Using The Aqualizer® vs T.E.N.S in Neuromuscular Occlusal Concepts Monday, November 17, 2014 @ 12:22:51
What is T.E.N.S & how is it used for bite registration?
T.E.N.S stands for 'Transcutaneous (through the skin) Electrical Nerve Stimulation', and in dentistry is often referred to as 'neuromuscular bite registration'.
The T.E.N.S or neuromuscular bite takes thirty to sixty minutes to record. The steps in taking a T.E.N.S bite are as follows:
- Step 1. Relax the muscles using an ultra-low-frequency T.E.N.S device. After thirty minutes to an hour of stimulation, the masticatory muscles are usually relaxed and the bite registration can proceed. While using the T.E.N.S device, the mandible will move up and down approximately 1mm.
- Step 2. Turn off the T.E.N.S unit. Have the patient close to centric occlusion for evaluation, then have the patient tap their teeth 3 times and protrude.
- Step 3: From here a position is found where tonus of the evaluated muscles is at a minimum and the vertical dimension is within a range of treatment.
- Step 4. Inject bite registration material between the occlusal surfaces of the teeth.
What is The Aqualizer® & how is it used for bite registration?
The Aqualizer® is a temporary fluid filled device that is used in between the teeth, in order to decompress the jaw joints and relax the muscles, prior to taking any kind of bite registration for evaluation or diagnosis. So that as the patient applies pressure, the fluid is driven side to side to always be able to dynamically equilibrate or level out the pressures on the jaw joint.
The Aqualizer® is worn for around twenty minutes prior to taking the bite, and can be worn by the patient in the waiting room. The steps in taking an Aqualizer® bite are as follows:
- Step 1. Insert an Aqualizer® into the mouth, allowing the muscles to bring the mandible to its natural most comfortable position. As a general rule the more severe and chronic the symptoms, the longer the period of Aqualizer® therapeutic wear before the bite registration is taken. For those with mild or episodic bruxism, just ten minutes of wear will be sufficient, but chronic sufferers may need to wear the Aqualizer® for a day or two to relieve facial jaw pain.
- Step 2. Next set the final VDO (vertical dimension of occlusion). Aqualizers® are available in 2mm, 4mm, and 6mm VDOs. To increase VDO for the bite registration, add base plate wax under the water beds.
- Step 3. Instruct the patient to bite down naturally with the Aqualizer® still in place, while injecting silicone across the anterior from cuspid to cuspid.
- Step 4. Remove the Aqualizer® with the anterior bite still in place. Inject registration material between the occlusal surfaces of the left and right posterior teeth. Instruct the patient to close carefully into the previously established anterior bite. This creates a one piece full arch bite registration.
- Step 5. Assemble the patient’s dental casts accurately into the bite registration. Send this assembly to your lab for phase 1 treatment...we believe the best phase 1 lab in Australia to be Functional Orthotic Design, based in QLD.
The Aqualizer® device
Why the Aqualizer® is superior over the T.E.N.S technique for bite registration
The Aqualizer® is a dynamic device, and some of the advantages over other devices used for either deprogramming or decompression techniques (like when using the T.E.N.S method) is that it is able to move. The fluid travels from one side to the other, and as a result, as muscles start to relax, then the dimension of the mandible to the maxilla changes in three dimensions.
The disadvantage of the T.E.N.S bite is that the bite position taken is found by reducing muscle tonus and relaxing the muscles, which is not normal. The T.E.N.S bite results in a greater vertical dimension and substantial vertical change of the maxillomandibular relationship. It is often necessary to either temporarily or permanently augment the occlusion (with an appliance or prosthesis) to maintain this new position.
The importance of quieting the neurology of inflammation in the jaw for bite registration
There are many techniques in finding the proper cranial mandibular relationships and, therefore, dentition relationships or occlusion. The other neuromuscular techniques used prior to doing any kind of bite registration include; the swallow technique, phoenetic "S" technique, romancing & positioning.
There's various schools of thought on how to accomplish the best relationship prior to stabilisation of the occlusion and, therefore, finishing techniques.
Prior to any technique, quieting the neurology of inflammation in the jaw joint itself, and relaxation of all external and internal muscles of closure and mastication, are ideal for finding the proper trajectory of closing and muscular stability and structure. And that's why the Aqualizer® should be the first step used in any technique to quiet all of these systems prior to the final bite registration.
The Aqualizer® is basically a good precursor for any bite technique that may be utilised and the beauty of it is that it doesn’t tie into any one technique. It's basically wiping the nociception (phonetic) away, relaxing the muscles, to give a good starting point for whatever final point of restoration, or for restorative purposes, or for oral appliance therapy.
Phase 1 Treatment - choosing the best maunfacturer for your dental appliances
Functional Orthotic Design is a specialist dental laboratory based in QLD, at the forefront of Appliance Therapy dealing with all aspects of TMD, Orofacial Pain Management, Sleep, Airway and Orthopaedic Appliances, and is Dentiform's lab of choice for all phase 1 dental orthotics.
Functional Orthotic Design owner, Shaun Strang has exhibited the quality and accuracy necessary in order to comply with standard protocols established by Dr. Steven Olmos, an internationally recognised lecturer and researcher, and the founder of the TMJ & Sleep Therapy Centre’s International. Dr. Olmos graduated from the University of Southern California, School of Dentistry, and has dedicated the past 26 years to the fields of craniofacial pain, TMD and sleep disordered breathing. Shaun’s commitment to excellence has given Dr. Olmos the confidence to recognise and support Functional Orthotic Design as a designated manufacturing arm for the Australian market.
Phase 2 Treatment - finishing the case and maintaining the best position
Dentiform Australia understands the importance of maintaining this phase 1 position, and finishes using the Acculiner and advanced CAD/CAM systems to enable a predictable, accurate and highly aesthetic outcomes.