I have some questions about repositioning splints. It's my understanding from reading, that repositioning splints are considered as non-reversible procedures, and it is always considered as a 'step'towards invasive treatment like orthodontic braces. Is this information correct? My second question is...can a patient just only wear a repositioning splint and not go through the route of getting braces?
If you wear a repositioning splint, it will change the bite. If this new position corrects the TMJD problem, that's good. The bite can then be "finished" to the new position with braces, contouring the teeth, crowns, or a permanent splint, depending on the individual situation. However, if you go without the repositioning splint for a while, the jaw will return to its original position, so it isn't permanent unless you want it to be. Obviously, if the TMJD symptoms disappear, it isn't likely that you would want to return to the original bite position.
Hi Genden,
So would you say that most people who go through repositioning their jaw alignment with the splint, ultimately need their bite adjusted with either braces or other extensive dental work??
I've been thinking alot about this...as I am at the beginning of my journey (and learning curve) with regard to the tmj.
Also.. does the repositioning of the Jaw change the facial structure in any way. One other question...
Does the repostioning of the jaw impact the patient's posture for better or worse??
Thanks so much for sharing your knowledge. I always find your posts to be informative and helpful!!
Robyn
Thank you so much for your reply! So, are you saying to me...that repositioning splints cannot be worn by someone who does not want to go through the permanent bite change by braces or other dental work...that you can't live just on repositioning splint only. What I mean is...could I wear a repositioning splint...say for life or whatever...and decided not to go all the way for the permanent bite by braces or other?
Hi Sandi:
It is my understanding that it is possible to have a permanent splint either bonded or a removable one. I do not think a person must have braces in order to get treatment for TMJ. If you haven't been dealing with TMJ for a long time I might say that when I first began having problems with TMJ I thought I could do just fine but as time went on my problems became worse to the place I am at now where I absolutely have to find some treatment to relieve my headaches and pain.
Tiffany
I am more than happy to answer your questions with what I know. But you should know that I am not a dental professional. I have gotten my information from lots of reading and asking dental professionals lots of questions. Please ask your TMJD specialist all the questions you need answers for. If he/she won't or doesn't answer to your satisfaction, I think that is a sign to go somewhere else.
I will try to answer with what I know. RobynRose, repositioning does change the bite. It doesn't change the facial structure to any noticeable extent. However, if the vertical is collapsed, it changes it for the better. It is sort of like a little face lift. The mandible is usually repositioned down and forward, but only 3mm or less forward. I don't know about posture. I've read that posture can affect the bite and that the bite can affect posture. I guess it depends on the individual case. Sandra, you could wear a permanent repositioning splint for life. I think that is what I am going to do.
Thanks GenDen - for your response to my questions.
I wonder... since the repostioning splint seems to be helping your case a lot --- do you feel it actually stabiized your joint?? I ask because my problem seems to be rooted in hypermobility and lax ligaments.
I know this isn't the problem for everyone with tmj problems, so I'm wondering if I would even be a good candidate for the repositioning splint. I do have an appointment with a tmj expert on June 6th...so I will learn more then. If you don't mind me asking... did you have a olot of clunking and "movement" before your splint. I am wondering if these devices simply take pressure off the joint, or truly stabilize it.
I'm glad to see it is working for you. I'd imagine that it's pretty comfortable if you could envision wearing it for life. Do you remove it when you eat??
Thanks again for anything you might add. I appreciate.
Robyn
The purpose for a repositioning splint is to increase the joint space between the condyle and the fossa. A tomogram will show if there is the necessary 3mm of space. If this is not your problem, then it is my opinion that the joint doesn't need to be repositioned. I am not a dentist, so this is just an opinion. A TMJD specialist should be able to diagnose your condition and determine what treatment would best stabilize your joints. TMJD treatment is not "one size fits all." Each case must be treated individually. Just because one person had success with a specific treatment doesn't mean that it will work for the next person. TMJ dysfunction has a variety of causes and each cause requires different treatment.
Even though my TMJD condition is a little different than most, my splint is a muscle repositional.
It has worked very well in letting the muscles assume a more comfortable and normal position. It has brought my jaw down as the muscles unclenched.
As GenDen reported, the only difference in facial features is for the good. My face is straighter & more symmetric, which has caused an increase in my opening and allows me to talk & eat much easier & better.
The splint has stabilized my joints and my bite is not all over the place. My bite was surgically altered many years ago and with no disc, my Dentist feels that any attempts to "pull" my teeth with orthodontics would put stress on my joints. (My bite is not to bad, so I'm going to take his advice and leave it alone.)
I will most likely wear this type of splint from now on for support of the joints and to keep the muscles from going back into a clench. I am now only wearing it at night, unless I feel tense, and it's still alleviating symtoms.
I just thought I would add, that at any stage of TMJD, if muscle problems are the cause of most your symtoms, the proper splint therapy (I Believe) can help most people.
I also have to believe that going on to orthodontics, if you need it, "can" work & not harm. I believe people with TMJD need to be treated differently and by an Ortho who understands the problems that can occur or be caused by orthodontics. I fear very few of them do understand the magnitude of this problem.
However, reading the steps that Marlene went through with her treatment is very convincing. Of course, as with all treatments, this would not be right for everyone.
Thank you so much - GenDen and Cymey Sue...
It is so encouraging to learn that the repositional splint therapy is working for so many. I agree that everyone's case is going to require unique treatment - and there is no magic bullet - though I wish there were!! I didn't realize (GenDen) that the dentist can actually measure this Condyle/Fossa space so concretely. This seems to be an ideal way to predict whether the jaw repositioning splint is appropriate.
I am seeing a specialist in NY on Friday, so I will be very interested in hearing his take on the repostioning splint therapy. I sure hope he understands what is necessary to alleviate my symptoms.
Cymey Sue, I was encouraged also to know that your splint prevents your bite from being "all over the place". That's what I feel mine is... like my jaw is completely "loose" - if that makes sense...no stability.
I think my case is a bit unusal since I've had instability in the spine (lumbar) for the past 10 years, and the current tmj situation seems to feed the back problem...and vice-versa. Has anyone ever heard of this???
Of course in my fantasy, the dentist will tell me that my whole pain situation is caused by a stressful jaw postion (Ive been told I had tmj since childhood- I'm 39... but didn't have symptoms till 1.5 years ago), and when we address that with a repositioning splint, not only will the headaches, neckaches, ear fullness, facial pain etc. go away.... but so will the spine locking!! I just feel this is all so connecected for me. I'm sure it's just wishful thinking though.
Do either of you (or any other members reading) know if the "Gelb" appliance is of the same theory as these repostioning splints?? I believe this is the orientation of the specialist I will see .... Or perhaps, like Cymey Sue - the Gelb appliance is more focussed on muscle repositioning??!!
It's still going to be a huge learning curve for me in this field...but I'm trying to gain as much understanding as possible before Friday.
Thank you so much for helping me to gain some insight here. You all are so supportive - I appreciate~!!!!
Robyn
[This message has been edited by RobynRose (edited 05-24-2003).]
[This message has been edited by RobynRose (edited 05-24-2003).]
I've had to play catch up on splint designs in just a few months. I was under the impression that "Splint Therapy." would not be helpful for me. Of course, that was incorrect.
There are several designs that are & have been discussed as helping members of the board. I think the key to success is whatever Design or Theory a Specialist uses, it must be individualized for each person. I believe GenDen made a statement about this therapy can not be based on, "one size fits all".
Mine is based on the Pankey Theory, but it's made for me & my condition. (My dentist said it's the thinnest one he's ever made, among other things) I believe the Gelb Appliances are also made for individualized treatment, as well as others I've seen pictures of & read about. http://www.healthboards.com/ubb/idea.gif
I hope this will be helpful as you continue your search for help.
The repositioning splint I wear is a Gelb. My TMJD specialist practices functional jaw orthopedics/orthodontics. I am glad Cymy Sue mentioned about muscle relaxation. I forgot to mention that splints do that as well. The repositioning splint trains the muscles to a more comfortable position. I also wear what is called a bionator at night which is different from my daytime splint. It maintains my new bite position but prevents the back teeth from touching so as not to allow nighttime clenching.
Thank you both for your information...you have been very helpful. I still need to ask you guys some more questions, if you don't mind.
Cymy Sue...you had said that your repositioning splint is to support your joints...your bite is not considered bad...what do you mean...what bite do you have...overbite or what? I have a overbite, and my current dentist had sort of recommened braces because of my bite...but I don't really want to go there.
GenDen...you said you may decide to wear repositioning splint for life...is the splint the removeable one that you wear only at night or what? Also you said that the tomogram reveal the space that needed to be increase around condyle...can't a MRI reveal that kind of information on the film? Does this mean I might need a tomogram as well as a MRI?
I hope this doesn't sound like a stupid question.
I would love to hear from both of you! You guys are great!
I have been reading your posts regarding splints and you said you are going to see your specialist soon. You and I are both trying to find everything about all this stuff before seeing our dentist...let us know how your appointment goes with the dentist...I would love to hear your report.
Take care,
Sandi
[This message has been edited by sandra1 (edited 05-24-2003).]
I have a very, very slight overbite.
My Dentist & former Ortho believe it would put too much tension or pull on my back teeth to try & correct it. (This would also put stress on my joints.) I had spoken to both of them several months ago and ask it we worked on my bite, would it help the TMJ problems. They reminded me that my bite had not been the cause of the TMJD problems to begin with. This is when my Dentist suggested the "Splint Therapy" that I am in now.
Basically the MRI shows tissues and the tomogram, which is a sort of catscan type of x-ray, shows bone. My TMJ specialist felt he needed to see both the tomogram and the MRI. I am sure each case is different. As for the permanent splint. I still have not decided for sure because it will be several months before I am finished with phase I, but I am leaning toward a permanent splint, which would be worn all the time 24/7. I am not a good candidate for braces because I have so many crowns. My other option would be to have the crowns redone. I think that would be my best option , but the cost may be the prohibiting factor.
GenDen & Sandra,
After several MRI's in the late 80's, in my hometown area, we were transferred to another city for a couple of years (same state). The team of Doctors there (OS, Ortho & Dentist) felt the Tomogram was just as important in Diagnosis as the MRI. I believe this is true, due to new & more indepth information I was given.
I have yet to figure out why all Doctors involved in TMJD treatment do not use all Diagnostic Tests & Tools available.
I've been keeping up with the requests the National Health Inst. has made recently in developing a National Registry for TMD sufferers and a Standardized Protocol in diagnosing and treatment.
I know it will take time, but I hope it's a step in the right direction for all who suffer with this condition.
You are right...I don't really understand why most tmjd doctors do not use all the diagnostic tests & tools available to them. I think a good example of this is my own current doctor...he suggested I get braces because of my overbite and I had asked him if he knew just actually what was going on with my muscles/joints in the tmj and he answered with a I don't know really type of thing. I was pretty upset when he said that, because here he was suggesting braces to me with no clue to what was going on with my joints. So, later on I asked the receptionist at the desk how much it will cost to have a orthodontic workup for braces, and she told me it will cost around $300.00 for it. That doesn't sound too expensive too me now...because I know now that to get a MRI test it cost over $700.00 at a local hopital or a private clinic. So, I think my doctor doesn't really include that much diagnostic tests to be done, only general x-rays.
I am planning on going back to my doctor soon, and discuss with him about diagnoistic tests, splints, etc. and I will see what happens.
But, I do think there should be some standard protocol for all tmjd dentists when it comes to using most of the diagnostic tests available. We all need the best available care for us, and we deserve it.
Thanks for all your helpful information, and take care.
Repositioning splints.... 
