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P
ORDER
INTRODUCTION PAGE
CHAIRSIDE SPLINTS:
      NTI-tss devices
      BruxSplint (full coverage)
ASSISTANCE with NTI protocol
     NTI 2.0 Chairside delivery protocol 
     ThermoPlasticBeads / Indications
      COMMON OVERSIGHTS
      Invisalign integration
      Orthodontic bracket adaption
      Upper or Lower?  Flowchart
      TROUBLE SHOOTING
     Contraindications
      Interpreting Patient Responses
ADMINISTRATION
     Documents
           Informed Consent, Brochures,
         
MSDS, Headache Questionaire,
          Recent articles

EDUCATION 
      TMD, Parafunction, Migraine
LABORATORY PROVIDED
       Keller Lab's NTI-plus    
SUPPORT 
      Contact for assistance

Opposing
Winged Deprogrammers








Opposing Winged Deprogrammers are intended to be used as diagnostic tools on a "provisionally permanent" basis (shown above prior to being lined with ThermoPlastic).  Once the practitioner has confirmed (or ruled out) the diagnosis through the observation of the change (or persistence) of symptoms, the practitioner may elect to use Opposing Winged Deprogrammers on a long term supervised basis, or transition to Full Coverage Clenching Suppression Splints.


Basics of TMD etiology and how it relates to the NTI Therapeutic Protocol.

 
CR-splint-clenching-blue
Temporomandibular disorders all have one perpetuating and/or causative factor in common: an excessive motor activity of the mandibular division of the trigeminal nerve, that is, excessive occluding of the teeth.


Four factors dictate the presenting signs and symptoms:
--Intensity of the occluding;
--Frequency of the occluding;
--Duration of the occluding;
--Degree of condylar translation
and direction of the pull on the condyle by the lateral pterygoid during the occluding event .

Of those four factors, the most significant is the intensity of the event.  The ideal occlusal splint (left) cannot reduce the intensity of nocturnal clenching, in fact, it allows clenching to exceed voluntary maximum.
 
In the animation above, the condyles are "stable" during the occluding event (sometimes referred to as "posterior support for the joint).  Due to the bilateral intensity of elevation, (that is, clenching), neither lateral pterygoid has the ability to translate its condyle and disclude the teeth.  Only until the temporalis' relax do all the teeth disclude.

When temporalis relaxation and ipsilateral translation of the condyle occurs unilaterally (right), the remaining scheme of occluding teeth becomes an influential factor in the presenting signs and symptoms, of which, contacting canines during mandibular depression ("canine rise) is highly desirable, as it minimizes condylar translation and muscle intensity, while directing the vector pull on the condyle more anteriorly than a posterior contact. (The ideal directional pull of the LP's on the condyle is anteriorly, and the more translated the condyle is during parafunctional occluding events, the more pathologic strain on the condyle and shearing load to the disc there is)
Parafunctional-occluding
 
Protrude-to-incisors
Clinical Insights:
"Condylar compression" and development of
an anterior open bite.
When lateral pterygoids bilaterally protrude the mandible (left: while teeth are still occluding, from A to B), or when there is an incisor-to-incisor contact during functional closure, clenching (elevation) intensity is minimized.  The force vectors of the pull of the lateral pterygoids on the condyles brace and support the condyle anteriorly against the slope of the eminence.

Therefore, the provision of "incisal guidance" is the optimal goal of nocturnal occlusal splint therapy.

Below, an NTI device provides for incisal guidance in the centered clench and in an excursive occluding event.


        protruding-w-NTI
 
 
An NTI device is a modified, or enhanced, anterior bite stop
which prevents reciprocating posterior tooth contacts,
or canine contact on the device or another tooth.
 
Canine-purpose
 
It is therefore imperative to prevent the canine from receiving stimulation though its long axis, as doing so allows for increased intensity of parafunctional events.
 
Enhancing-a-deprogrammer
 
In order to keep condylar ROTATION
(the graphic below should state "rotation", not translation) to a minimum,

the VDO of the Discluding Element (DE) needs to be minimized.
(excessive VDO of the DE shown in yellow below)
 
Keep-VDO-minimal
 
Resistance schemes during parafunction and the forces directed:
Parafunctional-resistance-points-3D
Below, blue vectors represent the SHLP, orange vectors the IHLP:
Parafunctional-resistance-points