This activity has been
planned and implemented in
accordance with the standards of Academy of General
Dentistry Program Approval
for Continuing Education (PACE) through the joint program provider
approval of
Meridian Center of Keller Laboratories, Inc., Dr. Jim Boyd, and Dr.
Barry
Glassman. The Meridian
Center
is approved for
awarding FAGD/MAGD credit.
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NTI
Tension Suppression System
The most effective FDA-approved method of
migraine prevention
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"FAILING" ANTERIOR DEPROGRAMMER
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An AD with an inadequate DE to provide resistance-less protruding.
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The same device can allow canine clenching in excursive...
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...and posterior clenching when protruding.
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The scenarios above allow for chronic joint strain and
pathologic load. To enhance the deprogrammer, the DE is extended
distally and anteriorly to ensure incisal edge contact in the extremes
of protrusion. The practition is still obligated to confirm that
a lower canine cannot occlude on the DE in extreme lateral excursion.
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CANINE CONTACT ON THE IG
The lower IG device (top-middle) rarely makes contact with an upper
canine (top-left). If it does (top-right), reduce the occluding
acrylic accordingly (left). All that is required is an absense of
contact (right). If the ROM increases, the IG may once again make
contact with the upper canine, therefore, recall is mandatory.
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The canine contact may not be lateral to the central, but
distal/lateral to it (right and left). Either increase the
anterior VOD of the device, or reduce the distal extension of the DE
(below left, middle), with the goal of obtaining central or lateral
incisal contact.
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POSTERIOR CONTACT
IN PROTRUSION
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Posterior contact in protrusion (top left-right).
Increase DE verticaly and distally (bottom-center & right) to
maintain posterior disclusion (bottom left)
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The
example to the left appears to have the ideal minimal posterior freeway
space, and does not allow the VDO to increase upon protrusion
(right).
However, in protrusive, there is posterior contact (botton left).
Increasing the height and distal extension of the DE (bottom center and
right) maintains posterior disclusion.
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The correction of this DE...
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...was to extend it distally...
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...then reduce it vertically.
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ABOVE: Protruding
the lower DE in front of the upper incisors.
BELOW: Protuding lower incisors in front of the upper DE.
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The
example patient's extreme protrusive position had bilateral multiple
occluding contacts (above left, center). The enhancement of the
DE must be as extended as necessary to maintain posterior occlusion.
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A preexisting anterior open bite...
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...which "opens" further with a exaggerated curve of Spee.
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The DE must achieve the dimensions necessary to maintain posterior
disclusion.
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EXCURSIVE CANINE
CLENCHING
When
reducing the VDO of the DE as much as possible to minimize
contralateral translation in excursion, canine contact (left) may
dictate that the canines be sculpted to relieve the occluding (right),
instead of increasing the VDO to prevent it.
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DISTALIZING THE
CONDYLE
Patients
occasionally protrude slightly when asked to bite on an
incisally-placed object. Failure to observe a normal retruded
clench may allow the device (or teeth) to "get behind" the opposing
teeth (or device)(left), thereby providing the risk of enhancing
distalizing forces to the posterior disc space. (the
fix)
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Flared Incisors
If the
Standard Device is chosen to be fitted over flared maxillary incisors
(left), the orientation of the incisors will dictate initial level of
the DE, with the "heal" of the device often creating excessive VDO
(middle). Reduce the DE so that it is parallel with the maxillary
plane distal to the incisors.
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