You are welcome. You might enjoy my video on "Fundamentals of Occlusion." Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
This the next level of feeling less responsible of what my patients do wrong with their teeth. When I started practising it took some time to understand that patient’s pain is not my fault. Now I put in mind that not all the restorations can survive the excessive loads. Thank You Sir, this video helps to understand a lot.
Good for you to understand "The patient's teeth are not your teeth" and the patients "are not yours to raise." Early in my dental practice a terrific dentist told me, 'There is no restoration you place that a patient cannot destroy if they try hard enough." You can restore the teeth, but you cannot guarantee how long the restorations will last because you cannot control the habits of the patient. Look what they did to their natural teeth. You can give them the methods to have the best chance of keeping their teeth, and restorations, for the longest period of time, but never guarantee the longivity of a restoration. Too many variables that depend on the patient's compliance. If a patient wishes to have restoration, they must decide if they are willing to take the responsibility for maintaining the restoration. You, the dentist, can only place the restoration to the best of your ability. I often tell patients "the only things that last a lifetime are a shot put and a flint rock." Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Do you have a protocol sheet/video on taking care of the night-guard that you mentioned at the end of this ideo - would be interested to see and compare to previous protocols I have seen. Thank you.
Yes, soak the nightguard in a tub of clear mouthwash during the day when not wearing it. Rinse it with hot water after you remove it from your mouth before replacing it in the mouthwash tub. Soak the nightguard in a glass of water after removing it from the mouthwash at night to get rid of the mouthwash taste. Change the mouthwash in the tub every Sunday morning. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
I have no idea what the Michigan splint is. This splint is flat plane, hard acrylic with contacts only on the anterior teeth. When only the anterior teeth contact when the patient bites together, only 10% of the muscle fibers of mastication fire, so the patient puts less stress on the biting system. Also, the condyle is automatically placed in centric relation since there are no posterior teeth keeping the condyle from seating maximally in the fossae. Since the posterior teeth are not in contact, it is important the patient not wear the splint more than about 8-10 hours straight, when they are sleeping, or the posterior teeth will begin to super erupt. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
You are welcome. I hope you subscribe to DentistryMasterClasses.com if you like these videos. There is an organized library of all the Dental Minute Videos plus many other complete comprehensive cases.
Great video. Thank you. I am a new dentist. Could you post a link or reference to the study about muscle activation with anterior occlusion. I would like to give it a read.
Watch my videos on Treatment of TMJ/facial pain cases and Fundamentals of Occlusion in the library of DMC.com. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Teeth do not begin to shift without contact for 24-48 hours, so be sure to tell the patient not to wear the appliance except when they are sleeping (no more than 6-10 hours). Even if I am fabricating a TMJ appliance, I only have the patient wear the CRO, only anterior contact appliance while they are sleeping). Watch my videos on the treatment of facial pain and TMJ dysfunction in the library of DMC.com. 90% of the muscle fibers of the muscles of mastication relax and do not fire if only the anterior teeth are contacting. If all the opposing teeth contact the appliance, all the muscle fibers fire, creating much more pressure on the TMJs, muscles of mastication and opposing teeth. We want to diminish the pressure on the system. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
I’ve heard that eliminating posterior occlusion is bad because it can lead to gradual supra-eruption of posterior teeth. What are your thoughts about that?
Do not wear the splint for more than 8 hours or so. Supereruption/tooth movement takes 24-48 hours to begin to move. The diminished facial muscle fiber contraction if only the anterior teeth are contacting is the reason for only anterior teeth contact on the nightguard. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Make the anterior part of the nightguard thicker so the lower anterior teeth contact the nightguard. Watch my videos in the library of DMC.com. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Is it possible for a patient to wear this style of nightguard as well as a lower clear retainer? or should the lower clear retainer be switched to a lower lingual bar?
I normally prefer this upper arch nightguard along with a removable wire/acrylic lower arch retainer. The lower removable retainer does not fit over the occlusal surface of the teeth, so it does not impact the occlusion. If made the way I am teaching, the upper arch nightguard also acts as a retainer because it fits the teeth snugly. The problem I have with post ortho. vacuform type retainers is the occlusion is normally not ideal (CRO) and might contribute to myofacial or TMJ pain and dysfunction if the patient is a nighttime bruxer (stress on an imbalanced system). Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Unfortunately, there is no treatment until the child stops growing at about age 18. There is normally no specific reason. Some people just grind their teeth while sleeping (bruxism).
dr during manipulating the patientt to centric relation how we can find which tooth are contacting because mouth is less open and not able to see inside? and second question is for all types of restoration like venner crown etc is it mandotary to manipulate in centric relation and make restoration in cr position?
Use plastic cheek retractors. I use them for most procedures if the procedure does not call for a rubber dam. Use the cheek retractors that retract both cheeks with one retractor. Watch my new patient exam video.
Hello Dr. Steven, Thank you for making this video. How could I combine this technique with digital scanner? I have CBCT, Trios and Sprintray printer in office. and I use them all to fabricate NG. I make resin base occlusal guard. However, I spend lots of time on adjustment when delivering. Could I have pt in centric relation with compound and scan the patient? Could you please advise?
I have never used a scanner for a nightguard, so I cannot answer your question. I have fabricated night guards in the fashion I describe successfully for many, many years. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Good question. The amount of horizontal overlap would factor in. If the class 3 horizontal overlap was edge to edge or just a few mm, then the procedure would be the same. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Greetings Sir, Great video , I have a query regarding centric relation how it is maintained as shown the surface is almost smoothened out so when patient will wear the night guard how will it maintain the centric relation. Regards
Since there are no posterior teeth contacts, there is nothing to prevent the condyles from seating maximally into the mandibular sockets when the patient closes their teeth together on the splint with their tongue positioned up and into the posterior part of the palate.
Bimanual manipulation of the mandible into centric relation. You can also have the patient move the tip of their tongue to the posterior part of the palate. That tongue position is helpful in moving the mandible into CR.
Maybe a wad of acrylic or some other type of wax that gets hard when cooled. What is the reason you do not have green stick compound? It is a common dental material.
In Centric Relation position, only the anterior teeth (primarily cuspids) are contacting the splint. Be sure the patient only wears the splint while sleeping. If they wore the splint all the time with only anterior contacts, the posterior mandibular teeth would super erupt. Remember, if the posterior teeth are not contacting, only about 10% of the facial muscle fibers of closure contract, so that 90% of the facial muscle fibers are not firing when the patient clinches their teeth while sleeping (bruxism) if they wear the splint. You cannot stop a patient from bruxing, but you can eliminate tooth to tooth contact with the splint and diminish the pressure on the system if only the anterior teeth contact. Watch my video on occlusion in the library of DentistryMasterClasses.com.
Either upper or lower works, so long as the occlusion is correct (CRO with only anterior teeth contacting as described in the videos.). I make uppers 95% of the time. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Very informative video,thank you sir, but i was wandering why would you prefer hard acrylic over silicone and if the nightguard was made of silicone how would you make the contact scheme (only anterior contact) or (all teeth contact) thanks
The night guard should normally be made of a material that is hard, but just a bit softer than tooth structure so the opposing teeth can "slide" on the surface of the night guard. That way, there is minimum pressure placed on the teeth, muscles of the face or TMJs when the patient is bruxing while sleeping. If the night guard is soft, like silicone, the patient "digs in" to the material when they grind their teeth, placing maximum pressure on the system. You can actually exacerbate a myofacial or intraarticular pain and dysfunction condition with a soft night guard. Be sure only the most anterior teeth are contacting the night guard so that 80-90% of the muscle fibers of the masseter, medial pterygoid and temporalis muscles do not fire when the patient clinches on the splint.
Thank you very much for the reply sir, your videos are very helpful, informative and full of clinical hints everytime I watch one of your videos i learn something new, thanks again
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Bis Acrylate does shrink on average about 1.5 per cent. Ethyl methacrylate shrinks significantly less. Ethyl methacrylate materials commonly available are Snap and Trim.
Thanks for the comment. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Watch the video. Teeth do not move for 24-48 hours, so unless the patient wears the nightguard 24/7 there is no issue with super eruption. Be sure to tell them not to wear the nightguard more than 12 hours or the teeth will super erupt. We fabricate this type nightguard with only the anterior teeth contacting so that 90% of the muscle fibers of mastication do not contract, so most of the pressure on the TMJs, teeth, bone around the teeth and muscles of mastication is reduced by 90% if the posterior teeth do not contact the nightguard while the patient is bruxing (clinching) while sleeping. You cannot eliminate bruxing, but you can greatly reduce the pressure on the system with an anterior contact only nightguard. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
When they wear it out. This may be 1-2 years in some patients and 10 years in others, depending on how severe their brusixm. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Very well explained, I have learned a lot! Is this type of nightguard indicated for bruxism patients only? Would you recommend this type of nightguard to patients who suffer from TMD and myofacial pain?
Yes, I treat many intraarticular (TMJ) and myofacial (muscle) pain and dysfunction patients. The splint alone will not remedy the problem, but it is an essential part of the treatment. With this particular flat plane, hard acrylic, anterior contact only splint, the patient must not wear it all the time or the posterior teeth will super erupt. I will be presenting diagnosis and treatment of comprehensive intraarticular and myofacial pain and dysfunction cases in DentistryMasterClasses.com. The treatment method I will be presenting is conservative and fantastic!
Thank you very much for the great video! Could you please provide the citation from Dr. Williams' study characterizing the neural firing of mastication muscle using the anterior night-guards?
Dr Cutbirth - I am a patient with upper & lower veneers, I am looking to replace my nigh guard and the suggestion is a Michigan splint.. I want to protect my veneers but I am not sure if you advise this type. I enjoy your videos despite not being in the dental area. What are your thoughts ? Cheers
Thank you so much for the video doctor.Is it possible to take a centric record and bite as you have shown and send it to a lab for fabrication.Is it possible to achieve the same result?What material and instructions should I give the lab?
If you have a Class II , Div II , would it not be beneficial for overuption of the posterior teeth and thereby decrease overjet and avoid traumatic occclusion and detrimental consequences in the future .
Every night while they sleep their entire life unless they start snoring. My daughters received one when they were 16 and had stopped growing. Men usually stop growing around 20 or in their low 20s. Then they should wear a Dental Snoring/Sleep Apnea Appliance that pulls the lower jaw forward to remedy snoring and sleep apnea. The one I wear and give to my patients is a Somnimed. It also acts as a nightguard to protect the teeth/restorations from wear from nighttime bruxism.
Hi Dr saludos from Mexico just a suggestion, if you still fabricate this appliances, if possible use a clear material, they turn out much much nicer, I know you made this video 6 years ago, but is just a suggestion.
The only problem with clear appliances is the articulation marks with articulating paper is often difficult to see on clear retainers. Also, we fabricate the "shells" for the night guards in my office and reline them in the patient's mouth once restorations have been seated so the patient does not have to go without a nightguard for a week or more, waiting for the lab to fabricate the nightguard, once restorations are seated. I reline the nightguard shell directly in the patient's mouth once any restorations are seated. Thanks for the comment. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
No, because the patient is only wearing it at night approximately 8 hours while sleeping, not all the time. It takes 24-48 hours for a tooth to move microscopically.
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I have used this technique but patient was saying she feels her posteriors become high on waking up...is it ok? N one query is that as after delivering this patient will start grinding on acrylic..does this cause trauma to teeth?
No. There is always the possibility the patient will wear the anterior acrylic nightguard material over time, especially if they are a big bruxer, which could bring the posterior part of the splint into contact with the opposing posterior teeth, but the posterior teeth should be several mm out of contact with the splint when you place the splint, so it should take several years for the anterior part of the splint to wear enough for the posterior part of the splint to come into contact with the posterior teeth. That is why you should check the occlusion on the nightguard at least once a year. When we text the patient a dental hygiene appointment notice, we also remind them to brig their nightguard with them to that appointment. The nightguard is a good teaching tool for the patient. When they see the wear on the splint, I remind them that same wear would be occurring on their natural teeth if they were not wearing the nightguard.
The occlusion and function is basically the same, since it is discluding the posterior teeth and positioning the TMJ in centric relation. The difference is the cuspids, which are designed to bear load, are bearing the main load and, since the appliance covers all the maxillary teeth, it is more stable in the mouth and larger, making it less likely to disclude from the teeth and be swallowed.
Yes. This nightguard method protects the teeth and also deprograms the muscles of mastication. The patient should not wear it more than at night when they are sleeping since the posterior teeth are not in occlusion and the lower posterior teeth could super erupt over time if the anterior contacting only nightguard were worn all the time.
Do we always put nightguard on upper teeth? Or can we put it in the lower too? And what are the criteria for choosing which jaw to put it on? Thank you!
I normally place the nightguard on the teeth in the maxillary arch because those anterior teeth are being pushed facially, outward, in all eccentric movements and especially protrusive. I will place the nightguard on the teeth in the lower arch if those teeth are mobile or have other issues that make them less stable than the maxillary teeth. If there are destabilizing issues with teeth in each arch, primarily mobility, I will sometimes place flat plane, hard acrylic, CRO night guards on both arches.
so, the peroxide based mouthwash, does that contain alcohol or anything that could damage the nightguard. I remember alcohol based ones are not recommended to use on nightguards.
No, the peroxide in the mouthwash does not damage the nightguard. For many years I had the patient soak the nightguard in straight peroxide, then soak it in water for 10 minutes or so before placing it in their mouth to get rid of the peroxide taste.
If there are no canines for cuspid protected occlusion, move the CRO contacts to the first bicuspids, moving to the anterior teeth in eccentric movements unless the patient has a major anterior open bite. In that case, place the eccentric movements on the most anterior teeth available. Watch my video on occlusion in the library of DentistryMasterClasses.com. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
I treat mild-moderate teeth crowding in my practice with Clear Correct orthodontic trays. The Clear Correct staff are very knowledgable and helpful. The computer generated treatment plans are fantastic. The CC headquarters are located in the Houston area.
My pleasure! Glad the videos are helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Thanks for making such videos. Had few questions regarding this video, can all the acrylic splints be fabricated the way you explained in your presentation? Did the assistant in the video, remove the bite-registration material before applying the tin-foil to the cast?
Than you dr Stephen for sharing all this precious accumulated knowledge..this is the first time i see this type of nightguard and i tried simulating the anteriour bite on my own teeth and you are right as usual..it does feel much less muscle contraction is occuring I will definitely try it on one of my patients..but i have a question..dont they complain of uncomfortability ? Again thank you dr and wish you all the health so you can keep sharing your expertise and experience
In DentistryMasterClasses.com I am going to teach you how to predictably manipulate into centric relation as well as discussing all aspects of proper occlusion. We will then be presenting diagnosis and predictable treatment of myofacial and intraarticular (TMJ) pain and dysfunction. I am actually filming CR manipulation and occulusion this coming Friday and Saturday mornings. Watch it on DentistryMasterClasses.com and view it live on our Facebook page.
Yes, absolutely, if the patient wears the appliance more than while sleeping. It normally takes teeth 48 hours to start super erupting, so it is imperative you instruct the patient both verbally and in writing that they not wear the night guard more than 8-12 hours straight.
@@centerforard There was a case I heard of with super eruption from only wearing it at night for about 3 months. It was because the night guard didn't cover atleast half of the 3rd molar.
This was great. What do you think of day time bruxers (as you said non occlusal contacts in the multicusppid teeth will make them protrude)? Would you approach the same way or try to go for "maximum intercuspation"?
If someone is wearing a CRO splint all the time, you would have to go with a splint that had all the teeth contacting. The best way to accomplish that is to place only the anterior contacts on the hard acrylic splint first. Have the patient bite down on the splint as hard as they can and grind the teeth together. Be sure none of the posterior teeth contact the splint. Next, add unset, soft acrylic to the posterior occlusal surface of the hard acrylic splint. Have the patient bite down as hard as they possibly can into the soft, unset acrylic on the posterior part of the splint and grind their teeth making indentations into the soft, poster acrylic. Let the soft acrylic on the posterior part of the splint set completely, then grind off all the fresh acrylic except for the centric stops. Eliminate all eccentric contacts. Adding the posterior contacts this way is the only way to ensure there are no posterior premature centric occlusion contacts.
Glad the videos are helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Both. Sometimes they come to my practice knowing they grind their teeth and need a night guard. Sometimes the patient is not aware they are grinding their teeth and I make them aware of it by observing the photo I take of their teeth during their new patient exam.
Are you referring to a Somnident sleep apnea/snoring device? I deliver many of those SADs. I actually wear one myself because I started snoring several years ago. They really work well. I can make a video on SADs, but it is really straight forward. What aspect of SAD fabrication are you unclear on? Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
@@centerforard I want a video on it because it is something new for me and I didn't do that before and I think everything will be easy if I follow your steps and hints
Great. I place a lot of Somnident Dental Sleep Apnea/Snoring Devices. I wear one myself. They really work, so long as the patient's Body Mass Index is within normal ranges. If the patient is considerably overweight, they should normally first loose weight down to their proper BMI before placement of a SAD. Obesity is a real problem in the US. Not only do these obese patients have sleep apnea, they have diabetes, heart issues, bad knees, hips and feet and low back pain and problems. If they do not loose the weight, all these issues will exacerbate and they will spend much of their time having surgeries and other medical treatments. Give the overweight patient a BMI chart and instruct them to stop eating all carbohydrates until they get their weight down to the proper BMI for their height. With no carbohydrates, people can loose 20-30 lbs./month. Once the correct BMI is reached, regulate carbs to very small portions and maintain the proper BMI weight within a 5 lb. range. It is not difficult to loose weight, it just takes discipline. It's all about restriction of carbohydrates. Watch the TV series, ALONE, on Amazon Prime. It is really a program on how to loose weight. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Hi! I have a short question: Would you still do this on a patient who has anterior composite restorations involving the incisal edges? in your experience, would a heavy bruxer flick that restoration right off during the night? especially given that contact is only on the anterior teeth. P.S Awesome video!!! thank you :)
How can I find a dentist that knows how to make this exact type of nightguard? I tried to explain to my dentist that a basic guard only protects teeth from wearing but does nothing to stop the forces of bruxism. Kinda ridiculous that this concept isn't common knowledge to all dentists.
@@centerforard I wish things were more clear when it comes to these guards. I see one side saying anterior occlusion only guards are dangerous because they cause intrusion and also eruption which leads to an open bite. It's scary as a person who clenches and grinds since this seems like the only thing that will help yet many pros strongly advise against them. Tough spot to be in as a layman who is suffering. I just wonder how much of those concerns are truly valid if only worn at night and if they are just being alarmists.
Subscribe to DentistryMasterClasses.com and watch the videos on occlusion and manipulation into CR. You must know these things to be a competent dentist. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.
finally a time well spent watching occlusion related issue and a real treatment with full understanding! , thanks a ton
You are welcome. You might enjoy my video on "Fundamentals of Occlusion."
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This the next level of feeling less responsible of what my patients do wrong with their teeth. When I started practising it took some time to understand that patient’s pain is not my fault. Now I put in mind that not all the restorations can survive the excessive loads. Thank You Sir, this video helps to understand a lot.
Good for you to understand "The patient's teeth are not your teeth" and the patients "are not yours to raise." Early in my dental practice a terrific dentist told me, 'There is no restoration you place that a patient cannot destroy if they try hard enough." You can restore the teeth, but you cannot guarantee how long the restorations will last because you cannot control the habits of the patient. Look what they did to their natural teeth. You can give them the methods to have the best chance of keeping their teeth, and restorations, for the longest period of time, but never guarantee the longivity of a restoration. Too many variables that depend on the patient's compliance. If a patient wishes to have restoration, they must decide if they are willing to take the responsibility for maintaining the restoration. You, the dentist, can only place the restoration to the best of your ability. I often tell patients "the only things that last a lifetime are a shot put and a flint rock."
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Do you have a protocol sheet/video on taking care of the night-guard that you mentioned at the end of this ideo - would be interested to see and compare to previous protocols I have seen. Thank you.
Yes, soak the nightguard in a tub of clear mouthwash during the day when not wearing it. Rinse it with hot water after you remove it from your mouth before replacing it in the mouthwash tub. Soak the nightguard in a glass of water after removing it from the mouthwash at night to get rid of the mouthwash taste. Change the mouthwash in the tub every Sunday morning.
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Awesome - look forward to watching more of your expert clinical work!
Thank you doctor for this fantastic video
Would you care to explain the difference between the Michigan splint and the one you explained here?
I have no idea what the Michigan splint is. This splint is flat plane, hard acrylic with contacts only on the anterior teeth. When only the anterior teeth contact when the patient bites together, only 10% of the muscle fibers of mastication fire, so the patient puts less stress on the biting system. Also, the condyle is automatically placed in centric relation since there are no posterior teeth keeping the condyle from seating maximally in the fossae. Since the posterior teeth are not in contact, it is important the patient not wear the splint more than about 8-10 hours straight, when they are sleeping, or the posterior teeth will begin to super erupt.
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Thank you so much Dr Steven for making videos on such pertinent dental topics and procedures.
You are welcome. I hope you subscribe to DentistryMasterClasses.com if you like these videos. There is an organized library of all the Dental Minute Videos plus many other complete comprehensive cases.
Great video. Thank you. I am a new dentist. Could you post a link or reference to the study about muscle activation with anterior occlusion. I would like to give it a read.
Watch my videos on Treatment of TMJ/facial pain cases and Fundamentals of Occlusion in the library of DMC.com.
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Thank you!
thank you for the video Dr.steven! i have a quistion: When you eliminate the contact of the posteriors you don't cause their extrusion ?
Teeth do not begin to shift without contact for 24-48 hours, so be sure to tell the patient not to wear the appliance except when they are sleeping (no more than 6-10 hours). Even if I am fabricating a TMJ appliance, I only have the patient wear the CRO, only anterior contact appliance while they are sleeping). Watch my videos on the treatment of facial pain and TMJ dysfunction in the library of DMC.com. 90% of the muscle fibers of the muscles of mastication relax and do not fire if only the anterior teeth are contacting. If all the opposing teeth contact the appliance, all the muscle fibers fire, creating much more pressure on the TMJs, muscles of mastication and opposing teeth. We want to diminish the pressure on the system.
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I’ve heard that eliminating posterior occlusion is bad because it can lead to gradual supra-eruption of posterior teeth. What are your thoughts about that?
Do not wear the splint for more than 8 hours or so. Supereruption/tooth movement takes 24-48 hours to begin to move. The diminished facial muscle fiber contraction if only the anterior teeth are contacting is the reason for only anterior teeth contact on the nightguard.
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Thank you very much Dr cutbirth , how do you make a nightgard to a patient with an open bite ؟؟
Make the anterior part of the nightguard thicker so the lower anterior teeth contact the nightguard. Watch my videos in the library of DMC.com.
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Is it possible for a patient to wear this style of nightguard as well as a lower clear retainer? or should the lower clear retainer be switched to a lower lingual bar?
I normally prefer this upper arch nightguard along with a removable wire/acrylic lower arch retainer. The lower removable retainer does not fit over the occlusal surface of the teeth, so it does not impact the occlusion. If made the way I am teaching, the upper arch nightguard also acts as a retainer because it fits the teeth snugly. The problem I have with post ortho. vacuform type retainers is the occlusion is normally not ideal (CRO) and might contribute to myofacial or TMJ pain and dysfunction if the patient is a nighttime bruxer (stress on an imbalanced system).
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Is this appliance more for clenchers and not grinders?
It is for both clinchers and grinders.
Hi Steve
Sometimes even,in 3-6 years old children,moderate to severe wear is seen,what are the reasons and the management?
Thanks
Unfortunately, there is no treatment until the child stops growing at about age 18. There is normally no specific reason. Some people just grind their teeth while sleeping (bruxism).
dr during manipulating the patientt to centric relation how we can find which tooth are contacting because mouth is less open and not able to see inside? and second question is for all types of restoration like venner crown etc is it mandotary to manipulate in centric relation and make restoration in cr position?
Use plastic cheek retractors. I use them for most procedures if the procedure does not call for a rubber dam. Use the cheek retractors that retract both cheeks with one retractor. Watch my new patient exam video.
Hello Dr. Steven, Thank you for making this video. How could I combine this technique with digital scanner? I have CBCT, Trios and Sprintray printer in office. and I use them all to fabricate NG. I make resin base occlusal guard. However, I spend lots of time on adjustment when delivering. Could I have pt in centric relation with compound and scan the patient? Could you please advise?
I have never used a scanner for a nightguard, so I cannot answer your question. I have fabricated night guards in the fashion I describe successfully for many, many years.
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Doctor does this procedure differ in a class 3 patient ? Edge to edge bite
Good question. The amount of horizontal overlap would factor in. If the class 3 horizontal overlap was edge to edge or just a few mm, then the procedure would be the same.
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Greetings Sir,
Great video , I have a query regarding centric relation how it is maintained as shown the surface is almost smoothened out so when patient will wear the night guard how will it maintain the centric relation.
Regards
Since there are no posterior teeth contacts, there is nothing to prevent the condyles from seating maximally into the mandibular sockets when the patient closes their teeth together on the splint with their tongue positioned up and into the posterior part of the palate.
@@centerforard okay sir, thanku
hello! beautiful presentation! May i ask how do you achieve the centric position, with a dawson maneuver?
Bimanual manipulation of the mandible into centric relation. You can also have the patient move the tip of their tongue to the posterior part of the palate. That tongue position is helpful in moving the mandible into CR.
@@centerforard thank you for response, doctor. Much appreciated!
Hello very nice video what else can we use if we don’t have green stick compound to guide patient into centric relation?
Maybe a wad of acrylic or some other type of wax that gets hard when cooled. What is the reason you do not have green stick compound? It is a common dental material.
Do you mean it should be done in RP?
In Centric Relation position, only the anterior teeth (primarily cuspids) are contacting the splint. Be sure the patient only wears the splint while sleeping. If they wore the splint all the time with only anterior contacts, the posterior mandibular teeth would super erupt. Remember, if the posterior teeth are not contacting, only about 10% of the facial muscle fibers of closure contract, so that 90% of the facial muscle fibers are not firing when the patient clinches their teeth while sleeping (bruxism) if they wear the splint. You cannot stop a patient from bruxing, but you can eliminate tooth to tooth contact with the splint and diminish the pressure on the system if only the anterior teeth contact. Watch my video on occlusion in the library of DentistryMasterClasses.com.
Thank you for the video, it was helpful. Do you recommend Upper night guard in general for Clenchers?
Either upper or lower works, so long as the occlusion is correct (CRO with only anterior teeth contacting as described in the videos.). I make uppers 95% of the time.
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@@centerforard Appreciate you taking time out to reply. Also, any video on how to treat non specific sensitivity in clenchers?
Very informative video,thank you sir, but i was wandering why would you prefer hard acrylic over silicone and if the nightguard was made of silicone how would you make the contact scheme (only anterior contact) or (all teeth contact) thanks
The night guard should normally be made of a material that is hard, but just a bit softer than tooth structure so the opposing teeth can "slide" on the surface of the night guard. That way, there is minimum pressure placed on the teeth, muscles of the face or TMJs when the patient is bruxing while sleeping. If the night guard is soft, like silicone, the patient "digs in" to the material when they grind their teeth, placing maximum pressure on the system. You can actually exacerbate a myofacial or intraarticular pain and dysfunction condition with a soft night guard. Be sure only the most anterior teeth are contacting the night guard so that 80-90% of the muscle fibers of the masseter, medial pterygoid and temporalis muscles do not fire when the patient clinches on the splint.
Thank you very much for the reply sir, your videos are very helpful, informative and full of clinical hints everytime I watch one of your videos i learn something new, thanks again
Subscribe to DentistryMasterClasses.com. Only $15/month. This is the really good stuff. All the Dental Minute videos plus all sorts of comprehensive cases are organized in a video and or PowerPoint library for easy access. I promise you will love it!
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Bis Acrylate does shrink on average about 1.5 per cent. Ethyl methacrylate shrinks significantly less. Ethyl methacrylate materials commonly available are Snap and Trim.
Thanks for the comment.
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If the posterior teeth don’t make contact with the night guard, will there be supraeruption over time?
Watch the video. Teeth do not move for 24-48 hours, so unless the patient wears the nightguard 24/7 there is no issue with super eruption. Be sure to tell them not to wear the nightguard more than 12 hours or the teeth will super erupt. We fabricate this type nightguard with only the anterior teeth contacting so that 90% of the muscle fibers of mastication do not contract, so most of the pressure on the TMJs, teeth, bone around the teeth and muscles of mastication is reduced by 90% if the posterior teeth do not contact the nightguard while the patient is bruxing (clinching) while sleeping. You cannot eliminate bruxing, but you can greatly reduce the pressure on the system with an anterior contact only nightguard.
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Hello doctor, how often should the Patients change their night guards?
When they wear it out. This may be 1-2 years in some patients and 10 years in others, depending on how severe their brusixm.
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Very well explained, I have learned a lot! Is this type of nightguard indicated for bruxism patients only? Would you recommend this type of nightguard to patients who suffer from TMD and myofacial pain?
Yes, I treat many intraarticular (TMJ) and myofacial (muscle) pain and dysfunction patients. The splint alone will not remedy the problem, but it is an essential part of the treatment. With this particular flat plane, hard acrylic, anterior contact only splint, the patient must not wear it all the time or the posterior teeth will super erupt. I will be presenting diagnosis and treatment of comprehensive intraarticular and myofacial pain and dysfunction cases in DentistryMasterClasses.com. The treatment method I will be presenting is conservative and fantastic!
Thank you very much for the great video! Could you please provide the citation from Dr. Williams' study characterizing the neural firing of mastication muscle using the anterior night-guards?
Williamson and Lundquist, Journal of Prosthetic Dentistry, 1983
Dr Cutbirth - I am a patient with upper & lower veneers, I am looking to replace my nigh guard and the suggestion is a Michigan splint.. I want to protect my veneers but I am not sure if you advise this type. I enjoy your videos despite not being in the dental area. What are your thoughts ? Cheers
I prefer the Nightguard I describe in the videos.
Thank you so much for the video doctor.Is it possible to take a centric record and bite as you have shown and send it to a lab for fabrication.Is it possible to achieve the same result?What material and instructions should I give the lab?
Send the lab the models and CR bite record and have them make the nightguard to that bite.
If you have a Class II , Div II , would it not be beneficial for overuption of the posterior teeth and thereby decrease overjet and avoid traumatic occclusion and detrimental consequences in the future .
Sorry, I do not know what you are talking about.
Thank you for the great video, i have a question , how long patient should wear the night guard?
Every night while they sleep their entire life unless they start snoring. My daughters received one when they were 16 and had stopped growing. Men usually stop growing around 20 or in their low 20s. Then they should wear a Dental Snoring/Sleep Apnea Appliance that pulls the lower jaw forward to remedy snoring and sleep apnea. The one I wear and give to my patients is a Somnimed. It also acts as a nightguard to protect the teeth/restorations from wear from nighttime bruxism.
Hi Dr saludos from Mexico just a suggestion, if you still fabricate this appliances, if possible use a clear material, they turn out much much nicer, I know you made this video 6 years ago, but is just a suggestion.
The only problem with clear appliances is the articulation marks with articulating paper is often difficult to see on clear retainers. Also, we fabricate the "shells" for the night guards in my office and reline them in the patient's mouth once restorations have been seated so the patient does not have to go without a nightguard for a week or more, waiting for the lab to fabricate the nightguard, once restorations are seated. I reline the nightguard shell directly in the patient's mouth once any restorations are seated. Thanks for the comment.
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Doesn't cause anterior openbite in the long run?
No, because the patient is only wearing it at night approximately 8 hours while sleeping, not all the time. It takes 24-48 hours for a tooth to move microscopically.
Hi Dr my name is Aron I am a dental technician in Dallas Texas I work for an all on 4-6 lab do you recommend this night guard for this prosthesis?
Yes. I recommend a nightguard for almost anyone.
@@centerforard thank you Dr please keep making this videos they are very educational love the one on fundamentals in occlusion
Terrific. Subscribe to DentistryMasterClasses.com and watch all the DM videos plus many complete comprehensive cases. They are all in an organized library.
I have used this technique but patient was saying she feels her posteriors become high on waking up...is it ok? N one query is that as after delivering this patient will start grinding on acrylic..does this cause trauma to teeth?
No. There is always the possibility the patient will wear the anterior acrylic nightguard material over time, especially if they are a big bruxer, which could bring the posterior part of the splint into contact with the opposing posterior teeth, but the posterior teeth should be several mm out of contact with the splint when you place the splint, so it should take several years for the anterior part of the splint to wear enough for the posterior part of the splint to come into contact with the posterior teeth. That is why you should check the occlusion on the nightguard at least once a year. When we text the patient a dental hygiene appointment notice, we also remind them to brig their nightguard with them to that appointment. The nightguard is a good teaching tool for the patient. When they see the wear on the splint, I remind them that same wear would be occurring on their natural teeth if they were not wearing the nightguard.
Nice video and great technique. I'm wondering though, how different is this functionally from an NTI?
The occlusion and function is basically the same, since it is discluding the posterior teeth and positioning the TMJ in centric relation. The difference is the cuspids, which are designed to bear load, are bearing the main load and, since the appliance covers all the maxillary teeth, it is more stable in the mouth and larger, making it less likely to disclude from the teeth and be swallowed.
Will this act as deprogrammer?
Yes. This nightguard method protects the teeth and also deprograms the muscles of mastication. The patient should not wear it more than at night when they are sleeping since the posterior teeth are not in occlusion and the lower posterior teeth could super erupt over time if the anterior contacting only nightguard were worn all the time.
@@centerforard thank you
How can you polish buff down a sharp spot at home?
Possibly an emory board.
Do we always put nightguard on upper teeth? Or can we put it in the lower too? And what are the criteria for choosing which jaw to put it on? Thank you!
I normally place the nightguard on the teeth in the maxillary arch because those anterior teeth are being pushed facially, outward, in all eccentric movements and especially protrusive. I will place the nightguard on the teeth in the lower arch if those teeth are mobile or have other issues that make them less stable than the maxillary teeth. If there are destabilizing issues with teeth in each arch, primarily mobility, I will sometimes place flat plane, hard acrylic, CRO night guards on both arches.
@@centerforard thank you so much!
so, the peroxide based mouthwash, does that contain alcohol or anything that could damage the nightguard. I remember alcohol based ones are not recommended to use on nightguards.
No, the peroxide in the mouthwash does not damage the nightguard. For many years I had the patient soak the nightguard in straight peroxide, then soak it in water for 10 minutes or so before placing it in their mouth to get rid of the peroxide taste.
Sir what if the canines are attrited, how can we give canine protected occlusion?
If there are no canines for cuspid protected occlusion, move the CRO contacts to the first bicuspids, moving to the anterior teeth in eccentric movements unless the patient has a major anterior open bite. In that case, place the eccentric movements on the most anterior teeth available. Watch my video on occlusion in the library of DentistryMasterClasses.com.
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@@centerforard thankyou sir!
@@centerforard can we add composite to canine,to make it canine protected occlusion?
Great video, sir. I wish there was someone who taught master level of orthodontic in such manner
I treat mild-moderate teeth crowding in my practice with Clear Correct orthodontic trays. The Clear Correct staff are very knowledgable and helpful. The computer generated treatment plans are fantastic. The CC headquarters are located in the Houston area.
Look at my father's TH-cam orthodontic channel. Dr. Bill Wyatt
th-cam.com/channels/t4qk1YVkOuITN53MQYEt4A.html
What is the name of that material you are using at 8:58 minute?
Luxatemp bisacrylate.
Doctor, You are the best
I always find what I'm looking for on your channel
Thank you very much for your effort ❤️
My pleasure! Glad the videos are helpful.
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Thanks for making such videos. Had few questions regarding this video, can all the acrylic splints be fabricated the way you explained in your presentation? Did the assistant in the video, remove the bite-registration material before applying the tin-foil to the cast?
She made it just like the video.
Than you dr Stephen for sharing all this precious accumulated knowledge..this is the first time i see this type of nightguard and i tried simulating the anteriour bite on my own teeth and you are right as usual..it does feel much less muscle contraction is occuring
I will definitely try it on one of my patients..but i have a question..dont they complain of uncomfortability ?
Again thank you dr and wish you all the health so you can keep sharing your expertise and experience
No.
Nice video sir.... Please explain the steps on taking centric occlusion in details
In DentistryMasterClasses.com I am going to teach you how to predictably manipulate into centric relation as well as discussing all aspects of proper occlusion. We will then be presenting diagnosis and predictable treatment of myofacial and intraarticular (TMJ) pain and dysfunction. I am actually filming CR manipulation and occulusion this coming Friday and Saturday mornings. Watch it on DentistryMasterClasses.com and view it live on our Facebook page.
Thank you for making these fantastic videos! I do have a question. Is there a risk of super eruption by only having the anterior teeth contact?
Yes, absolutely, if the patient wears the appliance more than while sleeping. It normally takes teeth 48 hours to start super erupting, so it is imperative you instruct the patient both verbally and in writing that they not wear the night guard more than 8-12 hours straight.
Thank you!
From my personal experience, there has been super eruption when wearing the appliance only at night.
@@centerforard There was a case I heard of with super eruption from only wearing it at night for about 3 months. It was because the night guard didn't cover atleast half of the 3rd molar.
This was great. What do you think of day time bruxers (as you said non occlusal contacts in the multicusppid teeth will make them protrude)? Would you approach the same way or try to go for "maximum intercuspation"?
If someone is wearing a CRO splint all the time, you would have to go with a splint that had all the teeth contacting. The best way to accomplish that is to place only the anterior contacts on the hard acrylic splint first. Have the patient bite down on the splint as hard as they can and grind the teeth together. Be sure none of the posterior teeth contact the splint. Next, add unset, soft acrylic to the posterior occlusal surface of the hard acrylic splint. Have the patient bite down as hard as they possibly can into the soft, unset acrylic on the posterior part of the splint and grind their teeth making indentations into the soft, poster acrylic. Let the soft acrylic on the posterior part of the splint set completely, then grind off all the fresh acrylic except for the centric stops. Eliminate all eccentric contacts. Adding the posterior contacts this way is the only way to ensure there are no posterior premature centric occlusion contacts.
Whoa! This is definitely not how my NG was made. Nicely done!
Thank you.
Why not recreate using heat cured material to reduce shrinkage?
There are other ways of making a nightguard. There are many reasons I prefer this method.
This is cool. Nice work Doctor.
Thank you.
❤sir lots of learning 🎸🌹🙏
Glad the videos are helpful.
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Do patients normally come to a dental office to get a nightguard or it is that they have to be referred to you? Nice video btw really educational 👍🏾
Both. Sometimes they come to my practice knowing they grind their teeth and need a night guard. Sometimes the patient is not aware they are grinding their teeth and I make them aware of it by observing the photo I take of their teeth during their new patient exam.
We want a video on how to make a somnimed
Are you referring to a Somnident sleep apnea/snoring device? I deliver many of those SADs. I actually wear one myself because I started snoring several years ago. They really work well. I can make a video on SADs, but it is really straight forward. What aspect of SAD fabrication are you unclear on?
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@@centerforard I want a video on it because it is something new for me and I didn't do that before and I think everything will be easy if I follow your steps and hints
Great. I place a lot of Somnident Dental Sleep Apnea/Snoring Devices. I wear one myself. They really work, so long as the patient's Body Mass Index is within normal ranges. If the patient is considerably overweight, they should normally first loose weight down to their proper BMI before placement of a SAD. Obesity is a real problem in the US. Not only do these obese patients have sleep apnea, they have diabetes, heart issues, bad knees, hips and feet and low back pain and problems. If they do not loose the weight, all these issues will exacerbate and they will spend much of their time having surgeries and other medical treatments. Give the overweight patient a BMI chart and instruct them to stop eating all carbohydrates until they get their weight down to the proper BMI for their height. With no carbohydrates, people can loose 20-30 lbs./month. Once the correct BMI is reached, regulate carbs to very small portions and maintain the proper BMI weight within a 5 lb. range. It is not difficult to loose weight, it just takes discipline. It's all about restriction of carbohydrates. Watch the TV series, ALONE, on Amazon Prime. It is really a program on how to loose weight.
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@@centerforard thank you alot
Please write material name using
Acrylic, powder and liguid, for the shell, lined with bisacrylate (I like Luxitemp). Be sure to cut retention holes in the shell.
Hi! I have a short question: Would you still do this on a patient who has anterior composite restorations involving the incisal edges?
in your experience, would a heavy bruxer flick that restoration right off during the night? especially given that contact is only on the anterior teeth.
P.S
Awesome video!!! thank you :)
The restorations will be lost from bruxism without a night guard.
Very interesting video!
Thank you.
Than You for Sharing ...Very Great teacher
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How can I find a dentist that knows how to make this exact type of nightguard? I tried to explain to my dentist that a basic guard only protects teeth from wearing but does nothing to stop the forces of bruxism. Kinda ridiculous that this concept isn't common knowledge to all dentists.
I do not know.
@@centerforard I wish things were more clear when it comes to these guards. I see one side saying anterior occlusion only guards are dangerous because they cause intrusion and also eruption which leads to an open bite. It's scary as a person who clenches and grinds since this seems like the only thing that will help yet many pros strongly advise against them. Tough spot to be in as a layman who is suffering. I just wonder how much of those concerns are truly valid if only worn at night and if they are just being alarmists.
Very good to me thanks a lot
Great!
Great nightguard, this is a prosthodontist level nightguard. Do you think you can explain about manipulating a patient's condyles more?
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Sounds like the concept of an NTI appliance but utilizing full coverage with no posterior occlusal contact.
Exactly. The full coverage stabilizes the splint so you do not have to worry about it coming loose and the patient aspirating or swallowing it.
Thank u❤🌹
You are welcome.
Please spanish substitules, thanks!
We will work on it!
god bless you dear dr
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You could also go digital with this software: th-cam.com/video/qWPGMtS1zJ0/w-d-xo.html
Thanks for the tip.
👍🏻👍🏻👌🏻👌🏻👌🏻
Mouth warsh
Crest Whitening or any non-colored mouthwash containing hydrogen peroxide.