Temporo-mandibular joint – Deprogramming

Occlusion is the way of contact of the upper teeth with the bottom teeth and the position of the temporo-mandibular joint with proper muscle tension. Misalignment of any of the above could cause occlusive disease. The symptoms could include difficulty opening the jaw, cracking of the temporo-mandibular joint, lockjaw, teeth grinding, headaches (including migraines), tiredness of face and neck muscles, hypersensitive and painful teeth, gum recession. Occlusive disease is a serious dental issue, which untreated can even lead to tooth loss. Occlusive disease causes tooth loss more often than decay, because untreated it can lead to teeth breaking or cracking, or shortening the dental arch.

Occlusive disease is frequently ignored by patients at first. They usually only contact the dentist when it’s in an advanced stadium

Patient diagnosis

Recognition, diagnosis and treatment of this disease requires a lot of occlusion knowledge and experience. The most important part is the diagnosis including all of the Patient’s problems – especially before a complex prosthodontic treatment, occlusion reconstruction or orthodontic treatment. Therefore it is only possible for the doctor to prepare a treatment plan after receiving complete information from all of the previous consultations and (in case it’s needed) deprogramming of the patient. A cooperation of doctors is a guarantee of a successful treatment.

Patients in our clinic go through a detailed diagnostic of the chewing apparatus, including a detailed health and dental questionnaire. A thorough medical and dental interview is very important in an interdisciplinary approach to the patient, because a jaw joint examination is necessary, as well as an examination of periodontium, biomechanical state of the dentition, prosthodontic replenishments and a functional test.

The treatment of occlusive disease is a multi-step process. Its goal is to return to a correct occlusal relation – one where no tooth damage occurs and there are no temporo-mandibular joint improperties. The treatment of occlusive disease includes multiple procedures and analyses, such as:

• Temporo-mandibular joint functional test
• Functional tests
• Diagnostic impressions
• Deprogramming
• Occlusion registration
• Bite analysis
• Preparation of an appropriate treatment plan

Every case needs to be approached individually, as there is no universal method of combating occlusive disease.

Occlusive disease cannot disappear by itself, it can only get worse. That is why treating the malocclusion is crucial, thanks to which symptoms such as e.g. recurring headaches can disappear. Untreated, occlusive disease can lead to periodontitis, tooth loss or damaging prosthodontic replacements (e.g. crowns, bridges).

Don’t ignore occlusive disease. If you notice the symptoms, make an appointment for a specialized consultation at our clinic.

The deprogramming process requires three to five appointments in our clinic. It is composed of a couple of stages:

EXAMINATION and impressions

The examination of the temporo-mandibular joint is composed of a broad interview with the Patient about their problems and ailments. It is frequently necessary to take a panoramic radiograph as well as rtg photos of the joints with the jaw open and closed. These photos can show bones, their degenerations, breakages or tumorous changes. The dentist can also use a ruler to measure how wide the patient can open their mouth. If the examination shows that a correction of the bite is necessary, the dentist will take impressions of the patient’s teeth, based on which a Kois deprogrammer will be prepared.

DEPROGRAMMER

It is the first necessary step in cases where full occlusion reconstruction is necessary. The Patient wears this platform on the palate for a week to a month, and can take it out to eat or brush their teeth. Usually this much time is enough for deprogramming

OCCLUSION REGISTRATION

A dental-facial analyzer is used to input the information regarding the Patient’s face and occlusion into an occluding frame. During the same visit impressions are made for diagnostic models (after deprogramming) necessary for the determination of a Patient’s correct, final occlusion.

OCCLUSION ANALYSIS

It is based on an assessment of the distribution of forces and the points of contact at the surface of the teeth, as well as an assessment of the chewing apparatus functionality. It is done based on X-ray and normal photos of the Patient’s face with the dental-facial analyzer, and also on the plaster models of the patient’s teeth after deprogramming placed in an occluding frame. An occluding frame is simply put a simulator of the Patient’s jaw and joint movement and allows for registering of the special relation of the teeth and other skull elements – especially the temporo-mandibular joint.

TREATMENT PLAN

It is a written, optimal treatment plan based on the analysis of the Patient’s occlusion. It aims to correct the contact points of the teeth, and eliminate all ailments originating in the joint by balancing and adjusting the points of contact of the upper and lower jaw.

Deprogrammer

Deprogrammer is a special tool similar to braces. It allows for an assessment of the Patient’s occlusion stability. By not allowing the teeth to contact, the Kois deprogrammer resets the muscle memory of an improper position (common in a habitual occlusion, perpetuated over the years). It allows the jaw to assume a more comfortable position. This relaxed jaw position is necessary for the further planning of the treatment, and it’s quantifiable and nearly instant effect is at least partial pain relief.

The recommended time for wearing the Kois deprogrammer is two weeks to a month. It should always be worn during the night, and as much during the day as possible. It is best to wear it around the clock and only remove it for eating and brushing teeth.

The deprogrammer was designed for maximum comfort. Nearly everyone gets used to talking with the deprogrammer after a couple of days. In some cases there might be some muscle pain, which passes once the muscles relax.

The method of treatment after deprogramming is always individually selected based on the needs of the patient. The treatment doesn’t always need to be complex. In some cases all that is necessary can be a proper prosthodontic reconstruction, removal of wisdom teeth or taking care of gum problems by proper hygiene.

A relaxation splint is frequently the basic conservative treatment thanks to its therapeutic properties. This kind of a spint (silicone overlay over the dental arch) reduces muscle pains by relaxing muscles. It is especially useful for bruxism – grinding teeth.

Dental treatment:

Conservative – change of shape and size of teeth by proper tooth restoration, changing of infills

Prosthodontic – In case of tooth deficit the preparation of crowns, bridges. It is frequently tied to implants. Thanks to deprogramming, prosthodontic treatment can be more precise, better fit the occlusion and serve for a longer time. The dentist might also enjoin an occlusion splint – plastic overlays that go on the teeth or below the tongue for the night and/or for the day which will allow for a proper alignment of teeth. They prevent clenching the jaw and tensing of the the jaw muscles.

Orthodontic – in case of malocclusion.

Periodontic – curettages, treatment of gum recession, tooth ligation. Improper occlusion conditions affect the gums and bones in the overstressed regions. Tooth roots can get exposed as a result of receding gums, causing oversensitivity. Disappearing ligaments between the bone and the teeth deepen gum pockets, which makes hygiene more difficult and leads to gum inflammation. That is why in some cases periodontitis treatment should begin with deprogramming.