Page 53 - Open versus closed Mandibular condyle fractures

Management of post-traumatic malocclusion: an alternative treatment
Occlusal stops or bite-raising adjustments are also applied in the Dahl concept.16 The Dahl concept refers to the relative axial tooth movement that is observed when a localized appliance or localized restorations are placed in supra-occlusion, the occlusion reestablishes full-arch contacts over a period of time.16 This technique is used in patients with tooth surface loss. In order to evaluate the possible effects of axial tooth movement on correction of the malocclusion, measurements were performed on the pre-treatment CT and post-treatment CBCT scans.
Landmarks were indicated on the premolars and molars on both the CT and CBCT scans, and repeated measurements showed good reproducibility of the measurement strategy. Indeed, the use of two different imaging modalities may be a source of measurement error; however, the size of the measurement error introduced is expected to be small in comparison to the extent of the malocclusion. Significant axial tooth movement could not be distinguished and thus did not provide an explanation for the correction of the occlusion that occurred in this case. Moreover, axial tooth movement is a long-term process and the contribution of axial tooth movement to correction of occlusion is expected to be limited during short-term occlusal stop treatment.
We can only speculate at this point that the effect of physiotherapy in tracing back the pre-traumatic propriocepsis of the patient, by finding the correct occlusion, may likely contribute significantly towards correction of the bite. In the long-term, occlusion refinement and control might be achieved through combination of the Dahl concept and training by the physiotherapist.
In the present technical note, only four cases were evaluated. Although these results are promising, a larger study population and a randomized study design are needed to establish the clinical value of occlusal stop treatment in managing post-traumatic malocclusion after closed treatment of condylar fractures. The effect of timing of occlusal stop placement, thickness and location of the occlusal stops, and duration of occlusal stop treatment on the outcome of occlusal stop treatment, merit further investigations. Alternatives for the occlusal stops, such as splints, should also be considered in future research. Finally, a reliable measurement has to be established to quantify the effect of the physiotherapy in malocclusion treatment.
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