muscle programming / orthodontic courses by indian dental academy

Muscle Muscle Programming Programming and and DeprogrammingDeprogramming

INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.com

ContentsContents

IntroductionIntroductionMuscle physiologyMuscle physiologyRole of Muscles in orthodonticsRole of Muscles in orthodonticsMuscle programmingMuscle programmingMuscle deprogrammingMuscle deprogrammingSummary Summary


IntroductionIntroduction


ParadigmParadigmIINNTTRROODDUUCCTTIIOONN ParadigmParadigm


Shift in ParadigmShift in Paradigm

IINNTTRROODDUUCCTTIIOONN



Cause of Cause of MalocclusionMalocclusion

Cause of RelapseCause of RelapseMuscular ImbalanceMuscular Imbalance

Shift in ParadigmShift in Paradigm



Admittedly, the mission of an Admittedly, the mission of an Orthodontist is no longer Divine (i.e. Orthodontist is no longer Divine (i.e.

carrying out Nature’s plan) but Human.carrying out Nature’s plan) but Human.


Muscle PhysiologyMuscle Physiology


What is MuscleWhat is Muscle??

MMUUSSCCLLEE

PPHHYYSSIIOOLLOOGGYY


Elasticity and ContractilityElasticity and Contractility

MMUUSSCCLLEE



Myotatic ReflexMyotatic Reflex

MMUUSSCCLLEE


These are reflex contractions of These are reflex contractions of HealthyHealthy muscle which results from a pull on its muscle which results from a pull on its tendon.tendon.

All or None LawAll or None LawThe intensity of the contraction of any muscle The intensity of the contraction of any muscle fiber is independent of the strength of the fiber is independent of the strength of the exciting stimulus.exciting stimulus.


Role of Muscles Role of Muscles In OrthodonticsIn Orthodontics


Concept By Melvin MossConcept By Melvin Moss

MMUUSSCCLLEE

IINN

OORRTTHHOODDOONNTTIICCSS

Orofacial capsuleOrofacial capsule

Neurocranial capsuleNeurocranial capsule


Muscles as basis of Myofunctional TherapyMuscles as basis of Myofunctional Therapy

MMUUSSCCLLEE

IINN



Post Treatment RetentionPost Treatment Retention

MMUUSSCCLLEE

IINN



Muscle ProgrammingMuscle Programming


Muscle Programming Muscle Programming is a term is a term applied to process by which applied to process by which muscles are trained in a specific muscles are trained in a specific way to attain proper form, way to attain proper form, function and stability of hard function and stability of hard and soft tissues in surrounding.and soft tissues in surrounding.

MMUUSSCCLLEE

PPRROOGGRRAAMMMMIINNGG


Muscle ProgrammingMuscle ProgrammingMMUUSSCCLLEE


Muscle Muscle ExerciseExercise

Myofunctional Myofunctional TherapyTherapy


Muscle ExerciseMuscle Exercise

MMUUSSCCLLEE


Alfred P. Rogers, was the first Alfred P. Rogers, was the first person to propose Muscle person to propose Muscle ExercisesExercises

He is known for his concept of He is known for his concept of Muscle as Living Orthodontic Muscle as Living Orthodontic ApplianceAppliance


MMUUSSCCLLEE


Muscle Exercise as applied Muscle Exercise as applied to Orthodontics and Dentofacial to Orthodontics and Dentofacial Orthopedics is defined as the Orthopedics is defined as the Controlled RhythmicControlled Rhythmic contraction of the muscles contraction of the muscles around the teeth and jaws to around the teeth and jaws to achieve normal function and achieve normal function and development of these structures.development of these structures.


MMUUSSCCLLEE


Muscles exercises Muscles exercises are divided into are divided into following following

Lip exercisesLip exercises Tongue exercises Tongue exercises Mastication muscle Mastication muscle

exercisesexercises


MMUUSSCCLLEE


Various Muscle Various Muscle Exercises areExercises are

Blowing BaloonsBlowing Baloons Button Pull Button Pull

ExerciseExercise Gum Drop ExerciseGum Drop Exercise Weighted StringWeighted String Lip Pull ExerciseLip Pull Exercise Lip PufferLip Puffer Mechanical Mechanical

StimulatorStimulator Card pull ExerciseCard pull Exercise Wooden Spatula Wooden Spatula

ExerciseExercisewww.indiandentalacademy.com

MMUUSSCCLLEE





ExerciseExercisewww.indiandentalacademy.com

MMUUSSCCLLEE





ExerciseExercise

Patient is asked to Patient is asked to hold the wooden hold the wooden spatula (with little spatula (with little amount of weight) amount of weight) between upper and between upper and lower lipslower lips

Holding time –15–Holding time –15–20secs20secs


MMUUSSCCLLEE


Ask the patient to stretch the upper lip Ask the patient to stretch the upper lip over the labial surfaces of upper anteriors over the labial surfaces of upper anteriors and hold it lingual to the lower incisors. and hold it lingual to the lower incisors. Holding time – 30 secondHolding time – 30 secondFrequency – 15 to 20 times a dayFrequency – 15 to 20 times a dayThis will improve the tonicity of upper lipThis will improve the tonicity of upper lip

For Hypotonicity of Upper LipFor Hypotonicity of Upper Lip


MMUUSSCCLLEE


For Hypotonicity of Upper LipFor Hypotonicity of Upper Lip


MMUUSSCCLLEE


Ask the patient to raise the lower lip over the labial surfaces of upper lip and hold it in close approximation with the upper lip. Holding time – 30 secondFrequency – 15 to 20 times a dayThis will improve the tonicity of lower lip

For Hypotonicity of Lower LipFor Hypotonicity of Lower Lip


MMUUSSCCLLEE


For Hypotonicity of Lower LipFor Hypotonicity of Lower Lip


MMUUSSCCLLEE


Ask the patient to lower down the Ask the patient to lower down the chin with the help of forefinger chin with the help of forefinger and thumband thumb

Raise the lower lip to contact with Raise the lower lip to contact with upper lipupper lip

Holding time 10-15 secsHolding time 10-15 secsFrequency 10 – 15 times a dayFrequency 10 – 15 times a day

Mentalis Muscle ExerciseMentalis Muscle Exercise


MMUUSSCCLLEE


Mentalis Muscle ExerciseMentalis Muscle Exercise


MMUUSSCCLLEE


Wilson’s ExerciseWilson’s Exercise Ask the patient to stand in front of mirrorAsk the patient to stand in front of mirror Close the jaws in centric occlusionClose the jaws in centric occlusion Contract the left corner of mouth so that it Contract the left corner of mouth so that it

will move laterally and downwardswill move laterally and downwards With the palmer surface of the left hand With the palmer surface of the left hand

press the right cheek medially and close press the right cheek medially and close the right nostril with the forefinger of left the right nostril with the forefinger of left hand, simultaneously.hand, simultaneously.

Take deep breath from left nostril and hold Take deep breath from left nostril and hold it for 10 to 15 secs and then exhale slowlyit for 10 to 15 secs and then exhale slowly

This exercise is performed 3-4 times on This exercise is performed 3-4 times on one side and then same procedure is one side and then same procedure is repeated for the other siderepeated for the other side

This whole procedure is done twice a dayThis whole procedure is done twice a daywww.indiandentalacademy.com

MMUUSSCCLLEE


Wilson’s ExerciseWilson’s Exercise


MMUUSSCCLLEE


It is indicated in cases in mild It is indicated in cases in mild mandibular deficiencies.mandibular deficiencies.

Care should be taken that incisors Care should be taken that incisors should have normal inclinationshould have normal inclination

Ask the patient to protrude the lower Ask the patient to protrude the lower jaw so as to engage the lower jaw so as to engage the lower incisors labial to the upper incisorsincisors labial to the upper incisors

Holding time – 10-15 secsHolding time – 10-15 secsFrequency – 10 – 15 times a dayFrequency – 10 – 15 times a day

Pterygoid ExercisesPterygoid Exercises


MMUUSSCCLLEE


Pterygoid ExercisesPterygoid Exercises


MMUUSSCCLLEE


Ask the patient to touch the tip of Ask the patient to touch the tip of the tongue in the rugae area of the tongue in the rugae area of palate and swallow with teeth in palate and swallow with teeth in occlusion.occlusion.

( Teeth together Swallow)( Teeth together Swallow)Frequency 30 to 40 times a dayFrequency 30 to 40 times a dayThis will correct the abnormal This will correct the abnormal

swallowing pattern.swallowing pattern.

Tongue ExerciseTongue Exercise


MMUUSSCCLLEE


Tongue ExerciseTongue Exercise


MMUUSSCCLLEE


Ask the patient to clench the teeth Ask the patient to clench the teeth on right and left side on right and left side alternatively.alternatively.

While doing so patient should feel While doing so patient should feel (palpate) at the angle of jaws (palpate) at the angle of jaws for massater and at the temple for massater and at the temple region for temporalisregion for temporalis

Frequency 10 – 15 times a dayFrequency 10 – 15 times a day

Temporalis and Masseter Temporalis and Masseter Ex.Ex.


MMUUSSCCLLEE


VoiceGym is designed to correct VoiceGym is designed to correct tongue position and rebalance face tongue position and rebalance face muscles in favor of the tongue being muscles in favor of the tongue being suspended in the palate. suspended in the palate.

Programming of Face and Programming of Face and tongue muscles using Voice tongue muscles using Voice GymGym - Angela Caine


MMUUSSCCLLEE


If the palate is underdeveloped however, it If the palate is underdeveloped however, it may be necessary to coordinate VoiceGym may be necessary to coordinate VoiceGym Exercises with functional orthodontics to Exercises with functional orthodontics to restore the width of the arch. restore the width of the arch. Arch width is then maintained by the Arch width is then maintained by the tongue articulating against the palate, thus tongue articulating against the palate, thus stimulating bone developmentstimulating bone development

Programming of Face and Programming of Face and tongue muscles using Voice tongue muscles using Voice GymGym - Angela Caine


MMUUSSCCLLEE


Studies related to Muscle Studies related to Muscle ExerciseExercise

J.D. EnglishJ.D. English, , M. TranM. Tran, , P. BuschangP. Buschang, and , and G. ThrockmortonG. Throckmorton, Baylor College of , Baylor College of Dentistry, Dallas, TX, USA studied Muscle Dentistry, Dallas, TX, USA studied Muscle Exercise Effects on the Early Treatment of Exercise Effects on the Early Treatment of Skeletal Open Bite MalocclusionsSkeletal Open Bite Malocclusions

Sample - 31Sample - 31

They found that clenching exercises helped They found that clenching exercises helped control the vertical dimension and its control the vertical dimension and its effects on facial morphology may help to effects on facial morphology may help to reduce aberrant vertical growth patternsreduce aberrant vertical growth patterns


MMUUSSCCLLEE



Orthodontic treatment and masticatory muscle exercises Orthodontic treatment and masticatory muscle exercises to correct a Class I open bite in an adult patient.to correct a Class I open bite in an adult patient.

English JD, Lindsey CA, AJO-DO 2003English JD, Lindsey CA, AJO-DO 2003

Results were similar to their previous studyResults were similar to their previous study


MMUUSSCCLLEE



Masticatory Exercise as an Adjunctive Treatment for Masticatory Exercise as an Adjunctive Treatment for Hyperdivergent PatientsHyperdivergent PatientsLaurie R. Parks; Peter H. Buschang; Richard A. Alexander; Laurie R. Parks; Peter H. Buschang; Richard A. Alexander; Paul Dechow; Paul Emile RossouwcPaul Dechow; Paul Emile RossouwcThe Angle Orthodontist: Vol. 77, No. 3, pp. 457–462The Angle Orthodontist: Vol. 77, No. 3, pp. 457–462

Sample - 50Sample - 50

They concluded that Masticatory muscle They concluded that Masticatory muscle exercise performed during the treatment of exercise performed during the treatment of hyperdivergent patients produced greater hyperdivergent patients produced greater increases in overbite than treatment alone.increases in overbite than treatment alone.


MMUUSSCCLLEE


Studies related to Muscle Studies related to Muscle ExerciseExerciseUrs Thüer and Bengt IngervallUrs Thüer and Bengt Ingervall studied the effect of studied the effect of

muscle exercise with an oral screen on lip functionmuscle exercise with an oral screen on lip function The European Journal of Orthodontics 1990 12(2):198-208The European Journal of Orthodontics 1990 12(2):198-208

They drew following conclusionsThey drew following conclusions The treatment resulted in a decrease of the overjet The treatment resulted in a decrease of the overjet

and upper dental arch length, but with some and upper dental arch length, but with some relapse after the treatment.relapse after the treatment.

The strength of the lips increased during the The strength of the lips increased during the treatment, but decreased afterwards. treatment, but decreased afterwards.

The pressure from the lips on the teeth at rest and The pressure from the lips on the teeth at rest and during swallowing was unaffected by the lip during swallowing was unaffected by the lip training. training.

The pressure from the lower lip during chewing The pressure from the lower lip during chewing increased temporarily during the treatment period.increased temporarily during the treatment period.


Muscle DeprogrammingMuscle Deprogramming


Muscle Deprogramming Muscle Deprogramming is a term is a term applied to process by which applied to process by which muscles are allowed to revert back muscles are allowed to revert back to unstrained, normal functional to unstrained, normal functional relationship by the means of some relationship by the means of some kind of inter-occlusal appliance.kind of inter-occlusal appliance.

MMUUSSCCLLEE

DDEEPPRROOGGRRAAMMMMIINNGG


Inter-Occlusal SplintsInter-Occlusal Splints(Deprogramming Splints)(Deprogramming Splints)

MMUUSSCCLLEE


Diagnostic Diagnostic SplintsSplints

Therapeutic Therapeutic SplintsSplintsOcclusal splints are removable Occlusal splints are removable

appliances that are usually made of appliances that are usually made of hard acrylic and fit over the occlusal hard acrylic and fit over the occlusal surface of either the maxillary or surface of either the maxillary or mandibular dentition to create a mandibular dentition to create a precise occlusal relationship with the precise occlusal relationship with the teeth of the opposing arch or to teeth of the opposing arch or to eliminate occlusal contactseliminate occlusal contactswww.indiandentalacademy.com

MMUUSSCCLLEE



These type of Splints are used to These type of Splints are used to diagnose the discrepancy diagnose the discrepancy between Centric Relation (CR) between Centric Relation (CR) and Centric Occlusion (CO).and Centric Occlusion (CO).


MMUUSSCCLLEE



If there is an improper relationship between the If there is an improper relationship between the upper and lower jaws and/or the upper and upper and lower jaws and/or the upper and lower teeth, the patient will be required to lower teeth, the patient will be required to wear temporary oral appliances (Splint). wear temporary oral appliances (Splint).

The objective of the splint is to try and establish The objective of the splint is to try and establish

the correct position of the mandible to the the correct position of the mandible to the maxilla in three dimensions; namely, maxilla in three dimensions; namely, transverse, sagittal and verticaltransverse, sagittal and vertical


MMUUSSCCLLEE




MMUUSSCCLLEE



A temporary deprogramming A temporary deprogramming splint is frequently used for splint is frequently used for breaking Neuro-muscular breaking Neuro-muscular imbalances. imbalances.

The MAGO (Maxillary Anterior The MAGO (Maxillary Anterior Guided Orthotic) is just one Guided Orthotic) is just one example of a modern attempt to example of a modern attempt to aid identification and then aid identification and then recording of a stable condylar recording of a stable condylar position position - H. Stean- H. Steanwww.indiandentalacademy.com

MMUUSSCCLLEE



The "CR" splint captures the orientation of The "CR" splint captures the orientation of the condyle during the last few millimeters of the condyle during the last few millimeters of closure, when the condyle has been seated closure, when the condyle has been seated and braced against the slope of the and braced against the slope of the eminenceeminence


MMUUSSCCLLEE



Ronald Roth (Functional Occlusion for Ronald Roth (Functional Occlusion for Orthodontist)Orthodontist)

Two greatest causes of failure of Two greatest causes of failure of orthodontic treatmentorthodontic treatment

• Failure to stabilize and then capture true Failure to stabilize and then capture true centric relation prior to occlusal therapy.centric relation prior to occlusal therapy.

• Failure to alter the occlusion with a high Failure to alter the occlusion with a high enough degree of precision to hold centric enough degree of precision to hold centric and still clear on movement.and still clear on movement.


MMUUSSCCLLEE



Ronald Roth (Functional Occlusion for Ronald Roth (Functional Occlusion for Orthodontist)Orthodontist)

Unmasking the DiscrepancyUnmasking the Discrepancy


MMUUSSCCLLEE


Therapeutic Therapeutic SplintsSplints

Therapeutic splints are Therapeutic splints are Interocclusal appliances generally Interocclusal appliances generally used to relieve TMJ pain used to relieve TMJ pain originating due to some kind of originating due to some kind of pathology like Bruxismpathology like Bruxism


MMUUSSCCLLEE



Progressive Appliance therapyProgressive Appliance therapyChristopher J. Christopher J.

StevensStevens

•Mandibular Decompression Appliance Mandibular Decompression Appliance (MDA)(MDA)•Hard Pivotal ApplianceHard Pivotal Appliance•Muscle Rehabilitation ApplianceMuscle Rehabilitation Appliance•Neuromuscular Demand ApplianceNeuromuscular Demand Appliance


MMUUSSCCLLEE



Mandibular Decompression Mandibular Decompression ApplianceAppliance

•May be utilized in the diagnosis & May be utilized in the diagnosis & treatment of all occlusal dysfunctions treatment of all occlusal dysfunctions & cranio-mandibular disorders& cranio-mandibular disorders

•Bioplast SplintBioplast Splint•Soft Pivot ApplianceSoft Pivot Appliance•Pain Release SplintPain Release Splint•Temporary Diagnostic ApplianceTemporary Diagnostic Appliance


MMUUSSCCLLEE



Mandibular Decompression Mandibular Decompression ApplianceAppliance

•The primary indication for the MDA is The primary indication for the MDA is TMJ pain.TMJ pain.•The secondary indication is The secondary indication is dysfunction.dysfunction.•It can also be helpful in diagnosis.It can also be helpful in diagnosis.•The appliance allows proprioceptive The appliance allows proprioceptive deprogramming of masticatory deprogramming of masticatory muscles, and support of vertical muscles, and support of vertical dimension.dimension.www.indiandentalacademy.com

MMUUSSCCLLEE



Hard Pivotal ApplianceHard Pivotal Appliance

Features of the pivot appliance:Features of the pivot appliance:

1.1.Used as an initial follow up to the Used as an initial follow up to the MDAMDA

2. Provides further decompression of 2. Provides further decompression of the joints.the joints.

3. Assists in reprogramming vertical, 3. Assists in reprogramming vertical, A-P, and lateral orientation of the A-P, and lateral orientation of the mandible.mandible.

4. It is worn 24 hours, even when 4. It is worn 24 hours, even when eating.eating.


MMUUSSCCLLEE



Muscle Rehabilitation ApplianceMuscle Rehabilitation Appliance

Features of the muscle rehabilitation Features of the muscle rehabilitation appliance:appliance:

1.1.Used as a follow up to the hard Used as a follow up to the hard pivotal appliancepivotal appliance

2. Improves and rehabilitates muscle 2. Improves and rehabilitates muscle tonetone

3. Improves mandibular stability3. Improves mandibular stability

4. It is worn 24 hours, even when 4. It is worn 24 hours, even when eatingeating


MMUUSSCCLLEE



Neuromuscular Demand Neuromuscular Demand ApplianceAppliance•This appliance has occlusal anatomy This appliance has occlusal anatomy which maintains the 3-D which maintains the 3-D craniomandibular relationship. craniomandibular relationship.

•Features of the mandibular demand Features of the mandibular demand appliance:appliance:

•Predicts mandibular position for Predicts mandibular position for stabilization proceduresstabilization procedures

•Can be used for long term Can be used for long term maintenancemaintenance


MMUUSSCCLLEE



Anterior Repositioning SplintAnterior Repositioning Splint•Rationale of anterior repositioning Rationale of anterior repositioning splint is to diminish TMJ pain by splint is to diminish TMJ pain by unloading the Articular Diskunloading the Articular Disk


MMUUSSCCLLEE


Therapeutic Therapeutic SplintsSplintsOcclusal Splint therapy for Occlusal Splint therapy for

BruxismBruxism

Soft vacuum-formed Soft vacuum-formed polyvinyl splintspolyvinyl splints

The stabilization The stabilization splint with canine splint with canine

rampsramps

The NTI tension The NTI tension suppression system.suppression system.


MMUUSSCCLLEE


Therapeutic Therapeutic SplintsSplintsMechanisms Proposed for Oral Splint Mechanisms Proposed for Oral Splint

Efficacy/EffectivenessEfficacy/Effectiveness

•Myofacial painMyofacial pain•Change in the vertical dimension of Change in the vertical dimension of occlusionocclusion

•Repositioning of the temporomandibular Repositioning of the temporomandibular jointsjoints

•Decrease in the level of muscle activityDecrease in the level of muscle activity

•Reducing bruxismReducing bruxism

•Removal of occlusal interferencesRemoval of occlusal interferenceswww.indiandentalacademy.com

MMUUSSCCLLEE


Therapeutic Therapeutic SplintsSplintsMechanisms Proposed for Oral Splint Mechanisms Proposed for Oral Splint

Efficacy/EffectivenessEfficacy/Effectiveness

•Disc displacement disordersDisc displacement disorders•"Recapturing" the disc"Recapturing" the disc•““Unloading" the jointsUnloading" the joints

•Arthritis/arthralgiaArthritis/arthralgia•"Unloading" the joints"Unloading" the joints

•Sleep bruxismSleep bruxism•Removal of occlusal interferencesRemoval of occlusal interferences•Change in muscle activityChange in muscle activity


MMUUSSCCLLEE


Dr. N.R. Krishnaswamy (7Dr. N.R. Krishnaswamy (7thth IOS P.G. IOS P.G. Convention) outlined the objectives of Splint Convention) outlined the objectives of Splint therapy as followstherapy as follows

•To find the “true” anatomic relationship of To find the “true” anatomic relationship of the mandible to the maxilla by the mandible to the maxilla by “deprogramming” the muscle to eliminate the “deprogramming” the muscle to eliminate the neuromuscular reflexes. neuromuscular reflexes. •To test the patient’s response to a change in To test the patient’s response to a change in the occlusionthe occlusion•To determine if the craniomandible To determine if the craniomandible relationship can be stabilized. relationship can be stabilized.


MMUUSSCCLLEE


ARMAMENTARIUM FOR FABRICATION OF ARMAMENTARIUM FOR FABRICATION OF OCCLUSAL SPLINTOCCLUSAL SPLINT

• • Vacuum adapter e.g. Omnivac, Biostar, Vacuum adapter e.g. Omnivac, Biostar, etc.etc.• • Acetate marking pen: e.g. any waterproof Acetate marking pen: e.g. any waterproof felt tip.felt tip.• • Acrylic trim bur.Acrylic trim bur.• • Small metal spatula for mixing acrylic in Small metal spatula for mixing acrylic in dappen dish.dappen dish.• • Dropper bottle (½oz.) for acrylic monomer Dropper bottle (½oz.) for acrylic monomer • • Squeeze-type dispenser (3oz.) . for acrylic Squeeze-type dispenser (3oz.) . for acrylic polymer powder.polymer powder.• • Articulating paper Articulating paper


MMUUSSCCLLEE


Fabrication of Splint Fabrication of Splint

Accurate ImpressionsAccurate Impressions

Pouring of Stone ModelsPouring of Stone Models

Construction of splint base with 0.08” Construction of splint base with 0.08” Omnivac material or Biocryl II material on Omnivac material or Biocryl II material on

Biostar machineBiostar machine

Trial of splint base in mouthTrial of splint base in mouth

Splint base should be of minimum vertical Splint base should be of minimum vertical dimension and should extend upto last dimension and should extend upto last

erupted teetherupted teethwww.indiandentalacademy.com

MMUUSSCCLLEE


Fabrication of Splint Fabrication of Splint

Occlusal Lining of Splint using Biocryl acrylicOcclusal Lining of Splint using Biocryl acrylic

Polish the splint Polish the splint

Insert the splint in mouth and check for even Insert the splint in mouth and check for even contactcontact

Adjustment of splint in mouth in subsequent Adjustment of splint in mouth in subsequent visitsvisits


MMUUSSCCLLEE


Some Commercially Some Commercially available Splintsavailable Splints

DSG Relaxer

Dental Services Group has recently developed a new muscle deprogramming splint that is designed to use the body ’s natural reflex protection to relax the muscular components of bite-related migraines,chronic headaches and jaw disorders.


MMUUSSCCLLEE



DSG Relaxer

Super Splint(Dentech Services)


MMUUSSCCLLEE



Flexible inner Layer

Hard Outer Layer

Thermo-Splint Classic-- Soft thermo-plastic polymer throughout

Thermo-Splint Hard Face --Two layers – the softer, flexible, thermo-plastic layer plus an additional harder acrylic layer for added durability on occlusal and incisal surfaces. (See diagram at right)

Thermo-Splint Custom Fit --Monomer free, reprogrammable, self aligning, versatility plus


http://www.obriendentallab.com/

MMUUSSCCLLEE



Developed by Prof.Dr.Martin Lerman, the Scientific Director at the Temporo Mandibular Joint Center at the University of Illinois


MMUUSSCCLLEE


Studies related to Splint Studies related to Splint TherapyTherapy

Solange Mongelli de Fantini et al (Solange Mongelli de Fantini et al (Braz Oral Braz Oral ResRes2005;19(3):176-82 ) 2005;19(3):176-82 ) studied effect of studied effect of occlusal splint therapy on condylar occlusal splint therapy on condylar displacement between centric relation and displacement between centric relation and maximal habitual intercuspationmaximal habitual intercuspation

Sample – 22 Subjects 11 male – 11 femaleSample – 22 Subjects 11 male – 11 female

They concluded that use of occlusal splints They concluded that use of occlusal splints results in greater mean condylar results in greater mean condylar displacement values, especially vertically, displacement values, especially vertically, between CR and MHI positions, which between CR and MHI positions, which contributed to a contributed to a more accurate more accurate orthodontic diagnosis.orthodontic diagnosis.


MMUUSSCCLLEE



John Grubb (John Grubb (Angle Ortho 1999 210-213) Angle Ortho 1999 210-213) presented a Case report of a Patient presented a Case report of a Patient suffering from TMJ pain.suffering from TMJ pain.

Deprogramming Splint was used as Deprogramming Splint was used as Diagnostic as well as therapeutic deviceDiagnostic as well as therapeutic device


MMUUSSCCLLEE



Donald Joondeph (Donald Joondeph (Angle Ortho 1999 201-Angle Ortho 1999 201-209) 209) studied the Long Term stability of studied the Long Term stability of Anterior Repositioning SplintAnterior Repositioning Splint

•Treated 12 patients Treated 12 patients •Complete RelapseComplete Relapse


MMUUSSCCLLEE



Ahlin et al 1991 found that use of splint with Ahlin et al 1991 found that use of splint with only anterior flat bite plane can cause an only anterior flat bite plane can cause an open bite open bite


MMUUSSCCLLEE



T.T.T. Dao and G.J. Lavigne T.T.T. Dao and G.J. Lavigne (Crit Rev (Crit Rev Oral Biol Med 9(3):345-361 1998) Oral Biol Med 9(3):345-361 1998) from a from a review of Literature on Occlusal splints, review of Literature on Occlusal splints, concluded that true efficacy for oral splints in concluded that true efficacy for oral splints in treatment of TMJ dysfunction remains treatment of TMJ dysfunction remains unknownunknown

However, the results of a controlled However, the results of a controlled clinical trial lend support to the effectiveness clinical trial lend support to the effectiveness of the stabilizing splint in the control of of the stabilizing splint in the control of myofacial pain.myofacial pain.

Thus oral splints should be used as an Thus oral splints should be used as an adjunct for pain management rather than a adjunct for pain management rather than a definitive treatment.definitive treatment.


MMUUSSCCLLEE



Alexander S Fu et al studied the Alexander S Fu et al studied the Maxillomandibular relationship in TMD Maxillomandibular relationship in TMD patients before and after short-term flat patients before and after short-term flat plane bite plate therapy. plane bite plate therapy.

Cranio. 2003 Jul ;21 Cranio. 2003 Jul ;21 (3):172-9(3):172-9

Sample – 20 with Deviated mandibleSample – 20 with Deviated mandible

•After Flat Bite plane Therapy, the mandibular After Flat Bite plane Therapy, the mandibular position of all subjects shifted toward the midline position of all subjects shifted toward the midline positionposition

•Significant movement of both condyles in the Significant movement of both condyles in the anterio-posterior plane as well as the vertical planeanterio-posterior plane as well as the vertical plane

•There was also significant reduction in TMJ pain and There was also significant reduction in TMJ pain and clickingclicking


SummarySummary


Role of Muscles and soft tissue Role of Muscles and soft tissue in orthodontics is gaining in orthodontics is gaining importance in recent timesimportance in recent times

Both, Muscle Programming and Both, Muscle Programming and Deprogramming are becoming Deprogramming are becoming part and parcel of part and parcel of Orthodontist’s LifeOrthodontist’s Life

SSUUMMMMAARRYY


Thank YouThank You


For more details please visit www.indiandentalacademy.com

muscle programming / orthodontic courses by indian dental academy

Documents