Manage TMD/TMJ appliance product selection and clinical use

Overview: This guide provides specifications for Dandy's custom intraoral TMD appliances, including the Anterior Deprogrammer, NTI device, Dawson B-Splint, and Gelb Appliance, to assist in clinical diagnosis and selection.

TMD Appliance Product Overview

Anterior Deprogrammer features and benefits

The Anterior Deprogrammer is a custom device that covers the entire dental arch. The Anterior Deprogrammer uses an anterior ramp to disclude the posterior teeth. This disclusion helps retrain jaw muscles and prevents bruxing. The Anterior Deprogrammer is primarily used on the maxillary (upper) arch.

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  Full arch protection: The Anterior Deprogrammer provides tooth protection through full arch coverage.

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  Enhanced retention: The Anterior Deprogrammer offers greater retention than the NTI device due to the full arch design.

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  Occlusion interference: Coverage on the posterior teeth may cause some occlusion, which can interfere with the retraining of jaw muscles.

NTI device specifications and use

The NTI device is a small, unobtrusive appliance placed on the anterior teeth. The NTI device avoids occlusion of the posterior teeth to inhibit bruxism and relieve stress. The NTI device specifically covers teeth #7 through #10 on the maxillary (upper) arch.

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  Muscle retraining: The NTI device completely prevents occlusion, which retrains the patient’s muscles to stop bruxing.

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  Retention challenges: Because of the small size of the NTI device, some patients may experience difficulty with retention.

Dawson B-Splint movement support

The Dawson B-Splint is an appliance that covers both the upper and lower dental arches. The Dawson B-Splint avoids occlusion of the posterior teeth to inhibit bruxism while still allowing for horizontal jaw movement.

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  Complete arch protection: The Dawson B-Splint provides coverage for both arches for complete protection.

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  Movement support: The Dawson B-Splint facilitates and supports lateral and excursive jaw movements.

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  Lack of muscle retraining: The Dawson B-Splint does not retrain the patient’s muscles.

Gelb Appliance posterior protection

The Gelb Appliance sits on the posterior teeth and repositions the mandible to control jaw positioning and avoid excess force. The Gelb Appliance maintains the mandible arch shape and moves the condyle into a more anterior position.

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  Mandible positioning: Mandible movement results in an inferior position in the fossa and increases the vertical opening to relieve pain.

• Increased tongue space: The Gelb Appliance allows for more tongue space because the Gelb Appliance lacks anterior coverage. This benefits patients who snore or have sleep apnea.

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  Lack of muscle retraining: The Gelb Appliance does not retrain the patient’s muscles.

TMD Treatment Clinical Selection

Clinical examination and imaging requirements

To properly diagnose a TMD patient, providers should take proper imaging to understand the root cause of the chief complaint. The root cause typically involves muscular issues or joint damage (erosion, alignment, cartilage damage, or trauma).

Required Diagnostic Imaging:

• X-rays

• CBCT scans

Patient assessment screening questions

Use the following questions to determine if the TMD root cause is muscular or joint-related:

• Do you have frequent or regular headaches?

• Are your jaw muscles ever sore or tender?

• Are your joints sore or tender when eating or chewing?

• Does your jaw make noise, such as snapping, clicking, or popping?

• Does your jaw lock when trying to open or close?

• Do you have any teeth that are sensitive or uncomfortable?

• Have you worn a splint or nightguard previously?

• Have you ever had a jaw or face injury?

Selection guide by clinical need

Choose the appropriate appliance based on these specific clinical goals:patients with temporal headaches

Related Information

• TMD Appliance Turnaround Times

• Choosing the Correct TMD Appliance for Your Patient