Ramin Mehregan DMD
Gneuromuscular Dentist
"Making Your Dentistry Matter"
K7 Evaluation System and TENS (Trans-Electrical-Neural-Stimulation)
A brief history on NM dentistry:
For the past forty three years, dentistry has enjoyed an exciting evolution in the delivery of care. Technological advances have predominantly driven this evolution. Scientific advances have resulted in dental materials as technological break troughs using bio-instrumentation that have completely changed our perspectives on how dentist diagnose, manage and treat their cases. Technological advances have also allowed us to go beyond visualizing occlusal relationships solely from an anatomic perspective.
The early years from 1967 to 1977 gave insights and appreciation for the intellectual and courage of Dr. Bernard Jankelson (the Father of Neuromuscular Dentistry) single handed challenged the dental occlusionist establishment with science and technology we now may take for granted and is available today. Dr. Jankelson fight for new technology and new paradigms to dental occlusal treatment brought to light the dogmas, skepticism and epic confrontations from various levels of the profession.
After Dr. Jankelson's death in 1987, battles erupted in the American Dental Association and U.S. Food and Drug Administration. By 1986 the scientific foundation for neuromuscular concepts and techniques were firmly ground in scientific literature and the technology was recognized as safe and effective for the purposes intended by the American Dental Association Council on Scientific Affairs. The clinical techniques which continue to be advocated by his son Dr. Robert Jankelson, Dr.'s James F. Garry and Clayton A. Chan and others (through 2005) have been found to be precise, predictable and successful in spite of some continued attacks from those who ignore the documented science.
K7 Evaluation System
"The K7 and TENS does not diagnose neither records the Optimized Bite…the trained dentist does!"
Jaw Tracking Functions and INDICATIONS FOR USE:
- Tracks mandibular movement and position
- For the diagnosis of functional disorders such as TMJ/MPD syndrome, muscle, tension, bruxing, and instability of occlusion
- Identification of mandibular rest position
- Identification of interocclusal distance and freeway space
- Monitors the position of the jaw in three dimensions
- Represents the spatial position of the mandibular incisal edge relative to the skull.
Electromyographic EMG Functions and INDICATIONS FOR USE:
- Intended for use for the muscles of mastication, especially temporalis massetter, and digastric
- Designed to perform a limited number of functions in dental diagnosis
- For use as a stand alone system for clinical monitoring of up to eight different muscles. It is ideally suited for diagnosis and treatment evaluation by recording function/dysfunction of the muscles of the stomatognathic system.
- The determination of the degree of relaxation of a particular muscle or muscle group at rest.
- The precise measurement of relative levels of contraction of several muscles during a functional test.
TENS (Trans-Electrical-Neural-Stimulation)
The battery operated J5 Myomonitor TENS unit delivers controlled, periodic, bilateral electrical stimulation to both the masticatory muscle region as well as the lower back and cervical neck region synchronously. Myomonitor/TENS technology has a 48 year proven track record for effective bite recordings before, during and post treatment bite management. Finding a bite relationship, without manual intervention, after 45-60 minutes of muscle relaxation has allowed NM clinicians to capture an un-torqued bite registration of the mandible in a sitting up right postural position.
- Relax muscles and establish a physiologic occlusion
- Aids the clinician to take occlusal registrations
- Aids in taking denture impressions
- Treat TMD dysfunction and associated pain
- Relieve symptoms associated with muscle spasm
- Increase local blood circulation
- Increase mandibular range of motion
"To Read More: FDA Approved CMS and TENS Myotrode Placement Guidelines Specific for Both the V and VII Cranial Nerve Stimulation"
This is a side by side comparison of Scan 9 before TENS (Trans-Electrical-Neural-Stimulation) and Scan 10 after TENS.
Scan 9 is used for the analysis of accommodated resting EMG raw data before pulsing. It shows the relative resting activity of the masticatory and or cervical muscles and muscle tension in each muscle group relative to one another.
Scan 10 is used for the analysis of EMG raw data after pulsing. It shows the degree of muscle relaxation at the physiologic rest position.
Scan 6 is a simultaneous Sagittal/Frontal view showing mandibular movement during swallowing and to identify tongue activity.
It is a powerful objective measurement to assist in distinguishing whether there is long term occlusal stability or instability.
It distinguishes between normal swallowing patterns, aberrant lateral tongue swallowing, and aberrant anterior tongue swallowing patterns.
Scan 8 is a simultaneous Sagittal/Frontal tracing showing the movement of the mandible during functional chewing cycles.
It gives important information of the terminal tooth contact position and the intercuspal and lateral border movements. This chewing motion is dependent on muscle and joint health. Those with balanced muscualture and with normal joints will display repeatable overlapping traces both in sagittal and frontal tracings after the initial terminal contact position both on closing and opening.
Scan 15 is a combination of jaw tracking and sonography allowing to correlate the acoustic signature patterns with real time events within the open and closing cycles of mandibular movements.
It shows if there are any alterations and joint morphology as it relates to normal function. In addition it indicates if there are thickening of the articular surfaces, any substantial macroscopic remodeling, and any articular disc displacements.
CHAN Optimized Bite™ DENTISTRY
Dr. Chan’s approach recognizes that proper jaw position as it relates to the cranium and the teeth is crucial to a healthy balance of musculature, jaw joints, and the accompanying structures that are crucial for optimal function, stability, protection and comfort.
Scan 2 and 7 is designed to record a sagittal, frontal and velocity of mandibular movement during opening and closing. Scan 2 is designed to be taken before pulsing and Scan 7 after Myomonitor pulsing.
The opening and closing patterns along with the velocity tracing are important because they can be clinically insightful as how the temporomandibular joint (condyle, disc, eminence) along with occlusal patterns are correlating to functional joint anatomy. Clicks (slow down in velocity) during opening and closing cycles are displayed showing exactly where these clicks are.
Scan 11 is designed to record EMG muscle activity during a function test to see how much muscle recruitment the patient has on the masseter and temporalis anterior muscles groups. Typically two clenches are recorded on natural dentition and two on cotton rolls.
It indicates the force applied by each muscle during clenching, in addition it also reflects the relative amount of "work" each muscle is capable of exerting.
Scan 13 is used to record the mandibular range of motion (ROM) before or after treatment. The range of motion includes the maximum vertical opening, maximum left lateral and right lateral movement and the maximum anterior and posterior movement.
It give information of restricted mandibular movements due to joint, bone and muscular pathology.
Scan 4/5 is a scan that uniquely establishes the quality and level of neuromuscular understanding both in the diagnosis and treatment of dental occlusion.
It is a recording of both the sagittal, frontal and lateral positioning of the mandible as it relates to the maxilla from centric occlusion over time in split screen mode.
This scan shows the quality of physiologic rest position both vertically and sagittally as well as the location of various trajectories (habitual trajectory, the classic NM trajectory and the Optimized NM trajectory). This scan demands a higher level of physiologic and anatomical understanding of both temporomandibular joints and disc positioning along with mandibular, head and neck posturing.
Scan 4/5 jaw tracking displays the movement of the mandible and its related neuro and muscular responses to the anatomical tooth morphology, occlusal plane relationships between the maxillary and mandibular arches, cervical neck condition and head posture.
Scan 4 is recorded AFTER the patient has been pulsed with the low frequency TENS for at least 45 minutes. If the muscles have been truly relaxed, the jaw will be at its neuromuscular rest position (blue records the vertical position of the jaw over time. This position is usually a different “rest position” than a habitual (accommodated ) relaxed jaw position because the tension-shortened muscles have lengthened as they became relaxed during the 45-60 minutes of TENsing. Notice that, as the muscles relax and lengthen, the intra-oral freeway space between the teeth usually increases. The red line measures over time the antero-posterior (AP) mandibular position. the green line measures over time the frontal mandibular position.
Scan 5 represents a summation of the jaw movements and positioning over time seen from the sagittal and frontal views. The lower colored bars display simultaneous electromyographic (EMG) muscle recordings of the temporalis, masseter, cervical and digastric/suprahyoid musculature.
Visualizing this data allows the dentist to observe small jaw changes within 0.1 millimeters.
- It allows for effective monitoring of the Myomonitor/TENS pulse both sagittally and frontally.
- Monitors muscle activity – whether high or low EMGs
- Clinician can see where to set the Myo-centric Target when recording a bite registration.
- Clinician can see how much tooth will need to be ground prior to equilibration treatment.
Posture and TMJ
Posture has an effect on the relationship of the lower jaw to the cranium and can result in a malocclusion (improper bite). If body symmetry is not within normal limits, aligning the atlas-axis (C1-C2), the occiput and pelvis may be necessary via specialized chiropractics as Atlas Orthogonists (AO), and or Sacral Occipital Therapists.
Atlas Orthogonal is a chiropractic technique, based on the vertical relationship of the body, where the head is centered over the pelvis and feet. This positioning is established to support the body from the stresses of gravity. The first vertebra is the foundation of the spine, supporting the head, the equivalent in weight to that of a bowling ball. The atlas needs to be level to support the head over the lower spine and pelvis. An unleveled atlas will lead in a shift in the head and consequently a shift of the lower spine away from the vertical.
A secondary effect of a misaligned spine is interference to the nervous system. This nervous system is crucial to providing function to every tissue, organ and system throughout the body. In addition, complex musculoskeletal conditions such as back, neck pain, etc. may occur.
To read more on AO chiropractic: http://atlasorthogonality.com/
The GNM Orthosis
The lower anatomical orthotic is the one appliance that has been proven successful, consistent and able to meet the needs of most of my TMJ pain patients. After accurately identifying, by objective measurements, the correct physiologic bite relationship and properly adjusting the orthosis, the appliance can be worn 24/7.
