Orthopedic treatments address the root cause of TMJ disorders, because these are musculo-skeletal conditions involving the bite table as an orthopedic structure that has to function in harmony with the other orthopedic structures of the postural system for health. The good news is that, to permanently eliminate their symptoms, most people only need the right type of oral orthopedic appliance to wear during sleep, when the jaw system undergoes its big workouts and when all facial growth occurs. However, different types of oral orthopedic appliances and treatments are needed for different facial growth patterns and different stages of the disorder. For example, when a TMJ is inflamed, a joint protective oral orthopedic appliance worn during sleep, when the jaw muscles reflexively undergo a workout, can quickly stop the chronic bruising that has been causing the inflammation, which also stops the reflex protective bracing and hypervigilance of the jaw muscles. Once the TMJ is no longer inflamed and the bite is stable, the orthopedic features of the appliance can be changed to focus on rehabilitating the jaw muscles and optimizing facial growth to acquire a state of healthy function that is resistant to injury. The appliance should provide at least some relief within a week, or it is not the right one for you. Some appliances, such as a lower MORA in class 1 and class 2 occlusions, can provide short term relief but long term exacerbation of the problemmatic condition by shifting the bite gradually backward. Our complete in-house dental laboratory enables us to change the orthopedic features of appliances, repair broken appliances, or make old appliances fit new dental work while you wait.
Our most commonly used orthopedic treatments include:
- Joint protective stabilization appliances
- Joint protective telescopic appliances
- Pivoting for unilateral condylar distraction
- Orthopedic disk recapturing
- Front flat plate appliances
- Rubber bite cushion appliances
- Bite restoring appliances
- Bite stabilization
- Functional orthodontics
These orthopedic treatments are summarized below and described in detail in separate files under the TREATMENTS tab.
JOINT PROTECTIVE STABILIZATION APPLIANCES – worn during sleep, are the simplest way to relieve an inflamed TMJ. Unlike nightguards, which do not have a sculpted bite table; and unlike common stabilization appliances, which simply provide a raised and stable bite table; joint protective stabilization appliances have sculpted anti-retrusion ramps that can protect a damaged TMJ by preventing the condyle from access to its chronically bruised retrodiskal area. If the appliance is made correctly, no matter how hard you bite on it, you cannot reproduce the pain that you experience when biting forcefully on your natural teeth, because your condyle cannot contact or further traumatize the chronically bruised and swollen retrodiskal tissues.
JOINT PROTECTIVE TELESCOPIC (HERBST) APPLIANCES - A telescopic appliance is made of separate upper and lower appliances that are connected by tubes and rods which engage on each side like a straight arm to prevent the lower jawbone from retruding (going backwards) any further than permitted by the set point of the tubes, which is adjustable. A Herbst appliance provides even more protection for the TMJs than a joint protective stabilization appliance, because its protection continues as the mouth opens; and the forces it uses to keep the condyle off the bruised retrodiskal tisues are spread out evenly among all the teeth.
FRONT FLAT BITE PLATE APPLIANCES, worn during sleep, reduce the forces used in nocturnal bruxism, just like Botox does; but they do it without damaging the muscles that are needed to regulate facial growth, the failure of which is the root cause of most TMJ disorders. From the first night they are worn, front flat bite plate appliances reduce the forces of nocturnal bruxism by about half, and they redirect the remaining bruxism forces onto the front teeth in order to gradually reduce the overbite. Within days or weeks, they deprogram the jaw muscles to stop them from aiming every jaw closure at your existing natural bite so that we can see if your natural bite is strained and how to improve it. Over the long-term, the gradual reduction of overbite promotes the horizontal facial growth that preserves an open airway. However front flat bite plate appliances are muscle treatments. If a TMJ is inflamed, they can increase the pain.
RUBBER BITE CUSHION APPLIANCES - are molded rubber shells that fit closely over the lower teeth for use during the day to relieve jarring bite impacts in people who have neuromuscular systems that have been sensitized by chronic pain or to simply provide a cushioned platform for the jaw to rest on in people who feel their bite is uncomfortable. These appliances are easy to wear and don't affect speech. However, they should not be worn during sleep, because the rubbery feel evokes chewing activity, which increases nocturnal clenching and grinding, usually accompanied by dreams of eating.
DISK RECAPTURING APPLIANCES - can restore the disk to its proper anatomical position by combining a telescopic night appliance with a daytime bite restoring appliance to keep the lower jawbone advanced just far enough to stop all the clicking and popping. Such "disk recapturing" usually provides rapid and complete relief; however it requires a finishing phase which can involve significant dental work, so the condition of your teeth needs to be weighed against the severity of your symptoms and your prognosis. In most cases, the symptoms can be eliminated without such extensive treatment by treating "off the disk".
BITE RESTORING APPLIANCES are used to try out and refine a new bite before undertaking the expensive dental work necessary to finalize it with crowns or onlays. Many TMJ disorder patients have bites that have been destabilized by a strained facial growth pattern, excessive tooth loss, or using any oral appliance for long enough to make the teeth fit the surface of the appliance rather than the natural bite. A typical example can be seen below left. In such cases, we can establish the proposed new bite on a provisional basis using tight fitting unobtrusive unilateral removable bite restoring appliances that can be worn all day including eating, as seen below right. After that new bite has proven comfortable and effective at eliminating the symptoms for at least a few months, it can be transferred to the teeth by bonded composite resin onlays for further refinement and testing prior to finalizing it in gold or porcelain, usually performed by the patient’s general dentist with Dr. Summer providing any support required.
UNSTABLE BITE BITE STABILIZED BY APPLIANCE
FUNCTIONAL ORTHODONTIC APPLIANCES - have important advantages over esthetic orthodontics (braces and clear aligners) for treating and preventing TMJ disorders, because they can stimulate healthy facial growth. Removeable oral appliances can support the mandible in an orthopedically improved location while moving the teeth into positions that will stabilize it there. Palatal expansion can enlarge the nasal airway and increase the space available for crowded upper teeth.