The Joint Protective Telescopic Appliance
Telescopic appliances are the most effective tools for protecting injured TMJs. As shown below, a telescopic appliance is composed of an upper and a lower dental plate connected on each side by a tube and rod (telescopic) mechanism. The telescopic mechanism provides a zone of absolute protection, much like a straight arm holding the condyle away from the bruised retrodiskal area. In addition, the protection is maintained even when the mouth is partly open, unlike single arch appliances which only protect the TMJs when you bite down far enough to engage their inclines. Thus if a TMJ is inflamed a telescopic appliance can make it impossible to rebruise it while it is being worn.
Telescopic appliances have several advantages over simpler appliances for protecting injured TMJs. One advantage is that all the upper and lower teeth are embedded in plastic so that any forces applied by the jaw muscles are spread out evenly among the teeth. This feature prevents directional tooth pressures that can cause inadvertent tooth movement in single arch or partial coverage appliances. Another advantage is that there is no interference with normal tongue posture, because the telescoping mechanisms rest between the teeth and the cheeks, well away from any potential contact with the tongue. Studies have shown that anything that interferes with tongue posture affects jaw posture.
When telescopic appliances are used for TMJ protection, the length of the telescopic components is not set to hold the lower jawbone further forward than its natural bracing position, just to prevent it from retruding excessively during sleep. In this way, they work like joint protective stabilization appliances, but they protect the joint with mechanics that are more effective and controllable. In addition, telescopic appliances can also include a variety of different bite surfaces to create special orthopedic effects, such as pivoting to relieve inflammation or a flat front bite plate to reduce the force of nocturnal clenching or grinding.
Telescopic appliances can also be outfitted with patient adjustable components that are slightly more expensive but give you complete control of your jaw position. In the adjustable version, you can finely control the length of each telescoping mechanism by simply removing the flat rod, turning the flat tube, and then re-inserting the flat rod to lock in the adjustment. The adjustment process takes a little dexterity, but the control it offers may be worthwhile, especially if you live far away.
A basic telescopic appliance costs $1300. A telescopic appliance with microadjustable features costs $1500.