Download orthopedics appliances used in systemic odontology and pam

Roseli Luppino Peres
Agné Cervo Peres
ORTHOPEDICS APPLIANCES USED IN SYSTEMIC ODONTOLOGY AND PAM – AEROMUSCULAR
POSSIBILITATOR
The technique used most preferably is the Functional Dynamic Reabilitation of
the Maxillaries developed by a brasilian dental surgeon called Dr. Maurício Vaz de
Lima. They are encapsulating appliances which stimulate the growth by utilizing
the resistance of the majotity of the teeth against the minority of them.
These appliances cause anteroposterior, lateral and posteroanterior
movements, that is, they cause a three-dimensional stimulus of growth, which
favors the re-establishment of the structural balance of the adult patient.
When there is lack of space for the proper alignment of the teeth, specially the
canines, we use the distalization, which promotes the recuperation of the
anteroposterior dimension, becoming unnecessary any extraction. With this
technique, we can have the opening of the palatine suture, disjunction, which
favors the growth of laterality. This palatine disjunction occurs more slowly, without
the pain caused by a palatine disjunction made by braces.
We start the treatment by placing the Neural or anterior Aero Muscular
Possibilitator , AMP, ( Possibilitador Aero Muscular – PAM), which, when well
related in the mouth, helps bringing the jaw back to its rest position without the
need of a constructive bite to be in a position of balance. The anterior PAM has
been used as an auxiliary form of diagnosis and it is also a resource/ way of
treatment that aims at muscular relaxation.The touch of the teeth happens
under the anterior AMP (PAM), stimulating the recuperation of the neuro-muscular
balance of the Stomatognathic System. This apparatus is used for 60 to 90 days
( there can be an opening of the anterior bite when it is left in the mouth for too
long, because a vertical posterior growth can happen). After this period, we
exchange the Anterior Aero Muscular Possibilitator for a Posterior Possibilitator,
which is also flat and smooth and has all the curves and planes in balance,
favoring the movement because all muscular interferences are eliminated because
the neuro muscular system is in balance due to the AMPs.
Having eliminated the muscular interferences and giving the right stimulus for
growth, there will be no need for extractions to put the stomatognathic system in
balance, even in an adult. And it is important to remember that we will have a
greater chance of recuperation of the balance with all the teeth in place.
For those patients who will have their balance recuperated through prosthesis,
we use splints with the AMP (PAM) , first the splint with the anterior AMP,
afterwards with the posterior AMP in which we will determine what is the vertical
dimension which re-establish the balance. For this determination, the muscular test
will show us when we’ve got the postural balance of the patient. In these cases, the
appliances with AMP (PAM) are also utilized for the recuperation of the neuro
muscular balance of the stomatognathic system so that it is possible, afterwards, to
do a re-habilitation with the prosthesis, whether they are fixed, implants, removable
or total, which has the function of maintaining the acquired balance.
The PAM, whether anterior or posterior, is tested through muscular tests
when put in the patient’s mouth in order to prove / confirm its efficiency. We
also do a postural analysis before installing the appliances and immediately
after, which shows us, on the descendent cases, the immediate alteration of
the posture.
This type of appliance allows the placement of apparatus from other
techniques which can favor and accelerate the treatments. Utilization of devices on
the appliances, for the repositioning of the tongue and the normalization of the
anterior muscular chain which will interfere in the whole body posture.
The muscle testing facilitates the diagnosis of local and general balance.
PAM – AEROMUSCULAR POSSIBILITATOR
The majority of the temporo mandibular dysfunctions have as predisposing
and coadjuvating factors, alterations at occlusion level, which have been
pointed as responsible for the compromising of the muscular system.
Lack of adequate occlusion, with premature contacts, can generate tensions
at muscular level and painful symptomatology, due to accumulation of toxins
at the interior of the muscular fibers.
The rest position of the mandible has been considered the base position,
from which one can obtain the Vertical Dimension of the Occlusion, which
can suffer alterations, due to occlusion pathologies and parafunctional
habits.
The anterior PAM has been used as an auxiliary form of diagnosis and it is
also a resource/ way of treatment that aims at muscular relaxation.
ANTERIOR PAM – the contact between the articular/ articulary surfaces of
the ATM is basically maintained by the muscular activity. The position of
physiological rest of the mandible, when its supporting musculature is in
tonus balance, necessary to overcome the gravity force and determined by
the study of the semi-contraction, can vary with the position of the head and
the body, as a consequence of the proprioceptive stimulus that begin on the
teeth or, still, as a consequence of emotional or chemical factors. The
space / hollow between the superior and the inferior teeth, when the
mandible is in this position, is called free functional space / hollow and it
determines also the height of the PAM (in the mouth??). As it only touches
at the anterior part, it is necessary to maintain / keep this appliance at a predetermined period of time because it is possible to have vertical growth on
the posterior bone blocks.
The posterior PAM, during the orthopedic- orthodontic treatment, oral
rehabilitation or others, has the objective of keeping the stomatognatic
system in muscular balance so that the balanced occlusion can be reestablished, without taking in consideration which odontological treatment is
being done.
The PAM, whether anterior or posterior, is tested through muscular tests
when put in the patient’s mouth in order to prove / confirm its efficiency. We
also do a postural analysis before installing the appliances and immediately
after, which shows us, on the descendent cases, the immediate alteration of
the posture.
This balance situation caused by the appliances favors /enhances general
comfort and the work of other professionals that can be working together,
such as body, chemical, and psychological work.