Efficient.  Economical.  Effective.




The next evolution in NTI dental splint therapy:

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


Trouble Shooting

Enhancing Retention
Extending the DE
Divot in the DE
Occlusal Scheme Change (AOB development)C
"New" clicking




Enhancing Retention






To extend the device to enhance retention, more TPB can be added to existing cured TPB material. Dip the exposed TPB material (at the distal ends of the device) into very hot water for 3-5 seconds, thereby creating a "sticky" layer.  TPB material in the warm, clear putty stage will "bond" to the sticky layer, and can be manipulated to extend the extensions of the device.


Excessive Protrusive; Patient "falls off" distal end of lower DE







Above left shows the patient's full protrusion, with the distal end of the DE arriving at the labial side of the maxillary incisors.  The remedy is to add acrylic to the distal end of the DE.  Mark the distal end of the DE with pencil prior to adding acrylic, so as to provide a visual guide (shown above middle).  Above left, final delivery in full protrusion.  The pencil line at the distal end of the DE can be seen (the occlusal surface at the distal ends was reduced to prevent occluding with the maxillary molars)

Divot developed in the DE




Once a therapeutic result has been achieved, and a divot in the DE appears a period of time later, do not reduce the level of the DE to the depth of the divot, but restore the divot with acrylic or composite restorative material.  The image on the right shows the surface of the DE of a Lower Device, with the wear indications of lateral excursive parafunction.  The is no need to fill in the wear, or to polish down the surface.

Development of Anterior Open Bite

See Contraindications
There is a concern expressed by some practitioners that long-term nightly use of an NTI device will cause "supra-eruption" of the second molars (but curiously, not the first molars, bicuspids, etc... This concern stems from the dynamic described in the paragraphs below).  There are no published orthodontic studies describing the method of intentionally extruding a molar that includes both the LACK of any attached brackets, or, use of any removable device that DOES NOT come into contact with the molar, while still providing for daily, unsuppressed occluding forces.  In one study observing over-eruption of teeth without antagonists, it was concluded that tooth eruption was largely age-dependant and not all molars without antagonists overerupt, not even in a long-term perspective.


A potential diagnostic revelation of NTI use is the development of an anterior open bite, of which the majority of the time occurs as a result of the reorientation of the condyles following normalization of the musculature. (Dynamics of condylar seating ) This can only happen if the condyle(s) were in a position anterior and inferior to their optimal musculo-skeletally stable position, and then reposition to a  more posterior-superior position.  This causes the mandible to pivot/rotate at the most posterior molars (thus giving the appearance of posterior supra-eruption), allowing the condyles to seat more posterior and superiorly, while the anterior mandible rotates posterior-inferiorly, which, depending on the degree of the initial incisal overlap, may present as an anterior open bite.



INVISALIGN's solution to Anterior Open Bites.

Treatment of Anterior Open Bite with the Invisialign System (Journal of Clinical Orthodontics article)

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The utilization of mini-implant screws at TADs (temporary anchoring devices) can efficiently intrude molars in order to close the anterior bite.

Example method of posterior intrusion:



As with any procedure, where a variety of outcomes is possible, all reasonable outcome scenarios should be disclosed.  For the patient, the NTI-tss may prove to be both a symptomatic treatment device, and a diagnostic device which demonstrates that the condyles were not in their optimal seated positions.  However, the treating dentist may not desire to be involved in the treatment modalities necessary to provide a occlusal scheme to the patient's satisfaction, in which case the dentist may elect to not provide treatment with the NTI-tss.

ADDRESSING CLICKING
An excessive vertical dimension created by the Discluding Element can reveal, or complicate the presense of an anteriorly displaced disc.  Reducing the VDO, especially in extreme protrusion is recommended.