthetic but also occlusal permit. New materials offer resistance and optical effects once unthinkable and also enable better management and control of occlusal relations in the various appointaments. The taking of the impression becomes the dividing line between "old" and "new". The use of plastics (PMMA) has completely changed the trial on the patient. Now we can see through the CAD / CAM an unimaginable amount of data compared with before. The control of space and occlusal thickness allows us a more predictable and individual anatomy of the occlusion. From the first plastics step to the final finished product there should be no differences in the final result, with the great advantage of having shared and discussed our work with the patient before arriving to the finished product. The finalization of the case using the latest materials such as zirconia ceramic Prettau, manually stratified, could open new horizons in the treatment of prosthetic patients and perhaps of bruxism.

Francesco Ravasini, born in Parma 05/10/1967. Graduated in Dentistry and Prosthodontics at Parma University in 1992. After graduation he frequented the prosthetics department at Freiburg university as a volunteer assistant of prof. J. Strub, From 1992 to 1996 he attends the course of Dental Medicine at the Zurich University. From 1996 to 1998 he worked in his private practice in Parma, and then returned to Zurich to cover the role of assistant in Temporomandibular diseases and Prosthetic Dentistry Department directed by Prof. Palla, where he gets the teaching role in the Total Prosthesis Course and is promoted to associate Professor in 2001. From 2002 he is part-time Professor at Universit degli studi di Parma and works in his private practice together with his father and brother. Author of numerous scientific publications and relator in congresses and courses in Switzerland, Germany and Italy. Nicola Gondoni, graduated in dental technician in Bologna in 1996 he began his training in various laboratories in particular in Bologna working in the laboratory of Rudolfo Timiani. He attended several courses including Prosthetics second Glauco Marino, Ceramic with Zilio Aldo, and Enrico Steger In 2002 he began his professional path and is following the philosophy gnathological second R.Slavicek attending annual courses, Gnathology Base, Advanced Gnathology, Temporomandibular joint dysfunction of the jaw, Total Denture second Slavicek Dysgnathia 1st 2nd 3rd class with Dr G.Cuman with whom he studied and worked for years in Ravenna.

Therapeutic position : from occlusal splint to final rehabilitation E. TANTERI (Italy)

1- When occlusal splint must be wearing 24h per day? 2- How to control the stability of mandibular position gived by splint? 3- Is occlusal splint can be interpreted as a real functional test? The need to change condylar position may be encountered in different dysfunctional situations. This change could either be transitory, for example if condylar relationships will be once again be normalized to their original situation at the end of the therapy for dysfunction, or in other case scenarios it may be a definitive change in relationship between articular structures. Our experience has brought us to face this situation in many cases, especially in joint locking when a reduction of the condyle-disc luxation is still possible. A correct decision can only be made after careful evaluation of the features of the whole system and after a precise diagnosis, always bearing in mind the fundamental principle that considers every dysfunction and every treatment to be unique and specific: there are no two equal dysfunctions, no two equal dental treatments, there are no two equal operators. We can therefore state that every rehabilitation represents a unique episode which is hardly equal to other cases. The only similar thing will be our attempt to standardize our methodology and rehabilitation procedures. There is one fundamental condition that has to be observed if we want our rehabilitation to be successful: reaching stability of the system. This condition is often guaranteed by the stomatognathic system itself. The latter has a great capacity for adaptation and can reorganize and re-balance itself by re-setting its functional arrangement just like a very sophisticated cybernetic system. We, as dentist, have a very delicate duty: help favouring the re-adaptation in the only possible way we can. That is to say by recreating a functional and stable- in- time occlusion. Eugenio Tanteri 1979 Dental Technician Diploma 1971-1978 Professor at the Institute for Dental Technicians G. Plana, Torino, Italy 1978 Degree in Medicine and Surgery, University of Torino, Italy 1981 Specialization in Dentistry, University of Torino, Italy 2003 Master of sciences in dental sciences Danube UniversityMASTER OF SCIENCES in DENTAL SCIENCES DANUBE UNIVERSITY, Krems (DIR. PROF. R. SLAVICEK). Cotranslator, along with A. Bracco, R. Prandi, S. Naretto of Prof. R. Slaviceks Book The masticatory organ into the italian language Author along with A. Bracco and R. Prandi of the book (2 volumes) Principles of Gnathology Ed. R.C. Libri Milano.

Virtual articulator and simulation of therapeutic position G. DUMINIL (France)

1- What is the state of the art about virtual articulator? 2- Is it possible to use non occlusal reference position? 3- Is it possible to simulate different therapeutic position to aid decision making? In the early 80's, Franois Duret has introduced new concepts in dentistry and since then, the trend for dentistry is to move more and more digital. Actually more than 30% of dental labs already use cad/cam equipments, and most dentists profit of these advances probably without even knowing it. The primary goal of these technologies is to mill prosthetic crown and bridge frameworks. The cosmetic (and thus the occlusion) is being elaborated by classical multilayering ceramic procedures. Today, can occlusion also go digital? The purpose of this lecture is to describe the means by which occlusion can be recorded and reproduced using electronic articulators. The questions are : If using an intraoral scanner, how can one record and reproduce proper occlusal contacts? If using a laboratory scanner, how can the dental technician properly set the functionnal parameters of the patient in the cad/cam software ? And finally, how accurate is the combined use of cone beam imagery and intra oral scanning of the dental arches ? Most Cad/Cam softwares actually include a so called "digital articulator". Is it worth the time and cost ? What are the real benefits for the patient and the dentist ? We will compare classical versus digital technics and discuss the present and the future of occlusal practice.

Grard Duminil : Gratuated from marseille dental university DDS in 1975, ; DSO, 1980 Certificates in Prio , Fixed Prothodontics DU Occluso, Implantology, Biophysics and computerizd dentistry. Private Practice in Nice since 1976 National and International lecturer in Occlusion, and implantology CNO and IAAID Member Guest lecturer in the dental faculty of Nice

Rehabilitation of patients with severe bruxism using Full Ceramic Cad-Cam A. KNAUS (Austria)
1- What are the advantages avec CAD-CAM technique in this type of reconstruction? 2- In severe bruxism, which type of occlusal concept is recommended: canine guidance or group guidance? 3- In this type of cases are there some specific protocols about splint, temporaries, or additional treatments?

At the prosthodontic department of the Dental School in Vienna, a standarised diagnostic pathway, we call it: diagnostic package, is used for all patients with severe occlusal relationships. This diagnostic package will be introduced very briefly in my presentation as well as the necessity to create the treatment plan for each patient. The relationship between bruxism and psychopathological symptoms were evaluated and introduced. Biofeedback therapy is helpful to control the bite force. Based on a patient case a step by step implementation of the treatment plan will be demonstrated. The advantages of the Cad-Cam techniques will be discussed.

The recent approach to craniomandibular disorder by prosthodontic and orthodontic treatment H. YOSHIMI (Japan)
1- Can we reconstruct the occlusion according to TRP accurately? 2- Can we eliminate the molar interferences in protrusion, laterotrusion, mediotrusion? 3- Can we control the mandible retrusive movement during Sleep Bruxism? Patients with temporomandibular disorder are frequently accompanied problems with the vertical growth of craniomandible . Mandibular position is adapted , under the influence of direction of occlusal plane, the activity of the orbicularis oris muscle ,maxillary growth, the potential of mandibular ramus growth. These elements are easily to lack of coordination and balance.We can find out the originally acquired mandibular position(TRP) through the examinations of Axiograph, models which are mounted to the articulator based on axis-orbital plane and RP point, and lateral cephalographic X-rays . The mandibular position can be adapted to TRP accurately through the prosthodontic Metal Overlays. The three dimensional position from Metal Overlays can be transferred to other teeth with orthodontic technique. Retrusive movement might be remained during Sleep Bruxism. We should eliminate the interferences in molars. The retrusive interferences in molar are excluded through controlling the inclination of retrusive guiding area and the molar occlusal plane. I would like to show that craniomandibular disfunction clinical case who was recovered through this way and has good prognosis.

Hidehiro Yoshimi Date/Place of Birth:01.03.1961 in Tokyo/Japan 1986 Nihon University School of Dentistry at Matsudo 1987-1990 Institute of Maxillo-Facial Implant/Urawa/Saitama/Japan 1992-1996 Institute of Kasumigaseki Post Graduate Center/Tokyo/Japan 2000-2007 Institute of Craniomandibular Function /Asahikawa/Hokkaido/Japan 2003-2009 Kanagawa Dental College Post-Graduate School, Department of Craniofacial Growth and Development Dentistry/Yokosuka/kanagawa/Japan 2009 Award of Kawamura as Best Thesis of the Year ,The Bulletin of Kanagawa Dental College Vol.36No2,63-68 Since1996 Private Office/Tokyo/Japan

Orthodontic treatment and therapeutic position following the centric relation of disco-condylar assembly S.Sato (Japan)
1- Can we have a stable centric relation with a disc-condyle disunion total and permanent? 2- What are the tecision criteria for changing the mandibular position in orthodontic treatment? 3- How to establish a retrusive guidance in orthodontic treatment? The objective therapeutic goal for the position of the mandible in orthodontic treatment is centric relation (CR) of the disco-condyle assembly. The definition of CR is normal physiological and functional relationship of the condyle and articular disc. Decision criteria for changing the mandibular position in orthodontic treatment are as follows: 1) Existence of one or more pathological conditions of the temporomandibular joint: noise, pain, difficulty of mouth opening, delta-Y shift of the condyles, and others. 2) Existence of symptoms of the craniomandibular system (CMS): poor retral stability of the condyle, muscles of mastication problems and others. 3) Class II during the growing period 4) Adult Class II with functional disturbances Strategies to achieve repositioning of the mandible: 1) Control the occlusal plane 2) Control vertical dimension 3) Establish coordination of the upper and lower dental arches 4) Establish retrusive guidance with adaptation and articular compensation of the condyles Sadao Sato, Academic Dean, Professor 1971 Assistant, Department of Orthodontics, Kanagawa Dental College 1979 Assistant Professor, Department of Orthodontics, Kanagawa Dental College 1988 Associate Professor, Department of Orthodontics, Kanagawa Dental College 1991 President, Japanese MEAW Technic and Research Foundation 1992 Active member of EH Angle Society of Orthodontists 1996 Professor, Department of Orthodontics, Kanagawa Dental College 2002 Visiting Professor, Donau University at Krems, Austria 2010 Academic Dean, Kanagawa Dental University (College), and Shonan Junior College

POSTER
1- Relation between legs lenght discrepancy (fLLD) and condylar position. Giorgio DeLuca di Pietralata Department of Interdisciplinary Dentistry and Technology at the University of Continuing Education / Danube-University Krems Advisor: Univ.-Prof. MR Dr. Rudolf Slavicek. Adress: Via Antiochia 8/7 16129 Genoa, ITALY tel/fax 0039 010 588295 0039 3474231781 email: giorgio.dlcdp@gmail.com A) functional LLD, Fukuda test, condylar position, Reference position, postural screening. B) Are fLLD and Fukuda test, two postural findings, related to condylar position measured from ICP to RP on casts mounted in Reference SL articolator? Can they be used for diagnostic purpose of occlusal therapeutic position? C) 20 patients tested for fLLD and Fukuda test in ICP and with an occlusal appliance made in RP, in order to observe their modifications between the two examinations. Condylar Position Measurement (CPM) were checked in articolator Reference SL Ghirbach to observe if the change of mandibolar posture induced by the appliance can be related to a particular pattern of direction of condyle from ICP to RP. Inclusion criteria: functional legs lenght discrepancy. Exclusion criteria: anatomic legs discrepancy, acute pain, dental and physical treatment, legs surgery or trauma. T-student test performed. D) 90% of fLLD changed with RP appliance, 50% completely, 40% partial change. Fukuda Test change was 80%. T-student test significative in both. 60% of omolateral condyle go to cranial position, but Tstudent test no significative. E) Both fLLD and Fukuda test are strongly related to mandibolar posture and can be used as screening tests for correlation between occlusion and posture during diagnostic and therapeutic procedures, but matched with clinical findings. Not possible to use them as indicators of condylar therapeutic directions. Correlation between occlusion and posture in literature is at the moment at a poor level. 2- Symetry of external auditive meatus - Pilot study on human skulls Simona Mizgiryte 1, Julius Vaitelis 1, Arunas Barkus 2, Linas Zaleckas 3, Rolandas Pletkus 2, Adomas Auskalnis 4. 1Institute of Odontology, Faculty of Medicine, Vilnius University, Lithuania 2Department of Anatomy, Histology and Anthropology, Faculty of Medicine, Vilnius University, Lithuania 3Department of Oral and Maxilofacial Surgery, Institute of Odontology, Faculty of Medicine, Vilnius University 4Clinic of Dental and Oral Pathology, Faculty of Odontology, Lithuanian Univeristy of Health Sciences Simona Mizgiryte Address: Zalgirio 117, Vilnius, 08217 Cell phone: +370 656 03714 E-mail: simona.mizgiryte@gmail.com Objectives: To evaluate the perpendicularity of the line connecting external auditive meatus to the midsagital plane and the palatal suture as a midsagittal symmetry reference line. Methods: 26 female and 36 male skulls of adult individuals were used for photography taking (Nikon 40 D and 50 mm Nikkor lens) from basal, frontobasal and frontal views. Images were analysed with Adobe Photoshop CS5 (Adobe). The first line was drawn over a region of petrous part of temporal bone connecting the frontal points of both external auditive meatus and the angle to the midsagittal plane was measured. The second line extending from sutura palatina mediana in frontal and distal directions

was evaluated in compare to the midsagittal plane. Statistical analysis included descriptive statistics, Kolmogorov Smirnov test, t-test and ANOVA (SPSS 17, IBM). Results: The mean value for the angles of the line between the external auditive meatus and the midsagittal plane in basal views was 90,12 (SD=1,48) and in frontobasal 90,36 (SD=2,25). No statistically significant differences were found between age groups and genders. The inter-rater agreement for evaluation of the adequacy of sutura palatina mediana with the midsagital plane was high (Cohen's Kappa 0,702 (p<0,05)) as well as the coincidence of both lines in basal and frontobasal views (respectively 90,3 % and 85,5 %). Conclusions: Considering the limits of this study the angle between external auditive meatus and midsagital skull plane has a characteristic fluctuating asymmetry. The congruence of sutura palatina mediana and midsagital plane is debatable. Clinical significance: Using facebow for every patient's mouth rehabilitation should be evaluated carefully because of a possible errors occuriong due to asymmetry of the human skulls. Alternative using of palatal suture as one of the reference lines needs more precise measurements on computer tomograms. 3- Kinematical comparison of the different incisal tables used for anterior guidance reconstruction Piero Simeone, Rudolf Slavicek Department of Interdisciplinary Dentistry and Technology University of Continuing Education / Danube-University Krems Austria Statement of Problem: Conventional articulators allow the user to adjust the inclination of the incisal table according the reconstruction principles; This fact suggests the adoption of an incisal table that exploits an appropriate curvature related to the individual incisal concavity, by the motion of the lower incisors. Purpose:The aim of this study was to compare different incisal tables by a kinematic analysis of the protrusion motion. Materials and Methods: Parametric planar multibody model of the articulator (Reference SL Gamma Dental) was developed by means of the implementation of the contact equations in the sagittal plane, both for the condylar and incisal pin/tables guides. Through the use of the parametric model, the equations of contact and motion were mathematically shown for the different devices used in the present study. Sequential incisal table, individual anterior guidance unit, and adjustable curvature were used for the comparison. All the tests were made using three shapes of condylar guidances (CI) with different Sagittal Condylar inclinations (SCI); The numerical parameters of any table were processed and compared to the trajectory of the upper palatal shape of the standard incisal by a Mean Deviation Factor (MDF). Results: The value of the MDF decreases from a mean value of 0.13 when a flat table is used to a mean value of 0.08 when an adjustable curvature device is used. In all cases the curvature is higher in the first part of the protrusion and progressively decreases during the protrusion path. The variation of the eminence angle may affect the inclination of the standard incisal table but the curvature is imperceptibly affected by this parameter. Conclusions: The comparison between three incisal tables shows a better matching of the adjustable curvature of anterior guidance, showing the full agreement with the results 4- Is a virtual articulator helpful in everyday practice? Authors: Daniele Togni *, Cesare Secchiaroli** * DDS, MSc, private practitioner, ** Dental Technician presenter author: Daniele Togni, DDS, MSc, via G. D'Annunzio 18, 23900 Lecco LC Italy phone +39 0341 367490 fax +39 0341 369144 email drdaniele@studiotogni.lc.it Objectives: the aim of the work is to evaluate if a virtual articulator is helpful for everyday practice,

especially to avoid posterior interference in our reconstruction therapies. A virtual environment was created in order to observe the effects of some factors on posterior disocclusion: Sagittal condylar inclination (SCI) Anterior guidance (AG), retrusive guidance (RG), canine guidance (CG) Occlusal plane (OP) Methods: a virtual model was created scanning two plaster models of Slavicek sequential wax-up with a laser scanner (Dental Wings 3D Series 5); they were positioned in a virtual articulator with the same rules: hinge axis, axio-orbital plane, reference position, overlapping of condylar tracing. The virtual environment was created with the software Rhinoceros and then different situations were simulated matching SCI (30, 45, 60) with different OP (-5, 0, 8, 20 and 30) and guidance inclination. With the animation module Bongo we tried to simulate some ideal movements with different guidances and Bennet angles. Results: the study shows how easy it is, in this virtual environment, to change the above parameters and see the consequences immediately. Other parameters, like curve of Spee and Wilson, could be introduced. Furthermore it is possible to put all the individual parameters (scanning individual models and positioning them in the individual space position, with the appropriate tracing) of real cases in the virtual articulator to help us to better comprehend the situation of clinical cases, without any limitations of the mechanical articulator (e.g. retrusion) Conclusions: the virtual environment can be very helpful to the dentist and the technician for the instrumental analysis, the diagnostic and therapy. Moreover it seems to be interesting from an educational point of view and it could have some relevant developments like implementation with conebeam x-ray images, muscular vectors investigations, virtual wax-up. Further interesting developments are expected with the use of the Rhinoceros parametric plug-in Grasshopper that we are going to introduce. Bongo does not seem suitable for the asymmetric movements that we need to simulate.

SPECIAL THANKS TO