During this visit, the patient will have similar computer analysis to the screening appointment. Measurement of baseline values are made and the the patients facial muscles are pulsed with a low frequency tens unit to help them approach a physiological state of relaxation. This position can then be captured by making an acrylic appliance. This appliance is what is known as an orthotic.
At this time, we note if any muscles demonstrate electrical activity beyond standard norms. Isometric analysis indicates the presence of neuromuscular asymmetry during maximum voluntary contraction of the involved muscles. Isokenetic testing scans reveal the presence of bradykinesia and dyskinesia. These muscle incoordinations are noted when comparing patterns of the open-close cycle.
Electrosonogrophy (ESG) is conducted to correlate particular joint sounds both with changes in mandibular velocity and spatial location during the open-close cycle. The sonogram (ESG evaluation) can indicate the presence of both amplitude and low frequency sounds during opening and closing. These are correlated to positions in the opening cycle and closing cycle. These particular signatures can be indicative of tissue displacement occurring as a result of chronic muscle overloading.
ULF-TENS is then utilized according to standard procedures. Following approximately 60 minutes of use, initial testing is repeated to indicate that elevated electrical activity in the muscles has returned to physiological limits. Based on the results of this assessment, a computer generated intraoral orthosis can be fabricated to function as a neuromuscular retraining device. Fabrication and adjustment of this device is done in accordance with the neuromuscular pattern during muscle recruitment.
The patient is given specific instructions regarding the proper care, use and maintenance of this retraining device, and informed that in the event of any difficulty or complication, they are to notify the office. The patient is then dismissed ambulatory and in good health.
Course of treatment will consist of continuous monitoring over the next 12 to 24 weeks.
TMJ Phase II
Following the creation of a stable neuromuscular occlusion, the doctors at MGC are most concerned with maintaining this physiologic position over an extended period of time. This can be achieved through orthopedic or prosthetic services. Attaining this physiologic position my create different levels of difficulty in determining the final stabilization, and often these services can be provided through MGC Associates. However, sometimes, final stabilization requires treatment by a dental specialist.