10 comments (Add your own)

1. Don Mungcal, DDS wrote:

Is a B-splint the same as a Kois Deprogrammer? And if it is, would the acrylic on the lingual posterior affect the anterior discluding reflex we are trying to take advantage of? In other words, because we have something hard like acrylic against the lingual posteriors, would that cause grinding??

With the NTI, sometimes lower anteriors are not all on the same level and its hard for the lower jaw to move freely when the NTI hits a #26 for example that is lower or higher than the rest of the lower anteriors. Isn't it important for the lower jaw to move in excursions smoothly? What would you recommend in a situation like this?

April 9, 2007 @ 7:01 PM

2. Shannon Johnson, DMD wrote:

I am not incredibly familiar with the Kois appliance, so I cannot comment on it well. In theory all anterior deprogrammers are similar. It is the subtle designs that differ.

The way we fabricate our B-splints is with a thin 1mm vacuum formed splint material around the entire arch. Posterior areas are covered only by the 1mm splint material and provide (1) retention of the appliance and (2)further discourage any supraeruption of posterior teeth. A flat plane of acrylic is then added to the anterior segment, keeping only on the incisors. It is critical that the plane is perpendicular to the lower incisor plane of occlusion to prevent distalization of the condyles. There is no contact on posterior teeth and consequently muscle activity is reduced. There is no evidence that I am aware of that states that having acrylic against the lingual surfaces causes grinding (if you have something to the contrary, please send it). Even if it did, the muscle activity generated by the anterior teeth contacting is significantly less than posterior teeth occluding.

Your second point is well made. Yes you want smooth transitions into excursive movements. Teeth can become very sore if it is not smooth and in some cases the lateral ptergoid muscles still have to work negating the benefit of the appliance. The way Dr. Wilkerson works around uneven lower anterior teeth is to fabricate another vacuum formed splint for the lower arch and then add enough acrylic to give yourself a flat plane. Therefore, you create two completely flat planes/surfaces rubbing against one another that is smooth. He has begun doing this technique in most cases to prevent sore lower teeth. This can really help in crossover situations because you can bring the lower plane in lingually enough that you can still keep flat planes contacting in extreme crossover situations.

April 9, 2007 @ 10:09 PM

3. Don Mungcal, DDS wrote:

To clarify the B-splint, when you say lower incisors, you mean 23, 24, 25, 26, correct? Canines or 22 and 27 do not occlude on the flat plane? And if you don't have lower incisors level, then you make a 2nd appliance for the lower that would level the occluding surfaces of those incisors?

I have a case right now were I'm trying to deprogram a patient that has this stubborn pain. Originally, I had the patient on a CR, anterior guidance TMJ appliance that I adjusted probably 3 or 4 times on him. This usually works on 90% of my patients. If this doesn't work, then I used an NTI as a deprogrammer and this usually does it except for this one. I assumed it didn't work because the NTI wasn't stable enough on the upper anteriors. I then made a Kois deprogrammer which is basically a custom made NTI that's built like a Hawley appliace so its more stable than a prefabricated NTI. That also didn't work, and I think because the lower incisors on this patient weren't level. The transition movement during excursions weren't smooth. So my next step now is your description on Dr. Wilkerson technique. Any other suggestions or things to watch out for?? By the way I also referred him to a neurologist and he thinks its dental related. His pain is mostly on the masseters and lateral pterygoids.

April 10, 2007 @ 7:59 PM

4. Don Mungcal, DDS wrote:

In addition to what I said above, another option I'm thinking about is making a Gothic Arch Tracer device for my patient as a muscle deprogrammer. What do you think about that? I have a kit that I could give to my laboratory to make me one easily.

April 10, 2007 @ 9:57 PM

5. Steven D Bender DDS wrote:

Hi Don,
You may want to fabricate the NTI or other enhanced deprogramer on the lower arch. This would serve to "even" the incisal plane. The lower arch fabrication also allows for more mandibular movement with out cuspid contact. For this reason, The NTI manufacturer now recommends the lower arch as the first option.
Good luck,
Steve

July 18, 2007 @ 9:08 AM

6. Shannon Shaw wrote:

Does the Occlusal Guard help with snoring

February 19, 2008 @ 3:54 PM

7. Shannon Shaw wrote:

The reason for question does the OG help with snoring is because I recently had a sleep study done which indicated that I do not have sleep apnea but a very bad case of the snores. It was suggested to me that I try the OG. Therefore, will it work for me.

February 19, 2008 @ 3:57 PM

8. jim kotsis wrote:

Dear Mr.Dawson,after orthodontic therapy which is the best retainer for stability since often the Hawley retainers demonstrate interferences in centric relations?
Sincerely yours ,
Jim Kotsis

February 20, 2008 @ 11:54 AM

9. Hector Valladares wrote:

Dear friemds;
As a patient who suffer of the problems of TMD; I want to ask if these methods
are efficient:

1, El method of obtain the centric relation with the tongue;
2, El method of use the plastic pad called "Aqualizer" for obtean the centric relation with it.

What opinions have you about these methods.

March 29, 2008 @ 7:16 PM

10. Debbie Shields - Tupelo Smiles wrote:

What is the correct code to file Hawley Retainers ? D8680

June 28, 2010 @ 3:22 PM

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