Splints. Questions to ask

26/09/2010

The TMJ Association: Splints – What you should know (…)

There isn’t an accepted standard of practice for splints. Here is a list of questions you should ask:

  • What is the splint going to do (flat plane or repositioning), and why are you recommending this kind to me?
  • Are you recommending this splint to decrease my pain, reposition my bite or both?
  • What are my other options?
  • What happens if my pain gets worse while wearing the splint?
  • What happens if I develop an open bite (teeth no longer touch)?
  • What proof do you have that this splint will help?
  • Do I wear the splint during the day, night, or both?
  • How long do I have to wear the splint to feel improvement?
  • If the splint doesn’t help, what are the next steps?
  • How many follow-up treatments will be necessary and how much each visit cost?
  • Will insurance cover the cost of the splint and the follow-up treatments?
  • Must I sign a financial contract with you to begin treatment?       (…)

Source: The TMJ Association: Splints – What you should know

Occlusal Bite Splints. Caveats.

26/09/2010

The TMJ Association – Occlusal Bite Splints: A Help For Many But Not Everyone
(…) The decision of whether a bite splint is a sensible treatment in your particular case is a clinical judgment call rather than a decision that is based on sound, scientifically validated criteria.

If you opt for a bite splint, you should be aware of the fact that not all bite splints are equal. Two major types are distinguished, namely (1) those that maintain the existing jaw relationship, and (2) those whose purpose is to intentionally alter the existing bite for a particular therapeutic intent, such as “capturing the articular disk” or “the realignment of the condyle in the articular fossa”. Occlusal appliances of the first group are also referred to as “stabilization” splints and members of the second group are often called “repositioning” appliances. Neither design has been proven to be incrementally superior over the other with any consistency as far as benefit for the patient is concerned. In terms of negative consequences, however, splints of the second group pose a substantially greater risk of inducing bite changes. When worn for months to years, the resulting bite changes often call for costly bite repair by means of new dental work, orthodontic treatment or even jaw surgery. (…)

Source: The TMJ Association – Occlusal Bite Splints: A Help For Many But Not Everyone

Splints: Stabilization and Repositioning. (NIDCR)

25/09/2010

Conservative Treatments (Stabilization Splints)

Your doctor or dentist may recommend an oral appliance, also called a stabilization splint or bite guard, which is a plastic guard that fits over the upper or lower teeth. Stabilization splints are the most widely used treatments for TMJ disorders. Studies of their effectiveness in providing pain relief, however, have been inconclusive. If a stabilization splint is recommended, it should be used only for a short time and should not cause permanent changes in the bite. If a splint causes or increases pain, stop using it and see your health care provider.

The conservative, reversible treatments described are useful for temporary relief of pain – they are not cures for TMJ disorders. If symptoms continue over time, come back often, or worsen, tell your doctor.  (…)

Irreversible Treatments 

Irreversible treatments that have not been proven to be effective – and may make the problem worse – include orthodontics to change the bite; crown and bridge work to balance the bite; grinding down teeth to bring the bite into balance, called “occlusal adjustment”; and repositioning splints, also called orthotics, which permanently alter the bite. (…)

See: TMJ Disorders   (National Institute of Dental and Craniofacial Research)

Self-Care as part of Initial Therapy

18/09/2010

Source: Orofacial Pain and Temporomandibular Disorders Download (Chapter 10)

Mandibular dysfunction – Questions asked

18/09/2010

Source: Orofacial Pain and Temporomandibular Disorders  Download (Chapter 10)

Sistema Estomatognático / Stomatognathic System – Muscles, Face and Neck

13/09/2010

Fuente: http://sistemastomatognatico.blogspot.com/

Hypnotic TMJ Therapy: Open and Close. Slowly, gently.

06/09/2010

 

    

   

 

Try it.           (Shock Wave Flash)

http://www.tmj-lessons.com/images/TMJ_Animation.swf

Dental Distress

05/09/2010

 

DDS 1

Fig. 1 The apex of the combined muscular control of the mandible in all functioning movements is located at the dens between the atlas and axis cervical vertebrae.

 

Fig. 2 When the mouth opens the 136 muscles above and below the mandible pivot the jaw at the xy-axis. The condyle translates forward and downward as the mouth opens.

 

DDS 3

Fig. 3 When the mandibular teeth occlude above the x-x plane, a pathologic Curve of Spee exists and the head of the condyle moves superiorly and distally.

 

Fig. 4 If the mandible did actually pivot in the TMJ as has been accepted as fact, the mandibular positioning as herein depicted would be able to occur.

 

A question for Bruxistas:  This horizontal line, does it seem right? These are drawings that were used to diagnose    “The Dental Distress Syndrome”  (Dr. A.C. Fonder). (1988) Yet another name for us bruxistas. See the following post, Lateral Ricketts. Compare the inclination of the occlusal plane in the photograph and the following X-Ray. Doesn’t that seem “more” natural? 

Lateral Ricketts

05/09/2010

 

Lateral Ricketts + Photo

 

 

Puntos mandibula

 

Ejes - planos

 

Ejes - planos

Ejes - planos

 

Interpretación/análisis cefalométrico de Ricketts – Bajar archivo (650 KB)

Archivo más completo:
http://www.cybertesis.edu.pe/sisbib/2004/chavez_mm/xhtml/sdx/chavez_mm-TH.2.xhtml

Cephalometric points

05/09/2010

 

  • a) Saddle (S) – Turkish saddle geometric center, set by inspection; 
  • b) Nasion (N) – nasal suture intersection with naso-frontal suture, in the median sagittal plane, set by inspection.
  • c) Porion (Po) – External acoustic meatus uppermost point. Very difficult to set because of other anatomical elements overlapping. To locate it, Miyashita (1996) reference points were used, in which the external acoustic meatus is located posteriorly to the mandible condillar process, above the basion and the axis odontoid process;
  • d) Orbitary (Or) – right orbit cavity contour lower most point;
  • e) Anterior nasal spine (ENA) – median point formed by the extension of both maxillas in the anterior and inferior portion of the nasal floor;
  • f) Posterior nasal spine (ENP) – median point formed by the union of the posterior borders of both palatine bones;
  • g) A (Sub spinal) – anterior maxilla concaveness deepest point, between the anterior nasal spine and the upper dental arch alveolar limit;
  • h) B (Supramenton) – deepest point in the symphysis anterior concaveness;
  • i) Pogonion (Pg) – anterior most point in the mandibular symphysis;
  • j) Tegumentary pogonion (Pgt) – anterior most or most prominent point on the chin soft tissue, in the median sagittal plane;
  • k) Mentonian (Me) – lower most point in the mandibular symphysis contour;
  • l) Gnathion (Gn) – most anterior and inferior point in the mandibular symphysis;
  • m) Articular (Ar) – Intersection point on the external skull base contour with the mandible condillar process;
  • n) Gonion (Go) – most anterior and posterior mandible point in the antero-posterior direction. Located at the ramus posterior border, tangent with the mandible inferior border angle bisectrix;
  • o) Inferior root apex (Ari) – point in the lower most region of the lower central incisive root apex;
  • p) Lower incisive border (BII) – Lower central incisive crown uppermost border region point;

Source: Comparative cephalometric study