Not going anywhere, at least for four months :-)

Mac-  This might interest you.  This is what the inventor of the NTI
therapeutic protocol has to say:
**************************************************************************
What is it about the acrylic placed on the teeth that is therapeutic?
Nothing.
What is it about the effect of the shape of the acrylic on the activity of
the masticatory musculature? Everything.

What are the goals of nocturnal splint therapy?
1--To minimize tooth wear during parafunctional occluding activity;
2--To minimize joint strain and disc load during parafunctional occluding
activity;
3--To minimize intensity of muscular activity during parafunctional
occluding activity.

What are the accepted criteria for splint design to achieve the desired
therapeutic result? (which are the same as that for a "good occlusion")
A--Bilateral even posterior contact in COR, with light anterior contact.
(statisfies 1 and 2 above)
B--Immediate posterior disclusion in the event of excursive occluding
movement, made possible by:
--opposing canine contact during the excursive occluding movement, with
transition to;
--incisal contact. (satisfies 1, 2 and 3)

But how do we know that these splint design criteria provide the desired
therapeutic goals? Through prior EMG research and force/load studies.

There are abundant EMG studies and force/load models of A which support its
intended provision of 1 and 2.
There are abundant EMG studies and force/load models of B which support 2
and 3.
(Unfortunately, there are abundant EMG studies to show that A cannot prevent
3).

We expect that a properly made splint or occlusal scheme should minimize
joint strain and disc load and minimize muscular activity in excursive
occluding events, based on the data from EMG and force/load models.

The only difference between an ideal full-coverage occlusal splint and an
NTI-type device is that an NTI-type designed splint can minimize the
intensity of muscular activity in a centric, as well as excursive,
parafunctional act.

So when a study compares a Michigan splint to an NTI on a group of patients
with jaw disorders, (excluding those "primary clenchers" who don''t have any
jaw/joint symptoms but present primarily with headache/migraine) you''d
expect the efficacy to be the same, and in fact, in the Norwegian study,
(one of two studies specifically observing the NTI), that is exactly what
was found.

Knowing what a properly designed Michigan splint and NTI device are supposed
to provide is what makes the Swedish study so curious. If both a Michigan
splint and a properly made NTI provide the same instant posterior disclusion
in excursive movements and incisal-only contact in protrusion, but the
Swedish study showed that nearly ALL Michigan splint subjects saw
significant improvement, while nearly half of the NTI subjects had no
improvement at all, what is one to conclude?

-El There''s-something-fishy-in-Sweden-O~

James P. Boyd, DDS, Developer of the NTI Therapeutic Protocol and Website
The Headache Center of Southern California Clincial Associate
Son of USC Hall of Fame Basketball Coach Bob Boyd
*************************************************************
And from a well known Swedish dentist (Hans Lennros)  that has participated
extensively in this newsgroup over the years.
*************************************************************
Toofy wrote in response to "-El There's-something-fishy-in-Sweden-O~": > So
what is this Swedish "properly made Michigan splint??? Yes, what is it? Good
question! Let's see how they properly made Michigan splints in the Swedish
study (Magnusson et al, 2004):
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra
ct&list_uids=15129601&query_hl=2&itool=pubmed_docsum
To prove that the NTI-splint is clinically worthless they not only
investigated its efficay but also cost-effectiveness measured in minutes.
They did not calulate that the Michigan splint needs TWO visits, that
patients cancel and re-schedule (which costs money), they disregarded cost
of impression material, packaging and stamps/delivery to send to dental
technician and the extra time spent on the Michigan splint compared to the
NTI-splint. In their world dental assistants do not want any sallary and
everything around the office is free of charge! Including the dental
laboratory fee. The result showed that the Michigan splint took a total of
17 minutes and the NTI-splint 27 minutes. The time consumed for the
NTI-splint can be explained by lack of experience (which indicates a risk of
not getting optimal clinical effect). What is more interesting, however, is
the time Magnusson and his fellow investigator Helkimo needed to make the
Michigan splint. In the Swedish textbook "Bite splints in the clinic and
laboratory" ("Bettskenor i kliniken och på laboratoriet", 1987) Magnusson
writes about the normal time needed in average to make a Michigan splint in
the public dental care system: (quote) "It is interesting that the new
government insurance for a splint is based on 34 minutes. During that time
the dentist must during one appointment make impressions of both jaws and
make a jaw registration to obtain inter-occlusal records. The next
appointment, which is also included in this just over half-an-hour, the
splint should be fitted and checked. We sure must have effective methods to
make this work!" (end quote) So he complains that 34 minutes is not really
enough time to do a Michigan splint and all of a sudden, in the scientific
NTI-study, the Michigan splint is made in half that time! Only to show that
the Michigan splint is 10 mintues clinically faster than the NTI-splint!
This can be compared with doping in sports when pride and honor is sold out
to beat someone with seconds or minutes. In this study he sold his
scientific integrity for 10 minutes! The obvious question that arises are:
in how many scientific studies has he done similar cheating before? And to
what degree do results in his previous career depend on concious bias, i.e.
academic dishonesty? I think it is really sad to have to watch how two
outstanding and former respected scientists (Magnusson & Helkimo) are
compromising their reputations in that way. What actually made them to
choose to commit scientific suicide over the NTI-splint? Hans
***************************************************
More from Hans
***************************************************
Hi Jim, The Magnusson picture is a mystery ! If you enlarge it enough you
will see the following: The lower jaw can go to the patient's left as far as
the mandibular midline (between the two lower front teeth) is aligned with
the distal surface on the upper left front tooth. But the patient can go to
the right further, in fact half the width of a lower tooth further. Most
likely if the patient has not an unilateral restricted jaw movement the
patient could go just as far to the left, and then would slide off the
discluding element. So they made the patient stop the excursive movement at
that fixed point that looks good on the picture certifying they were
following the NTI-protocol. Hence this is an arranged picture! Either this
is a model patient for presentation purposes only, or it shows to what
extent they actually paid attention to the NTI protocol. Besides, the NTI
does not seem to have a correct horisontal position from front to back as
the back of the discluding element seems lower than the front part. If this
is the best they could do in an educational model picture they knew would be
scrutinized, what does that tell you about the probability of high,
respectively low, quality of the actual NTI-splints used on patients in the
study? I have repeatedly asked to see those they used in the study but the
only answer I get is a legal mumble that they are not required by law to
show me anything. Which per se is wrong! They are obliged by law to show
their basic data so that clinical trials can be examined. So there is no
doubt they are lawbreakers. For a study to be scientific they must let out
information that can be evaluated. Also, the study should be possible to
repeat. If not it is no serious science. When I offered $150 to every
patient that I was allowed to examine, they responded they did have not time
to arrange that. Anyone ever wondered why Magnusson consistently excluded
headache in the study? Especially strange since Magnusson has stated that is
a common TMD symptom and over 25 years ago stated that clenching of teeth is
correlated to the severity of headache!
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra
ct&list_uids=281857&query_hl=5&itool=pubmed_docsum
and that TMD treatment are beneficial for many patients who suffer from
recurrent headaches:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra
ct&list_uids=6937100&query_hl=5&itool=pubmed_docsum
Real strange that this large group of typical TMD patients wasn't included
in the study ... maybe fear of the NTI would prove to be far more effective
than the other splint ... Hans the NTI-CSI (crime-scene-investigator)
**************************************************************
Mac here is some recent research you should take the time to read.
http://www.nti-tss.com/RESEARCH.html

Just because someone posts an abstract that apparently contradicts what
other clincians are seeing in their practices doesn't mean you should hang
your hat on it.  Research, research, research, research.  I am sorry you
already paid for the splint, but that doesn't mean you have to actually use
it.  In fact the frequency and severity of your migraines will likely
increase by using the full coverage design.  It simply gives you more
surface area to achieve maximum clenching ability while asleep.

Perhaps some of the others will weigh in on this issue and give you some
sound clinical advice from their perspectives.

Would be willing to bet money that very few dentist
outside of smd has ever heard of it.

;-)
D

OK but I get EGAPL from that.

{I used an A.G.E.LK for a one year period in the hope of avoiding
unnecessary maxillofacial surgery, and that hope was completely fulfilled}

What is the A.G.E. LK?
It is a device for gnathological use, simple and versatile to use.

Why  the "Gothic Arch"?

Prof. Luksich has been gradually and radically changed Gysi's device: with
the term "Gothic Arch" generally refers to the special technique and
relative device developed by the Swiss Alfred Gysi in 1910 solely to detect
the centric relationship only in fully edentate patients, using a graphic
tracing whose configuration is very similar to that of a Gothic Arch.

The structural features of Gysi's device have now reached a technical level
of use which is extremely linear, rapid and precise, no longer limited to
merely the detection of the centric relationship in edentate patients, but
extending to the full range of gnathological registrations and applicable in
all cases.

What does the A.G.E.LK consist of?

It basically consits of two parts:
a tracing point applied to the upper maxilla;
a tracing plane applied to the mandible.

These two parts are fitted onto two support structures built individually on
the two antagonistic upper and lower arches. These structures vary according
to the circumstances and the inventiveness of the person making them, but
must in any case serve two basic functions: maximum stability and proper
retention. These conditions are essential in order to take advantage of the
absolute precision of the A.G.E.LK.

What does the A.G.E.LK do?

It takes static and dynamic intermaxillary measurements, such as:
determinig the resting height;
determining the free way space;
determining the normal occlusive height with respect to the habitual height;
recording the centric relationship;
recording the mandibular dynamic in all possible directions (protrusive,
retrusive and lateral);
determining the physiological guide for checking and casting the occlusion
surfaces and incisor, canine and group disclusions.

What are possible uses of the A.G.E. LK?

Assuming that gnathology is the prevailing area of stomatology, it is
obvious that the A.G.E.LK can be used in all cases in which the normal
intermaxillary ratios with respect to habitual ratios must be determined,
such as:

In prosthetic and surgical orthognathodontia.
In prosthetic rehabilitation (permanent, removable, mixed and implants) when
the prostheses involve both arches or even a single arch.
In parodontology.
In gnathological alog-dysfunctional syndromes as a valid
diagnostic-therapeutic tool.
As a unique and rational bite plane.

What are the features of the A.G.E.LK?

It has the advantage of being extremely simple to use, requiring no special
aptitude by the operator.
All registrations are made freely by the patient, without the slightest
interference by the physician.
It allows extremely precise and constantly repeatable biomechanical
measurements.
All registrations made on the patient are transferred to the dental
technician in the laboratory with no margin for error.
It may be used to equal satisfaction in patients who are fully edentate,
partially edentate, or posses all teeth or the arch.
It may be used not only with individual or average value articulators, but
also with simple occlusors depending on the intended purpose.

You will find out that if you use AGELK:

 1.. condyles are not "essential" in determining the jaw position;
 2.. the movements and the exercises the patient performs allow total
relaxation of the patient's muscles : just a few days are sufficient if the
patient is asymptomatic, ten minutes three time a day for some months if
more serious symptoms are present.
Differently from other relaxation systems, exercises with AGELK can be
easily done at home,without the patient's staying in the dentist's chair for
a long time

It is a device of exceptional value; and here in smd, it was introduced
via a regular participant back during the 1990s.  He lives and practices
in northern Italy.

I have seen the device work its wonders.

Webby

I was ribbin' the regs...

Didn't mean to mislead you.