Muscle deprogramming in TMJ treatment

We use state-of-the-art protocols to restore joint function

Helps get rid of muscle tension

Duration of reception — 1.5 hours

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Deprogramming – is a relaxation, a change in the tone of the muscles of the maxillofacial region. It is a step in the treatment of temporomandibular joint dysfunction and helps to eliminate muscle tightness, discomfort, pain and other symptoms of the disease.

The position of the joint and the development of dysfunction depends on the pathology of the bite, movements of the mandible and the work of the masticatory muscles. Deprogramming allows determining the physiologically correct position of the temporomandibular joint head by relieving muscle tension.

Methods of muscle deprogramming

Manual method

The manual method, such as Dawson bimanual deprogramming, is used to quickly relax the lateral wing muscle and is performed right in the dental chair. The practitioner gently extends the lower jaw into the desired position and the muscles are relaxed for a few seconds. The dentist must have time to fix the correct position of the jaw with a base wax or silicone while the muscles are relaxing.

Using the devices in one visit

Frontal deprogrammer (standard or customized deprogrammer, Jig Lucia)

The jig is a bite pad in the area of the anterior incisors – the tooth rows are unlocked and the jaw is freely advanced on the «pad» to a physiologic position.

At Konfidencia, we prefer to use this method of deprogramming. The gnathologist gives you a custom-made device and you can relax at the reception desk, read a book or watch a movie while your muscles relax.

After half an hour of the device, the doctor checks the success of deprogramming, additionally massages the masticatory muscles and makes a silicone template in the new position of the jaw for MRI control of the obtained position.

Jig

Multi-leaf gauge

The appliance consists of several layers of flexible lavsan film. It is placed between the front teeth and separates the tooth rows like a jig. The clinician then selects the appropriate thickness at which optimal muscle relaxation occurs by removing or adding layers of film in a pattern between the teeth.

The device is placed between the teeth.

With long-wearing appliances.

Kois Deprogrammer

The appliance is a removable plate with a bite pad in the front. It must be worn continuously for 10-14 days and removed only for brushing or eating. The deprogrammer effectively realigns the muscles, disengages the teeth and allows the joint to assume a physiologic position.

The disadvantages of this method are the bulkiness of the structure, discomfort during wear, the duration of deprogramming, and the consequent lengthening of the overall treatment period.

Kois Deprogrammer

Aqualizer

Aqualizer – is a mouth guard with two pads in the sides filled with water. The patient bites down on the soft pads and the jaw assumes a comfortable position. Due to its structure, the device adapts to the anatomical features of each patient, has a temporary relaxing effect and relieves pain syndrome. The device is prescribed for long-term deprogramming and requires constant wearing for 10-14 days.

Aqualizer

TENS (transcutaneous electrical neurostimulation)

This is an additional physiotherapeutic method, in which the masticatory muscles of the face and neck are stimulated with a low-frequency electric current through special percutaneous electrodes. Relaxation of the muscles of the head and neck occurs due to simultaneous bilateral stimulation of the facial and trigeminal nerves, is an absolutely safe method and does not cause unpleasant sensations.

How is deprogramming at the Confidentia Clinic?

Deprogramming — is the first stage of joint diagnosis, the purpose of which — is to identify and fix the correct position of the jaw and the joint.

Consultation and Diagnosis

It all starts with a consultation with a gnathologist. The first visit lasts about 1 hour. The doctor clarifies all symptoms and factors that lead to the appearance or worsening of the joint, conducts load tests (exercises for the joint), palpates the muscles of the face and neck.

The physician will also check for any symptoms and factors that lead to the appearance or worsening of the joint, conduct stress tests (exercises for the joint), and palpate the muscles of the face and neck.

If at this stage the doctor confirms the presence of joint dysfunction, then additional studies are ordered CBCT and MRI of the TMJ) to see in what position the head of the joint and the articular disc are in.

Joint Diagnosis

After the doctor evaluates the imaging data and makes a final diagnosis, a joint diagnosis is ordered.

First step – is deprogramming. At your appointment, you are given a custom-made jig that is placed on your front teeth for 30 minutes. After the muscles have relaxed and the joint head has shifted, it is necessary to fix the new physiologic position of the jaw. To do this, the doctor makes an impression of the chewing surfaces of the teeth using wax or silicone material.
Next, the gnathologist needs two tools before making a joint splint – лThe facial arch and the articulator. Facial arch «memorizes» the position of the upper jaw in relation to the skull. The lateral guides are placed in the ear canals and a special fork is applied to the teeth of the upper jaw. The facial arch structure is rigidly fixed, removed from the patient's head and attached to the articulator to transfer your individual jaw position data.
Using the data obtained, the doctor uses an articulator to make a new silicone pad (or bite pad), which is given to you or, if necessary, sent by courier in an individual sterile package.
With a bite mark in your mouth, you need to do a repeat MRI scan to check the new position of the joint and the articular disc.
After analyzing the second MRI examination, an articular splint is made (a mouthpiece on the lower jaw with a special relief on the chewing surface), which helps to maintain muscle relaxation and the correct position of the joint.

Joint treatment

The next phase begins with active wear of the splint and regular follow-up visits. At the appointments, the doctor will refine the relief of the joint splint for more comfortable wear and monitor changes in symptoms of joint dysfunction.