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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CROWDING
For severely crowded teeth, aggressively relieve the internal and/or
phalges of the device to provide for a non-binding coverage..
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Relining the device with damp, doughy acrylic. Upon initial
removal prior to the acrylic fully hardening...
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...aggressively
relieve the internals with a scalpel.reduce the distal portion of the DE...
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...and add acrylic to the anterior portion of the DE...
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...to allow for a positive contact through the incisors' long axis...
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...once the acrylic has cured, it can be reduced down...
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...to the level of the indentation made by the incisors.
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ORTHODONTIC RETAINER
A segment of an IG device can be used as an addition to a Hawley
retainer.
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EQUAL CENTRAL CONTACTS
If the centrally placed IG device makes contact with only
one opposing incisor at try-in (left), shift the device
laterally (right) so that the curved surface of the DE
picks up both contacts.
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IG WIDE
The device to the right is the "IG Wide" (Sept '06), which has a
thicker DE than the regular IG device, making it stronger and less
susceptible to breakage. Canine contact is still avoided.
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INCREASING VERTICAL
DIMENSTION
Vertical dimension of the DE may need to be enhanced in order to
decrease clenching intensity. Tongue blades can be use to "test"
the patient's tolerance to new VDOs.
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Ask the patient to clench as hard as possible on the
tongue blades. If discomfort is reported anywhere, remove a blade
and test again.
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EXCURSIVE CLENCH
INCISAL
The
incisal edge of #8 might appear to have been "chipped"...
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Attempting to restore the incisal edge of #8 would fail...
...due to the "chipped"
area actually being a wear facet.
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EXCURSIVE
CLENCH
CANINE
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Habitual clenching on canines
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Watch
for an increase in range of motion shortly following delivery...
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apprears corrent, but is NOT
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SLOPE OF MAXILLARY DE
The DE should be parallel to the maxillary plane. Have the
patient's head upright, with maxillary plane parallel to the floor
(right) which reveal the actual slope, not resting back in the
headreast (left). Protrusion with the DE sloped as shown (right) will
create excess rotation during protrusion, thereby possibly creating new
symptoms. (more)
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can
cause/perpetuate symptoms
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DEGENERATIVE JOINT DISEASE In order for an
otherwise normal, healthy
person to develop degenerative osteoarthritis in one TM joint (MRI
report below of the above patient), there
must be a chronic pathologic force bearing on the joint. The more
distal a unilateral resistance point there is, the more
medially-directed and damaging the strain and load is on the opposite
joint. (more)
In protrusive incising (left), this patient has a unilateral posterior
contact (resistance). With an standard NTI IG device in place,
the contact persists (center). Increasing the VDO of the DE
prevented the contact, but by doing so, the opening was excessive and
symptoms remained. The remedy for this patient was
the reduction of the opposing contacting cusps. Within
two weeks, of nightly NTI use, joint symptoms had resolved.
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DAYTIME DEVICE Equal contact on the
opposing centrals is required. And device can be altered to
function as a "Daytime Device". Special attention must be paid to
patient comfort. Only provide as much acrylic as absolutely
necessary, leaving no ledges or angles, and minimizing the extensions
of the DE. (right)
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OPPOSING MARYLAND BRIDGES
Two Daytime Devices were used. Internal retention was relieved
under the pontics.
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CLASS III EDGE-TO-EDGE / INCREASING VDO
Patients with
minimal (or no) overlap will require an increase in the VDO of the IG's
DE. This can be easily be accomplished by providing "spacers" at
the molars during the 2-minute curing of the acrylic, thereby
preventing the device from seating fully over the incisors.
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Severe
clenching patients may require that the pre-existing device's VDO be
increased to further reduce clenching intensity following an intitial
trial with the device. A similar techique is used as above, but
with the additional acrylic being added to the external of the DE's
occluding surface (below). For ease of simultaneous cental
contact, mark the depth of the incisor's indentations into the acrylic with
a pencil and reduce the excess acrylic to that level.
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