Deprogrammers at a Glance

DEPROGRAMMERS At a Glance

  
Less Chair Time...
                               Easy Adjustments...
                                                              Multi-functional
...

 

Deprogrammers can be used for

• Headache sufferes
• Bruxers and/or clenchers
• Muscle relaxation
• Determining proper joint position
• Protection against wear
• Diagnosis

 

How do deprogrammers work?

When just the anterior teeth are in contact, the total amount of muscle contraction force the patient can achieve is only 30% compared to MIP/CO (Maximum Intercuspation/Centric Occlusion). The lateral pterygoid muscles relax allowing the temporal mandibualr joints to seat into their most comfortable position.

Deprogrammers allow muscle relaxation by removing all occusal interferences, and any habitual functional movements the patient has developed to avoid pain. If a patient has more than normal muscle tension or soreness during a load test or during overnight wear, this can be an indication of an intracapsular joint issue. A deprogrammer is contraindicated in these cases.

 
♦ Design Consideration

Absence of undercuts

Gag reflex




Anterior tooth sensitivity



Upper or lower deprogrammer




Orthodontic retention

Uneven or rough incisal edges

Equilibration

Recommendations

Add clasps

Lower arch
Minimal palatel coverage
Minimal number of teeth covered

No facial coverage
Isofolan on anterior teeth only
Hard/Soft material

Class I:  maxillary or mandibular
Class II:  maxillary
Class III:  mandibular
Cover the arch with the most crowding or mobile teeth

'B' splint or Kois deprogrammer

Fabricate deprogrammer on that arch

Cranham or Kois deprogrammer
 
View other deprogrammer designs
 
 
♦ Delivery  Confirm that the deprogrammer seats properly and has proper retention. Trim any areas where the patient indicates a tight feel on teeth with a carbide bur.

Next, check the contacts with articulating paper. There should be an evenly contacting dot on each contacting tooth. For most styles, there should be no interferences of any posterior teeth during protrusive and lateral movements.
 
♦ Wear Duration & Treatment
   Planning
Deprogrammers should only be worn when the patient goes to bed each night (up to 12 hours per day). Make sure the paitent knows not to wear the deprogrammer any longer than this as super-eruption of non-contacting teeth can occur (with the exception of the 'B' Splint dual arch).

Make the patient aware that if their bite feels 'unusual' in the morning after removing the deprogrammer, it should feel normal again after the patient eats breakfast. If it doesn't, instruct the patient to come in for evaluation. This is especially true of the patient will be wearing the deprogrammer long term.

If the patient is in more pain after wearing their appliance, this can be an indication of an intra-capsular joint issue. The patient should discontinue use and contact the dental office.

Depending on the treatment plan, the time period the patient continues to wear their deprogrammer can vary. Patients may find relief after a couple weeks wear, and can use the appliance whenever pain reoccurs. For other patients, once the the masticatory muscles have been relaxed allowing the joints to seat in a comfortable position, a treatment plan can be developed. Instruct the patient to wear their deprogrammer for at least one hour prior to their appointment in order to take a CR bite. With the models mounted on an articulator using the CR bite, the method to treat the occlusal-muscular problem can be discussed.

Depending on the patient's condition and needs, you may choose:

• Equilibration
• Restorations
• Orthodontics
• Surgery
• Full arch splint wear