ENG
Table of Contents
MOUELHI Majd, dentist&digital expert, LAB: HAOUET Malek
Abstract
Temporomandibular Joint Disorders (TMDs) have been a subject of extensive research due to the challenges in managing symptoms and stabilizing the therapeutic position. Digital technologies offer promising new opportunities in this regard, enabling clinicians to digitally assess and verify the stability of the new therapeutic position from a functional standpoint.
This case report illustrates an example of a full-digital treatment plan for a TMD patient, achieved by evaluating the mandibular kinematic activity through a digital device (MetiSmile Face Scanner’s Jaw Motion feature).
The report presents a patient with temporomandibular joint dysfunction, focusing on radiological, clinical, and digital findings that contributed to the diagnosis and treatment plan. The use of digital tools played a key role in understanding the underlying pathology and guiding patient management.
Digitalizing mandibular kinematics allowed for a more informed diagnosis, particularly from a dynamic perspective. It also facilitated faster execution of the intraoral appliance via a digital workflow, capturing the therapeutic position and testing the device before fabrication, based on the patient’s actual kinematics.
Introduction
The temporomandibular joint (TMJ) is a synovial ginglymoarthrodial joint that allows both translational and gliding motions. Its articular surfaces are formed by the mandibular condyle (inferiorly), the glenoid(mandibular )fossa, and the articular eminence of the temporal bone (superiorly). What distinguishes this joint is that its articular surfaces are covered by fibrocartilage rather than hyaline cartilage.
The TMJ disc is a biconcave fibrocartilaginous structure that lies between the mandibular condyle and the temporal bone’s articular surface. This interposition of the disc prevents joint damage and facilitates the sliding movement of the mandibular condyle relative to the temporal bone during mouth opening and closing.
The primary cause of temporomandibular joint dysfunction (TMD) is an abnormal relationship between the articular disc and the mandibular condyle. This disruption interferes with the normal biomechanics of the TMJ and can result in clinical manifestations such as joint pain, jaw deviation during mouth opening, or clicking sounds from the joint.
Today, digital technology aids clinicians by allowing them to visualize the condylar position and its movements, both during habitual intercuspation and after repositioning. This enables a more rational choice of a stable mandibular position for comprehensive treatment planning. The evaluation of mandibular kinematics can be performed using a recently developed device (MetiSmile JawMotion), which employs a digital camera to reproduce real mandibular movements in the STL files of the dental arches. This method enhances the accuracy of diagnosis, allowing for the design of a highly customized oral appliance based on functional considerations.
This device tracks the motion of markers to reflect the mandibular movement and focuses on visualizing digital dental models. These models can be aligned with the patient’s CBCT, integrating kinematic data with 3D imaging of the TMJ. This combination enhances the precision and predictability of results in complex clinical scenarios.
By tracking mandibular movements, clinicians can collect dynamic occlusion data. This system includes the detection of left and right lateral movements, centric occlusion, and open occlusion, providing detailed information for accurate diagnosis, appliance design, and treatment planning.
The treatment plan for this case was developed digitally based on precise kinematic tracings recorded for the patient, and the oral appliances were customized through a fully digital workflow.
Case presentation
This case report presents a 28-year-old female patient diagnosed with TMJ dysfunction. The focus is on the radiological, dental, and digital findings that contributed to the diagnosis and treatment plan. The patient displayed several symptoms on the right side, including ear pain, joint discomfort, and limited and deviated mouth opening, all of which were found to be linked to the TMJ dysfunction.
Inflammation leads to pain and reflexive muscle contractions, which restrict the condylar translation. As a result, mouth opening is limited and deviated towards the affected joint, while the healthy side shows limited movement. The use of imaging and digital technologies, combined with a comprehensive dental assessment, plays a vital role in understanding the underlying pathology and directing patient management.
Palpation of the masticatory muscles did not trigger pain, but palpation of the lateral pole and provocation tests (opening and protrusive movements) elicited familiar pain. The patient has a history of trauma and past clicking sounds, which have since resolved.
During clinical examination, mouth opening was restricted to 29.4 mm (measured using MetiSmile) and 27+4 mm (using the conventional ruler method) .
Figure 1: Opening measured using the conventional technique.
The application of mild force failed to increase the opening. A deviation to the right side was present during mouth opening. The patient reported pain in the right TMJ during left lateral excursions. Left lateral movement was 3.6 mm, while right lateral movement was 10.6 mm, carried out without pain. Protrusion was measured at 5.8 mm. Both opening and protrusion provoked a report of “familiar pain.” The patient self-assessed the pain level using a Visual Analog Scale (VAS), scoring 7 out of 10.
These measurements were made using MetiSmile, which offers precise and error-free measurements through the scanned forks.
Figure 2: scanned forks
Figure 3: Report Provided by MetiSmile
The occlusal relationships are shown in Figures (4,5)
Figure 4: Occlusal view (OBJ file)
Figure 5: clinical photos (a: left side, b: vestibular view (frontal/cheek side), c: right side, d: maxillary arch, e: mandibular arch)
The kinematic analysis of mandibular movements was performed using the MetiSmile Jaw Motion software. The software identifies points of interference and detects lateral and protrusive movements. However, it did not provide a Ferrar diagram.
Figure 6: opening
Figure 7: Right lateral movement
Figure 8: Left lateral movement
Figure 9: protrusion
Treatment
The patient was instructed to limit jaw movements to pain-free limits and provided with physical therapy exercises to perform throughout the day. NSAIDs were prescribed for emergency pain relief.
The treatment protocol consisted of self-administered exercises: passive muscle stretching (the patient was encouraged to open the mouth along a straight path by looking in the mirror) and assisted muscle stretching (the patient was instructed to apply gentle force with their fingers to the elevator muscles to increase mouth opening and push the disc forward). After two weeks, the patient reported significant relaxation of the masticatory muscles. A stabilization splint was fabricated in the therapeutic centric relation position with a 2 mm increase in the vertical dimension of occlusion. The patient was advised to wear the splint at night for TMJ decompression.
Figure 10: printed splint
Figure 11: conventional splint
Follow-up appointments were scheduled at 1, 3, and 6 months after wearing the splint. After six months of consistent splint use, the patient reported improvement in symptoms. Unassisted opening increased to 35 mm, while assisted opening reached 41 mm. Lateral movements were symmetrical. Occasional pain persisted only during the chewing of hard foods (VAS = 2). Palpation of the lateral condyle pole no longer elicited pain.
Discussion
MetiSmile-MR (2 in 1) is an advanced facial scanner equipped with jaw-motion tracking capabilities, capturing both 3D facial data and mandibular movement with a single device.
It integrates intraoral scans, facial scans, CBCT data, and jaw motion trajectories into one unified coordinate system, supporting both functional and aesthetic digital dental workflows.
It introduces a dedicated Jaw Motion Module, enabling clinicians to record and analyze real-time mandibular movement. This makes MetiSmile one of the first integrated systems for simultaneous facial and jaw motion capture.
By mapping these movements into standard 2D anatomical planes, it assists dentists in carrying out precise diagnosis and treatment planning for TMD patients.
In this case, a full digital workflow was employed to plan the treatment. Mandibular repositioning was automatically determined by the MetiSmile software, which offers personalized solutions to identify a stable mandibular position for each patient. This digital planning is based on functional tracings recorded through guided or spontaneous mandibular repositioning using digitally customized intraoral appliances (ex, Forks).
In digital dentistry, the integration of functional precision and aesthetic visualization represents a paradigm shift in diagnostic and treatment workflows. Among contemporary jaw motion tracking systems, Shining 3D MetiSmile MR emerges as a transformative all-in-one platform—combining facial scanning, mandibular motion tracking, CBCT, and intraoral data within a unified, simplified workflow.
Its clinical efficiency is remarkable: facial scanning takes less than 10 seconds, and jaw motion capture requires only about 5 minutes, significantly streamlining the clinical workflow. The latest software update (V2.2.5.4) enhances diagnostic and planning capabilities with dynamic jaw analysis tools like customizable trajectory templates, sectional and heat map visualizations, one-click export of motion data (jawmotion,xml), automated virtual articulator parameter transfer (e.g., to Exocad), and fast DICOM to STL export, which boosts both accuracy and efficiency.
Moreover, the system supports robust TMD and prosthodontic assessment by precisely capturing mandibular trajectories, facilitating objective evaluation of occlusal symmetry and condylar performance, and assisting in establishing optimal jaw relationships in both dentulous and edentulous patients, as a result improving prosthetic stability.
MetiSmile MR delivers both efficiency and comprehensive diagnostic capability unmatched by modular competitors through its all-in-one design, rapid capture, advanced analytics (including trajectory templates, heat map visualization, and virtual articulator exports), and patient-centric aesthetic previews.
Nevertheless, the software may require manual alignment if intraoral data and facial scans don’t perfectly match, potentially slowing workflow efficiency. Practical hurdles have also surfaced, with some users reporting challenges in maintaining smooth operation across different setups. Yet, MetiSmile MR’s ability to consolidate multiple diagnostic modalities into one device remains its most significant differentiator, offering both time-saving potential and a patient-centered workflow transformation.
Conclusion
The MetiSmile Jaw Motion Module by SHINING 3D empowers clinicians with a fully digital, functionally driven workflow in managing TMJ dysfunction.
By precisely capturing mandibular kinematics and integrating them with facial, intraoral, and CBCT data, this system offers a level of diagnostic accuracy and treatment predictability that traditional methods cannot match.
Shining 3D has been working to address previous limitations in articulator integration in the upcoming version. This update introduces a virtual articulator module and a physical one that allows automatic calculation and transfer of articulator parameters to software like Exocad, which helps streamline the digital workflow and reduce manual adjustments. Looking ahead, Shining 3D plans to enhance the system further by incorporating condyle position tracking. These advancements aim to provide a more comprehensive understanding of mandibular function and to enable more precise and personalized treatment planning in digital dentistry.