The Joint Protective Telescopic Appliance
Telescopic appliances are the most effective tools for protecting injured TMJs. A telescopic appliance is composed of complete and separate upper and a lower appliances connected on each side by a tube and rod (telescopic) mechanism, which provides a zone of absolute protection for a damaged TMJ by preventing the condyle from even being able to access 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.
One advantage of telescopic appliances is that they distribute the forces needed to protect the TMJs evenly among all the upper and lower teeth. This feature prevents directional tooth pressures that can cause inadvertent tooth movement in single arch or partial coverage appliances.
A second advantage of telescopic appliances is that they do not 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.
A basic telescopic appliance costs $1300. A telescopic appliance with microadjustable features costs $1500.