An orthopedic approach is necessary to treat TMJ disorders at their roots, because they are musculo-skeletal conditions. When a TMJ is inflamed, joint protective oral appliances can immediately stop the chronic bruising and thereby also the reflex protective bracing and hypervigilance of the jaw muscles. Once the TMJs are no longer inflamed and the bite is stable so the jaw muscles are no longer receiving signals that trigger them to stay on-guard, the orthopedic features of the oral appliance can be changed to focus on rehabilitating the jaw muscles and optimizing facial growth to acquire a state of healthy function which produces stable adaptation that is resistant to injury. Our most commonly used orthopedic treatments include:
- Joint protective stabilization appliances
- Joint protective telescopic appliances
- Pivoting for unilateral condylar distraction
- Orthopedic disk recapturing
- Front flat plate appliances
- Rubber bite cushion appliances
- Bite restoring appliances
- Bite stabilization
- Functional orthodontics
ORAL APPLIANCES - used just at night can effecitvely treat the vast majority of TMJ disorders by reducing or redirecting the powerful clenching and grinding forces (bruxism) that affect everyone during sleep in a manner that protects inflamed TMJs, stretches tight jaw muscles, reduces overbite, and/or stimulates horizontal facial growth. An orthopedic oral appliance should provide at least some relief within a week; or it's the wrong appliance. Our complete in-house dental laboratory enables us to change the orthopedic features of appliances, repair broken appliances, or make old appliances fit new dental work while you wait. The oral appliances we use most commonly and their costs are described below:
JOINT PROTECTIVE STABILIZATION APPLIANCES – worn during sleep, are the simplest way to relieve an inflamed TMJ. They work by temporarily eliminating just the jaw movements that were continuing to bruise the area of the TMJ behind the dislocated disk. Unlike nightguards, which do not have a sculpted bite table, and common stabilization appliances, which simply provide a raised bite table; joint protective stabilization appliances have bite tables with anti-retrusion ramps that protect the chronically bruised tissues in the damaged TMJ by preventing the condyles from accessing them. If your joint protective stabilization appliance is made correctly, no matter how hard you bite on it, you cannot reproduce the pain that you experience when biting forcefully on your natural teeth. The cost of the appliance is $1500.
JOINT PROTECTIVE TELESCOPIC APPLIANCES provide even more protection for the TMJs than joint protective stabilization appliances, because their protection continues as the mouth opens. A telescopic appliance, as seen below, is made of separate upper and lower appliances that are connected by tubes and rods which engage on each side like a straight arm to prevent the lower jawbone from retruding (going backwards) any further than permitted by the set point of the tubes, which can be easily adjusted. The appliance is surprisingly comfortable, because all its hardware is located between the teeth and the cheeks, where it doesn't interfere with tongue posture, and it provides better control of the position of the mandible than other appliances. The cost of the appliance is $1900.
FRONT FLAT PLATE APPLIANCES, worn during sleep, reduce the forces used in nocturnal bruxism just like Botox, but without weakening the muscles and without wearing off after a few months. The reduction in nocturnal bruxism forces lasts as long as the appliance is worn. These appliances deprogram the jaw muscles to stop them from aiming every jaw closure at your existing natural bite so that we can see if your natural bite is strained and how to improve it; and they redirect the forces of nocturnal bruxism onto the front teeth in order to gradually reduce the overbite. However these appliances are only designed to treat the muscles. If TMJs are inflamed, front flat bite plate appliances can increase the pain. After the inflammation is fully resolved and the involved TMJ has healed (usually 2 months), a front flat bite plate appliance can be used to improve the pattern of slow adult facial growth to prevent the symptoms from ever returning. The cost of the appliance is $950.
UPPER FRONT FLAT BITE PLATE APPLIANCE
RUBBER BITE CUSHION APPLIANCES - are molded rubber shells that fit closely over the lower teeth, where they don't inhibit speech, for use during the day to relieve jarring bite impacts in people who have neuromuscular systems that have been sensitized by chronic pain or to simply provide a cushioned platform for the jaw to rest on in people who feel their bite is uncomfortable. These appliances are available in many different thicknesses, from 1 mm to 4 mm. However, they should not be worn during sleep, because the rubbery feel evokes chewing activity, which increases nocturnal clenching and grinding, usually accompanied by dreams of eating. The cost of the appliance is $350
DISK RECAPTURING APPLIANCES
In some early stages of disk dislocation, the disk can be restored to its proper anatomical position by combining a joint protective telescopic night appliance with a daytime bite restoring appliance that advances the lower jawbone just far enough to stop the clicking and popping. Such "disk recapturing" usually provides rapid and complete relief, however it requires a finishing phase which can involve significant dental work. Thus, in considering disk recapturing, the condition of your teeth needs to be weighed against the severity of your symptoms and your prognosis. To help identify the anatomical features that affect the prognosis for disk recapture, Dr. Summer collaborated with the leading TMJ radiologist to perform and publish a study using before and after MRI on 119 joints undergoing this treatment. Reprints of this study are available by request. Cost of the appliances needed for phase 1 treatment (without finishing) is $2600.
BITE RESTORING APPLIANCES are often used to try out and refine a new bite before undertaking the expensive dental work necessary to finalize it with crowns or onlays. Many TMJ disorder patients have bites that have been destabilized by a strained facial growth pattern, excessive tooth loss, or using any oral appliance for long enough to make the teeth fit the surface of the appliance; resulting in a loss of bite on the natural teeth, as seen below left. In such cases, we can establish the proposed new bite on a provisional basis using tight fitting unobtrusive unilateral removable bite restoring appliances that can be worn all day including eating, as seen below right. After that new bite has proven comfortable and effective at eliminating the symptoms for at least a few months, it can be transferred to the teeth by bonded composite resin onlays for further refinement and testing prior to finalizing it in gold or porcelain, usually performed by the patient’s general dentist with Dr. Summer providing any support required. Cost of the appliances is $1500.
UNSTABLE BITE BITE STABILIZED BY APPLIANCE
FUNCTIONAL ORTHODONTIC APPLIANCES can temporarily support the lower jawbone in its proper location while moving the teeth into positions that will stabilize it there. For treating and preventing TMJ disorders, functional orthodontics has important advantages over esthetic orthodontics (braces and invisalign), because it can stimulate healthy facial growth. Palatal expansion both transversely and anteriorly can be included to enlarge the nasal airway or increase the space available for crowded teeth. Cost of a palate expansion appliance is $1900. A follow-up appliance at half that price is usually used as a finisher and retainer.