{"id":32094,"date":"2026-11-01T16:24:22","date_gmt":"2026-11-01T14:24:22","guid":{"rendered":"https:\/\/innovationmedical.ro\/?p=32094"},"modified":"2026-11-01T16:37:36","modified_gmt":"2026-11-01T14:37:36","slug":"articulatia-temporo-mandibulara-nu-functioneaza-singura-de-ce-disfunctia-atm-necesita-o-evaluare-interdisciplinara","status":"publish","type":"post","link":"https:\/\/innovationmedical.ro\/en\/articulatia-temporo-mandibulara-nu-functioneaza-singura-de-ce-disfunctia-atm-necesita-o-evaluare-interdisciplinara\/","title":{"rendered":"Articula\u021bia temporo-mandibular\u0103 nu func\u021bioneaz\u0103 singur\u0103. De ce disfunc\u021bia ATM necesit\u0103 o evaluare interdisciplinar\u0103"},"content":{"rendered":"
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De la articula\u021bie \u0219i musculatura masticatorie la func\u021bia oro-facial\u0103, sistemul neuromuscular \u0219i regiunea cranio-cervical\u0103: de ce preg\u0103tirea clinicianului conteaz\u0103 \u00een diagnosticul \u0219i recuperarea ATM<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Un pacient spune c\u0103 \u00eel doare maxilarul,\u00a0altul vine pentru c\u0103 articula\u021bia pocne\u0219te. Un alt pacient nu mai poate deschide gura normal pentru c\u0103 are dureri \u00een t\u00e2mpl\u0103 sau \u00een apropierea urechii, scr\u00e2\u0219ne\u0219te din din\u021bi ori observ\u0103 c\u0103 simptomele se accentueaz\u0103 \u00een perioadele de stres.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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To\u021bi pot ajunge la consulta\u021bie pentru \u201eATM\u201d. Dar nu au neap\u0103rat aceea\u0219i problem\u0103.\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Disfunc\u021biile temporo-mandibulare (TMD) reprezint\u0103 un grup de afec\u021biuni musculoscheletale care implic\u0103 articula\u021biile temporo-mandibulare, musculatura masticatorie \u0219i structurile asociate. \u00cen prezent, medicina a dep\u0103\u0219it perspectiva \u00een care TMD era explicat\u0103 aproape exclusiv prin ocluzie sau prin pozi\u021bia condilului. Evaluarea modern\u0103 este mult mai apropiat\u0103 de un model multifactorial \u00een care diagnosticul porne\u0219te de la simptome, examen clinic \u0219i func\u021bie, iar investiga\u021biile sunt selectate atunci c\u00e2nd pot aduce informa\u021bie relevant\u0103 pentru diagnostic sau tratament.<\/p>

Din acest motiv, atunci c\u00e2nd vorbim despre calitatea unei evalu\u0103ri ATM, tehnologia este numai o parte din ecua\u021bie.\u00a0La fel de important este cine interpreteaz\u0103 informa\u021bia \u0219i ce preg\u0103tire are pentru a \u00een\u021belege diferitele componente ale cazului<\/strong>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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ATM face parte dintr-un sistem, nu func\u021bioneaz\u0103 izolat\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Articula\u021bia temporo-mandibular\u0103 este una dintre componentele sistemului stomatognatic\u00a0 al\u0103turi de structurile dentare \u0219i ocluzale, musculatura masticatorie \u0219i celelalte structuri implicate \u00een func\u021biile oro-faciale.<\/p>

Mi\u0219carea mandibulei presupune articula\u021bie, mu\u0219chi \u0219i control neuromotor<\/strong>. Mastica\u021bia implic\u0103 mai mult dec\u00e2t din\u021bii. Func\u021bia oro-facial\u0103 presupune coordonare, iar durerea poate modifica la r\u00e2ndul ei felul \u00een care pacientul mi\u0219c\u0103 mandibula, mestec\u0103 sau \u00ee\u0219i protejeaz\u0103 regiunea dureroas\u0103.\u00a0De aceea, evaluarea nu ar trebui s\u0103 \u00eenceap\u0103 cu \u00eentrebarea \u201ece aparat folosim?\u201d, ci cu \u00eentrebarea:<\/p>

Ce component\u0103 a sistemului este afectat\u0103 \u0219i ce func\u021bie a pierdut pacientul?<\/strong><\/p>

Within the framework of Innovation Medical Center, <\/strong>evaluarea pacientului cu disfunc\u021bie ATM este construit\u0103 interdisciplinar. Dr. Anca Adam, <\/strong>medic specialist \u00een Medicin\u0103 Fizic\u0103 \u0219i de Reabilitare, aduce \u00een aceast\u0103 evaluare perspectiva musculoscheletal\u0103 \u0219i func\u021bional\u0103, completat\u0103 prin form\u0103ri dedicate TMD, neurostomatologiei, func\u021biei oro-faciale \u0219i <\/strong>sistemului neuromuscular.<\/strong>\u00a0<\/strong>Aceast\u0103 combina\u021bie este relevant\u0103 tocmai pentru c\u0103 TMD nu apar\u021bine, \u00een toate cazurile, unei singure perspective.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Medicina Fizic\u0103 \u0219i de Reabilitare: de la diagnostic la func\u021bie\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Specialitatea de baz\u0103 este primul nivel al preg\u0103tirii.\u00a0Medicina Fizic\u0103 \u0219i de Reabilitare prive\u0219te patologia prin prisma sistemului musculoscheletal, durerii, mobilit\u0103\u021bii \u0219i recuper\u0103rii func\u021biei.\u00a0\u00cen cazul ATM, aceasta \u00eenseamn\u0103 s\u0103 nu ne limit\u0103m la \u00eentrebarea \u201ece modificare exist\u0103?\u201d, ci s\u0103 evalu\u0103m \u0219i ce consecin\u021b\u0103 func\u021bional\u0103 produce acea modificare<\/strong>.<\/p>

C\u00e2t poate deschide pacientul gura? Exist\u0103 durere? Cum se deplaseaz\u0103 mandibula? Exist\u0103 devia\u021bie sau deflexie? Cum sunt lateralit\u0103\u021bile \u0219i protruzia? Exist\u0103 sensibilitate muscular\u0103? Poate mesteca normal? Exist\u0103 o component\u0103 cervical\u0103 asociat\u0103?<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Literatura recent\u0103 sus\u021bine tot mai clar rolul recuper\u0103rii \u00een TMD. O revizuire sistematic\u0103 publicat\u0103 \u00een 2026 \u00een Oral Diseases<\/em>, care a inclus pacien\u021bi cu deplas\u0103ri discale \u0219i boli degenerative ale ATM, a ar\u0103tat c\u0103 exerci\u021biile mandibulare active \u0219i pasive, uneori asociate tehnicilor de relaxare, \u00eembun\u0103t\u0103<\/strong>tesc <\/strong>deschiderea gurii.<\/strong><\/p>

Este o perspectiv\u0103 important\u0103 pentru practica clinic\u0103: recuperarea nu se opre\u0219te la componenta muscular\u0103 a TMD. Chiar \u0219i atunci c\u00e2nd problema este intraarticular\u0103, avem func\u021bie de recuperat \u2014 mobilitate, amplitudinea deschiderii, controlul mi\u0219c\u0103rii mandibulare<\/strong> \u0219i, \u00een final, capacitatea pacientului de a folosi mandibula confortabil \u00een activit\u0103\u021bile de zi cu zi.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Neurostomatologie \u0219i ATM: c\u00e2nd perspectiva medical\u0103 \u00eent\u00e2lne\u0219te sistemul dentar\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Preg\u0103tirea Dr. Anca Adam \u00een domeniul disfunc\u021biilor temporo-mandibulare include formare practic\u0103 dedicat\u0103 patologiei ATM \u0219i neurostomatologiei sub coordonarea Prof. Vincenzo De Cicco, medic \u0219i cadru didactic <\/strong>cu activitate academic\u0103 \u0219i de cercetare \u00een gnatologie neuromuscular\u0103, sistemul stomatognatic, rela\u021biile cranio-posturale \u0219i neurofiziologia sistemului trigeminal.<\/strong>\u00a0<\/strong>Activitatea sa academic\u0103 a inclus colabor\u0103ri universitare \u0219i cercetare asupra rela\u021biilor dintre sistemul stomatognatic, aferen\u021bele trigeminale \u0219i controlul neuromotor.<\/p>

Aceast\u0103 formare completeaz\u0103 perspectiva musculoscheletal\u0103 specific\u0103 Medicinei Fizice \u0219i de Reabilitare cu o \u00een\u021belegere mai larg\u0103 a sistemului stomatognatic: articula\u021bia temporo-mandibular\u0103, musculatura masticatorie, func\u021bia mandibular\u0103 \u0219i mecanismele neuromusculare care particip\u0103 la controlul acesteia.<\/p>

\u00cen practica clinic\u0103, aceast\u0103 perspectiv\u0103 este important\u0103 deoarece simptomele pacientului nu pot fi explicate \u00eentotdeauna printr-o singur\u0103 modificare structural\u0103. Un click articular, o deplasare de disc identificat\u0103 imagistic, durerea muscular\u0103 sau modificarea mi\u0219c\u0103rii mandibulare trebuie interpretate \u00een contextul \u00eentregului tablou clinic \u0219i func\u021bional.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Scopul nu este doar identificarea structurii modificate, ci \u00een\u021belegerea modului \u00een care acea modificare influen\u021beaz\u0103 func\u021bia sistemului stomatognatic \u0219i simptomele pacientului.\u00a0Aceast\u0103 formare adaug\u0103 perspectivei musculoscheletale \u00een\u021belegerea rela\u021biei dintre ATM, sistemul dentar \u0219i interven\u021biile stomatologice <\/strong>ortodontice <\/strong>sau protetice<\/strong>.<\/p>

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Este important\u0103 mai ales pentru pacientul care nu ajunge la consulta\u021bie cu o problem\u0103 izolat\u0103: poate avea TMD dup\u0103 tratamente stomatologice complexe, poate necesita reabilitare protetic\u0103 sau poate prezenta simptome \u00een care trebuie diferen\u021biate componentele dentare, musculare \u0219i articulare.<\/strong><\/p>

Formarea interdisciplinar\u0103 nu \u00eenseamn\u0103 c\u0103 medicul de recuperare preia rolul medicului protetician sau al chirurgului.\u00a0\u00censeamn\u0103 c\u0103 poate recunoa\u0219te mai bine unde se termin\u0103 propria interven\u021bie \u0219i unde trebuie s\u0103 \u00eenceap\u0103 cea a colegului din alt\u0103 specialitate<\/strong>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Componenta neuromuscular\u0103: m\u0103sur\u0103m, dar interpret\u0103m clinic\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Un alt nivel al preg\u0103tirii este reprezentat de formarea \u00een Neuromuscular Dentistry<\/strong>, printr-un masterclass interdisciplinar dedicat rela\u021biilor dintre sistemul dentar, musculatur\u0103 \u0219i func\u021bia mandibular\u0103.\u00a0Aceast\u0103 perspectiv\u0103 este util\u0103 pentru \u00een\u021belegerea func\u021biei, dar exist\u0103 o regul\u0103 important\u0103:\u00a0nicio m\u0103sur\u0103toare instrumental\u0103 nu trebuie confundat\u0103 cu diagnosticul.<\/strong><\/p>

Aparatele pot furniza date despre anumite componente ale func\u021biei. Ele nu \u00eenlocuiesc\u00a0anamneza, examenul clinic \u0219i diagnosticul diferen\u021bial.\u00a0Aceea\u0219i regul\u0103 este valabil\u0103 pentru \u00eentreaga tehnologie utilizat\u0103 \u00een TMD.\u00a0Calitatea nu este dat\u0103 de cantitatea datelor pe care le putem produce, ci de capacitatea de a distinge informa\u021bia relevant\u0103 clinic de informa\u021bia care nu modific\u0103 decizia terapeutic\u0103.<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Neuromuscular Dentistry Masterclass, sub coordonarea Dr. Raj Rav, clinician cu experien\u021b\u0103 interna\u021bional\u0103 \u00een disfunc\u021biile temporo-mandibulare, durerea cranio-facial\u0103 \u0219i medicina dentar\u0103 neuromuscular\u0103<\/strong>. Dr. Raj Rav este Fellow \u0219i Master al International College of Cranio-Mandibular Orthopedics (ICCMO), are formare \u00een Neuromuscular Orthodontics \u0219i Dental Sleep Medicine \u0219i este fondator al Department of Neuromuscular Dentistry din cadrul Kantipur Dental College, Nepal. Preg\u0103tirea al\u0103turi de acesta adaug\u0103 evalu\u0103rii ATM o perspectiv\u0103 asupra rela\u021biei dintre mi\u0219carea mandibular\u0103, musculatura masticatorie, sistemul dentar \u0219i analiza func\u021bional\u0103 instrumentat\u0103.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Terapia oro-facial\u0103 miofunc\u021bional\u0103: ce se \u00eent\u00e2mpl\u0103 dincolo de articula\u021bie?\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Preg\u0103tirea \u00een terapie oro-facial\u0103 miofunc\u021bional\u0103<\/strong>, prin Academy of Orofacial Myofunctional Therapy (AOMFT), completeaz\u0103 evaluarea sistemului stomatognatic cu o perspectiv\u0103 asupra musculaturii \u0219i func\u021biilor oro-faciale.\u00a0\u00cen cazurile \u00een care exist\u0103 indica\u021bie, pot deveni relevante mastica\u021bia, degluti\u021bia, func\u021bia limbii \u0219i anumite pattern-uri musculare.<\/strong>\u00a0<\/strong>Nu presupunem c\u0103 orice pacient cu TMD are automat o tulburare miofunc\u021bional\u0103, dar dac\u0103 aceasta exist\u0103, este important s\u0103 poat\u0103 fi recunoscut\u0103.<\/p>

Literatura disponibil\u0103 sugereaz\u0103 un beneficiu al terapiei miofunc\u021bionale \u00een TMD, inclusiv asupra durerii, \u00eens\u0103 baza de dovezi r\u0103m\u00e2ne limitat\u0103. O revizuire sistematic\u0103 a identificat numai patru studii randomizate, trei dintre ele raport\u00e2nd rezultate favorabile.<\/p>

Tocmai aici calificarea devine important\u0103: nu pentru a aplica aceea\u0219i terapie tuturor, ci pentru a identifica pacientul la care acea component\u0103 este relevant\u0103.<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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ATM \u0219i regiunea cranio-cervical\u0103: asociere nu \u00eenseamn\u0103 automat cauzalitate\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Formarea musculoscheletal\u0103 a fost completat\u0103 \u0219i prin preg\u0103tire \u00een cadrul International School of Osteopathic Medicine<\/strong>, inclusiv un modul dedicat articula\u021biei temporo-mandibulare.\u00a0Aceasta permite extinderea examenului c\u0103tre regiunea cranio-cervical\u0103 atunci c\u00e2nd simptomele pacientului justific\u0103 acest lucru.<\/p>

Un pacient poate prezenta simultan durere ATM \u0219i cervicalgie, limit\u0103ri ale mobilit\u0103\u021bii cervicale, cefalee sau alte simptome musculoscheletale.<\/strong><\/p>

Dar aici este important\u0103 precizia.\u00a0Faptul c\u0103 dou\u0103 modific\u0103ri coexist\u0103 nu demonstreaz\u0103 automat c\u0103 una a provocat-o pe cealalt\u0103. De aceea, postura sau regiunea cervical\u0103 nu sunt evaluate pentru a demonstra o teorie prestabilit\u0103 despre cauza TMD, ci pentru a identifica eventuale componente func\u021bionale asociate care pot avea relevan\u021b\u0103 pentru pacientul respectiv<\/strong>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Rela\u021biile maxilo-mandibulare \u0219i perspectiva protetic\u0103\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Formarea privind utilizarea arcului facial \u00een protetica dentar\u0103<\/strong> completeaz\u0103 \u00een\u021belegerea rela\u021biilor maxilo-mandibulare \u0219i a contextului \u00een care acestea sunt utilizate \u00een reabilitarea protetic\u0103 \u0219i aici trebuie f\u0103cut\u0103 o diferen\u021b\u0103 important\u0103 \u00eentre instrument \u0219i diagnostic.\u00a0Un arc facial poate avea o utilitate protetic\u0103 precis\u0103. Nu reprezint\u0103 \u00eens\u0103, singur, o metod\u0103 de diagnostic a TMD.<\/p>

Aceast\u0103 distinc\u021bie ilustreaz\u0103 foarte bine motivul pentru care calificarea clinicianului conteaz\u0103: trebuie s\u0103 \u0219tie nu doar cum se folose\u0219te o tehnologie, ci \u0219i ce poate \u0219i ce nu poate demonstra aceasta.<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Termografia medical\u0103: o perspectiv\u0103 func\u021bional\u0103 complementar\u0103\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Preg\u0103tirea Dr. Anca Adam include \u0219i formare \u00een termografie medical\u0103, metod\u0103 non-invaziv\u0103 de imagistic\u0103 func\u021bional\u0103 care \u00eenregistreaz\u0103 distribu\u021bia temperaturii la suprafa\u021ba corpului<\/strong>. \u00cen evaluarea cranio-facial\u0103 \u0219i a sistemului stomatognatic, termografia poate permite documentarea \u0219i compararea obiectiv\u0103 a patternurilor termice \u0219i a eventualelor asimetrii dintre regiuni anatomice omoloage, inclusiv la nivelul musculaturii masticatorii \u0219i corelarea cu lan\u021burile musculare posturale.<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Rolul s\u0103u trebuie \u00eens\u0103 bine delimitat. Termografia nu stabile\u0219te singur\u0103 diagnosticul unei disfunc\u021bii temporo-mandibulare \u0219i nu \u00eenlocuie\u0219te examenul clinic, RMN-ul sau CBCT-ul atunci c\u00e2nd acestea sunt indicate. Literatura o sus\u021bine mai degrab\u0103 ca metod\u0103 complementar\u0103, capabil\u0103 s\u0103 adauge informa\u021bie func\u021bional\u0103 care poate fi corelat\u0103 cu simptomatologia, examenul musculoscheletal \u0219i celelalte investiga\u021bii ale pacientului.<\/p>

\u00cen cadrul unei evalu\u0103ri interdisciplinare, valoarea termografiei const\u0103 tocmai \u00een aceast\u0103 posibilitate de a ad\u0103uga o dimensiune func\u021bional\u0103 \u0219i obiectiv documentabil\u0103 tabloului clinic, f\u0103r\u0103 expunere la radia\u021bii ionizante \u0219i f\u0103r\u0103 contact direct cu pacientul.<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Imagistica ATM: aceea\u0219i articula\u021bie, \u00eentreb\u0103ri diferite\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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La un pacient cu suspiciune de patologie intraarticular\u0103, RMN-ul<\/strong> poate oferi informa\u021bii despre discul articular \u0219i structurile moi.\u00a0Pentru componentele osoase, CBCT-ul<\/strong> poate r\u0103spunde altor \u00eentreb\u0103ri.\u00a0\u00cen cazurile selectate, ecografia dinamic\u0103<\/strong> poate aduce informa\u021bie suplimentar\u0103.<\/p>

Dar nu fiecare pacient are nevoie de toate aceste investiga\u021bii.<\/p>

Recomand\u0103rile interna\u021bionale actuale plaseaz\u0103 anamneza \u0219i examenul clinic \u00een centrul diagnosticului \u0219i recomand\u0103 imagistica atunci c\u00e2nd aceasta este indicat\u0103 \u0219i poate influen\u021ba diagnosticul sau tratamentul.<\/p>

A avea acces la multe investiga\u021bii nu \u00eenseamn\u0103 c\u0103 trebuie s\u0103 le facem pe toate.<\/strong>\u00a0Uneori calitatea actului medical se vede tocmai \u00een investiga\u021bia pe care alegem s\u0103 nu o facem.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Fotobiomodularea: tehnologia este valoroas\u0103 atunci c\u00e2nd indica\u021bia este corect\u0103\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Preg\u0103tirea Dr. Anca Adam include formare specific\u0103 \u00een Photobiomodulation Therapy prin THOR Photomedicine<\/strong>, cu instruire privind mecanismele fiziologice ale fotobiomodul\u0103rii, aplica\u021biile clinice, dozimetria, tehnicile de tratament, siguran\u021ba \u0219i contraindica\u021biile terapiei.<\/p>

\u00cen disfunc\u021biile temporo-mandibulare, fotobiomodularea poate fi integrat\u0103 \u00een anumite protocoale terapeutice, \u00een special atunci c\u00e2nd obiectivele urm\u0103rite includ controlul durerii \u0219i managementul componentelor musculare sau articulare. <\/strong>Literatura clinic\u0103 actual\u0103 descrie rezultate favorabile pentru durere \u0219i pentru unii parametri func\u021bionali, de\u0219i protocoalele difer\u0103 considerabil \u00eentre studii, iar r\u0103spunsul terapeutic depinde de indica\u021bie \u0219i de parametrii utiliza\u021bi.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Valoarea fotobiomodul\u0103rii nu st\u0103 doar \u00een performan\u021ba echipamentului, ci \u00een utilizarea lui fundamentat\u0103:<\/strong> alegerea \u021besutului-\u021bint\u0103, a parametrilor de tratament \u0219i a obiectivului terapeutic trebuie s\u0103 porneasc\u0103 de la diagnosticul \u0219i particularit\u0103\u021bile pacientului.<\/p>

Formarea specific\u0103 THOR completeaz\u0103 astfel evaluarea \u0219i recuperarea ATM cu o metod\u0103 non-invaziv\u0103 care poate fi integrat\u0103 selectiv \u00eentr-un plan terapeutic mai <\/strong>amplu<\/strong>,<\/strong> al\u0103turi de recuperarea func\u021bional\u0103 \u0219i celelalte interven\u021bii indicate clinic.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Medicina Tradi\u021bional\u0103 Chinez\u0103: o preg\u0103tire complementar\u0103, nu un substitut al diagnosticului\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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O component\u0103 distinct\u0103 a form\u0103rii este Medicina Tradi\u021bional\u0103 Chinez\u0103.\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Formarea Dr. Anca Adam \u00een Medicina Tradi\u021bional\u0103 Chinez\u0103 s-a desf\u0103\u0219urat pe parcursul <\/strong>mai multor ani<\/strong>, reunind preg\u0103tirea teoretic\u0103 \u0219i practic\u0103 cu experien\u021ba de formare \u00een acupunctur\u0103 \u0219i moxibustie desf\u0103\u0219urat\u0103 \u00een Taiyuan, provincia Shanxi, China.<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Aceast\u0103 preg\u0103tire permite integrarea, pentru pacien\u021bii selecta\u021bi, a unor metode complementare precum acupunctura sau laser-acupunctura.<\/strong>\u00a0<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Diagnosticul articula\u021biei temporo-mandibulare este biomedical. <\/strong>Medicina Tradi\u021bional\u0103 Chinez\u0103 nu \u00eenlocuie\u0219te examenul clinic, RMN-ul sau CBCT-ul atunci c\u00e2nd acestea sunt indicate.<\/strong>\u00a0Poate ad\u0103uga o op\u021biune terapeutic\u0103 \u0219i un alt nivel de individualizare<\/strong> pentru anumite cazuri.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Aici \u00eencepe multidisciplinaritatea real\u0103\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Un caz complex de TMD poate necesita contribu\u021bia medicului de recuperare, medicului dentist, proteticianului, ortodontului, specialistului \u00een imagistic\u0103 sau chirurgului oro-maxilo-facial \u0219i, \u00een anumite situa\u021bii, evaluarea neurologic\u0103 sau a altor specialit\u0103\u021bi.<\/p>

Multidisciplinaritatea nu \u00eenseamn\u0103 \u00eens\u0103 doar existen\u021ba mai multor speciali\u0219ti \u00een aceea\u0219i clinic\u0103.\u00a0\u00censeamn\u0103 ca informa\u021biile lor s\u0103 poat\u0103 fi integrate \u00eentr-o singur\u0103 strategie pentru pacient.<\/strong>\u00a0Aceasta este logica dup\u0103 care este construit\u0103 evaluarea ATM \u00een cadrul Innovation Medical Center.<\/p>

Un diagnostic, o problem\u0103 func\u021bional\u0103 \u0219i un plan construit \u00een jurul lor.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Ce \u00eenseamn\u0103, \u00een final, calitatea unei evalu\u0103ri ATM?\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Tehnologia modern\u0103 ne permite s\u0103 vedem \u0219i s\u0103 m\u0103sur\u0103m din ce \u00een ce mai mult.\u00a0Calitatea apare atunci c\u00e2nd clinicianul \u0219tie ce trebuie investigat, de ce trebuie investigat, ce poate demonstra fiecare metod\u0103, care sunt limitele ei \u0219i dac\u0103 rezultatul ob\u021binut schimb\u0103 ceva \u00een conduita pacientului.<\/strong>\u00a0Preg\u0103tirea profesional\u0103 conteaz\u0103 tocmai din acest motiv, pentru deciziile medicale mai bine informate pe care acea preg\u0103tire le poate sus\u021bine.\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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The Innovation Medical Center<\/strong>, acesta este principiul pe care construim evaluarea \u0219i recuperarea disfunc\u021biilor temporo-mandibulare:\u00a0tehnologia ne ofer\u0103 informa\u021bii, preg\u0103tirea medical\u0103 le d\u0103 sens, iar colaborarea interdisciplinar\u0103 ne permite s\u0103 le transform\u0103m \u00eentr-un plan adaptat pacientului.<\/strong><\/p>

Pentru c\u0103, \u00een final, nu trat\u0103m un RMN, o pocnitur\u0103 sau un disc. Trat\u0103m pacientul \u0219i func\u021bia lui.<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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\u00centreb\u0103ri frecvente despre evaluarea \u0219i recuperarea ATM\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tCe medic consult pentru probleme ale articula\u021biei temporo-mandibulare?<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t

Disfunc\u021biile temporo-mandibulare pot avea componente articulare, musculare \u0219i func\u021bionale, motiv pentru care evaluarea poate necesita colaborarea mai multor specialit\u0103\u021bi. \u00cen func\u021bie de caz, pot fi implica\u021bi medicul de Medicin\u0103 Fizic\u0103 \u0219i de Reabilitare, medicul dentist, specialistul \u00een imagistic\u0103, ortodontul, proteticianul, chirurgul oro-maxilo-facial sau neurologul. Important este ca informa\u021biile ob\u021binute s\u0103 fie integrate \u00eentr-un diagnostic \u0219i un plan terapeutic coerent.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tCe \u00eenseamn\u0103 o evaluare complet\u0103 a ATM?<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t

Evaluarea \u00eencepe cu anamneza \u0219i examenul clinic: localizarea \u0219i caracteristicile durerii, mobilitatea mandibulei, deschiderea gurii, lateralit\u0103\u021bile, eventualele devia\u021bii sau blocaje \u0219i examinarea musculaturii masticatorii. \u00cen func\u021bie de ceea ce identific\u0103m clinic, evaluarea poate fi completat\u0103 selectiv prin RMN ATM, CBCT, ecografie dinamic\u0103, evalu\u0103ri func\u021bionale, scanare intraoral\u0103 3D, analiza for\u021bei ocluzale, termografie medical\u0103 sau evaluarea regiunii cranio-cervicale.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tDe ce conteaz\u0103 preg\u0103tirea medicului care evalueaz\u0103 ATM?<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t

Pentru c\u0103 investiga\u021biile furnizeaz\u0103 informa\u021bii, dar interpretarea \u0219i integrarea lor apar\u021bin clinicianului. TMD se afl\u0103 la intersec\u021bia dintre articula\u021bie, musculatura masticatorie, sistemul stomatognatic, func\u021bia oro-facial\u0103 \u0219i sistemul musculoscheletal. O preg\u0103tire interdisciplinar\u0103 permite identificarea componentelor relevante pentru fiecare pacient \u0219i recunoa\u0219terea situa\u021biilor \u00een care este necesar\u0103 contribu\u021bia unui alt specialist.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tEste nevoie de RMN pentru orice problem\u0103 ATM?<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t

Nu. Diagnosticul \u00eencepe cu anamneza \u0219i examenul clinic. RMN-ul ATM este investiga\u021bia de referin\u021b\u0103 atunci c\u00e2nd este necesar\u0103 evaluarea discului articular \u0219i a altor \u021besuturi moi, dar indica\u021bia depinde de tabloul clinic \u0219i de \u00eentrebarea la care trebuie s\u0103 r\u0103spund\u0103 investiga\u021bia. Pentru structurile osoase, CBCT-ul poate fi mai relevant. Nu fiecare pacient are nevoie de toate investiga\u021biile disponibile.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tCe leg\u0103tur\u0103 exist\u0103 \u00eentre ATM \u0219i coloana cervical\u0103 sau postur\u0103?<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t

TMD poate coexista cu durerea cervical\u0103, modific\u0103ri ale mobilit\u0103\u021bii cervicale \u0219i alte disfunc\u021bii musculoscheletale. Literatura descrie asocieri \u00eentre TMD \u0219i anumite modific\u0103ri cervicale, dar acestea nu demonstreaz\u0103 c\u0103 o anumit\u0103 postur\u0103 este cauza TMD. De aceea, regiunea cranio-cervical\u0103 \u0219i postura sunt evaluate atunci c\u00e2nd exist\u0103 o justificare clinic\u0103, f\u0103r\u0103 a presupune automat o rela\u021bie cauzal\u0103.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tCe rol are terapia oro-facial\u0103 miofunc\u021bional\u0103 \u00een TMD?<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t

Terapia oro-facial\u0103 miofunc\u021bional\u0103 urm\u0103re\u0219te func\u021bii precum mastica\u021bia, degluti\u021bia \u0219i controlul musculaturii oro-faciale. Poate fi relevant\u0103 pentru anumite categorii de pacien\u021bi, atunci c\u00e2nd evaluarea identific\u0103 o component\u0103 miofunc\u021bional\u0103. Dovezile \u0219tiin\u021bifice actuale sunt \u00eenc\u0103 limitate, astfel \u00eenc\u00e2t nu trebuie considerat\u0103 un tratament universal pentru TMD.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tCe rol are termografia medical\u0103 \u00een evaluarea ATM?<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t

Termografia medical\u0103 este o metod\u0103 non-invaziv\u0103 care \u00eenregistreaz\u0103 distribu\u021bia temperaturii la suprafa\u021ba corpului \u0219i poate documenta patternuri \u0219i asimetrii termice \u00een regiunea cranio-facial\u0103. \u00cen TMD are un rol complementar: rezultatele trebuie corelate cu simptomele \u0219i examenul clinic. Termografia nu \u00eenlocuie\u0219te RMN-ul, CBCT-ul sau evaluarea clinic\u0103 \u0219i nu stabile\u0219te singur\u0103 diagnosticul.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tFotobiomodularea THOR poate fi utilizat\u0103 \u00een tratamentul TMD?<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t

Fotobiomodularea poate fi integrat\u0103 \u00een protocoale TMD, \u00een special pentru managementul durerii \u0219i al unor componente musculare sau articulare. La Innovation Medical Center, utilizarea sistemelor THOR Photomedicine este sus\u021binut\u0103 de formare specific\u0103 \u00een fotobiomodulare, inclusiv \u00een mecanisme fiziologice, dozimetrie, tehnici de aplicare, siguran\u021b\u0103 \u0219i contraindica\u021bii. Indica\u021bia \u0219i parametrii sunt selecta\u021bi \u00een func\u021bie de diagnosticul \u0219i obiectivele terapeutice ale pacientului.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tAcupunctura poate fi integrat\u0103 \u00een tratamentul disfunc\u021biilor ATM?<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t

\u00cen anumite cazuri, da. Ghidul clinic BMJ pentru durerea cronic\u0103 asociat\u0103 TMD include acupunctura printre interven\u021biile care pot fi luate \u00een considerare, cu o recomandare condi\u021bionat\u0103. \u00cen cadrul unei abord\u0103ri interdisciplinare, aceasta poate reprezenta o op\u021biune complementar\u0103 pentru pacien\u021bii selecta\u021bi, f\u0103r\u0103 a \u00eenlocui diagnosticul biomedical sau tratamentele indicate pentru patologia articular\u0103 ori muscular\u0103.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tO deplasare a discului articular \u00eenseamn\u0103 c\u0103 ATM nu mai poate fi recuperat\u0103?<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t

Nu. Identificarea unei modific\u0103ri intraarticulare nu \u00eenseamn\u0103 automat pierderea definitiv\u0103 a func\u021biei. Literatura recent\u0103 arat\u0103 c\u0103 interven\u021biile de recuperare pot \u00eembun\u0103t\u0103\u021bi mobilitatea \u0219i deschiderea gurii inclusiv la pacien\u021bi cu deplas\u0103ri discale sau modific\u0103ri degenerative. Obiectivul recuper\u0103rii nu este obligatoriu modificarea aspectului imagistic, ci reducerea simptomelor \u0219i \u00eembun\u0103t\u0103\u021birea func\u021biei pacientului.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tTo\u021bi pacien\u021bii cu TMD au nevoie de gutier\u0103?<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t

Nu. TMD reprezint\u0103 un grup heterogen de afec\u021biuni, iar tratamentul trebuie ales \u00een func\u021bie de diagnostic \u0219i de caracteristicile pacientului. O gutier\u0103 poate avea indica\u021bie \u00een anumite situa\u021bii, dar nu reprezint\u0103 tratamentul automat al oric\u0103rei dureri ATM, al oric\u0103rui click articular sau al oric\u0103rui pacient cu bruxism.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t<\/path><\/svg><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tCe \u00eenseamn\u0103, de fapt, tratament multidisciplinar pentru ATM?<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t

Nu \u00eenseamn\u0103 doar ca pacientul s\u0103 fie consultat de mai mul\u021bi speciali\u0219ti. \u00censeamn\u0103 ca informa\u021biile provenite din evaluarea medical\u0103, stomatologic\u0103, func\u021bional\u0103 \u0219i imagistic\u0103 s\u0103 fie corelate \u0219i utilizate pentru construirea aceluia\u0219i plan terapeutic. Atunci c\u00e2nd cazul o necesit\u0103, fiecare component\u0103 este preluat\u0103 de profesionistul cu preg\u0103tirea corespunz\u0103toare.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t

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\ud83d\udccd Schedule a comprehensive evaluation<\/strong>
\u00a0\ud83d\udccd Bucure\u0219ti –\u00a0 www.innovationmedical.ro<\/u><\/a>
\u00a0\ud83d\udcde 0753 666 111<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Autor: Dr. Anca Adam, Medic Specialist in Medicina Fizica si de Reabilitare, compartiment recuperare neurologic\u0103 \u0219i\u00a0disfunc\u021bii ATM\/TMJ, Expert Acupunctur\u0103 Laser & Competenta Medicina Traditionala Chineza (Tai Yuan, China), Termografie Medical\u0103 (Barcelona, Spania),\u00a0 LSO (Laser Safety Officer) AALZ Aachen Germania.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"

De la articula\u021bie \u0219i musculatura masticatorie la func\u021bia oro-facial\u0103, sistemul neuromuscular \u0219i regiunea cranio-cervical\u0103: de ce preg\u0103tirea clinicianului conteaz\u0103 \u00een diagnosticul \u0219i recuperarea ATM Un pacient spune c\u0103 \u00eel doare maxilarul,\u00a0altul vine pentru c\u0103 articula\u021bia pocne\u0219te. Un alt pacient nu mai poate deschide gura normal pentru c\u0103 are dureri \u00een t\u00e2mpl\u0103 sau \u00een apropierea urechii, […]<\/p>\n","protected":false},"author":7,"featured_media":32095,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30],"tags":[],"class_list":["post-32094","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articulatia-temporo-mandibulara-atm"],"_links":{"self":[{"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/posts\/32094","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/comments?post=32094"}],"version-history":[{"count":5,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/posts\/32094\/revisions"}],"predecessor-version":[{"id":32107,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/posts\/32094\/revisions\/32107"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/media\/32095"}],"wp:attachment":[{"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/media?parent=32094"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/categories?post=32094"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/tags?post=32094"}],"curies":[{"name":"WordPress","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}