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Old 07-09-2013, 10:09 AM   #1
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What's the purpose of an anterior repositioning splint?

So I had my MRI looked at by a dentist and TMJ research professor that said that I do have some degenerative changes in my joints. A lot of it is not necessarily on the joint surface, but internal, shown as he looked at the deeper layers of the joints. While being only 21 he said that is strange but not really the cause of my issue.

I am only able to open 36mm, which he says is a normal range of motion. I am, however, getting neck pain and muscle tightness. He also said that my left disc is anteriorly displaced but is trying to recapture which explains why I don't have a closed lock. He mentioned that he wants to give me an anterior repositioning splint to wear at night only as well as home exercises and I should get better over time. He also mentioned formation of pseudo-discs, but I did not really understand what that meant.

Does the ARS work to recapture and keep the discs in their correct place? I have to ask about the pseudo-discs but anyone have any ideas on why the condyle would operate on these discs if I could recapture my actual ones? Does the splint change the bite if I wear it only as directed? Thanks

 
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Old 07-09-2013, 07:59 PM   #2
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Re: What's the purpose of an anterior repositioning splint?

Did he show you an example of the anterior repositioning splint he is recommending? What did it look like? Is it an upper or lower splint? Will it cover all of your teeth? Just the front? just the back? Why is he recommending it for night only vs. 24/7?

Most of the time with splints when you hear about 'recapture' it is with ones that are worn 24/7. I'd want to ask your dentist what happens during the day if your jaw is in different positioning than it is at night? It certainly may be enough in your case if that is what he is recommending, but it couldn't hurt to ask.

I actually wore 2 repositioning splints in my Phase I of treatment. The daytime one was a lower mandibular repositioning splint. It had 'bumps' on the top that corresponded with my top teeth. I had to bring my lower jaw a bit forward and to the right in order to have my 'correct' bite. Over time with the treatment, my muscles relaxed and the bite began feeling much better that pre-splint therapy. That is the position my jaw is still in currently with continued treatment.

My nighttime splint was different. It was an upper splint designed to hold my lower jaw forward while I was sleeping. The jaw naturally falls back when we are laying down. This splint had a 'wedge' on it that came down in behind my lower teeth and keep the jaw from falling back. It was extremely effective in my case. It also had a 'beak' in the front. It kept my bite at a 'proper' height and kept me from being able to brux. It was EXTREMELY effective for me. I actually stopped bruxing within the year that I wore it.

In any case, the main purpose of the most tmj splints is to bring the bite into a more 'correct' position. It also allows time for the muscles that have tightened into incorrect position have time to relax and calm. Therapy in addition to the splints can be extremely helpful to aid in that relaxation. The muscle spasms are very hard to reduce and it can take up to 3 months for them to be happier. At that point, I found I felt much better. I had a choice of weaning off of the splints. There is no permanent bite change at that point. If you continue on to a Phase II treatment, that is permanent change.
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Old 07-10-2013, 06:34 AM   #3
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Re: What's the purpose of an anterior repositioning splint?

These are all good questions that I am going to ask him when i make the mold. Just have been so overwhelmed with information as to what is really going on. He also mentioned that he uses botox to relax the muscles and that he uses it very conservatively. I am really considering the botox because I have had this for six months with no relief. Does anyone know if the botox can provide lasting relief if I don't clench or grind? I figure if the splint is used to relieve the muscular tension and guide the jaw into a relaxed position, the botox might help relieve the symptoms until the splint does its job.

 
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Old 07-10-2013, 09:03 AM   #4
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Re: What's the purpose of an anterior repositioning splint?

Hi MountainReader, i want to ask several questions about lower repositioning splint that you wear during the day. Hope you don't mind
What does the orthodontist do each adjustment? thinner the splint?
after phase I, since it's not permanent, how the orthodontist make sure when wearing braces, the lower jaw will not fall back again? And the most problem i worry is after phase 1, the bite will be underbite. What if the upper teeth size is not possible to overlap the lower teeth even with braces?

 
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Old 07-10-2013, 10:38 AM   #5
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Re: What's the purpose of an anterior repositioning splint?

I said it once and I will say it again. Run, don't walk, from this dentist. They are using you as a guinea pig with all these splints!! You say most of your pain is in your neck. Why don't you get some physical therapy? Once you start wearing a repositioning splint, you are going to create more problems for yourself. You will experience even more neck pain...trust me!! Have you even tried any myofascial release therapies? Don't throw money away on splints that are just going to make your pain worse and create more of a TMJ problem. I know, because I have been there, and know many others who have. And yes, your dentist is always going to tell you you are making progress, so that you will continue to give him/her $$$$$

 
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Old 07-10-2013, 10:39 PM   #6
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Re: What's the purpose of an anterior repositioning splint?

Hi clencher, although I have bought the splint, i have decided that i will not use it and will just do physiotherapy. What a wasted money but i will count it as my bad luck. Now, anyone can give me idea what to say if the dentist assistant call me to ask why i don't come at the next appointment?

 
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Old 07-11-2013, 07:20 PM   #7
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Re: What's the purpose of an anterior repositioning splint?

Quote:
Originally Posted by clencher1 View Post
I said it once and I will say it again. Run, don't walk, from this dentist. They are using you as a guinea pig with all these splints!! You say most of your pain is in your neck. Why don't you get some physical therapy? Once you start wearing a repositioning splint, you are going to create more problems for yourself. You will experience even more neck pain...trust me!! Have you even tried any myofascial release therapies? Don't throw money away on splints that are just going to make your pain worse and create more of a TMJ problem. I know, because I have been there, and know many others who have. And yes, your dentist is always going to tell you you are making progress, so that you will continue to give him/her $$$$$
The reason I'm not "running" from this dentist was because he actually
Looked at an MRI and told me exactly what was going on. He is a professor and dentist that practiced with a major University and has conducted research on TMD dysfunction and myofascial pain. Hes not some advertised "TMJ" specialist that took a course at LVI and plastered a Plaque on his wall saying that he knows how to treat it. If he diagnosed my problem specifically and recommends this splint, then i think I'm making a good choice. I trusted a NM dentist before and he altered my bite. Maybe you should reconsider who you see and get a
Proper diagnosis.

 
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Old 07-11-2013, 10:09 PM   #8
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Re: What's the purpose of an anterior repositioning splint?

Hi,
My splint adjustments were more frequent in the beginning, then I'd go long periods of time with no adjustments needed. They have you bite/clench down on some transfer paper. Where you hit 'off', the ink will transfer so the tech can see it. They will contour the splint at that point. Occasionally I'd have a point that didn't show so they would do a minor adjustment based upon our conversation. The adjustments are extremely minor, but make a major difference in the comfort of the appliance.

I ended up wearing my lower splint for 26 months. (personal choice) I never felt my bite was changed by the splint. I was just much more comfortable wearing it. I had the option to wean off of it if I wanted to. I never developed anything like an under bite. I didn't have an over or under bite when I started treatment. I had to give up the splints that held my lower jaw in that forward position when I started my Phase II braces. I ended up wearing elastics at night from my back lower molars to my upper canines. They helped hold my jaw forward while I was sleeping. By wearing it at night only, it hasn't led to an under bite. I've been wearing that configuration for almost 23 months now.

I'm not certain what you mean by upper tooth size. I got my upper braces on first and continued to wear my lower splint for the first 11 months. The upper braces widened my upper arch significantly. I never realized it was narrow until I started seeing the progress. When my upper arch was in position, that is when I had to give up my lower splint for lower braces. I actually had my lower splint cut back to expose the molars when I got my uppers on. I had brackets put on those exposed molars. That is what allowed me to wear that nighttime elastic configuration to help hold my jaw in position while sleeping.

I hope that answers your question. If not let me know.
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Old 07-12-2013, 04:41 AM   #9
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Re: What's the purpose of an anterior repositioning splint?

I don't see her anymore. I was also seeing a university professor who is also a board certified prosthodontist who also did research on tmj. No LVI training. It is not just the NM, LVI host of clowns you need to worry about. I looked back at your posts and saw that this is your second splint with the same dentist. Doesn't sound right to me. I hope they are not charging you. I was burned and wish someone here had warned me before I pursued the splint route.

That being said, I hope you treatment is successful.

 
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Old 07-12-2013, 10:52 AM   #10
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Re: What's the purpose of an anterior repositioning splint?

I think a lot of what determines success is based upon the education, approach/philosophy and skill of the dentist.

I also think the approach should be individualized for the needs of the patient. A lot of people with tmjd will do fine with some basic therapy and lifestyle modifications. A smaller percentage will need more than that. While I think appropriate therapy can help to some extent, the underlying causes of the tmjd symptoms are a factor. Many people have mostly muscular issues. Others have physical or a combination of physical or muscular.

In my case, I have a couple physical issues in addition to the muscular issues that made splint therapy the best approach for me. My lower jaw was pushed back into my ears causing significant pain and hearing loss. I needed to get my jaw forward from my ear quickly. I was afraid I'd lose all of my hearing at the rate I was going. As it is, I have basically no hearing in one ear and a moderate hearing loss in the other and I now have to wear hearing aids. The moderate hearing loss all occurred in less than a year. Thankfully, with treatment, I haven't had any new hearing loss for the last 1 1/2 years.

I actually started therapy months before I chose to go with a splint. The therapist was very good. We made much more progress when I added the splint in though.

There are many different types of splints out there. I think if you need splint therapy the trick is to find the right splint for your needs. I've had a couple that were horrible for me. One that was just OK and my most recent 2 which did wonders for me.

One of the very frustrating things about TMJD is that there is no 'standard' thing that works for treatment. It is usually a combination of things and that combination is different for each person.
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Old 07-12-2013, 08:32 PM   #11
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Re: What's the purpose of an anterior repositioning splint?

Thank you for the answer MountainReader
With the splint on on my mouth, i became have underbite. If it's really the final result, it will be a trouble because even with braces, my upper teeth will not overlap my lower teeth except i get implant for 2 bicuspid that have been extracted from wearing braces when i was young.

 
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Old 07-12-2013, 11:14 PM   #12
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Re: What's the purpose of an anterior repositioning splint?

Quote:
Originally Posted by miss5427 View Post
Thank you for the answer MountainReader
With the splint on on my mouth, i became have underbite. If it's really the final result, it will be a trouble because even with braces, my upper teeth will not overlap my lower teeth except i get implant for 2 bicuspid that have been extracted from wearing braces when i was young.
Have you talked to your dentist about the underbite yet? I'd be concerned to. If you don't like his answer, I suggest seeking another opinion. The splint I had helped me find my 'correct' positioning which didn't bring my jaw forward that much. Just a few mm.

I wouldn't want braces immediately unless your muscles are fully out of spasm first. Once that happens, your tmj and bite should be re-evaluated before discussing your next options more in-depth.
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Old 07-13-2013, 06:07 AM   #13
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Re: What's the purpose of an anterior repositioning splint?

@mountainReader Yes, i asked him about the bite and i don't like the answer. He said "treat the jaw first, there will be so many things that can be done for the teeth".
That's why i run now lol.

 
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Old 07-16-2013, 06:43 AM   #14
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Re: What's the purpose of an anterior repositioning splint?

The thing is my first NM dentist gave me an NTI splint that did absolutely nothing because they assumed that I was clenching. So I wore the splint and had occlusal equilibration on my teeth according to a Tek-Scan machine. They only exacerbated my symptoms and according to their plan they wanted to give me a lower splint to wear that I would wear 24/7 to basically "control" the symptoms. Well my thought at that point was why risk changing my bite if I am only controlling my symptoms? I am going to demand my money back once I am back to my old self.

So I found this professor and DMD that has a private practice that told me that NM dentists are a bunch of hacks that boast they can fix TMD by taking a couple courses and hes right. There's no science behind it. What can a TENS unit possibly do if you don't address the cause of the issue? He actually ordered me an MRI, told me what was going on via email and in person, and offered a very conservative plan which required an anterior repositioning splint at night for three months. He also mentioned that he does conservative botox and steroid injections, but I want to wear the splint and go to a rheumatologist to fix the inflammation naturally via Magnesium fluid intravenously. Supplements alone will do nothing. I think the splint will be enough to fix the muscles and get me the relief I need.

I really believe the key to overcoming this is to find someone competent in understanding the effects of TMD on orofacial pain. Sadly, LVI and many of these self proclaiming cosmetic dentists don't understand this. I think I made the right choice and am simply praying that this treatment will help.

Quote:
Originally Posted by clencher1 View Post
I don't see her anymore. I was also seeing a university professor who is also a board certified prosthodontist who also did research on tmj. No LVI training. It is not just the NM, LVI host of clowns you need to worry about. I looked back at your posts and saw that this is your second splint with the same dentist. Doesn't sound right to me. I hope they are not charging you. I was burned and wish someone here had warned me before I pursued the splint route.

That being said, I hope you treatment is successful.

Last edited by dczech1; 07-16-2013 at 07:00 AM.

 
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Old 07-16-2013, 09:55 PM   #15
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Re: What's the purpose of an anterior repositioning splint?

I had 2 different dental specialists fit me with NTI's or NTI type devices. I HATED both of the splints. I was in so much pain. I much preferred the lower mandibular repositioning splint. It was fit well to meet my needs.

My tmjd orthodontist has one of his fellowships in craniofacial pain. He has had extended tmjd training over the years and spends weeks every year in advanced training. He believes in holistic dentistry and whole body health which involves including other specialists in treatment to get to the final results. (i.e. physical therapy, cranio-sacral work, chiropractic, massage, prolotherapy, nutritionist, sleep doctor, medical doctor, etc.....)
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Last edited by MountainReader; 07-16-2013 at 09:56 PM.

 
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