This document discusses muscle deprogramming and splint therapy for treating teeth grinding (bruxism) and temporomandibular joint disorders (TMD). It describes how a deprogramming device can be used to relax jaw muscles and determine a relaxed jaw position, and how a splint can then be made using this new bite registration to maintain the relaxed position. The document provides details on different types of splints and their uses, the history of splint therapy, and research on clinical outcomes of splint treatment for TMD symptoms like pain, clicking and limited jaw motion.
JOURNAL CLUB PRESENTATION IN PROSTHODONTICS on biologically oriented preparat...NAMITHA ANAND
1) A new digital technique is described for reproducing the subgingival part of a tooth prepared using the biologically oriented preparation technique (BOPT) which involves no finish line, along with the adjacent dentogingival sulcus.
2) Key steps involve double probing to measure bone levels, supragingival and subgingival tooth preparation using a diamond bur, and cementing a provisional restoration to shape the gingiva.
3) Multiple intraoral scans are taken at different stages to digitally capture the prepared tooth and surrounding gingiva both with and without the provisional in place. These scans are used to create a "virtual gingiva" and accurately align the digital model.
This document discusses orientation jaw relations and the use of facebows to transfer jaw relations to articulators. It begins by defining jaw relations and describing the three types: orientation, vertical, and horizontal. Orientation jaw relations involve rotation around the hinge axis. The hinge axis is defined as an imaginary line passing through the condyles that the mandible rotates around without translation. The document discusses the history of locating the hinge axis and controversies around whether it can be accurately located. It describes methods of arbitrarily or kinematically locating the hinge axis and variables that can affect its location. The literature review discusses studies that have evaluated arbitrary versus kinematic axis locations.
Recent advances in orthodontics include improvements to brackets, bonding materials, wires, software, and appliances. Brackets are now made from stronger materials with coatings to reduce friction and promote oral health. New bonding materials bond more effectively in fewer steps. Wires now come in various alloys and shapes to apply lighter continuous forces. Software includes apps for patients and artificial intelligence to assist with treatment planning. These technological advances have improved orthodontic treatment outcomes.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
JOURNAL CLUB PRESENTATION IN PROSTHODONTICS on ANDREW'S BRIDGE SYSTEMNAMITHA ANAND
This document summarizes a journal club presentation about the Andrews Bridge System. Key points include:
- The Andrews Bridge System is a fixed-removable partial denture that combines fixed retainers connected by a bar with removable pontics for esthetic rehabilitation of edentulous ridges.
- Advantages include improved esthetics, hygiene, phonetics and stress distribution compared to removable partial dentures.
- A clinical case report describes using the system to restore a patient missing maxillary and mandibular anterior teeth following trauma. Post-treatment, the patient had pleasing esthetics and function.
Treatment of class ii non compliant /certified fixed orthodontic courses b...Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
MBT wire sequence during orthodontic alignment and levelingMaher Fouda
This document discusses different archwire sequences used during tooth leveling and aligning. It begins by describing a case where a non-extraction approach was used with .016 HANT wires for initial alignment. After 3 months, rectangular HANT wires were placed, followed by .019/.025 stainless steel wires after 6 months to help correct the occlusion. The document then provides historical background on archwires and discusses the introduction of nickel-titanium wires as substitutes for steel wires during initial alignment. Heat-activated nickel-titanium wires are described as being able to replace 3 traditional stainless steel wires. Recommendations are provided on when stainless steel wires are still preferable to heat-activated wires.
The seminar includes- Introduction, definitions, history, Fundamentals of esthetics, Incorporation of Esthetics at different stages of complete denture construction, Dentogenic concept, Dynesthetic interpretation of dentogenic concept, Denture characterization and newer studies
JOURNAL CLUB PRESENTATION IN PROSTHODONTICS on biologically oriented preparat...NAMITHA ANAND
1) A new digital technique is described for reproducing the subgingival part of a tooth prepared using the biologically oriented preparation technique (BOPT) which involves no finish line, along with the adjacent dentogingival sulcus.
2) Key steps involve double probing to measure bone levels, supragingival and subgingival tooth preparation using a diamond bur, and cementing a provisional restoration to shape the gingiva.
3) Multiple intraoral scans are taken at different stages to digitally capture the prepared tooth and surrounding gingiva both with and without the provisional in place. These scans are used to create a "virtual gingiva" and accurately align the digital model.
This document discusses orientation jaw relations and the use of facebows to transfer jaw relations to articulators. It begins by defining jaw relations and describing the three types: orientation, vertical, and horizontal. Orientation jaw relations involve rotation around the hinge axis. The hinge axis is defined as an imaginary line passing through the condyles that the mandible rotates around without translation. The document discusses the history of locating the hinge axis and controversies around whether it can be accurately located. It describes methods of arbitrarily or kinematically locating the hinge axis and variables that can affect its location. The literature review discusses studies that have evaluated arbitrary versus kinematic axis locations.
Recent advances in orthodontics include improvements to brackets, bonding materials, wires, software, and appliances. Brackets are now made from stronger materials with coatings to reduce friction and promote oral health. New bonding materials bond more effectively in fewer steps. Wires now come in various alloys and shapes to apply lighter continuous forces. Software includes apps for patients and artificial intelligence to assist with treatment planning. These technological advances have improved orthodontic treatment outcomes.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
JOURNAL CLUB PRESENTATION IN PROSTHODONTICS on ANDREW'S BRIDGE SYSTEMNAMITHA ANAND
This document summarizes a journal club presentation about the Andrews Bridge System. Key points include:
- The Andrews Bridge System is a fixed-removable partial denture that combines fixed retainers connected by a bar with removable pontics for esthetic rehabilitation of edentulous ridges.
- Advantages include improved esthetics, hygiene, phonetics and stress distribution compared to removable partial dentures.
- A clinical case report describes using the system to restore a patient missing maxillary and mandibular anterior teeth following trauma. Post-treatment, the patient had pleasing esthetics and function.
Treatment of class ii non compliant /certified fixed orthodontic courses b...Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
MBT wire sequence during orthodontic alignment and levelingMaher Fouda
This document discusses different archwire sequences used during tooth leveling and aligning. It begins by describing a case where a non-extraction approach was used with .016 HANT wires for initial alignment. After 3 months, rectangular HANT wires were placed, followed by .019/.025 stainless steel wires after 6 months to help correct the occlusion. The document then provides historical background on archwires and discusses the introduction of nickel-titanium wires as substitutes for steel wires during initial alignment. Heat-activated nickel-titanium wires are described as being able to replace 3 traditional stainless steel wires. Recommendations are provided on when stainless steel wires are still preferable to heat-activated wires.
The seminar includes- Introduction, definitions, history, Fundamentals of esthetics, Incorporation of Esthetics at different stages of complete denture construction, Dentogenic concept, Dynesthetic interpretation of dentogenic concept, Denture characterization and newer studies
Learn more about how to tooth replacement options for missing teeth, There are some options like Dental bridges treatment, denture treatments, Dental Implant treatments, Dental Restorative Surgeries etc...!!!
Orthodontic tooth movements and biomechanics.Sk Aziz Ikbal
The document discusses biomechanics principles related to orthodontic tooth movement. It covers topics such as:
- Forces applied to teeth can cause movement through bone remodeling.
- Biomechanics refers to mechanics applied to biological systems. Knowledge of forces is needed to control orthodontic treatment.
- Teeth can move through light forces during normal function but heavier sustained forces over 1 second are needed for orthodontic tooth movement.
- Forces have magnitude and direction, while scalars only have magnitude. Resultant forces and moments from multiple applied forces are calculated.
- Different force systems and moment-to-force ratios produce different types of tooth movement such as tipping, translation, rotation, and torque.
hai this is a nice seminar and inculcated all the recent materials and biomaterials and biomechanics of the invisalign techniques , materials to be used and clinical aspects just have a look to it
This document discusses attachments used in prosthodontics. It begins with an introduction to attachments, defining them as mechanical devices used to retain and stabilize prostheses. The document then covers the history, classification, indications, disadvantages, and selection of attachments. It discusses both intracoronal and extracoronal attachments. In summary, the document provides an overview of attachments, their uses in prosthodontics, and factors to consider in selecting the appropriate attachment.
This document discusses various methods for remounting dentures, including direct correction in the mouth, laboratory remounting, and clinical remounting. Laboratory remounting involves fabricating remount casts of the dentures and mounting them on an articulator to eliminate deflective contacts through selective grinding. Clinical remounting techniques include split cast mounting, which involves constructing the maxillary cast in two parts to allow for easy removal and replacement of the casts. The modified split cast technique is also described as a timesaving clinical remount method. Remounting aims to improve denture occlusion and patient comfort by correcting errors that occurred during the fabrication process.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document provides an overview of achieving esthetics in complete dentures. It discusses the definition and history of denture esthetics. The fundamentals of esthetics including visual perception, composition, proportion, dominance and illusion are covered. Methods for achieving complete denture esthetics are described, including accurate impressions, jaw relation, selection of anterior teeth, arrangement of teeth, and characterization of the denture base. Dynesthetic interpretation of dentogenic concepts and laboratory steps are also summarized.
This document discusses concepts and techniques related to occlusal rehabilitation. It covers topics such as centric relation, anterior guidance, restoring anterior and posterior teeth, and solving various occlusion problems. The Pankey-Mann-Schuyler philosophy advocates establishing stable centric stops, proper anterior guidance in harmony with jaw movements, disclusion of posterior teeth in protrusion, and non-interference of teeth during lateral excursions. The document provides guidelines for determining tooth contours and positions to achieve optimal function, stability, and aesthetics.
There are several protocols for loading dental implants after surgery based on bone density and healing time requirements. Protocols include Brånemark's loading protocol, progressive loading, and immediate/early loading. The density of the bone where the implant is placed determines the appropriate loading protocol, as less dense bone requires more healing time before loading to allow for sufficient bone mineralization and strength. Progressive loading gradually increases stress on the implant over time to allow the bone to adapt, reducing risks of failure. It is particularly important for lower density bone which is weaker.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document discusses lingualized occlusion for removable prosthodontics. It begins by providing background on the search for ideal denture occlusion and defines lingualized occlusion. Key points include:
- Prof. Alfred Gysi first introduced the concept of lingualized occlusion in 1927 using maxillary teeth with single linear cusps fitting into shallow mandibular depressions.
- Lingualized occlusion aims to maintain esthetics and food penetration of anatomic teeth while providing the mechanical freedom of non-anatomic teeth. It utilizes anatomic maxillary teeth and modified non-anatomic mandibular teeth.
- The document outlines the evolution and advantages of lingualized occlusion and provides principles for its use in
This document discusses biomechanics and mechanics of tooth movement in orthodontics. It covers:
1. The basic definitions of mechanics, stress, strain, stiffness, strength and other mechanical properties relevant to orthodontic tooth movement.
2. Theories of tooth movement including biomechanical, pressure-tension, fluid dynamics and piezoelectric theories.
3. Factors that influence tooth movement including force magnitude, duration, and decay over time. Light continuous forces produce faster movement through bone remodeling compared to heavy forces which cause bone necrosis.
4. Types of tooth movement including tipping, bodily movement, intrusion, extrusion, rotation and root uprighting.
Anoverview of TMD'S categories and main types of interocclusal appliances( occlusal splints ) used during the management of these musculoskeletal disorders .
A 3D printer fabricates physical models from computer-aided design files by depositing materials layer by layer. It can produce models of skulls, mandibles, maxillae and teeth from CT scan data for uses such as surgical planning, research, and teaching. The process involves capturing a CT scan, converting the data to an STL file, and producing the 3D model using a printer that works by laying down a binder pattern on a powder surface in a build chamber in a series of thin layers.
This document provides an overview of orthodontic treatment mechanics using the McLaughlin, Bennett and Trevisi (MBT) bracket system. It discusses the history and development of the MBT system, variations in appliance specifications including bracket selection and torque specifications. It also covers important aspects of treatment including bracket positioning, arch forms, anchorage control, archwire sequences and finishing the case.
Temporary anchorage devices in orthodonticsParag Deshmukh
The document discusses temporary anchorage devices (TADs) used in orthodontics, specifically mini-implants. It provides background on how TADs have improved orthodontic anchorage compared to traditional methods. The introduction describes how TADs solve limitations of extraoral anchorage devices and provide reliable anchorage. It then covers implant terminology, history, parts, types, indications, bone physiology, and clinical applications of TADs as absolute anchorage for various tooth movements.
An altered cast procedure to improve tissue supportCPGIDSH
The document discusses an altered cast technique for removable partial dentures. The technique involves making an impression of the edentulous ridge after the metal framework is cast. This refined impression is used to alter the edentulous areas of the master cast, accurately reproducing the supporting tissues. This provides correct denture base extension and favorable physiologic support when seated. The technique offers benefits like reducing adjustments and preserving residual ridges by improving stress distribution. Two case examples demonstrate using the altered cast technique for mandibular and maxillary removable partial dentures.
Adjunctive orthodontic treatment aims to facilitate restorative dental procedures in adults by improving function and aesthetics. The goals are to enhance periodontal health, establish favorable tooth anatomy, and facilitate restorative treatments. Careful treatment planning is required considering diagnostic records, biomechanics, and the sequence of other procedures like periodontics and restorative dentistry. Orthodontic techniques can help upright tilted molars, close extraction sites, and prepare teeth for prosthetics like bridges or implants. Close monitoring of periodontal health and limiting tooth movements to minor adjustments are keys to success.
This Presentation tells 4th Stage of Comprehensive Orthodontic Treatment in Orthodontics, Retention, which is used to Prevent Relapse after Orthodontic Treatment.
Muscle deprogramming /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Temporomandibular joint (TMJ) disorder affects an estimated 10 million Americans. TMJ disorder is characterized by pain relating to the joints on either side of the jaw, or a compromise in the ability to make normal jaw movements. It can occur for a number of reasons, and there is a range of TMJ disorder treatments, both conservative and extensive, designed to address patients' specific needs.
Learn more about how to tooth replacement options for missing teeth, There are some options like Dental bridges treatment, denture treatments, Dental Implant treatments, Dental Restorative Surgeries etc...!!!
Orthodontic tooth movements and biomechanics.Sk Aziz Ikbal
The document discusses biomechanics principles related to orthodontic tooth movement. It covers topics such as:
- Forces applied to teeth can cause movement through bone remodeling.
- Biomechanics refers to mechanics applied to biological systems. Knowledge of forces is needed to control orthodontic treatment.
- Teeth can move through light forces during normal function but heavier sustained forces over 1 second are needed for orthodontic tooth movement.
- Forces have magnitude and direction, while scalars only have magnitude. Resultant forces and moments from multiple applied forces are calculated.
- Different force systems and moment-to-force ratios produce different types of tooth movement such as tipping, translation, rotation, and torque.
hai this is a nice seminar and inculcated all the recent materials and biomaterials and biomechanics of the invisalign techniques , materials to be used and clinical aspects just have a look to it
This document discusses attachments used in prosthodontics. It begins with an introduction to attachments, defining them as mechanical devices used to retain and stabilize prostheses. The document then covers the history, classification, indications, disadvantages, and selection of attachments. It discusses both intracoronal and extracoronal attachments. In summary, the document provides an overview of attachments, their uses in prosthodontics, and factors to consider in selecting the appropriate attachment.
This document discusses various methods for remounting dentures, including direct correction in the mouth, laboratory remounting, and clinical remounting. Laboratory remounting involves fabricating remount casts of the dentures and mounting them on an articulator to eliminate deflective contacts through selective grinding. Clinical remounting techniques include split cast mounting, which involves constructing the maxillary cast in two parts to allow for easy removal and replacement of the casts. The modified split cast technique is also described as a timesaving clinical remount method. Remounting aims to improve denture occlusion and patient comfort by correcting errors that occurred during the fabrication process.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document provides an overview of achieving esthetics in complete dentures. It discusses the definition and history of denture esthetics. The fundamentals of esthetics including visual perception, composition, proportion, dominance and illusion are covered. Methods for achieving complete denture esthetics are described, including accurate impressions, jaw relation, selection of anterior teeth, arrangement of teeth, and characterization of the denture base. Dynesthetic interpretation of dentogenic concepts and laboratory steps are also summarized.
This document discusses concepts and techniques related to occlusal rehabilitation. It covers topics such as centric relation, anterior guidance, restoring anterior and posterior teeth, and solving various occlusion problems. The Pankey-Mann-Schuyler philosophy advocates establishing stable centric stops, proper anterior guidance in harmony with jaw movements, disclusion of posterior teeth in protrusion, and non-interference of teeth during lateral excursions. The document provides guidelines for determining tooth contours and positions to achieve optimal function, stability, and aesthetics.
There are several protocols for loading dental implants after surgery based on bone density and healing time requirements. Protocols include Brånemark's loading protocol, progressive loading, and immediate/early loading. The density of the bone where the implant is placed determines the appropriate loading protocol, as less dense bone requires more healing time before loading to allow for sufficient bone mineralization and strength. Progressive loading gradually increases stress on the implant over time to allow the bone to adapt, reducing risks of failure. It is particularly important for lower density bone which is weaker.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document discusses lingualized occlusion for removable prosthodontics. It begins by providing background on the search for ideal denture occlusion and defines lingualized occlusion. Key points include:
- Prof. Alfred Gysi first introduced the concept of lingualized occlusion in 1927 using maxillary teeth with single linear cusps fitting into shallow mandibular depressions.
- Lingualized occlusion aims to maintain esthetics and food penetration of anatomic teeth while providing the mechanical freedom of non-anatomic teeth. It utilizes anatomic maxillary teeth and modified non-anatomic mandibular teeth.
- The document outlines the evolution and advantages of lingualized occlusion and provides principles for its use in
This document discusses biomechanics and mechanics of tooth movement in orthodontics. It covers:
1. The basic definitions of mechanics, stress, strain, stiffness, strength and other mechanical properties relevant to orthodontic tooth movement.
2. Theories of tooth movement including biomechanical, pressure-tension, fluid dynamics and piezoelectric theories.
3. Factors that influence tooth movement including force magnitude, duration, and decay over time. Light continuous forces produce faster movement through bone remodeling compared to heavy forces which cause bone necrosis.
4. Types of tooth movement including tipping, bodily movement, intrusion, extrusion, rotation and root uprighting.
Anoverview of TMD'S categories and main types of interocclusal appliances( occlusal splints ) used during the management of these musculoskeletal disorders .
A 3D printer fabricates physical models from computer-aided design files by depositing materials layer by layer. It can produce models of skulls, mandibles, maxillae and teeth from CT scan data for uses such as surgical planning, research, and teaching. The process involves capturing a CT scan, converting the data to an STL file, and producing the 3D model using a printer that works by laying down a binder pattern on a powder surface in a build chamber in a series of thin layers.
This document provides an overview of orthodontic treatment mechanics using the McLaughlin, Bennett and Trevisi (MBT) bracket system. It discusses the history and development of the MBT system, variations in appliance specifications including bracket selection and torque specifications. It also covers important aspects of treatment including bracket positioning, arch forms, anchorage control, archwire sequences and finishing the case.
Temporary anchorage devices in orthodonticsParag Deshmukh
The document discusses temporary anchorage devices (TADs) used in orthodontics, specifically mini-implants. It provides background on how TADs have improved orthodontic anchorage compared to traditional methods. The introduction describes how TADs solve limitations of extraoral anchorage devices and provide reliable anchorage. It then covers implant terminology, history, parts, types, indications, bone physiology, and clinical applications of TADs as absolute anchorage for various tooth movements.
An altered cast procedure to improve tissue supportCPGIDSH
The document discusses an altered cast technique for removable partial dentures. The technique involves making an impression of the edentulous ridge after the metal framework is cast. This refined impression is used to alter the edentulous areas of the master cast, accurately reproducing the supporting tissues. This provides correct denture base extension and favorable physiologic support when seated. The technique offers benefits like reducing adjustments and preserving residual ridges by improving stress distribution. Two case examples demonstrate using the altered cast technique for mandibular and maxillary removable partial dentures.
Adjunctive orthodontic treatment aims to facilitate restorative dental procedures in adults by improving function and aesthetics. The goals are to enhance periodontal health, establish favorable tooth anatomy, and facilitate restorative treatments. Careful treatment planning is required considering diagnostic records, biomechanics, and the sequence of other procedures like periodontics and restorative dentistry. Orthodontic techniques can help upright tilted molars, close extraction sites, and prepare teeth for prosthetics like bridges or implants. Close monitoring of periodontal health and limiting tooth movements to minor adjustments are keys to success.
This Presentation tells 4th Stage of Comprehensive Orthodontic Treatment in Orthodontics, Retention, which is used to Prevent Relapse after Orthodontic Treatment.
Muscle deprogramming /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Temporomandibular joint (TMJ) disorder affects an estimated 10 million Americans. TMJ disorder is characterized by pain relating to the joints on either side of the jaw, or a compromise in the ability to make normal jaw movements. It can occur for a number of reasons, and there is a range of TMJ disorder treatments, both conservative and extensive, designed to address patients' specific needs.
Hi this is a very good powerpoint presentation on a limited topic on net that is DEPROGRAMMING SPLINT just have a look to it and any suggestions most heartly welcome
Invisible Yet Magical Twin Block Appliance poster BADICON2023.pptxIshfaq Ahmad
The Twin Block Appliance is used to align the upper and lower jaws of growing children and teenagers so that the jaws come together properly. It has two blocks, one that fits in the upper palate behind the upper teeth and one that fits behind the lower front teeth. When the blocks come together, they guide the jaws into the correct position. The Twin Block is normally worn for 9-12 months before braces are applied. It is effective for correcting mouth breathing, repositioning the lower jaw, and reducing tongue pressure on the throat.
This document discusses various treatment methods for temporomandibular disorders (TMDs). It separates treatments into definitive treatments, which aim to eliminate the underlying cause, and supportive therapies, which aim to manage symptoms. Definitive treatments include reversible occlusal appliances, irreversible occlusal therapies, relaxation techniques, and management of parafunctional habits. Supportive therapies include medications, physical therapies like ultrasound and manual techniques, and self-care methods. The document provides detailed descriptions and indications for different appliance types, including stabilization, anterior repositioning, and soft splints.
Muscles of mastication prosthodontic considerationNeerajaMenon4
The document discusses the muscles involved in mastication and their influence on denture borders. It describes the masseter muscle pushing the buccinator medially, requiring a masseteric groove contour in dentures. The medial pterygoid contracts during closing and influences the retromylohyoid border. Temporalis and lateral pterygoid position the condyles in centric relation, with lateral pterygoid controlling condylar movement during function. Occlusal splints promote muscle relaxation and neuromuscular harmony.
1. A bite splint is a removable appliance made of acrylic or composite that covers the teeth of the upper or lower jaw.
2. Bite splints are used to protect teeth from bruxism, treat TMJ disorders and pain, improve jaw muscle function, and test changes in occlusion.
3. Common types of conservative bite splints include the Michigan splint, plane splint, Shore splint, Sved plate, and Gelb splint. Non-conservative splints can cause irreversible changes if worn over 4-6 weeks.
Splints in orthodontics /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Hey have you ever heard about Smilestone Dental Clinic .Its the Best Dental Clinic in Nagpur. And what to say Dr. Arvind Ashtankar is the Best Dentist in Nagpur. With expertise he is friendly and gives best treatment of Dental. Expert endodontic facilities are passed out in our clinic.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Aqua Splint universal therapy tmj orthodontics.pptxMaen Dawodi
Pain and tired facial and masticatory muscles or TMJ pain
Craniomandibular disorders (TMD) result from an interplay of multiple factors:
Malocclusion
Hyperactivity of masticatory muscles
(bruxism/pressing)
Psychosomatic disorders, stress syndrome
Joint hyper-mobility
Trauma
Neck disorders / cervical spine syndrome
Internal diseases
Splints
made from acrylic resin and cover all or most of the teeth in one arch
Device which can also allow repositioning of the condyles and jaws into centric relation
allow muscles in spasm to relax, protect the teeth and jaws from the adverse effects of bruxism, and normalize periodontal ligament proprioception
TMD symptoms during orthodontic treatment and
post orthodontic treatment
Temporomandibular joint screening prior to occlusal rehabilitation is indispensable for preventive, therapeutic reasons.
The Aqua Splint is used in the treatment of TMD and orofacial pain. It gives immediate help by providing pain relief and muscle relaxation without impressions, bite registration, or laboratory fabrication.
Is a pre-fabricated TMD
splint, which can be inserted immediately without preparations,
impressions, or bite registrations.
device consists of two water pads connected
by a tube (hydrostatic aqua-balance
provide excellent assistance when deciding whether or not a particular symptom or problem may have anything to do with occlusion or jaw positioning.
can easily test for if a balancing of the occlusal forces results in a change or improvement of symptoms.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses various methods for treating teeth with cracked or damaged roots, including traditional metal posts cemented into the root canal versus newer fiber-reinforced composite posts. Traditional methods have problems like post loosening over time or teeth fracturing. Newer fiber posts and resin cements allow for bonding a post directly into the canal to create a strong "monoblock" restoration from apex to crown in a single appointment without waiting for cement to set. The document also discusses causes of post failures and techniques for directly bonding or indirectly building up composite posts in a root canal.
Stability /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document discusses using bite ramps or bite turbos in orthodontic treatment to correct deep overbites and curves of Spee. It provides instructions on how to make and place bite ramps using light cure material. Bite ramps are bonded to the palatal surfaces of maxillary central incisors. The ramps can be extended lingually if needed. Bite ramps are a useful orthodontic device to correct deep overbites and allow bonding of lower anterior brackets which may otherwise not be possible.
Facemask is a wide term used for an orthodontic application that secures about the top to exert stress from the outer surface of the patient’s jaws. While not every kid or grown-up who has a bracket will require a facemask, the facemask is significant for sure cases with has its advantages.
This document provides an overview of the current status and use of Twin Block appliances in orthodontic treatment. It discusses the original Twin Block design developed by Clark and modifications that have been made. It describes how Twin Block appliances can be used to treat Class II and Class III malocclusions. Details are provided on bite registration, appliance design for different malocclusions, and clinical management over an active treatment phase and retention phase. Treatment of open bites and modifications for different cases are also summarized.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
You can complete the whole process in 3-4 months.Salary range for DH/DT is around 2500-3500 Pounds per month.
Eligibility / requirements-
1. An International English Language Testing System (IELTS) certificate
at the appropriate level.(Within 2 yrs of application date )
2: A recent primary dental qualification that has been taught and examined in English..(Within 2 yrs of application date )
3: A recent pass in a language test for registration with a regulatory authority in a country where the first language is English.
If you are interested Please contact us for more details.
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry,
Periodontics and General Dentistry.
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This document discusses dental occlusion concepts and philosophies for complete dentures. It introduces key terms like physiologic occlusion and defines different occlusion schemes like balanced articulation and monoplane articulation. The document discusses advantages and disadvantages of using anatomic versus non-anatomic teeth for complete dentures. It also outlines requirements for maintaining denture stability, such as balanced occlusal contacts and control of horizontal forces. The goal of occlusion for complete dentures is to re-establish the homeostasis of the masticatory system disrupted by edentulism.
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Your smile is beautiful.
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3. The key to treating TMD/ Bruxism patients is to
reduce the patient's tendency to clench and grind
their teeth. Even if, when the teeth are closed
together, and the joints do not line up properly, all
the symptoms tend to fade away if the patient does
not tend to keep the teeth together with the forces
characteristic of bruxing. The most common, and
least expensive treatment for TMD is the
construction of a hard acrylic bruxing guard/
interocclusal splint.
www.indiandentalacademy.com
4. These are horseshoe shaped plastic appliances
which fit over (usually) the top teeth and have a
smooth surface on the underside so the lower teeth
can slide over the plastic without resistance. This
prevents the teeth from locking together, and
relieves a lot of the force placed on the teeth and
joints.
www.indiandentalacademy.com
5. Unfortunately, these splints still allow the patient to
clench against the guard. Since clenching is
associated with overuse of the temporalis muscle,
patients may still experience tension headaches
even though they wear their guard religiously.
www.indiandentalacademy.com
6. Bruxing guards work even better if they are built so
that when the lower teeth contact the plastic, the
joints are forced to sit in their most relaxed positions
in the most superior part of the socket. This position
can be determined quite easily by a simple trick
called deprogramming in which a piece of plastic is
inserted over the top front teeth that does not allow
the posterior teeth to make any contact. Usually,
within an hour or so of wearing one, the jaw "drops"
into a relaxed position with the joints in a more
desirable position.
www.indiandentalacademy.com
7. A bite registration is taken with the deprogramming
device (deprogrammer) in place so the new bruxing
guard can be built to the new bite-adjusted jaw
position which corresponds to a more physiologically
acceptable joint position. Deprogrammer has an
additional advantage in that it will relieve the
symptoms very quickly and can be worn until the
deprogrammed bruxing guard can be built.
www.indiandentalacademy.com
8. Deprogrammers
The concept of deprogramming is based on the
reflexive relaxation of the lower jaw when the
posterior teeth are not permitted to engage. The
various muscles that open and close the jaw learn
and remember the level of contraction needed to
perform their movements in a coordinated,
comfortable way.
www.indiandentalacademy.com
9. They learn which positions of these muscles cause
pain, and which don't, and store all the information in
your brain in the form of "engrams" which are similar
to automatic, unconscious computer programs that
our body uses each time we open or close our
mouth. In persons with TMJ, these movements can
be quite complex.
www.indiandentalacademy.com
10. The relief of symptoms is the result of a forced
relaxation of the muscles of mastication, which in
turn brings about relief of pressure on all anatomic
structures including the TMJ, the muscles of
mastication, the teeth and supporting structures.
Deprogramming frequently brings about a shift in the
position of the lower jaw leaving the joints in a more
relaxed functional position which probably
corresponds fairly closely to Dawson's definition of
centric relation. The condyles thus occupy a more
centric and relaxed position in the fossae. This
position is reproducible without forceful manipulation
by the dentist.
www.indiandentalacademy.com
11. Why Deprogram? An anterior midline contact produces minimal
temporalis contraction intensity and minimal joint
strain, and tends to allow the TMJ to translate slightly
forward to rest against the eminence. Furthermore,
an attempt to brux against an anterior midline
discluding element produces sore lower incisors,
which discourages further bruxing. Thus
deprogramming is a simple trick to produce a forced
relaxation of the temporalis, masseter and pterygoid
muscles allowing the TM Joints to rest in a
functionally comfortable position in the fossa.
www.indiandentalacademy.com
13. Masseter and Temporalis are the key players in the
action of mastication. Muscular activity is
independent of the occlusal scheme. However, the
occlusal scheme modifies the forces generated by
the muscular activity.
www.indiandentalacademy.com
14. The best application of the occlusal splint seems to
be in its application prior to any occlusal adjustment.
It is important to bring the patient to ‘round zero’
lowering EMG activity in the masster and temporalis
muscles, and then proceed with further treatment.
It is imperative to understand that results of splint
therapy are temporary and recurrent symptoms are
likely to show up within 4 wks of discontinuing the
splint.
www.indiandentalacademy.com
15. Thus use of splints is symptomatic treatment and
for an orthodontist it acts to accomplish the balance
within the muscles, can also facilitate procedures
such as occlusal analysis or an adjustment to a
patients bite. Thus in the second phase the
orthodontic treatment would relieve the occlusal
dysfunction.
www.indiandentalacademy.com
16. The deprogrammer, followed by a bruxing guard built
using the new functional (deprogrammed) bite
registration can bring about immediate and
permanent relief of pain in a majority of TMD cases.
Symptoms relieved include a reduction in tension
headaches, ear aches and the neck stiffness
associated with parafunction. Sensitive teeth and
"phantom toothaches" in otherwise healthy teeth
frequently respond to this form of treatment.
Crepitus and popping of the temperomandibular
joints may be lessened or relieved.
www.indiandentalacademy.com
17. The deprogrammer accomplishes three goals
1. The deprogrammer brings about nearly
immediate relief of acute symptoms. In general,
pain is reduced or eliminated within one or two
hours of insertion of the deprogrammer. Muscle
relaxants, analgesics or other drugs are generally
not necessary.
www.indiandentalacademy.com
18. 2.The butterfly deprogrammer helps to confirm the
diagnosis of TMD, and the appropriateness of jaw
repositioning as a treatment. In cases where the
deprogrammer does not bring about sufficient relief
from pain, the construction of a functional appliance
will be of little benefit. While this does not mean
that jaw repositioning therapies are entirely
inappropriate, it does imply that the practitioner
should rule out other causes for the patient's pain
before proceeding with expensive therapies.
www.indiandentalacademy.com
19. 3.The butterfly deprogrammer brings about
relaxation of masticatory structures, and allows for
the determination of a functional centric jaw relation
and the construction of a "deprogrammed" bite
appliance. Any symptoms of TMD that have been
relieved by the use of the deprogrammer should be
also be corrected by a properly fabricated
deprogrammed bruxing guard. Unfortunately,
bruxing guards, even deprogrammed guards, do
not always relieve tension headaches since the
patient can still clench against the guard. Even so,
patients often experience a reduction in the
frequency and intensity of tension headaches.
www.indiandentalacademy.com
23. Taking and using a bite registration
The patient should be allowed to wear the
deprogrammer on and off for several days prior to
taking a bite registration. Just before the bite is to be
registered, the patient should wear the
deprogrammer continuously all day until the
appointment time. Schedule this appointment for the
morning instructing the patient to sleep with the
deprogrammer in place and remove it only to eat and
brush the teeth. Otherwise, the patient's posterior
occlusion should be discluded for as long as possible
before the appointment.
www.indiandentalacademy.com
24. With the deprogrammer in place, have the patient sit
in an upright position and gently tap the lower teeth
against the bite ramp a few times. NOT HARD!
when the dentist is satisfied that the position of
contact of the ramp with the lower teeth is stable and
reproduced with each tap, have the patient hold the
lower teeth gently against the ramp. Now begin
injecting the Blue Mousse (or Regisil) between the
teeth starting on the posterior teeth on one side, and
continuing anteriorly being sure to overlay the buccal
cusp tips and incisal edges of all teeth while injecting
around the arch to the posterior teeth on the other
side.
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25. With the deprogrammed bite in hand, remove the
deprogrammer and take alginate impressions of
upper and lower teeth. Then mount the teeth using
the Regisil bite, and not to change the vertical
dimension when building the bruxing guard.
A hard acrylic flat plane guard for heavy bruxers can
be used, although the newer Thermoflex or ValPlast
materials make fitting the guard much easier since
warm water softens the plastic and allows the
appliance to self adjust to any discrepancies in the
exact fit to the teeth.
www.indiandentalacademy.com
26. Hence, Interocclusal orthopedic appliances are
routinely used in the treatment of disorders of the
temporomandibular joint (TMJ) and masticatory
system. Hard or soft removable acrylic appliances
covering the teeth have been used to eliminate
occlusal disharmonies, prevent wear and mobility
of the teeth, reduce bruxism and parafunction,
treat masticatory muscle dysfunction, and correct
derangements of the TMJ. Mandibular orthopedic
repositioning appliances (MORA’s) have been
recommended for increased strength and athletic
performance.
www.indiandentalacademy.com
27. History of Splints
With the development and patenting of vulcanite
rubber in 1855, Charles Goodyear provided dentists
with material that could be molded for many different
oral appliances.
In November 1862, Thomas Gunning , a practicing
surgeon, used vulcanite to fabricate a custom fitting
splint to treat himself for a broken jaw.
www.indiandentalacademy.com
28. The Gunning vulcanite splint, is remarkably similar to
appliances used today to treat TMD. Additionally, his
double arch splint, very closely resembles early
orthodontic positioners, snoring and sleep apnoea
appliances in use today.
In 1887, twenty five yrs after Gunning’s
development, Kingsley, published an article
discussing the use of soft vulcanized rubber to make
an obturator.
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29. In 1888, Farrar, discussed the use of a splint to
disarticulate the teeth for the purpose of increasing
the eruption of selected teeth.
Karolyi, a German, introduced an occlusal splint in
1901 for the treatment of bruxism.
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30. Hawley, in 1919, and then Monson, in 1921, each
suggested that bruxism led to a loss of occlusal
vertical dimension, which gave rise to occlusal
disorders.
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31. Resilient appliances
One of the first reference to the use of a soft
appliance is by Matthews in 1942, for the treatment
of bruxism
In 1946, Kesling’s article discussed using a maxillary
soft occlusal appliance in order to maintain the
mandible in predetermined relationship to the
maxilla.
www.indiandentalacademy.com
32. Ingersoll and Kerens, in 1952, authored a paper
discussing the treatment of occlusal trauma using a
semi soft vinyl resin appliance made of vinolin.
In 1957, Campbell described soft appliance
approach for treating bruxism.
www.indiandentalacademy.com
33. Shore, in 1959, provided an outline for treating TMJ
pain and facial pain.
He cautioned about the disadvantages of the soft
appliances, such as perforations, functioning like
orthodontic appliances.
www.indiandentalacademy.com
35. Stabilization splints
Stabilization splints are commonly used for treatment
of masticatory dysfunction signs and symptoms such
as muscular pain, TMJ pain, clicking, crepitus,
limitation of motion and incoordination of movement.
This type of splint is constructed with even posterior
occlusal contact in centric relation with the condyles
"seated", separation of posterior teeth in protrusive
or lateral movements (anterior disclusion) and canine
rise in lateral excursions. It can cover the maxillary or
mandibular dentition.
www.indiandentalacademy.com
36. Carraro and Caffesse (1978) described the response
of 170 TMJ patients treated only with a full coverage
stabilization splint. Eighty-two percent of subjects
responded favorably to the splint therapy. Symptoms
of TMJ pain, muscle pain or dysfunction all
improved. Thirty-seven percent of the patients were
cured and 45 percent improved. Pain symptoms
were significantly more likely to be cured than
dysfunction symptoms. Clicking was the most difficult
dysfunctional symptom to eliminate.
www.indiandentalacademy.com
37. Repositioning splints
Along with change in tooth contact and muscle
function, splints can influence the
temporomandibular joint. The proper position of the
condyle to the meniscus and fossa is generally
thought to be necessary for normal function. While
there is some variation in condylar position in an
asymptomatic population, derangement of the disc
with displacement of the condyle is implicated in
disturbances of motion and degenerative joint
changes. Splints may affect the joint in two ways:
alter the stress or loading of the joint, and recapture
or change condyle-disc fossa position.
www.indiandentalacademy.com
38. Most clicking is caused by a rapid change in position
of the condyle or disc, sometime during condylar
translation. Since the direction of pull of the external
pterygoid is anterior and medial, in derangements
the meniscus is usually dislocated forward and
inward. Conceptually, keeping the mandible forward
with a splint would "recapture" the normal disc-
condyle orientation and eliminate the clicking. The
initial enthusiasm for repositioning was supported by
studies showing good clinical success. Comparisons
with flat plane splint treatment showed the superiority
of repositioning appliances.
www.indiandentalacademy.com
39. Increasing the length of the splint therapy does not
improve the treatment result. Following six months or
more of active repositioning splint therapy, control of
noise and pain was achieved in 70 percent of 241
patients. (Moloney et al 1986) 53% were successful
after two years, and by the end of three years only
36%were successfully treated. The later the click
occurred in opening, the poorer the long term
prognosis. 14 of the successfully treated cases were
occlusally reconstructed and 34 had orthodontic
treatment to maintain the altered jaw position. 43%
of the restored patients and 50%of the orthodontic
patients had return of clicking.www.indiandentalacademy.com
40. Ronqillo et al, (1988) studied the relationship
between the pretreatment position of the condyle in
the fossa to unsuccessful protrusive splint therapy.
Of 142 patients with internal derangements, 72 were
arthrographically confirmed to be suitable for
repositioning therapy. The initial condylar position
was measured on CO tomograms. The patients were
followed from six months to five years. Seventy-one
percent of the patients in the sample were
successfully treated while 29 percent had return of
clicking, locking and/or return of pain. Whether the
condyle was anteriorly, centrally or posteriorly
positioned before splint therapy had no bearing on
the success of treatment.
www.indiandentalacademy.com
41. Okeson (1988) took a retrospective look at 40
patients treated for eight weeks with anterior
repositioning splints. All patients had a primary
diagnosis of a disc-interference disorder: disc
displacement associated with distinct single joint
sounds (n=25), a history of locking with recapture
(n=8), and permanent dislocation (locking without
recapture, n=8). After eight weeks of therapy 80
percent of the patients were free of pain, clicking and
locking. The splints were phased out with a step-
back procedure. No occlusal changes were
attempted.
www.indiandentalacademy.com
42. Two and one-half years later 66% of the successfully
treated patients had a return of joint sounds. 23%
reported joint pain. The average maximal interincisal
opening improved from 37 millimeters to 43
millimeters. 18% had decreased opening. This study
would conclude that repositioning therapy
permanently resolves joint sounds only one-third of
the time but reduces long term pain three-quarters of
the time.
www.indiandentalacademy.com
43. The author used the same data to evaluate success
under differing criteria. The success rate was 25
percent if the patients were free of pain, clicking and
locking. Accepting painless joint sounds, the success
rate was 55 percent. Seventy-five percent were
successful if only pain resolution was considered and
80 percent were better according to the patient.
Therefore, if resolution of pain is the primary
objective, repositioning has a good long term
prognosis. If elimination of all signs of dysfunction is
the goal, repositioning splint therapy is of limited
value.
www.indiandentalacademy.com
44. The enthusiasm and the high success rate reported
initially for anterior repositioning is not supported by
carefully controlled long term studies. Successful
recapture of a displaced disc depends on readaption
of stretched or torn ligamentous attachments and
repair of the retrodiscal tissue. The disc
displacement may also be of a type that is
impossible to recapture. (Leidberg 1988) Return of
clicking after successful treatment means that the
joints are not repairing themselves or that the original
clicking was not caused by disc displacement.
www.indiandentalacademy.com
45. Pivot splints
Treating an injured or painful articulation with traction
is common in physical medicine. The pivot splint is a
hard splint with single posterior contact on each side.
The contact is usually on the most posterior tooth. If
the mandible rotates forward around the fulcrum of
the pivots, the condyle is distracted from the fossa
and the joint is unloaded.
www.indiandentalacademy.com
46. Theoretically, unloading should be desirable in
patients with internal derangements and
intracapsular inflammations. In the craniofacial
configuration of most patients the elevator muscles
lie on or posterior to the most distal tooth. Therefore,
contraction of the closing muscles does not result in
joint unloading. The closing vector must be anterior
to the pivot.
www.indiandentalacademy.com
47. Lous (1978) published the results in a study of 60
clicking patients treated with pivots. Previous
traditional treatment methods had been
unsuccessful. In these cases splint wear was
supplemented with vertical pull headgear attached to
a chin strap. The average treatment lasted three to
four weeks with a three month follow-up. 72% of the
patients had elimination of symptoms. 17% had
improvement but reoccurring symptom episodes.
www.indiandentalacademy.com
48. Another limitation of this splint is that because of the
limited occlusal contact with this splint there is a
possibility of change in tooth position. The clinician
has better control of the occlusion with a full
coverage splint. For treatment of internal
derangements, the anterior repositioning splint would
give the therapist more control over condylar
position. If joint unloading is the object of therapy,
auxiliaries must be considered.
www.indiandentalacademy.com
49. Soft splints
Soft, resilient splints are easily constructed. They
may even be prefabricated. Their value for protection
from trauma in athletics is well substantiated; their
use to reduce parafunctional clenching and grinding
is not. Harkins and Marteney (1986) tested
prefabricated soft splints (a modified Doubleguard
appliance) in one-half of a sample of 84 dysfunction
patients who had clicking and pain. The other half
served as controls.
www.indiandentalacademy.com
50. The splints were worn full time for 10–20 days. 10%
of the patients stopped clicking, 64%had less
clicking, 7% increased and 19% had no change.
Myalgia did not change or worsened in 26% of
patients. Minor occlusal changes were noted in 67%.
There was no change in the controls.
www.indiandentalacademy.com
51. Okeson (1987) tested the response of a soft splint
and a hard splint on the same bruxing patient. Soft
splints might be useful on a temporary basis for relief
of symptoms but because of the resilient material,
adjustment of the occlusal contacts is difficult. Also,
uncontrolled changes in tooth position may occur.
www.indiandentalacademy.com
52. Bite plate Splint
Design: A maxillary or mandibular hard splint
allowing contact of only one or more anterior teeth.
The posterior teeth do not contact.
Other names: Anterior jig, Luca jig, Hawley with bite
plate or anterior deprogrammer.
It interrupts mandibular position sense, eliminate
proprioceptive feedback from the posterior teeth
and / reduce muscle activity.
www.indiandentalacademy.com
53. Mandibular Orthopedic repositioning appliance
Design: Hard mandibular posterior coverage splint
usually with a lingual bar connecting the posterior
segments.
Also known as Gelb Splint
It increases the strength and athletic performance,
change posterior occlusal contact , eliminate anterior
tooth contact or restore vertical dimension.
www.indiandentalacademy.com
54. Hydrostatic splint
Design: Fluid filled reservoir
covering the teeth.
It equalizes the biting pressure.
www.indiandentalacademy.com
55. Aqualizer™
The Aqualizer™’s revolutionary water system is
different than other products in the market. While
most splints simply disable the bite long term and
guess at optimal occlusion, the Aqualizer™ takes the
guesswork out of treatment by allowing the body to
naturally find functional balance.
The Aqualizer™ applies a physical law of nature
called Pascal’s Law, meaning that when you bite
down on the Aqualizer™, the fluid is evenly
distributed across the entire bite.
www.indiandentalacademy.com
57. The Aqualizer™ is unique. Its revolutionary “floating
action” enables the body to find and restore its own
systemic function and balance. The Aqualizer™’s
built-in fluid system automatically eliminates the
occlusal imbalances that trigger the patient’s
symptoms. This fluid system works by freeing up the
patient’s muscles so they can reposition the jaw to its
most comfortable position, which takes the
uncertainty out of reestablishing the correct “bite.”
www.indiandentalacademy.com
58. Diagnosis no longer wastes valuable chair time.
Simply remove the Aqualizer™ from its package and
insert it into the mouth. The Aqualizer™ ’s perfect
occlusal balance starts treatment instantly! No
impressions, lab work, or time consuming
adjustments needed! It is truly an “instant splint.”
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59. Occlusal changes
The nature of the occlusal scheme and specific tooth
contact influences behavior of the muscles. The
splint therapist has control over which teeth contact
in the various mandibular functions. It is important to
understand the changes in muscle behavior that
accompany alterations in occlusal patterns so that
better decisions can be made in the design of a
splint.
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60. With cemented maxillary splints adjusted for different
tooth contact patterns, Wood (1984) monitored the
activity of the masseter, the anterior temporal and
posterior temporal muscles. Clenching with full
contact of all teeth on the splint increased EMG
activity 17 percent, predominately in the masseter. If
the second molar occlusal contact on the same side
was removed, electrical activity dropped 20 percent.
EMG activity decreased 13 percent with only canine
to canine contact.
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61. Different occlusal protrusive functions also influence
elevator muscle activity. Protrusion reduces elevator
muscle activity but the number of teeth contacting
appears to be the most significant factor in this
reduction. Whether muscular inhibition emanates
from the TMJ, the muscles or the periodontal
membrane is unclear. In cats, stimulation of the
pressure sensors in the periodontal membrane leads
to a jaw opening reflex. Bruxing may override normal
neuromuscular feedback so muscle activity may not
be reduced.
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62. The clinical benefits of anterior guidance were
demonstrated by Williamson and Lundquist. A splint
limiting excursive contacts to the anterior teeth shut
down the masseter and anterior temporal activity that
normally occurred with posterior tooth contact. They
concluded that anterior guidance was necessary to
reduce muscle activity. However, in their experiment
the variable of change in vertical dimension with the
splint was not controlled.
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63. The following principles based on the above studies
would apply to the use of different occlusal schemes
in splint therapy:
1. Bilateral, even contact allows maximal muscle
effort, balances right and left muscle contraction and
reduces pain of muscle origin.
2. Reducing the number of teeth in contact does not
reduce clenching effort if bilateral balance is
maintained.
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64. 3. In protrusive and lateral function, reducing the
number of contacting teeth reduces muscle activity.
4. The anterior-posterior location of the working
side tooth contact in lateral excursions is not the
critical factor in reducing muscle activity.
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65. Vertical dimension
Most splints alter the vertical dimension of occlusion
and increase the functional length of muscles. The
muscular length that develops maximum tension is
defined by physiologists as the resting length. A
fiber’s isometric tension is enhanced by elongation
and loading.
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66. It has been assumed that clinical rest position
(postural position) would be the vertical dimension of
minimal muscle effort. In other words the elevator
muscles would be the most relaxed at clinical rest.
Rugh and Drago,(1981), determined that the mean
vertical of minimal masseteric activity was 8.6
millimeters between the anterior teeth. The average
postural position was 2.1 millimeters. Testing the
masseter, posterior temporal and anterior temporal
over the full range of mandibular opening, Manns
showed the minimal EMG activity of the temporals at
12 millimeters and the masseter at 10 millimeters.
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67. So these authors concluded that as the vertical
dimension increases from occlusal contact, muscular
effort decreases. Presumably at the opening of
minimal EMG, passive tissue stretch maintains
mandibular position. With greater opening, stretch
receptors become activated and muscle contraction
increases.
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68. Mandibular rest position and electrical activity of the
masticatory muscles.
Michelotti A, Farella M, Vollaro S, Martina R.
The objectives of this study were to analyze the
relation between mandibular rest position and
electrical activity of masticatory muscles and to
compare clinical and electromyographic rest position
in subjects with different vertical facial morphologic
features.
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69. Clinical rest position and electromyographic rest
position were investigated in 40 subjects.
Electromyographic rest position ranged from 0.4 to
12.7 mm (average 7.7 +/- 2.7 mm). Clinical rest
position ranged from 0.1 to 4.4 mm (average 1.4 +/-
1.1 mm). The average difference between
electromyographic rest position and clinical rest
position was 6.3 +/- 2.5 mm (range 0.3 to 10.3 mm).
Sixteen subjects were selected according to the
Frankfort mandibular plane angle and separated in
two groups having a mandibular plane angle > or =
28 degrees.
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70. RESULTS: Rest position was significantly greater in
the low-angle group (2 +/- 1.3 mm) than in the high
angle group (0.8 +/- 0.8 mm). Electromyographic rest
position did not differ between subjects with different
facial morphologic features (8.1 +/- 1.7 mm low-
angle group; 7.6 +/- 4.1 mm high angle group). By
varying the vertical dimension millimeter by
millimeter, masseter and anterior temporal
electromyographic activity demonstrated a
considerable decrease over an interocclusal distance
of 3 to 4 mm.
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71. Further mandibular opening up to 18 mm
corresponded to small changes in postural activity.
This study suggests that a jaw posture with a few
millimeters of interocclusal distance involves a great
reduction of masticatory muscle activity.
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72. Integrated electromyography of the masseter on
incremental opening and closing with audio biofeedback: a
study on mandibular posture.
Gross MD, Ormianer Z, Moshe K, Gazit E.
The purpose of this study was to test the hypothesis
of a minimum electromyographic (EMG) rest position
based on masseter surface EMG recordings of
incremental opening and closing of the mandible with
simultaneous audio EMG biofeedback.
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73. Nineteen alert subjects in an upright seated position
opened and closed the mandible in 1-mm increments
20 mm interincisally. An electronic recording device
allowed each subject to maintain the vertical
dimension of each increment while simultaneously
reducing right masseteric muscle activity to the
minimum possible level using audio EMG
biofeedback. Integrated EMG masseteric activity was
recorded at each static opening and closing
increment.
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74. RESULTS: Analysis of variance for repeated
measures showed no difference in opening and
closing EMG levels and no interaction between
opening, closing, and change in vertical dimension.
CONCLUSION: These results, with those of other
studies, raise questions regarding the validity of the
concept of a unique physiologic rest position of the
mandible with the masseter or associated muscles at
minimum muscle activity. The idea of overlapping
postural ranges appears to be more appropriate.
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75. The indications for the splints
patients with TMD.
differential diagnosis in patients with signs and
symptoms that imitate TMD.
patients with bruxism and parafunction.
patients with moderate to severe occlusal/incisal
teeth wear.
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76. stabilization of mobile teeth.
treatment of periodontal trauma from occlusion.
temporary stabilization of the occlusion for
orthodontic purposes.
establishing the optimum position of the mandible to
the maxilla in centric relation before definitive
occlusal therapy.
postsurgical occlusal/jaw stabilization.
treatment of headaches caused by masticatory
muscle tension.
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77. Maxillary Occlusal Device-Indications
and Advantages
The maxillary occlusal device is the treatment of choice
over the mandibular occlusal device because:
ideal occlusal contacts in centric relation can be
established for all lower buccal cusps tips and incisal
edges.
ideal anterior guidance can be established.
it covers more lingual soft tissue and is less likely to
fracture.
it is more easily tolerated during non work and
nonsocial situations.
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78. it does not cause flaring of the maxillary incisors,
especially during episodes of bruxism, which is a
concern with mandibular occlusal devices.
Some dentists argue that “speech difficulties” may be
encountered with the maxillary occlusal device.
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79. Mandibular Occlusal Device–
Indications and Advantages
The mandibular occlusal device is recommended in
patients who:
object to acrylic resin that will be visible on a
maxillary occlusal device which provides anterior
guidance, especially in “open bite cases.”
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80. do not want to display any amount of anterior clear
acrylic resin on maxillary devices.
exhibit a severe gag reflex with the maxillary
occlusal device.
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81. Characteristics of ideal splint
1. Accurately fits the maxillary teeth, with no rock.”
2. Adequate retention, no tighter than removable partial
denture.
3. All mandibular buccal cusp tips and incisal edges contact
on flat surfaces in the centric relation position.
4. In protrusive jaw excursions, only the lower incisors are in
contact. Anterior guidance is no steeper than 45 degrees.
5. A long centric of 0.5 mm sometimes may be necessary,
especially for class II jaw relation patients.
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82. 6. In lateral jaw excursions, only the mandibular
canines are in contact.
7. In the upright position, the posterior teeth contact
more prominently than the anterior teeth in the
centric relation position (maximum intercuspation).
8. It is polished to prevent soft-tissue irritation.
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83. Appliance wear for Bruxism Patients
During the insertion visit, patients are given a written
explanation of the purpose, use, and care of the
appliance. Bruxism patients, or those with severe
teeth wear, are instructed to wear the prosthesis
while they sleep. They should wear it during daylight
hours when there is a tendency to clench the teeth.
Bruxism patients should return to the office 1 week
after insertion to check the device in the mouth and
to further refine the occlusion.
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84. Patients who experience difficulty adjusting to the
appliance should return 2 weeks after the 1-week
visit.
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85. Appliance wear for TMD Patients
Patients being treated for TMD, including muscle and
TMJ pain, are instructed to wear the appliance
continuously, except when eating and for cleaning.
Patients are cautioned not to clench their teeth
without the appliance in the mouth. After 1 week,
these patients are scheduled for a postinsertion visit
where changes in TMD signs and symptoms are
recorded.
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86. Slight changes in jaw and joint position usually
require occlusal refinement to the appliance in
centric relation and in excursive movements. These
changes may be the result of reduced edema,
reduced inflammation, and/or reduced muscle
splinting/tonicity. Patients are seen at 2 to 4 week
intervals until the TMD signs and symptoms have
markedly disappeared.
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87. Ideally, the patients should be “weaned” off of the
splint, first during the day and then during sleeping
hours.
If modest to good improvement is not made within 4
weeks, patients should be referred to a TMD
specialist.
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88. Adjunctive TMD Therapy
Over a limited time, splint therapy may be all that is
needed to eliminate bruxism and/or TMD signs and
symptoms.
Adjunctive therapy that may help in TMD therapy
includes, but is not limited to, physical therapy,
counseling, nonsteroidal anti-inflammatory drugs,
biofeedback, and selective occlusal equilibration
therapy.
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89. It has been shown that some patients who did not
obtain complete relief of their bruxism and/or TMD
symptoms after prolonged use of a splint, did
improve when selective occlusal equilibration was
added to their therapy. However, dentists should
attempt to equilibrate the occlusion only if they
possess the appropriate knowledge and skill.
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90. If modest to good TMD improvement is not made
within 4 weeks of initiating therapy, patients should
be re-evaluated or referred to a TMD specialist. In
this instance, other diagnoses and factors should be
considered including chronic pain behavior,
misdiagnosis, and TMJ internal derangements.
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91. Complications of Occlusal Device Therapy
Tooth caries, gingival inflammation, and/or mouth
odors are the result of poor compliance by the
patient to maintain cleanliness of the device and the
underlying teeth and gingivae.
A few patients may complain that the device
interferes with the tongue space. This problem is
corrected by locating the lingual areas of the
occlusal device that restrict tongue movement in
function.
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92. Pressure- indicating paste is applied to the occlusal
device and then inserted into the mouth. The patient
is asked to swallow and then speak a few words. The
occlusal device is removed from the mouth, and the
areas on the device where paste has been rubbed
off are thinned and/or shortened with a carbide
denture bur.
In the bruxism patient, occasional minor teeth
discomfort, masticatory muscle myalgia, and/or an
uncomfortable “bite” may be reported. These
problems are resolved by refinement of the occlusal
device to produce a more stable, mutually protected
occlusion.
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93. Patients with TMD who report no improvement on
postinsertion visits should be reevaluated. The first
step is to refine the mutually protected occlusion on
the occlusal device. If discomfort persists at future
visits, refer the patient for adjunctive TMD therapy.
Some patients may develop a psychological
addiction or dependence to wearing the occlusal
device. It is the responsibility of the dentist to monitor
these patients for as long as they continue to wear
the device to ensure there are no irreversible
changes in the interocclusal relations.
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94. An electromyographic study of aspects of
'deprogramming' of human jaw muscles.
Donegan SJ, Carr AB, Christensen LV, Zieber GJ.
(1990)
Surface electromyograms from the right and left
masseter and anterior temporalis muscles were used
to detect peripheral correlates of deprogramming, of
jaw elevator muscles. Putative deprogramming was
attempted through the clinically recommended use of
a leaf gauge, placed for 15 min between the
maxillary and mandibular anterior teeth and
disoccluding the posterior teeth by about 2 mm.
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95. Use of the leaf gauge did not affect normalized
postural activity (about 4%), the duration (about 900
ms) and static work efforts of clenching (about 1200
microV.s), the time to peak mean voltage of
clenching (about 400 ms), and the peak mean
voltage of clenching (about 300 microV). Activity and
asymmetry indices showed that the studied motor
innervation patterns were not changed by the leaf
gauge.
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96. Occlusal splint on the temporal and masseter muscles
in patients with functional disorders and nocturnal
bruxism.
Sheikholeslam A, Holmgren K, Riise C. (1986)
The postural activity of the temporal and masseter
muscles in thirty-one patients with signs and
symptoms of functional disorders were studied:
before, during and after 3-6 months of occlusal splint
therapy. The fluctuating signs and symptoms, as well
as the postural activity of the temporal and masseter
muscles were significantly reduced after treatment.
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97. After cessation of the splint therapy the signs and
symptoms recurred to the pre-treatment level within
1-4 weeks in about 80% of the patients. The results
indicate that an occlusal splint can eliminate or
diminish signs and symptoms of functional disorders
and re-establish symmetric and reduced postural
activity in the temporal and masseter muscles, which
can facilitate procedures, such as functional analysis
and occlusal adjustment.
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98. Occlusion in temporomandibular disorders:
treatment after occlusal splint therapy
Hobo S (1996)
The concept of using the condylar path as the
reference for occlusion is questionable for the patient
whose temporomandibular joint has pathological
changes because the condylar path of TMD patient
deviates greatly. After occlusal splint therapy it is
suggested that the patient's occlusion be treated
using the Twin-Stage Procedure which does not
require measurement of the condylar path
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99. The research findings that occlusion controls the
condylar path seems to support the concept that if
the dentist creates the occlusion properly, the
condylar path may be corrected and thereby
minimise the micro-trauma which causes TMD.
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100. Critical evaluation of orthopedic interocclusal
appliance therapy
Clark GT. (1984)
This paper reviewed the effectiveness of occlusal
splints on specific symptoms that are often
associated with TM disorders. The research has
shown the clicking TMJ is sometimes helped but not
cured by the traditional stabilization interocclusal
appliance and that TMJ clicking is the least
responsive to treatment. Questions have been raised
about the need to specifically treat the clicking joint;
more research on this issue is necessary.
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101. Painful TMJs have been shown to respond to
occlusal appliance therapy, but questions still exist
about the effectiveness of interocclusal appliances
for this symptom. There is little scientific proof
available about the ability of splints to effectively
slow down or reverse degenerative TMJ changes
that are evident on radiographs. Masticatory muscle
pain is by far the symptom that has the best
experimental evidence to support occlusal splints as
a highly effective method of treatment. These
changes are probably mediated via an alteration in
the patient's muscle activity patterns.
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102. Those patients with more severe symptoms are less
likely to be helped with splints as a sole treatment
modality. The effect of occlusal appliances in muscle
trismus has been discussed but not effectively
evaluated in the literature. Occlusal splints have
been shown to have a distinct influence on improving
mandibular muscle coordination. Inter-occlusal
splints are a commonly used method of controlling
attrition and adverse tooth loading, and few
questions have been raised in the literature about
this therapeutic application.
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103. Occlusal stabilization appliances - Evidence of
their efficacy
Kreiner M, Betancor E, Clark GT (2001)
BACKGROUND: There is substantial controversy
regarding the value of occlusal appliances for
managing temporomandibular joint disorders. This
article specifically assessed whether the evidence is
sufficient to judge occlusal appliances as being
efficacious for the management of localized
masticatory myalgia, arthralgia or both. A major
confounder is that few studies have measured or
evaluated whether subjects had strong, ongoing
parafunctional activity (such as clenching or grinding)
and whether appliances influenced this behavior.
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104. LITERATURE REVIEWED: The authors evaluated
four placebo-controlled studies, several randomized
wait-list controlled studies and several random-
assignment treatment-comparison studies. Data from
the wait-list condition studies vs. those from the
occlusal appliance condition studies consistently
suggested that the latter treatment's effect on patient
symptom level is far more than that of no treatment
on a wait-list group's condition. In contrast, the
studies on placebo-controlled vs. occlusal appliance
studies yielded a mix of data: two showed a positive
benefit of occlusal vs. nonoccluding appliances, and
two showed a null effect or no difference.
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105. CONCLUSIONS: Considering all of the available
data (pro and con), the authors concluded that the
use of occlusal appliances in managing localized
masticatory myalgia, arthralgia or both is sufficiently
supported by evidence in the literature. CLINICAL
IMPLICATIONS: The mechanism of action by which
occlusal appliances affect localized myalgia and
arthralgia probably is behavioral modification of jaw
clenching. However, if the behavior continues
unabated, even the best splint will not work.
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106. Clinical comparison between two different splint
designs for temporomandibular disorder therapy.
Jokstad A, Mo A, Krogstad BS (2005)
OBJECTIVE: To compare splint therapy in
temporomandibular disorder (TMD) patients using
two splint designs. MATERIAL AND METHODS: In a
double-blind randomized parallel trial, 40 consenting
patients were selected from the dental faculty pool of
TMD patients. Two splint designs were produced: an
ordinary stabilization (Michigan type) and a NTI
(Nociceptiv trigeminal inhibition). The differences in
splint design were not described to the patients. All
patients were treated by one operator.
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107. A separate, blinded, examiner assessed joint and
muscle tenderness by palpation and jaw opening
prior to splint therapy, and after 2 and 6 weeks’ and
3 months' splint use during night-time. The patients
reported headache and TMD-related pain on a visual
analog scale before and after splint use, and were
asked to describe the comfort of the splint and
invited to comment. RESULTS: Thirty-eight patients
with mainly myogenic problems were observed over
3 months.
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108. A reduction of muscle tenderness upon palpation
and self-reported TMD-related pain and headache
and an improved jaw opening was seen in both splint
groups. There were no changes for TM joint
tenderness upon palpation. No differences were
noted between the two splint designs after 3 months
for the chosen criteria of treatment efficacy.
CONCLUSION: No differences in treatment efficacy
were noted between the Michigan and the NTI splint
types when compared over 3 months.
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109. The use of a deprogramming appliance to obtain
centric relation records.
The purpose of this study was to investigate the
effect of an anterior flat plane deprogramming
appliance (Jig) in 40 subjects for whom centric
relation (CR) records were obtained before and after
the use of the appliance. Incisal overbite and overjet
dimensions and three-dimensional instrument
condylar representation using the Panadent condylar
path indicator (CPI) were recorded from maximum
intercuspation and centric relation. Subjects were
assessed subjectively to determine the degree of
difficulty manipulating the mandible to obtain the
centric relation record.
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110. The mean overbite difference from maximum
intercuspation (MI) to centric relation without (CR)
and with (CRJ) the appliance were statistically
significant and decreased 1.58 mm and 2.23 mm,
respectively. The mean overjet values from MI to CR
and CRJ were statistically significant and increased .
44 mm and .57 mm, respectively. Significant
differences were determined on the Panadent
articulator for the absolute vertical (Z) and absolute
horizontal (X) values for centric relation with and
without the appliance.
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111. The number of subjects who exceeded the threshold
values of 2 mm for CPI recordings in either the
horizontal or vertical direction was 7 (18%,) from MI
to CR and 16 (40%) from MI to CRJ. The Lucia-type
jig deprogramming appliance provides a centric
relation record with greater displacement from MI
than a centric relation record alone. This appliance
may be a useful adjunct in a patient where
mandibular manipulation in taking a centric relation
bite registration is deemed not easy
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112. Conclusion
Understanding the relationship between occlusion
and functional disorders of the masticatory system is
no easy task. The static, functional, and dynamic
relationships of the occlusal condition to the signs
and symptoms of masticatory dysfunction should be
well understood. In TMJ therapy, as with most
treatments, the patient's improvement is closely
connected to a proper diagnosis based on sound
physiologic principles.
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113. Interocclusal orthopedic appliances of varied design
and application have been employed in the treatment
of myofascial pain dysfunction (MPD) and
temporomandibular joint disorders (TMD). These
appliances provide the practitioner with a non-
invasive, reversible form of intervention to manage
the patient's symptoms. These appliances are often
used in conjunction with other forms of treatment
such as physiotherapy or medication.
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114. References
Moloney and Howard: Internal derangements of the
temporomandibular joint. III. Anterior repositioning
splint therapy. Aust. Dent. J. 31:30, 1986.
Ronquillo, Guay, Tallents, Katzberg, Murphy and
Proskin: Comparison of condyle-fossa relationships
with unsuccessful protrusive splint therapy. Cranio.
2:178, 1988.
Okeson: Long term treatment of disc-interference
disorders of the TMJ with anterior repositioning
occlusal splints. J. Prosthet. Dent. 60:611, Nov 1988.
www.indiandentalacademy.com
115. Liedberg and Westesson: Sideways position of the
temporomandibular joint disc: Coronal cryosectioning
of fresh autopsy specimens. Oral Surg. Oral Med.
Oral Pathol. 66:644, Dec 1988.
Lous: Treatment of TMJ syndrome by pivots. J.
Prosthet. Dent. 40:179, Aug 1978.
Tallents, Katzberg, Millar, Manzione, Macher and
Roberts: Arthrographically assisted splint therapy:
painful clicking with a nonreducing meniscus. Oral
Surg. Oral Med. Oral Pathol. 61:2, Jan 1986
www.indiandentalacademy.com
116. Okeson: The effects of hard and soft occlusal splints
on nocturnal bruxism. J. Am. Dent. Assoc. 114:788,
Jun 1987.
Karl PJ, Foley TF. The use of a deprogramming
appliance to obtain centric relation records. Angle
Orthod. 1999 Apr;69(2):117-24; discussion 124-5.
Wood and Tobias: EMG response to alteration of
tooth contacts on occlusal splints during maximal
clenching. J. Prosthet. Dent. 51:394, Mar 1984.
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117. Williamson and Lundquist: Anterior guidance: its
effect on EMG activity of the temporal and masseter
muscles. J. Prosthet. Dent. 49:816, 1983.
Rugh and Drago: Vertical dimension: A study of
clinical rest position and jaw muscle activity. J.
Prosthet. Dent. 45:670, Jun 1981.
Ramfjord, Ash: Occlusion , 3rd
Edition, Philadelphia:
WB Saunders Co 1971
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118. Donegan SJ, Carr AB, Christensen LV, Ziebert
GJ.An electromyographic study of aspects of
'deprogramming' of human jaw muscles. J Oral
Rehabil. 1990 Nov;17(6):509-18.
Dylina TJ.A common-sense approach to splint
therapy J Prosthet Dent. 2001 Nov;86(5):539-45.
Clark GT. A critical evaluation of orthopedic
interocclusal appliance therapy: effectiveness for
specific symptoms.J Am Dent Assoc. 1984
Mar;108(3):364-8.
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119. Kreiner M, Betancor E, Clark GT. Occlusal
stabilization appliances. Evidence of their efficacy. J
Am Dent Assoc. 2001 Jun;132(6):770-7.
Jokstad A, Mo A, Krogstad BS. Clinical comparison
between two different splint designs for
temporomandibular disorder therapy Acta Odontol
Scand. 2005 Aug;63(4):218-26.
Gray RJ, Davies SJ. Occlusal splints and
temporomandibular disorders: why, when, how?
Dent Update. 2001 May;28(4):194-9.
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120. Batra P, Rao L, Bhattacharya A, Duggal R, Prakash
H: Muscle Deprogramming- An Orthodontist
perspective. J Ind Orthod Soc 2002; 35; 113-117
Boero RP.The physiology of splint therapy: a
literature review. Angle Orthod. 1989 Fall;59(3):165-
80
Du Pont J, Brown C: Occlusal slplints from beginning
to the present. Journ Cran Mand Pract 2006 ; 24(2);
141-45
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121. Gross MD, Ormianer Z, Moshe K, Gazi E.Integrated
electromyography of the masseter on incremental
opening and closing with audio biofeedback: a study
on mandibular posture.Int J Prosthodont. 1999 Sep-
Oct;12(5):419-25.
Michelotti A, Farella M, Vollaro S, Martina
R.Mandibular rest position and electrical activity of
the masticatory muscles.
J Prosthet Dent. 1997 Jul;78(1):48-53.
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122. Thank you
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