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Stability bite appliances. Roxana Petcu. Timișoara Romania


Last month I attended Roxana Petcu’s course on occlusal splints for temporomandibular joint disorders. It is the first time the course has been delivered in English, and has been a popular course in the 5 years it has been delivered in Roxana’s native Romanian. I had previously attended occlusion and TMD courses by prosthodontists and restorative dentists, but felt the subject had not translate well into orthodontics, so this was my first orthodontist taught occlusion and TMD course.

The details

The course

The course was delivered over 3 days, with a mixture of both theory and practical. The location for the course was Roxana’s clinic 10 minutes from the centre of the vibrant Timișoara.

Day 1: Started off with a gentle introduction into the topic and examples of what an unstable TMJ is and the potential consequences of it. After the break the ante was upped with a detailed visual exploration of anatomy and physiology, through excellent imagery and use of a skull model. The lecture developed to explore what TMD looks like from an anatomical and physiological perspective. The day concluded with implementing what had been learned through the day with a clinical examination of delegates assessing each other in Roxana’s decadently designed clinic. We met in the evening and had a talking tour of the lovely Timișoara by a local university lecturer.

Day 2: Started with a recap of day 1, followed by an interesting discourse of the role of imagery in TMD. Information regarding plain radiographs, CBCT and MRI were had and how not all imagery is relevant to most cases. The main aspect of day 2 was different splint designs and their indication, as well as a protocol for reassessment during splint therapy. Roxana explored the orthodontic management of the patient following splint therapy, with emphasis on re-assessment of occlusal goals with TMJ stability, which often entailed (but not necessarily)  prosthodontic rehabilitation.

Day 3: Began with another review in the morning, necessary for those light in memory like myself. There were a series of cases presented with assessment information, and the group analysed and diagnosed the cases, and proposed both TMD and orthodontic management for the cases. This was an excellent way to consolidate the learning from the previous 2 days. The cases were carefully chosen to address the different levels of joint stability and appropiate management strategies. Day 3 was mostly a practical day with two aspects, 1 – occlusal registration with a facebow and demonstration of articulating models in house, 2 -another session of splint fabrication, however this time it was for a different occlusal scheme from day 2.

What Was Good

The quality of Roxana’s visual presentation was excellent. She had created exceptionally high-quality images exploring TMJ anatomy, TMJ pathology and explained the effects of splint therapy. Through illustrations. I have attended a number of TMD courses and this course was the first time I had seen such a clear visual explanation of both disease and the effects of its management. Roxana was also very honest with what can be achieved with splint therapy, and ‘stability’ differing from complete resolution.

The flow of the training over the 3 days had been carefully considered, from theory to several practical elements to practice the taught theory. Having two sessions of different splint fabrication allowed the skill to be consolidated.  

Close teaching. The group was kept purposefully small at 7 delegates, this enabled Roxana to spend time with each delegate, address their learning needs and give plenty of time to help during the hands-on sessions. With the small group there was a friendly and open atmosphere with the delegates getting to know each other quickly and working together throughout the course.

What Was Not So Good

The pace of the lectures on day 1 was intense at times, and required some re-reading later in the day to assimilate what was new information, for me at least. Looking back from day 3 it was necessary to have the detailed information of anatomy and physiology at day 1, however it was a lot to cover and for those less familiar with the topic could have benefited from a slower pace (or stronger coffee). Fortunately Roxana recapped key information at the beginning of each day and was happy to recap content we felt unclear on.

Verdict

Roxana has created a course in which her expertise as both an orthodontist and expert in TMD management have been interwoven and shared to the delegates. She has, uniquely, management to promote evidence based clinical practice of TMD without considering splint therapy the panacea of all TMD issues. For me Roxana embodied what a true expert is in this course, exploring the grey areas of the topic, showing change in her clinical practice as her own understanding increased, and demonstrating practical day to day management of her field of expertise. She had a warm and calm demeanour, which meant for an enjoyable 3 days.

I have attended previous courses on TMD, however my opinion has been there was little evidence in both theory and research presented, and a condemnation if TMD protocols were not implemented rigidly for all patients. Roxana’s course was balanced, she detailed the theory and research, but crucially explored the critical aspects of both, as well as highlighting the management is only for those with, or at risk of TMD. For me this fits in with what is seen in clinical practice, most patients are without issue, however a minority do require TMD management.

The success of any course is based on delegates ability to implement the skills gained, and I have been able to use the skill of splint management since returning to my clinic.

I would hope Roxana considers making her course more widely available, as it exceeded my expectations in both understanding and clinical skills I learned from the course.

 

Contributions

Edited/contents: Farooq Ahmed

I have no financial interest in the meeting.

 

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