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Medical Forum / General / Dentistry / July 2005NTI questions
Hi Folks, after a couple of weeks I can agree in NTI being a good tool for my patients. I have one patient complaining about the teeth not fitting together but every day it's different. I use the NTI myself and have the same problem. Does anyone here have hints what this might cause and how to treat? Thanks, JK  SignatureDr. Jochen Kulow |email: jochen.kulowNOSPAM Zahnarzt/Dentist | (at)dentalmail.de |remove NOSPAM |PGP: http://wwwkeys.de.pgp.net |HP: http://www.dr-kulow.de --------------------PGP-Fingerprint------------------- DAA3 468E 10FB 463D AE5C A135 6D6B 9250 7746 6FC7 ------------------------------------------------------ You are seeing a change in the acquired centric closing position. It may well require a minor adjustment. Odds are that the condyles are seating in a more posterior position and the occlusion becomes heavy on second molars. If the TMJ capsules were inflamed internally, you could end up with heavy contacts in the anterior region as the swelling goes down. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Hi Folks, > after a couple of weeks I can agree in NTI being a good tool for my [quoted text clipped - 7 lines] > > JK > You are seeing a change in the acquired centric closing position. It may > well require a minor adjustment. [quoted text clipped - 4 lines] > If the TMJ capsules were inflamed internally, you could end up with heavy > contacts in the anterior region as the swelling goes down. OK, but the problem I is making definite changes in the occlusion whiles the spots the are disturbing wander around. I would expect that allways the same spots are disturbing. From my personal experience I wonder if my teeth could change their axis slightly while at night having no fixation by the oppsite side. When chewing alot or in the evening i dont have this odd feeling. But directly after removing the device my teeth hurt when biting together, and this feels the same like whearing an appliance that doesn't fit and move the teeth. One Patient reported the same. So i think it could be about movement of the teeth instead of respositioning of the jaw(which will occur as well of course). Should I recommend waering the NTI also at daytime to get the teeth stable at their new position and the adjust the occlusion. As I said, I feel not well adjusting in an constantly changing situation. JK SignatureDr. Jochen Kulow |email: jochen.kulowNOSPAM Zahnarzt/Dentist | (at)dentalmail.de |remove NOSPAM |PGP: http://wwwkeys.de.pgp.net |HP: http://www.dr-kulow.de --------------------PGP-Fingerprint------------------- DAA3 468E 10FB 463D AE5C A135 6D6B 9250 7746 6FC7 ------------------------------------------------------ Never adjust occlusion which is not comfortable in the appliance and never adjust occlusion unless the patient has the appliance in their mouth for a few hours immediately prior to checking contacts. When doing an equilibration (unless your lab can create templates for you to adjust from), requires that you make 1-3 adjustments then check again in a week or two, then make more adjustments, and repeat until nothing changes. Premature contacts can vary all over the place. Please describe your technique for equilibrating. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... >> You are seeing a change in the acquired centric closing position. It may >> well require a minor adjustment. [quoted text clipped - 26 lines] > > JK Hi Dr S... just got back from services for my sister... > Never adjust occlusion which is not comfortable in the appliance What do you mean by this? Adjusting contacts with the NTI in the mouth? (Which should not be there in the first place if the NTI is doing its job)... Or do you mean grinding on the Disclusion Element? Thanks SP >and never > adjust occlusion unless the patient has the appliance in their mouth for a > few hours immediately prior to checking contacts. Of course.... It is acting as an anterior deprogrammer here... Even _I_ know that... > When doing an equilibration (unless your lab can create templates for you to > adjust from), requires that you make 1-3 adjustments then check again in a > week or two, then make more adjustments, and repeat until nothing changes. > Premature contacts can vary all over the place. > > Please describe your technique for equilibrating. SignatureFinally: take out the TRASHH > Hi Dr S... just got back from services for my sister... > [quoted text clipped - 3 lines] > (Which should not be there in the first place if the NTI is doing its > job)... Or do you mean grinding on the Disclusion Element? I mean that if the patient is having symptoms with the appliance in place, you will probably make things worse if you adjust anything now (except huge discrepancies). Going in and adjusting triangular ridges, marginal ridges, deepening fossae, etc, while symptoms are present will only lock the patient tighter into the pathologic position. You only begin adjusting teeth, when you have the muscles comfortable on the appliance. Once the muscles are comfortable with the appliance, you have the patient appear for the adjustment wearing the appliance. Actually the appliance should be in the mouth continuously for many hours prior to the appointment. The first tooth to tooth contact without the appliance in place should occur in your office with some thin accufilm between the teeth. Recognize that by the third time you check the occlusion this way, you will seeing the "pathologic" position again, so you need to stop and re-appoint for further adjustments. It is a long slow process to fine tune occlusal contacts in the symptomatic patient. > Recognize that by the third time > you check the occlusion this way, you will seeing the "pathologic" position > again, so you need to stop and re-appoint for further adjustments. It is a > long slow process to fine tune occlusal contacts in the symptomatic patient. OK, thanks. SP SignatureFinally: take out the TRASHH > > Recognize that by the third time > > you check the occlusion this way, you will seeing the "pathologic" position [quoted text clipped - 3 lines] > OK, thanks. > SP Welcome back StovePipe. Sincerely, Webby > > > Recognize that by the third time you check the occlusion this way, you > > > will seeing the "pathologic" position again, so you need to stop and [quoted text clipped - 8 lines] > Sincerely, > Webby Thanks, TW. This has been a helluva summer... and as I already said: bad news seems to always come to me in the summer. I shudder to think what is lying in wait for us after our vacation.... We are taking the last two weeks of July and the first two days of August off and going down to my Dad's place. Since he has no phone and no Internet down there, we'll be again out of touch. Hope the summer is going better for the rest of youse SP SignatureFinally: take out the TRASHH |
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