Treating Failed TMD therapy with an NTI

Treating failed TMD therapy with an NTI device

Patient's reported history:
Several years of chronic headaches and joint pain. TMJ pain escalated throughout 1999.
Bilateral arthoscopic joint surgery in early 2000.
Use of full coverage splint (Tanaka A) for six months. Pain persisted, joint pain increased.
Early 2001 initiated NeuroMuscular TM therapy. Was provided a NM orthotic.
Within 2 months, joint pain significantly reduced, headaches persist.
By end of 2001, joint pain returning, headaches persisting, although orthotic adjusted frequently.
By March of 2003, has daily headaches and moderate joint pain. Wears the NM orthotic 24/7.
Experiences significant joint pain upon closure without NM orthotic in place.
Delivered NTI device on March 18th, 2003 (Patient's report)


Patient presented with a full mandibular NM othotic.	Orthotic in place.

Patient's occlusal scheme without the NM orthotic in place. Note posterior open bite.

Patient is provided an NTI device for nocturnal use. Following 3 weeks of use, posterior open bite has closed considerably. Patient reports no joint pain and no headaches. Once posterior occluding is established, equilibration will be performed to enhance patient's chewing comfort. Patient wil bee instructed to continue nocturnal use of the NTI.
Emails from patient: 3-19-03 AM -Woke up with no aching muscles. -Put daytime device in and as day progresses feel muscles in cheeks ache. -Catch myself trying to clench. -Muscle pain and soreness. -Trying to adjust to new device after taking out NM orthotic yesterday. 3-26-03 -I seem to be getting better every day. The headaches were really bad - I think my muscles went into shock when I took the NM device out - but now they seem to be adjusting. -I have some soreness but more in the hollow of my cheek area on both sides of my face. I find myself biting down in the front and trying to clench and the muscles do tense up. -Re: my bite without device - My teeth still do not touch when I bite down, only the front ones make contact when I eat. -Overall I am surprised I don't have to wear that full lower orthotic. I thought I would be chained to that like a denture... -I am happy to have some good results so far! 4-14-03 (office visit. photos above) No headaches. No jaw pain. No joint pain. Posterior open bite closing. No pain upon mastication. 8-12-03 Patient presented to have a new NTI made... Had been completely asymptomatic since prior visit, but broke her NTI two weeks ago and has begun to get headaches again (and had two migraines). Posterior occlusion has completely closed.