Why is the GETTING THE BITE RIGHT important?
The importance of bite relation (occlusal analysis) cannot be over-emphasized in the dental practice setting. The placement of fillings, crowns, bridges, bite splints, implants, veneers, onlays, inlays, dentures; just about anything we do in dental medicine demands a proper spatial relationship between the temporomandibular joints (TMJ’s) and the oral cavity, not to mention a proper relationship between the maxilla and the mandible. Ignorance to the occlusion, or bite, can create havoc for the patient, creating problems ranging from sensitive teeth, to root canal therapy, to temporomandibular disorder (TMD or “TMJ” as it’s known widely), and even certain types of chronic headaches. Traditionally, a colored ribbon of paper known as articulating paper is used by the dentist to check the bite. The use of this thin paper is problematic though, as it only qualifies where the bite is “high”, doing nothing to quantify/show how much or how hard…
Bite ribbon that most dentists use exclusively is highly inaccurate statistically per research conducted repeatedly in the dental scientific literature.
The Tekscan T-Scan® handle which is connected to a software program which tracks force/time in 3/1,000 of a second increments.
T-Scan data of a patients bite. An interactive movie is created which displays the force/time data in 2-D (top left), 3-D (top right), and graphical formats (lower).
An instrument borrowed from the world of engineering known as the T-Scan® allows a dentist to do just that, QUANTIFY how hard or how much the teeth touch, in 3/1,000 second increments (IN TIME).
The T-Scan® digital occlusal analysis is used in Dr. Nick Yiannios’s office as needed to augment treatment relating to CEREC® insertions, fillings, implant restorations, and in particular, to assist in the novel Occlusal Adjustment procedure known as ICAGD to accomplish DTR for muscular TMD treatments.
Joint vibration analysis is a painless, digital screening tool to measure the health of the TMJ’s. It resembles a headset that is placed over the patients’ temporomandibular joints that “listens” for vibrations that might be emanating from the joints, which are characteristic of joint pathology, or lack thereof. These vibrations can be correlated against known vibrations from the scientific literature to give Dr. Nick Yiannios a rapid assessment of the state of health of that patient’s TMJ cartilage that is ~90% accurate, in minutes! This is significant, because the cartilaginous disk that sits between the lower jaw bone and skull bone (the TMJ-we have a right and a left TMJ located just in front of our ears), when damaged, can have a devastating effect upon dental treatment. Damaged TM disks can be directly related not only to the bite, but potentially painful muscular manifestations, leading to unpredictable dental treatment outcomes. Most in dental medicine do not have a true understanding of this fact. Having a full appreciation for this fact, Dr. Nick Yiannios uses the JVA on all of his regular patients. Akin to a blood pressure reading in your physician’s physical exam, we track your JVA readings over time at every dental checkup, which helps to identify problems before they manifest themselves.
The Joint Vibration Analysis headset which detects frictional interactions between internal cartilaginous surfaces in the TMJ’s and converts the information into quantifiable data in software which can be cross-referenced and used as an indicator of TMJ health.
JVA software data.
An EMG readout in the software.
Electromyography is a painless, highly accurate, and objective digital tool that Dr. Nick Yiannios uses to measure muscular activity in the chewing muscles. Surface electrodes are placed over the target muscles so that the tiny little currents that muscles create can be measured, allowing us to analyze chewing sequences and patterns just like neurologists and researchers do. This is a totally painless and safe procedure. Why are muscles important in dental medicine? For multiple reasons; muscles:
- Break teeth
- Can cause pain in the orofacial region, such as headaches
- Can damage the cartilaginous TMJ disks
- Must be in a balanced state or problems will potentially arise over time
EMG allows us to measure certain chewing muscles accurately in microsecond increments, allowing us to accomplish evaluations of oral-facial pain that normal dentists can only dream of!
Placement of EMG skin-surface electrodes over pertinent muscles of mastication. No current is generated. The tape electrodes simply sense for minuscule changes in microvoltage outputs generated in the target muscles as they change during function as the lower jaw functions.
Tscan technology synchs with EMG (muscle electromyography) technology down to the microsecond enabling Dr. Nick Yiannios to measure instantaneously changes in muscular output relative to miniscule changes in the bite. This combination of technologies is the ultimate TMD treatment aid when the cause of the joint problem is muscular in origin, which it usually is… Click here to watch YouTube videos that Dr. Nick Yiannios has created about the use of the Tscan/EMG link for the treatment of TMD patients in our practice.
The T-Scan (left) & EMG (right) linked in real-time. The bite forces are measured on the left, while simultaneously whatever is happening to the muscles at that instant is displayed on the right.
The T-Scan (left) & EMG (right) linked in real-time. The bite forces are objectively measured on the left, while simultaneously displaying whatever is happening to the muscles at that instant, objectively, on the right.
- RESOLVING TMJ! Watch a grown man cry with relief!:
- Her 45 minute TMJ Cure:
- 3 months after DTR. No more headaches!:
There are many more related videos that exist on Dr. Nick Yiannios’s channel on YouTube: drnickdds.
So what is DTR, ICAGD, and NEURAL OCCLUSION?
These are treatments for muscular TMD issues that DO NOT rely upon traditional splints and acrylic appliances. These treatments are a new, more definitive way of addressing TMD issues by creating a permanent physiological change in patients with confirmed stable and adapted joints (via digital metrics such as JVA and 3-D imaging), rather than the temporary change that splint appliances create. Dr. Nick Yiannios rarely makes acrylic splints that the vast majority of dentists do, but rather relies on the following protocols when indicated for muscular based TMD issues, in a patient with a pair of objectively confirmed stable and adapted TMJ’s.
DTR stands for Disclusion Time Reduction. This is the process whereby “interferences” or “speed bumps” in the way the back teeth from the top jaw interact with the opposing teeth from the lower jaw, during function, are precisely removed with data gleaned from the Tscan/EMG link. This process decreases muscular output, relaxing the muscles of mastication (via instantaneous confirmation with EMG), which typically alleviates many TMD symptoms. Years ago, Dr. Nick Yiannios was personally trained by the creator of this new process, researcher Dr. Robert Kerstein of Tufts University, and is considered an expert in this process. Dr. Nick Yiannios is also a beta tester for Tekscan, the company that created the T-scan technology.
ICAGD stands for Immediate Complete Anterior Guidance Development. Basically, the human chewing system is more efficient the faster the back teeth separate when chewing side to side, as we all naturally do. Hence our front teeth should cause a separation QUICKLY (via measurement w/ the Tscan or Tscan/EMG link) of our back teeth based on known values. Sometimes bonding materials are added to front teeth to help assist in a more “immediate” separation than the patient can based on the shape, condition, or position of their natural dentition. This creates huge advantages for TMD sufferers because the muscles of mastication are made more efficient and do not produce excess lactic acid as a result of being overworked and chronically fatigued. It is this excess lactic acid buildup that at least partially creates many TMD symptoms, such as tension headaches, painful and stiff jaw muscles, neck tension, clenching and grinding of teeth, etc. ICAGD is not a mainstream treatment as of 2015, so this is not something that you can find in just any dental practice. In just the past year, there are a growing number of TMD experts who are beginning to see the advantages and effectiveness of this process. Dr. Nick Yiannios expects that over the next 20 years this novel protocol will become more practiced and available, but presently, his practice is one of the only places where a patient can have this therapy done. From his experience with this process dating back to 2008, it simply changes the lives of muscular TMD sufferers almost every time!
So what is Neural Occlusion? Neural Occlusion is a novel TMD screening protocol that Dr. Nick Yiannios created to help him decide whether or not a particular TMD patient might predictably benefit from ICAGD Occlusal Adjustment to accomplish DTR. It involves a combination of numerous technologies (CT, JVA, EMG, TScan®, and sometimes MRI) combined with a thorough history, examination, and FDH screening. As of 2015, there is no other place that a TMD patient might go for this particular type of screening. Dozens of video examples of the Neural Occlusion protocol and DTR via the ICAGD occlusal adjustment process may be found on the practices YouTube homepage:
Dr. Nick Yiannios and Dr. Robert Kerstein discussing the utility and usefulness of DTR for the muscular TMD treatment: