ANODYNE BITE RESTORER

THE LONG TERM PAIN-RELIEVING SPLINT FOR TMD SUFFERERS

Johns Dental Laboratories has long been aware of TMJ syndrome and the related discomfort it causes.  The dysfunction of the temporomandibular joint results in stress on muscles, often causing head, neck, shoulder and back pain.

With proper treatment, relief for TMJ pain does exist.  The initial use of a bite opening acrylic splint from Johns Dental Laboratories (such as Gelb, Farrar, Mays, Sears, Witzig and others) is recommended to guide the jaws into alignment whenever the wearer occludes.  In most cases pain begins to disappear in a remarkably short time.  Much of the discomfort vanishes soon after the splint is inserted.

Can adjustments be made?

As changes take place in the joint during treatment, adjustments in the occlusal contacts can be made by grinding and/or adding additional acrylic.  Once the new occlusion is firmly established with the acrylic splint, treatment may proceed with a more permanent type of restoration.

Can Bite Restorers work for older patients?

In the case of TMD patients who do not desire orthodontics or crown and bridge work, bite restorers are often chosen as the permanent restoration best suited to maintain a TMJ patients correct occlusion.  The Anodyne (pain relieving) Bite Restorer, constructed by Johns Dental is a Vitallium framework with composite bonded to the occlusal surfaces.  The composite material is about the same hardness as tooth enamel and is kind to the opposing dentition.

The basic design of an Anodyne Bite Restorer includes four clasps (most often on the first molars and bicuspids) and a lingual apron as the major connector.  Edentulous areas are restored using a conventional acrylic saddle.  We suggest the use of composite, hardened acrylic teeth in such cases because of their proximity to the hardness of enamel.

The bite restorer may be built with a composite cap to fit onto the anterior teeth, but patients are often displeased with the appearance of these appliances.  Alternatives, such as composite buildup, laminates or crowns, may be better suited for treatment if an anterior open bite exists. 

Preparing the mouth

Proper preparation of the arch will help ensure an appliance that fits well and maintains the goal of TMJ treatment.  Taking the following measures can help eliminate complications which could lead to appliance failure.

TMJ syndrome is often associated with bruxism or clenching.  As a result of these abrasive habits, posterior teeth may have sharpened edges.  Such areas need to be rounded by the dentist.  Also, amalgams that are worn or breaking down should be repaired or replaced.  The fit of the Anodyne Bite Restorer will be enhanced by correcting these intraoral conditions. 

Another common condition of TMJ patients is posterior teeth that have collapsed lingually.  Buccal undercuts necessary for the retentive clasps may not be present.  Two solutions are suggested for this problem: 

1. Create a slot on the buccal surface near the gingival on each first bicuspid and first molar (or teeth which will be clasped).  The slot need only be 1 mm long by 1/2 mm wide and .3 mm to .5 mm deep. This will provide ample undercut for the clasp.

2. Recontour the bicuspids and molars by adding a ridge of composite above the gingival that the retentive clasp can snap over.  Increasing the retention available will result in a stable fit of the bite restorer

If the posteriors are severely tipped it may be advantageous to reduce the lingual surface at the height of contour.  The Anodyne Bite Restorer can then be constructed with reduced bulk on the occlusal, making more tongue room for the patient.

Taking the bite

Taking the bite with the mandible in its new and proper position is crucial to the successful placement of an Anodyne Bite Restorer.  Prior diagnostic use of  an acrylic splint is the key to taking a well established bite.  By following the steps outlined here, the Partial Denture Laboratory technicians will have the necessary information to build the appliance to the correct position.

1. Remove the splint and prepare the mouth for taking an anterior core bite:

   1. Vaseline the teeth
   2. Trim off any anterior coverage built onto the splint.
   
   

2. With the splint in place, take an anterior core bite using quick cure acrylic  Note: The acrylic may be an irritant if it comes in contact with the gingival.

3. Remove the splint and replace it with heated, pliable wax.  It is very important the wax be softened and heated  (139F) or condyles may sublux.  The anterior bite core is placed back in the mouth, and the patient is instructed to bite into the posterior wax, using the anterior bite core as a guide.

4. The final impressions are taken after the bite procedure is complete. The splint remains out of the mouth for the impression.  Use a poly or silicone impression material for the arch on which the bite restorer will be placed.  Alginate may be used for the opposing.

5. The opposing alginate impression should be poured in die stone within 10 minutes after being taken.  Johns Dental will pour the ply or silicone impression in a special stone that resists chipping and cracking during the construction process.

In Summary

1. Establish correct position of the mandible with an acrylic splint.

2. Prepare the arch which will receive the Anodyne Bite Restorer.

3. Take the anterior core bite using the acrylic splint as a    guide,  followed by a wax bite.

4. take the final impressions with poly vinyl or silicone type material.

5. Send impressions, opposing model and bites to Johns Dental.  Return splint to patient.

6. Framework with wax rims will be constructed. Allow five working days in the laboratory plus transit time.

7. Try frame for fit and verify bite.  Return to Johns Dental.

8. Johns Dental finishes the framework with composite occlusal pads. Allow three working days in the laboratory for composite only.  Two extra days are required for acrylic saddle areas.

9. If the patient has a pattern of bruxism or clenching, the composite occlusal pads will be subject to excessive wear.  Metal stops can help reduce the stress on the composite.  We also highly recommend nighttime protection with a soft night guard to slow wearing of the occlusion.

Our technicians will be pleased  to consult with you on the design of your next bite restorer.  Send models and a treatment plan for a free estimate.  Your model will be returned with the appliance outlined on it.

Related Products

BOOKS & TMJ EQUIPMENT PATIENT EDUCATION

"The Clinical Management of Basic  Maxillofacial Orthopedic Appliances" (Vol. III)
Authors: John W. Witzig / Terrance J. Spahl
This book provides the tools necessary to diagnose and treat  TMJ disorders as well as give the best overview of  joint anatomy available today.

"Diagnosis to Splint Construction"
Author: Brendon Stack, B.S., D.D.S., M.S.
Dr. Stack's book illustrates and documents TMJ physiology from the biomechanics of the temporomandibular joint and diagnostic work-up to fabrication of the Mora and Maxillary Pull-Forward appliances.

"Myofascial Pain and Dysfunction"
Authors: Janet G. Travell, M.D. & David G. Simons M.D.
This "Trigger Point" Manual is an illustrated guide to trigger point therapy and deals with examination, diagnosis and treatment of the head and neck muscles.

Denar/Witzig TMJ Articulator & Face Bow System
The Cadillac of articulators!
Using TMJ X-Rays and the Denar/Witzig articulator, a proper  condyle-fossa relationship and posterior vertical dimension can be easily dialed in.

TMJ Tutor
This magnetic model demonstrates disc dysfunction to patients, including perfect occlusion, malocclusion, and splint in place positions.

"TMJ Disorder & Chronic Pain"
a patient education brochure by Dr. R. L. Bubenzer explaining TMJ Syndrome.  Symptoms, causes and illustrations are explained in layman's terms.

Call toll-free (800)457-0504 for Pricing and delivery times on any  of these products.

Request a copy of this document.

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