The jaw is SHIFTED and DEVIATED to the right.

Do I have any chances my condyles move forward/ backward in this splint when it comes to that grooves on splint ? or it’s not good splint for my case in this phase ?

This is my first splint from NM dentist. He calls it neuromuscular splint (is it REALLY ? ) and it’s my 1st of 2 or 3 phases in treatment. It was made based on some tests using Myotronic devices like K7 / TENS.

The idea is to decompress the joints by relaxing muscles and give better chances for articular discs to move in more proper positions hence to put my jaw in the right place.
The jaw is SHIFTED and DEVIATED to the right. I have open bite as well. The bite is completely off. I have also quite significant curve of Spee.
If the reaction to splint is too poor, the dentist will add pivot feature (probably only on right side) and other solution (some modification on splint) to force shifting in opposite direction.
After one week of wearing this splint I feel minimally better contact on the other side, but….
I wonder how this splint is going to allow the jaw to be unshifted, since on the top of splint there are grooves which fit to my actual wrong teeth position. When I clench my teeth (for example during swallowing) the position is strongly fixed since the upper teeth goes into that grooves.
So, on one side we expect some shifting to better position, on the other side it looks (for me) like the grooves protect from shifting. Am I right ?
I’m not sure how this splint is going to work to achieve the goals in treatment.
Do I have any chances my condyles move forward/ backward in this splint when it comes to that grooves on splint ? or it’s not good splint for my case in this phase ?
I asked my dentist about that, but as far no response.
Dr Clayton A. Chan & Gregory Yount Dmd, since you are expert in this field. What you think about that splint considering what I want to achieve with my dentist ? I need your opinion. Please HELP.
PS My dentist told me I could ask what you think about that splint. He reads your articles.
UPDATE: below, in comments section, in response to Amit Alok Pandey’s request, I put more interesting photos, including how it looks installed on my teeth model

Discussion

Clayton A. Chan
I would be asking the same questions. You need to ask your NM dentist who you chose to treat you these great questions. He knows about your concerns, symptoms and conditions the best. I don’t do those kind of appliances, so you should find out why the appliance is designed in such a way and what its purpose is in helping you. I am sure there is a specific purpose your doctor had in mind to meet your particular needs of your muscles, joints and teeth/occlusion.

Donat Lewandowski
If I had an orthotic you use, which has some grooves on surface… how those groves on orthotic let the jaw to change position ?

Clayton A. Chan
If more dentists would come and learn at OC what and why we advocate certain things…it would help so many more.

Clayton A. Chan
Each groove, each fossa, each ridge height on the occlussal surface must function in very particular ways in order to allow muscles, joint/condyle disc and jaw positioning to occur whether positively or negatively. it all matters. If there are high spots the patient feels during the chewing cycle, the muscles will not calm down.

Donat Lewandowski
Clayton A. Chan the problem is time and money. My dentist does not use orthotic since they are too expensive in this region, but he is going to use 3D printer to make them soon. This solution will be cheaper in that way and dentist will have full control on the whole process

Clayton A. Chan
Printing orthotics is not the answer. Anyone can print just about anything these days for less…but it is a matter of does what is printed and designed fit the “functional” anatomy in the mouth in order to achieve the desired results? That is the challenge.
Hi spots that hit at the wrong time during jaw function whether you move your jaw left or right, up or down, forward or backward, if you slide around on your orthotic can either add to the problem or help diminish the problem…that is up to the understanding of the dentists who adjusts your appliance.

Donat Lewandowski
Clayton A. Chan so you could not make the same orthotic using 3d printer ? ..the one designed in the same way for particular patient

Clayton A. Chan
Printing is not the problem. Finding and establishing the correct jaw relationship first (so you print the correct occlusal surface) and secondly adjusting the printed orthotic are 2 keys to successful treatment (to accommodate to the pathologic joints, disc and muscles). If one cannot find a proper adjusted position ….well the printing is obviously not the issue…Right?

Keren Purchase
how do they make dentures? They don’t need to print dentures. why can’t they make splints in a similar way?

Susan Go
Hi Keren Purchase. Dentures are easier in the sense that all the teeth can be set up exactly how you want them. With real teeth, we have to adapt the inclinations of the occlusal surfaces of our orthotics to match those of the real teeth (which are not always ideal) and at the same time, allow for eccentric movements without interferences which may cause noxious stimuli to the muscles/nerves preventing them from calming down. Having said that, you may still have to make adjustments on dentures to even out the bite.

Amelie Giraud
Clayton A. Chan no attack here, but regarding your comment on more dentist coming at OC, don’t you think that the fees for the courses are limiting quite a bit the abililty of more dentists to afford? Do you offer special prices depending on needs? Just asking.

Clayton A. Chan
Amelie Giraud Great question. No, OC’s pricing and doctor course fees for each of the 2 courses are very comparable and competitive within the post graduate dental continuing education programs. In fact, those dentist who come learn soon realize our programs are packed with quality information, accompanied each with a text book like instructional manuals that doctors can actually read and reference throughout their OC GNM learning journey. Non of our courses have marketing or promotions, but are dedicated each to advance our doctors diagnostic and clinical experience. I believe not all dentist are willing to discipline themselves in Occlusion and TMD. It is hard work, requires another way of thinking, as well as very challenging. It is not for the light at heart. Not until they get tired and burnout from performing the routine and typical dentistry are they willing to be open to seek and find another way of dental care and services that they realize can impact a human life on a whole different level.

Clayton A. Chan
Dentist are often attracted to tangible topics and things the can see and gain instant gratification. Occlusion is not tangible, you can’t see occlusion on an x-ray, companies don’t sell it in any packages, yet it is between every human being that walks into a dental office for treatment…yet dentists are confused by the topic and figure out how to effectively treatment.
As you know in this dental arena, there are some dentists who believe that occlusion doesn’t even exist nor is it a cause for TMD problems, etc. So part of our dental profession is in denial about the whole topic of occlusion and TMD as we all know.

Amelie Giraud
I did not understand your answer sorry but I don’t want to take u too much time on this anyway, it might be a cultural difference anyway. I don’t get what the two courses are.
I looked up at the fees and for one level they are 3495dollars on your website. That means to complete all 8levels which do not include the ortho nor the orthotic making, flights and housing and it is approx 27 000 dollars.
So I see that as a huge barrier for doctors coming from Europe who, as exhausted of running into circles as they can be, won’t be able to do it.
I know that generally in the US education is very expensive. However in universities there’s always a way to get discount prices depending on your situation, or programs such as fullbright or others mechanisms of stipends who allow students who would not otherwise have access to good Uni to study there. There are also stipends based on merits, with for instance in law as it is my field propose ways to get a tuition paid for one year at a very good Uni if one presents a moot litigation and gives very good legal argumentation. So it it based on merit, it rewards those who really show an interest for the topic, and prove they are good and ready to put a lot of work into the submission of an application that will prove they are very good and could be brillant if they had the chance to get this program.
Are there maybe similar mechanism at OC? I’m pretty sure young dentists already sometimes wonder what’s wrong on their patient (I saw it on French professional forums for dentists) but habe no clue what to do with them and even further:they know that they have no clue but have not really a way to learn. I would see a call for application for brillant dentidtd who want to take OC courses but have not enough money to do so very interesting. They could submit a case and résolution as part of their application, for instance.

Clayton A. Chan
OC’s fees are comparable to other quality dental continuing education program here in the U.S. Our courses are purposely small and quality oriented so the doctor can learn well. We don’t have more than 14 doctors in a course. Thank you for your thoughtful considerations.

Donat Lewandowski
no young dentist (even old) from Europe, especially central Europe will be able to spend almost 30 000 for courses having in mind he won’t sell very expensive product on market – the reason is simply, here (Poland for example) less than 1% of people with TMJD will be able to pay a few thousands euros or dozens thusands $ for such treatment

Amit Alok Pandey
Show a pic of this splint in the mouth with teeth occluding.

Donat Lewandowski
you won’t see anything, better to show it on teeth model (some teeth a bit damaged on model). The idea of recapturing disc is to decompress the joint and at the same time to let the condyle move (for example forward if the disc is displaced anteriorly

Donat Lewandowski
actual bite – the midline went on the other side – jaw shifted to the right (2mm) and deviated 1-2mm

Donat Lewandowski
how it should look on model. take a look at midlines . Of course in the same way it looked before I damaged glued the teeth , then what you think ?

Amit Alok Pandey
I am not happy with the Splint. It creates anterior open bite despite anterior coverage. A picture in your mouth would be better. I think you will soon require adjustment. Your habitual bite looks fine from the model with no midline shift

Amit Alok Pandey
Are u advised to wear 24 hrs even while eating?

Donat Lewandowski
Amit Alok Pandey origianlly midline is shifted and should be. in my case ! take a look closer. lower midline should be about 1mm to my left, and now it’s almost 1mm shifted to the right

Donat Lewandowski
Amit Alok Pandey yes a lot of x-rays… why you think it creates open bite ?

Donat Lewandowski
Amit Alok Pandey 22h-24h …i can’t eat with it. it’s not orthotic..how to eat with such splint 🙂

Amit Alok Pandey
Are anterior upper teeth contacting the splint?

Donat Lewandowski
Amit Alok Pandey i don’t think this splint will allow my jaw to shift to the left as it’s shfited to the right . What you think ?

Amit Alok Pandey
If you don’t use for eating and for 24 hours then how do you expect it to balance the Cranio-facial structure?

Donat Lewandowski
Amit Alok Pandey no the contact is only on 4,5,6,7

Donat Lewandowski
Amit Alok Pandey eating is just a short process, i think you more cench your teeth during swallowing a saliva ..more often

Amit Alok Pandey
contact only on 4,5,6, 7 is not good. Then why full arch splint?

Donat Lewandowski
Amit Alok Pandey i don’t know… my next phase is pivot splint. the question is what kind of splint do i have now ? isn’t it positioning splint ? I mean a splint which fixes the jaw in actual position ?

Amit Alok Pandey
This is not NM splint. NM splint is full coverage and contacts all along.

Donat Lewandowski
Amit Alok Pandey ok ..the second question is if this is splint which allow my jaw to change position ? you read my post what are my concerns

Amit Alok Pandey
I have not seen your TMJ X rays. I remember u had facial bones dislocation after surgery…right? I really can’t say how splint will help in such case. Sorry ! If u find the splint uncomfortable, don’t wear it.

Donat Lewandowski
but why? normally you do not have contact on no 1 teeth, even on 2 if i;m not wrong

Donat Lewandowski
Amit Alok Pandey it’s comfortable, but I do not know how it’s going to unshift my jaw and the dentist does not answer my question as far

Donat Lewandowski
why you need contact on 1,2 ? strange

Amit Alok Pandey
contact is there on the labial side of incisor

Donat Lewandowski
perhas i have contact on 3-7

Donat Lewandowski
for sure not on 1,2

Donat Lewandowski
i think, i should get repositioning splint..my next phase, but i do not know why i got this one as first

Amit Alok Pandey
If it does not contact then the gap between the incisors and splint should not be more than 1.5 mm