Deprogramming-Reprogramming Workflow

Summary

In this educational webinar, Dr. Hector F and Jenny from the Education team at Madden explore the concepts of deprogramming and reprogramming in dental treatment. They discuss the use of anterior bite splints for diagnosing joint issues, stabilizing joints, relaxing muscles, and adjusting bites. The presentation covers the design, printing, and integration of these devices into comprehensive treatment plans, emphasizing the importance of patient education and expectation management. Real-life case studies illustrate the effectiveness of deprogrammers in complex dental cases, highlighting the role of these tools in achieving optimal occlusal harmony.

Takeaways

• 😀 Deprogramming and reprogramming are techniques used to alter a patient's bite, with deprogramming aimed at making the patient's muscles 'forget' their usual bite position to allow for a new bite to be established.
• 🔧 The use of deprogrammers is a diagnostic tool to assess the health of the temporomandibular joint (TMJ) and to determine if there are any issues that need to be addressed.
• 🦷 Deprogrammers can help in various dental treatments such as orthodontics, full mouth rehabilitation, and in cases where patients exhibit heavy bruxism or have muscle symptoms.
• 👨‍⚕️ Dr. Hector F alone discusses his experience with deprogramming and reprogramming, emphasizing the importance of understanding when and why to use these techniques in dental practice.
• 🛠️ Anterior bite deprogrammers, like NTI and BPL devices, are designed to be worn by patients to help in the deprogramming process, and they can be customized using digital tools like Med splint.
• ⏱️ The time it takes for a patient to deprogram can vary widely, from minutes to weeks, depending on the individual's muscle activity and other factors.
• 💡 Deprogrammers can serve as a starting point in complex dental cases, helping to establish a new bite position that can guide subsequent orthodontic or restorative treatments.
• 🤔 Patient expectations should be managed when using deprogrammers, as the bite change they experience may be temporary and will require further treatment for long-term stability.
• 🗓️ Deprogrammers can be integrated into a comprehensive treatment plan, helping to diagnose, treat, and protect the patient's bite in a step-by-step process.
• 📈 The use of AI in dental software, like Med splint, is advancing the ease and speed of designing deprogrammers, potentially leading to more automated and precise outcomes in the future.
• 📚 The webinar format provides an opportunity for continuing education on topics like deprogramming and reprogramming, with real-case examples and discussions on best practices.

Q & A

What is the main purpose of using deprogrammers and reprogrammers in dental treatment?

The main purpose of using deprogrammers and reprogrammers in dental treatment is to help patients forget their habitual bite patterns and reprogram their bite into a new, more suitable position. This process is particularly useful for diagnosing joint issues, checking joint stability, relaxing muscles, and establishing a starting point for complex dental cases.

What is the difference between deprogramming and reprogramming in the context of dental treatment?

Deprogramming refers to the process of making the patient's muscles and joints forget their usual positions and movements, which can be influenced by muscle memory. Reprogramming, on the other hand, is the process of guiding the patient's muscles and joints into a new, therapeutically desired position after deprogramming.

How can deprogramming help in diagnosing joint problems?

Deprogramming helps in diagnosing joint problems by allowing the practitioner to observe changes in the patient's bite and joint behavior when the usual muscle memory is disrupted. If there are issues within the joint, the patient's response to deprogramming can provide valuable diagnostic information.

What is the role of scanning technology in the creation of deprogrammers and reprogrammers?

Scanning technology plays a crucial role in creating deprogrammers and reprogrammers by providing an accurate digital impression of the patient's mouth. This digital data can then be used to design and fabricate customized dental appliances, such as splints, which can be used for deprogramming and reprogramming purposes.

Why is it important to manage patient expectations when using deprogrammers?

Managing patient expectations is important because deprogrammers can temporarily alter the patient's bite, which may cause discomfort or changes in their daily life. Patients need to understand that these devices are part of a larger treatment plan and that their bite will eventually be reprogrammed to a new, more suitable position.

How can deprogrammers be used in cases involving orthodontics or full mouth rehabilitation?

Deprogrammers can be used in orthodontics or full mouth rehabilitation to establish a neutral starting point for treatment. By deprogramming the patient's bite, the practitioner can more accurately assess the patient's jaw position and muscle activity, which can then be used to inform the design of orthodontic appliances or the planning of full mouth rehabilitation.

What are some common types of deprogrammers mentioned in the script?

Some common types of deprogrammers mentioned in the script include anterior bite splints, NTI (Nociceptive Trigeminal Inhibition) appliances, BPL (Bite Plane Lip) devices, and Co programmers. These devices work by creating an interior stop or by keeping the teeth apart to facilitate deprogramming.

How can the design of a deprogrammer be customized using digital tools?

The design of a deprogrammer can be customized using digital tools by adjusting the shape, size, and position of the appliance to fit the patient's specific needs. This can include adding retention features, extending the appliance towards the back of the mouth, or modifying the occlusive surface to ensure comfort and effectiveness.

What factors should be considered when deciding whether to use a deprogrammer on the upper or lower arch?

Factors to consider when deciding whether to use a deprogrammer on the upper or lower arch include the patient's existing dental work, such as crowns or partial dentures, the presence of any mobile or compromised teeth, and the antagonistic relationship between the upper and lower arches.

How can deprogrammers be integrated into a comprehensive treatment plan?

Deprogrammers can be integrated into a comprehensive treatment plan by using them as a diagnostic tool to determine the patient's optimal jaw position and muscle activity. Once the patient has been deprogrammed, the practitioner can then design a treatment plan that includes orthodontics, full mouth rehabilitation, or other restorative procedures to reprogram the patient's bite into a new, more suitable position.

Outlines

00:00

😀 Introduction to Deprogramming and Reprogramming in Dentistry

The paragraph introduces a webinar on deprogramming and reprogramming in dental practices, focusing on the importance of forgetting the old bite and creating a new one. Jenny from the Education team at Madden welcomes the attendees and is joined by Dr. Hector F. They discuss the agenda for the webinar, which includes understanding the difference between deprogramming and reprogramming, the use of deprogrammers, and live demonstrations. The conversation highlights the goal of the webinar to educate dentists on these techniques and their applications in patient treatment.

05:00

🛠️ Deprogramming Devices and Their Clinical Applications

This section delves into the specifics of deprogramming devices, such as anterior bite splints, and their use in diagnosing joint problems and ensuring joint stability. Dr. Hector explains the importance of these devices in relaxing muscles and establishing a starting point for complex dental cases. He also shares his professional background, emphasizing his experience with occlusion and joint health, and discusses the potential of scanning technology in dental practices for efficiency and patient comfort.

10:03

🦷 Understanding the Importance of Joint Health in Deprogramming

The paragraph discusses the significance of joint health in the deprogramming process. It explains the anatomy of the temporomandibular joint (TMJ) and the role of muscles in its function. The text emphasizes that deprogramming devices help diagnose issues within the joint and ensure it is in the correct position. It also touches on the concept of muscle memory and how patients' brains remember their usual bite positions, which may not be ideal.

15:05

🔧 Methods and Techniques for Deprogramming Patients

This section explores various methods and devices used for deprogramming patients, including midpoint splints and devices that keep the teeth apart. It discusses the importance of the position of the device in the mouth for effective deprogramming and mentions specific brands and types of deprogramming devices. The paragraph also covers how to design these devices using dental software and the considerations for printing them, ensuring they provide adequate support and retention.

20:05

📏 Selection Criteria for Deprogramming Devices

The paragraph outlines the criteria for selecting appropriate deprogramming devices, considering factors such as the duration of use, the health of the patient's joints, and the presence of any dental restorations or dental appliances. It also addresses the importance of managing patient expectations and the potential need for alternative treatments if the deprogramming devices do not provide the desired results.

25:08

👥 Patient Expectations and Management of Deprogramming

This section discusses the expectations patients may have when using deprogramming devices and the potential experiences they might encounter, such as muscle tension, facial relaxation, and changes in their bite. It emphasizes the importance of informing patients about these changes and planning subsequent treatments to address any bite discrepancies that may arise after deprogramming.

30:10

📚 Integrating Deprogramming into Comprehensive Treatment Plans

The paragraph illustrates how deprogramming can be integrated into a comprehensive dental treatment plan, using simple and complex case examples. It demonstrates the process of using deprogramming devices to adjust a patient's bite and the subsequent steps taken to address the new bite position, such as extractions, orthodontics, or full-mouth rehabilitation.

35:10

⏱️ Duration of Deprogramming and Patient Variability

This section addresses the variability in the duration of deprogramming among patients, which can range from minutes to weeks, depending on individual muscle activity and the complexity of the case. It highlights the importance of patient assessment and the potential need for adjustments or referrals to specialists for more complex cases.

40:11

🔄 Conclusion and Recommendations for Deprogramming Practice

The final paragraph summarizes the key points of the webinar, emphasizing the benefits of deprogramming in diagnosing joint health, managing muscle tension, and serving as a starting point for complex dental cases. It concludes with recommendations for the practical application of deprogramming in dental practice, including the importance of reprogramming the patient's bite after deprogramming to ensure long-term stability.

45:12

📨 Closing Remarks and Invitation for Further Questions

The closing paragraph wraps up the webinar with an invitation for attendees to ask further questions and provide feedback. It acknowledges the informative nature of the lecture and expresses openness to addressing more in-depth questions or organizing additional webinars on the topic of anterior deprogrammers.

Keywords

💡Deprogramming

Deprogramming in the context of the video refers to the process of resetting a patient's bite and muscle memory to a neutral position, which is essential for proper dental treatment, especially in cases of misaligned bites or joint issues. It is a crucial step before reprogramming the patient's bite to a new, healthier position. The script mentions using deprogrammers to help diagnose joint problems and to relax muscles, indicating its importance in dental treatment planning.

💡Reprogramming

Reprogramming is the subsequent step after deprogramming, where the patient's bite is adjusted to a new position that is in harmony with the functional movement of the jaw. This concept is vital for ensuring long-term stability and comfort in dental treatments, such as orthodontics or full-mouth rehabilitations. The video discusses reprogramming as a means to create a new bite that is comfortable and functional for the patient.

💡Splints

Splints in dentistry are devices used to alter or protect a patient's bite. In the video, splints are discussed as tools for deprogramming and reprogramming, helping to diagnose joint issues and muscle tension. They can be designed using digital tools and 3D printed for a precise fit. The script mentions various types of splints, such as NTI, BPL, and Co programmers, which serve different purposes in bite adjustment.

💡Anterior Bite

Anterior bite refers to the way the front teeth of the upper and lower jaws come together. It is a critical aspect of dental occlusion and is often the focus of deprogramming and reprogramming efforts. The video emphasizes the importance of anterior bite in achieving a proper and comfortable bite, especially when using devices like deprogrammers and reprogrammers.

💡Muscle Memory

Muscle memory is the phenomenon where the muscles remember and tend to return to a certain position or pattern of movement. In dentistry, this concept is important because patients' habitual bite patterns can affect the success of dental treatments. The script discusses how deprogramming aims to reset this muscle memory to facilitate a new, healthier bite.

💡Dental Occlusion

Dental occlusion is the way the teeth fit together when the jaw is closed. It is a fundamental aspect of oral health and function. The video discusses occlusion in the context of deprogramming and reprogramming, where the goal is to achieve an optimal occlusion that reduces strain on the jaw muscles and temporomandibular joints.

💡3D Printing

3D printing is a manufacturing process used to create three-dimensional objects from digital models. In the video, 3D printing is mentioned as a method for fabricating dental splints, which are custom-made to fit a patient's teeth. This technology allows for precise and comfortable fit, which is essential for effective deprogramming and reprogramming treatments.

💡Temporomandibular Joint (TMJ)

The temporomandibular joint is the joint that connects the jaw to the skull and is central to the function of the jaw. The video discusses the importance of assessing the health of the TMJ when using deprogrammers and reprogrammers, as any issues with the joint can affect the success of dental treatments and the patient's comfort.

💡Orthodontics

Orthodontics is a branch of dentistry that focuses on the diagnosis, prevention, and treatment of dental and facial irregularities. In the video, orthodontics is mentioned as a potential treatment that may follow deprogramming, where the teeth are aligned to improve occlusion and overall oral health.

💡Full Mouth Rehabilitation

Full mouth rehabilitation is a comprehensive dental treatment plan that aims to restore and improve the function and aesthetics of a patient's mouth. The video discusses using deprogrammers as a starting point for such complex cases, where multiple dental issues need to be addressed simultaneously.

Highlights

Introduction to the concept of deprogramming and reprogramming in dental treatment, focusing on changing a patient's bite.

The importance of deprogramming for patients with heavy bruxism or undergoing orthodontic treatment.

Use of anterior bite splints, like NTI and BPL, for deprogramming and their design process using Med splint app.

The role of deprogramming in diagnosing joint problems and ensuring joint stability before treatment.

Explanation of how deprogramming helps in relaxing muscles and serves as a starting point for complex dental cases.

The significance of scanning in dental clinics for reducing impression material distortion and time efficiency.

Advantages of using digital scanning over traditional impression methods for immediate evaluation and storage.

Different types of deprogrammers and their specific uses, including LIF Gates, NTI, and BPL devices.

The process of designing and adjusting deprogrammers using AI in dental software to fit patients' needs.

Indications for using deprogrammers, such as in cases of muscle symptoms or before full mouth rehabilitation.

Discussion on patient expectations when using deprogrammers and managing potential discomfort or pain.

Integration of deprogramming and reprogramming in comprehensive treatment plans for complex dental cases.

Demonstration of a simple case where deprogramming led to the extraction of wisdom teeth and symptom relief.

Presentation of a complex case involving multiple treatments and the use of deprogrammers to achieve a stable bite.

The variability in the time it takes for patients to deprogram, depending on muscle activity and individual response.

Recommendations for managing patient expectations and the importance of reprogramming after deprogramming.

Conclusion emphasizing the value of deprogramming and reprogramming in dental treatment for diagnosis and treatment planning.

Transcripts

yeah so what we're trying to do is make

them forget where the bite is used to

go and then once we know that the

patient is deprogrammed then we need to

reprogram the patient into a new bite

that we're going to be

creating hello everyone thank you for

joining us today my name is Jenny and

I'm a part of Education team at Madden

nice to meet you everyone and today we

have Dr Hector F alone hi

good to see you yenny yeah all good

thank

you so how have you been doing all good

oh good we we're really working on this

so I think this webinar is going to be

really interesting for everyone it's a

kind of part two of a part one that we

did so is a is a continuing education

really no yeah last time I asked you uh

the difference between deprogramming and

reprogramming and Dr Hector prepared a

very interesting topic this time yeah

thank you so many dentists will be so

eager to learn more about it

yeah I I hope it's interesting I think

it's a is a really broad topic and I try

to concentrate the part of De

programming we're going to talk about it

I think it's and the good thing is we're

going to do like a live session so we're

going to do it now I think that's going

to be really interesting as well yeah

yeah from this time I'll be attending

the lecture together from the beginning

and I'll be asking the question on the

behalf of the listeners yeah that's good

thank you yeah Sher your St dror

yeah great so thank you for joining me

today uh Jenny thank you very much for

um helping me with those webinars we'll

be talking today a bit more about

splints we already did talk about splint

last time and these are the kind of

splin that we had before uh I don't know

I'm going to see if we can uh see

something can you see the laser yeah I

can that's great so with this laser I'll

be pointing a few things that I think uh

the attendees will be looking at and we

can see together where this presentation

is pointing so those are the kind of

split that we talked about last time

this time I'll be talking a bit more

about de programmers so the de

programmers are going to be showing a

workflow the work that I use we're going

to see when and why we're going to be

using these kind of D programmers this

is some uh anterior bites um that Med

splint app can do so those are the kind

of splints that you can do as D

programmers with a platform in the

front and I'll be showing how to do them

um how to design them as well and then

considering the printing part of it I

think the the first part we already

talked about printing this is more about

understanding when and why using this

kind of um the programmers then on the Y

part of it and why do we use them why do

I want this interior bite Anor D

programmer the most important part here

is to understand that these little

devices help us us is going to they're

going to help us to diagnose if we have

any problems in the joints so the joints

is this part here we're going to talk a

bit about anatomy in the joint as well

but we need to understand that if there

is any problem here this little device

is going to help us uh to know well

there is a problem or the joints are

fine then the second kind of part on why

we use them is to check if there is

stability in the joint because some

joints are not healthy they are

destroying themselves or they're just

not in the right position then this

little device is going to help us as

well another thing that it does is

relaxing the muscles we're going to see

that why as well it's going to help with

with a starting point if we want to do

like a complex case if we want to do a

big case or if we're not really sure if

the bite is right this is a perfect time

to use these kind of De programmers and

then that's going to help us to sit the

cond in the right

position so this is just a bit about me

um I changed the picture but uh

I haven't changed much since last

presentation so I'm a general dentist

working in

Malaga uh I've been working for sorry

I've been working for a few years now

and I graduated and I went straight to

the UK I worked with Dr Ian Buckle in

this um talking I mean and I do some

courses um in occlusion so we are trying

to share a bit the expertise that we got

in inclusion splints and then uh joint

health and joint position and uh we've

been doing a great job in Copenhagen and

and Denmark and in the UK and I'm trying

to do this in Spain as well I think if

at some point I could go to South Korea

That'll be amazing but until then uh I

think we can do some webinars and uh

that that'll be good

enough so um

continuing into scanning scanning has a

really potential uh cost and time

Effectiveness when we scan if we are

thinking about introducing the scanner

in our Clinic is going to help us

reducing the Distortion of the

impression materials and also the time

wise because patient comes in first time

we do is scanning the patient as soon as

we scan the patient we can start

designing the splint and this going to

help us with big treatment cases

then it's going to be more comfortable

with the with the patient of course

because we don't have these materials

that go into our mouth I mean that's

well known already that scanners is part

of the future it's not something that

it's not even part of the future it's

part of the present it's not something

uh that we need to avoid anymore it's

something that we need to introduce in

our Clinic if we want to move forward in

these kind of things it's going to give

us an immediate evaluation uh of The

Impressions the impression is okay or

not

Yeah because sometimes we take an

impression we send it to the lab and

then the lab says well that's not too

good an impression so scanners help with

with this and then it's also so easy to

store because nowadays we have hundreds

of patients hundreds of records that we

need to keep for five years sometimes

even more uh ideally we want to have

those stored

somewhere so today what I'm trying to do

is organize this as in an agenda uh

we're g to try understanding what's the

muscle deprogramming and reprogramming

because that sounds like what is he

talking about yeah try to understand

that part then we're going to see when

is it important to do it or not or when

we don't need it to do it the methods to

do it um and the type of splint that we

can use not only we can use splint but

we can Al um but we can use all the kind

of the programmers then we're going to

see uh which is the most appropriate

Sprint in each case

we're going to see how to manage the

patient expectation because some

patients think that we're going to Sol

that life with this kind of De

programmers we not but we're going to

see how we can help the patient then

we're going to see how we're going to

introduce this is um and integrate this

in a big treatment plan we're going to

do a big case we're going to see how

this device is going to help us so for

the first part would be the

reprogramming deprogramming part yeah

part yeah this part so the first thing

that we need to understand is the joint

the anatomy that we got in the joint so

each one of us uh is the same yeah

considering that we have a healthy joint

I can't really go into detail and we

could do another webinar into not

healthy joints or problems in the dis or

things like that get really complex when

we get into that part but with healthy

joints the only thing that we need to

understand is this is the gleno fosa and

then inside that fosa we have a cile

which is part of the mandible in between

these two we have a dis and got we got

some RTO discal tissue so this muscle

that you can see

here um this is the lateral teroid so

this is the muscle that's going to allow

the joint to move forward that muscle

needs to be as relaxed as possible so

the cile is seated in the right position

where most of the patients have this

muscle a bit active so if that muscle is

slightly active the joint is not in the

right

position it can be a bit forward and

some patient they don't have any

symptoms but some others they do have

symptoms so we're going to see those

kind of patient that have muscle

symptoms but not joint issues and we're

going to see what the big difference

between them two and we got some

articles here talking about muscle

memory because patient when they try to

bite in the normal bite they kind

of they kind of have a a memory in their

brain that they always going to go into

the same position where they biting the

way they used to bite so we don't really

know if they're in the right position

because they're used to it and then they

feel comfortable some feel comfortable

others don't and we're going to see that

they do have a chewing pattern so some

patient they when they chew um they

always going to do the same movement

because teeth are going to dictate where

the joints they're going to be if my

teeth are forward then the The Joint

needs to be forward if the teeth are

back then the joint needs to be back and

then we need to know that this is a

healthy joint we cannot go into really

complic cases this is simple joints are

healthy the only way to know if joints

are healthy there's no sharpen pain or

there's no tension in the joint up here

yeah so we talked about why why we're

going to use this so those are the five

kind of points that we're going to be

seeing that why but then when do we use

this that's that's an important one when

do I want to use this Hector is it for

uh just healthy joints well ideally yes

we need patient with healthy joints but

if they don't have healthy joints

they're going to give us a feedback and

then we know as a diagnostic too this is

not good for them to use so that's

that's one part of it then we can

Orthodontics we're going to change um

the way the patient uh Al alignments the

the alignment in the patient teeth then

we can use this kind of device if we

have any muscle symptoms if we're going

to do a full mouth Rehabilitation on

impatient with heavy broism I think

that's a good thing to

use so will you deprogram every

patients so you you can deprogram every

patient but if the patient don't don't

have any symptoms I don't think it's

necessary so I wouldn't say that every

patient needs to be de program just in

patient that you're either going to be

doing orthodontist for M Rehabilitation

if they have any symptoms of they are

really heavy bres so those are the three

four cases that I'll be using these kind

of

devices overall the main thing that you

need to understand is when we're going

to change the patient occlusion if we're

going to do just a c filling and we

probably don't need this kind of devices

but if we're going to do a big case then

ideally yes H using in this kind of

paent um so before moving on um can you

explain more about deprogramming and

reprogramming so that we can so yeah de

programming what we trying to do is uh

make the patient

forget uh where the muscles and the

joint where the muscles are programmed

to be sorry so the joints can sit in the

right position so when we tell the

patient when we talk about deprogramming

that means make the patient uh so they

programmed to do the same that's a

muscle memory yeah so what we're trying

to do is make them forget where the is

used to

go and then once we know that the

patient is deprogrammed then we need to

reprogram the patient into a new bite

that we're going to be creating got it

so that's the whole concept of

deprogramming the patient with really

deprogramming the muscles to reprogram

the patient again into another scheme

they're going to be working in a

different

scheme yeah I think everyone also got

the idea yeah because I got it everyone

got it okay that's great so moving on

the method on how to deprogramming the

patient or the muscle of that

patient ideally and this is the studies

that many years ago we had this some

studies you got some um on the

bibliography that I that I

had when we have a midpoint Splinter

something that's in between the teeth

most

anally the the more interior you have

something the more it's going to

deprogram the muscle the activity of the

muscle is going to be reduced so the

cond can sit in the right position so

anything that's a midpoint splint that

goes in the middle that's going to help

us the NTI bepl of Co programmers those

are just names they're not my names that

the names that have been use um uh for

those kind of De

programmers but really these kind of De

programs the patient is wearing it and

they can take it them at home or not

where the LIF Gates and the Luci we

talked about this in the other webinar

as well it's something Anor as well but

they cannot wear it and we're going to

be using that in the clinic we can print

those kind of LIF Gat or Lucid or we can

have a stock of those so you can buy

them and you can have them in the clinic

so uh and then we got others if we keep

the teeth apart and the patient is going

to start deprogramming itself but also

you got Brands like

aqualizer that they help to deprogram it

anything that you place in between your

teeth is going to do some sort of

deprogramming because the muscle they're

not going to remember where they used to

go if you have something in between your

two so into the meod the first one that

I've designed is some sort of

Niti so the Niti is something that goes

in the front fairly

easy Med spint allows you to just with

AI to do this follow all the steps so

you can understand what we need to do

but we need to have a lot of retention

because we're only going to grab two to

three teeth sometimes four so we need a

lot of retention um that's loading it's

just you can't see the message in

loading but that's loading so the the

program is going to think well then

needs to go here and it's going to give

us some sort of um

design on where that uh anterior NTI is

going to

go that's simple then we can add the

name I like to have a name to so I know

which one which is the patient this is

just

mine yeah that's my name

and then you can print directly this

kind of uh NTI but

also sometimes some patients they might

clench it into this so this little uh

surface can break one of the things that

you can do is add a bit so you can give

it an extra support yeah so I'm just

adding it's just easily adding uh with

the adding

tools you can add anywhere you can add

in the front you can add in the

occlusive surface here I'm just kind of

adding and smoothing adding and

smoothing and at the end you have some

sort of

anterior um

stop but with support that support is

important the patient is going to bite a

bit Harden into

that don't think the patient is going to

hard too hard bite too hard into this

you don't really need to do

this that's just give an extra support

yeah this just little trick you can do

and so you know these kind of programs

help you to change a few things if you

like okay so moving on to the

bint is something quite similar again

you click onto anterior bite in

um Med spint and then

into manual creation you can do

automatic problem with automatic is

going to create something like the one

we did before yeah we want to do BPL we

need to extend the bit towards the back

the BPL the difference here is say the

patient can swallow this because it's

small so if you worri that the patient

is going to sleep with it and it's a

small device you can extend this kind of

splint toward the back so if it's big

enough the patient won't be able to

swallow it yeah and also if there is not

much retention see you can go towards

the back

[Music]

just a few changes that that you can

do this kind of video they're not

accelerated they're just at the same

speed as I'm doing it so if this video

takes two minute that's the two minute

that it took me this is not going any

quicker so sometimes you want to

accelerate things because it's loading

but this kind of splints because the

computer doesn't need to think too much

because they're quite simple to do uh

it's quite easy so once you got the

roughly the

idea you can move into the next step

that's what takes to

think of a design that you want to

do have you seen this kind of splints

before uh Jenny yeah this kind of splint

is quite ler right

yeah I think Med is doing a great job

with the anterior but not many program

that I seen you have that little square

in there oh and I I like it because it's

flat it allows me to have a flat surface

so what we don't want is having the

teeth the teeth form into these oh so it

needs to be as flat as possible so the

patient can move

freely anywhere to the left to the right

or towards the front and you can add the

name and again it's just the same

you need a certain thickness I think

this is 1.5 to 2

mm uh so the you can print the material

and it doesn't

break but you're not touching anything

in the back you're only touching in the

front yeah and then a CO deprogrammer

it's just Dr Co created this kind of um

de programmers the idea is the same you

have an interior

stop but it's just a way to hold it

especially we're going to see it later

on the co programmer just goes through

the pallet so if it goes through the

pallet you don't need the teeth say

maybe you have Restorations that are

breaking maybe you have certain teeth

that are moving and you don't want to

grab into any teeth so the good thing

with this kind of devices it goes around

the

gums we can change the design slightly I

think that that's loading again

and then changeing the

design it's fairly easy so you just need

to tell the program to drag the points

you bring that closer to the

tooth

y eventually I think Med is doing some

so many uh the feedback that we give we

give and then so many advancements and

improvements if we say thanks to AI

really in not no time there's going to

be one button that we click and it's

going to create this kind of things I

think that things are moving really

quick so you can make a coyd programmer

with AI function right not at the moment

but I think I'm really sure really close

in the future you can click to Ai and it

can give you some sort of Co programmer

this is

because the program at the moment is not

trained to do these kind of things oh

but if you do aund of these then the

program knows how to do it

and it's it's going to be possible soon

and I think AI is taking over in many

many things uh and I think Med is doing

an amazing job with a with AI as

well yeah something like that so that

goes round the

G this look so different from the normal

one is it yeah not uncomfortable is it

okay no those kind of devices they're

not uncomfortable so like removable

Dentures they go into soft tissue but it

just grabs to the teeth and it it's not

not uncomfortable at

all you don't need to wear this uh

247 sometimes you do but not not always

but the good thing with these kind of

devices is because it's not wrapping the

teeth you can't you can barely see it

because it's in the back yeah AIT more

aesthetic as well yeah so moving on to

which one so we we saw three of them

there is others out there those are the

ones that you can do with Med splint

fairly easy the most important part that

we need to understand is is it for

shortterm or is it for longterm use if

we're going to be using something for

shortterm I think we can use like um

Lucy CH or a LIF gauge or like the NTI

something that goes in the

front um and it's small because it's

only for shortterm but if the patient is

going to sleep with it uh and it's going

to be for a few weeks then we need

something more like a beis bling because

we want those teeth uh to to hold the

teeth in the right position and then to

avoid the patient to swallow or lose it

because sometimes you just lose this

small bit what is a bit bigger it's a

bit more difficult to lose

it but also if we're going to be using

this for a long term we need to

understand that the joints need to be

healthy that's the second part of this

if the joints are not healthy we cannot

use this for a long time yeah so when we

said when we want to use it we also need

to understand that the joint needs to be

healthy sorry the joint need to be

healthy

um but there there needs to be no pain

in the joints okay we're going to see on

the patient expectation when uh we need

to remove move it but then we need to

understand that if there is any temporal

Mula disorders we need to take that out

okay what what kind of strch mod should

be done so um we're going to see that

Jenny as well um but if we can cannot

use this kind of anterior bite we need

something like a full coverage like the

ones that we saw in another webinar

that's going to help with the joints

these kind of devices they don't help

with the joint they're going to help

with muscle but not really joint I

so talking about upper or

lower say we have really crowded teeth

in the lower but we have really aign

teeth in the front then we might want to

do a lower yeah de program instead of

the top one because if we do a top one

and the teeth are really crowded then

it's not going to be even on the

platform that we created so which one

either top or bottom it's going to

depend as well on the antagonist that we

have if we have any partial DST we don't

want to have this device on top of a

partial denter because at the end you're

going to be removing this and removing

the denter and you can break the uh

denture as well so I think it'll be

easier to have it in the antagonist yeah

also if you have crowns or teeth that

can that can break say a crown that can

fall out or a tooth that's Peri

compromis that moving you have a two

that mobile that has Mobility in it yeah

you don't want to flash against this

platform say you have with Mobility 3

you don't want to be using this kind of

devices use something different or place

it in the lowest so you can hit the top

you need to find an alternative to

it so the process of doing this is the

same that we saw in the first part we

need the scanner we need we can use the

medit i700 I think the i900 is out there

if we have it then we can use any

scanner will work because the good thing

with medit is at the moment we can use

the apps but the good thing with medit

is you can record and we will see how

the recording yeah is going to help us

integrate this at the very end if we're

going to be using another kind of

scanners then we got not going to have

the recording uh

included then we can use the med this

splint up and then we need a printer

once we got the printer we can send this

to a lab they can do it for us we have a

printer we can do it that's depending on

uh whatever we got in the

clinic and then we can use these kind of

resins key keyint soft works really

nicely for me if we want to polish them

we can use key print key polish that

helps with the polishing of the splint

we're not going to produce it you don't

need this part if you're going to

produce it this kind of material works

really really

nicely so in the patient expectation

what does the patient expect or Nick to

expect when they wearing this kind of

device it keeps going to the next

presentation I don't know why I'm not

clicking anything

yeah so the patient expectations so the

patient want to wear these kind of

device they need to think about what's

going to happen what do I need to feel

or what you need to tell them that can

happen the first thing that can happen

is pain so patient can experience pain

and that's important to know because we

need to understand how to manage the

pain or if we can use these kind of

devices in the patients or not so if the

pain comes from tension in the muscle

that can be normal sometimes they may

feel I never experience this kind of

tensions here and here and sometimes it

goes down in

that that can be normal because some

patients and this is interesting when

you wear them this this kind of device

they're going to relax the muscle but

that pain sometimes come from patient

getting used to the pain and they always

they always been in pain and then you

give them this kind of device they're

starting to relax and now they they

remove it and it's oh now it's painful

now it's painful it was painful before

but you never noticed

because the pain you can manage the pain

or you were used to the pain so that's

the first kind of pain it's more like a

tension tenderness sort of thing in the

muscles but if that tensional tenderness

comes in the joint which is a sharp kind

of pain coming close to the ear then we

need to ask the patient to remove that

immediately yeah so we need to tell them

don't wear it bring them back um bring

them back to the clink maybe we need to

the sort of they're going to be using

okay so also the second thing that can

happen is the muscle activity we're

going to reduce that muscle activity so

the patient can feel and I have patient

that their wife or their husband they be

like well his face is a bit more relaxed

I can see his face he's not like that

he's now bit more like that so you can

see some facial relaxation and also the

muscle activity is going to be reduced

so if the patient had some headaches

coming from this area here they might

feel a bit better thanks to these

devices right so that you can tell the

patient well this can

happen also and that's probably what we

want this kind of devices for is for the

bite adjustment so if the patient wear

this say for8 hours at night time once

they wake up they're not going to be

able to bite in their position where

they used to

bite so they're going to feel really

weird and they're going to ask us well

when I woke up I had my breakfast and

now I can't really bite then my bite is

in the back tee or I can only bite in

one side because the joints yeah are

sitting and now the teeth don't really

match but after this we need to think

about some treatment that we need to do

either like we said big cases full

Rehabilitation maybe Orthodontics and we

need to align the teeth into the correct

position or sometimes we need just to

don't know maybe give them a partial

denter

or depending on the case we need to do

an appropriate treatment plan but we

need to tell them your bite is going to

change and that's

important

yeah I think you got a question Jenny

yeah so um what if the patient has

symptoms with the de

programmers so they can have symptoms

um because of the load that we are

applying in the joints so if they have

any pain we need to ask them to take it

out come back to the clinic as soon as

possible and then we need to see maybe

changing that patient into a full

coverage splint again it's a broad topic

and we're always talking about healthy

joints if the joints are not healthy

then that's that's a different part of

the presentation maybe we can do another

webinar talking about that was very

interesting yeah those are really

difficult cases probably we need to we

can refer those kind of patient to the

specialist we're not really sure if the

patient is feeling better with this kind

of anterior bites maybe refer them

that's probably the best thing that we

could do for them h

yeah okay then uh the why they have pain

here sometimes is because there's not

really um a dis in between the joint and

the

glenoid and then those patient are

pressing against the rod discal tissue

which can be quite so so it's important

to know that if they have any pain in

the joints take it

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out so moving on to integrate this which

is the the bit that I like as a dentist

into a comprehensive treatment

plan I prepared just a simple case and a

complex case the simple

one we're going to talk through these

kind of

cases so this is the patient came to the

clinic we recorded him uh into this

position which is maximum intercuspation

so mi so teeth are just together but we

can see this patient has a bit of wear

so this is a um professional heavy

lifter he was always complaining about

pain coming from here um he had a lot of

tension in the

muscles and then he was biting into that

bite and well that's my bite and it

feels okay that's what he thought so we

gave him some sort of

deprogrammer and after taking just a

week with this

we saw that the wisom teeth are the

first oh my God the once the cor is

sitting the correct bite of this patient

is this one problem is when he was

trying to bite he had to move forward to

join the the the jaw a lot to bring that

into the correct

position that's why he had a lot of

tension a lot of tenderness in mus and

the joints so the only thing that we

needed to do with him was to extract now

we have the extraction of the wh and

teeth and now that's a different

completely different case because now

the the patient is biting properly all

the symtom has disappeared and he feels

a lot better and as we said he's a

professional heavy lifter he needed to

have an he was clenching a lot when he

was

lifting so now he uh feels a lot better

thanks to just really simple case where

thanks to the deprogrammer you can see

where the bite of that patient was

and then we can do a treatment according

to this in this case we just needed to

remove the wisdom teeth in other cases

we need to do different different things

but this is just a really simple case

that illustrate really well how the D

programmer can help

us

yeah and then into a really complex case

and this is a case that took me few

weeks to it wasn't really wasn't

easy but if you follow up protocol I

think you can do this kind of complex

cases the patient that comes in that has

a lot of wear that has a lot of um tooth

surface Lo tooth surface lost you have

over the years he had some treatment

done he had a veneer in that lateral and

then you want to restore this case but

if he's biting completely you don't have

space to restore him so you want to open

the bite and how much you want you want

to open the bite before opening the bite

that just complicates everything the

first thing that I would do if give them

some sort of

deprogramming so once they got something

you can record the second bite

yeah then we give them

this same case we give them the de

programmer they wait it for a week

sometimes less sometimes more we're

going to go through that together

and then that's just how the jaw goes to

a different position that's a different

position and the implant that he

had why it's in

plaster the first point of contact the

interference that he had uh was in the

in the uh

implant sometimes an implant and implant

crown and you're like well the patient

is fine well we need to make sure that

the patient is fine and I have to remove

that uh Crown so we Restorations for him

in the front

we and then you can see with the tempies

I mean this is a case that I could go

and it takes me 14 minutes just to talk

about this case long case but we did

some uh overlays in the back uh veneers

overlays sort of thing

yeah and then we did some three quarters

veneers in the front simple composite

lowest this is composite but then we pre

and we did ven poers because a case that

we wanted to have him stable in a

temporary phase sorry temporary phase

and then move into a final

case and that took me weeks so maybe I

think even up to three months I think

that case was how long should we wait

for de programming

so that can take I mean I have patient

that in a week they completely de

program I have patient that in a few

minutes the de program it does yeah it

does

depend because I can show

you um it it really depends on the

patient muscle activity if

that that it's going to take a bit

longer but if you see that

moves freely maybe sometimes in five

minutes those patient are fully

deprogrammed more complex the patients

are the more um they're going to need

that de programming so it does depend on

the patient really I

see so these kind of cases the good

thing with medit as well is where we can

record the mandibular movements and then

we finished the case and we recorded the

mandibular movements and this helped me

to to understand that the patient now

has a new bite and we reprogram the bite

to be in a different position now this

bite let me just press play this is the

left laterality this is Canan guidance

which help us a lot with uh muscle

activity as well on the right on the

right side he's class two I mean he's

just skeletic on the the jaw is smaller

so skeletic it's a bit smaller so I

can't really have K9 to K9 contact so I

had

lateral here lateral against K9 so when

I press play again oh

sorry let me go

back so when we

have here the movement we got the left

side

then we got the right side this is

lateral against K9

yeah I think I tried to do like a group

function with the with the preoral as

well

yeah and then we got the interior we

don't have any Prem maturities in the

back and we can make sure that there is

no teeth catching in the back thanks to

this as

well what we done with this kind of this

this patient with a heavy breure once we

done with the full case and I want to

protect my work everything that I've

done the ven that I've done again we

done this in the first webinar we can do

a full full mouth coverage um splint on

the top or on the lower and that's going

to protect the job that we've

done yeah

yeah so talking about deprogramming and

this is answering a bit more about your

question how long

how long is the question that I get ask

a lot and uh it's really difficult to

point at the patient that they're going

to De program really quick I think with

experience you can get to understand

okay this patient now is De programed

but if you are unsure and the the the

joints are healthy I'll say keep the

patient a bit

longer because it's not going to cause

any armm if the joints are healthy yeah

we want to deprogram the patient we want

to make this those muscle forget where

they are used to go and everyday basis

where they

chewing it can take few few minutes it

can take a couple of days it can take a

couple of weeks that depends on the

patient and then we need to do something

about it because if we don't do anything

about it then the patient is going to

feel like his bite is always

off that can lead to orthodontic that

can lead to just a simple equilibration

that can lead to a complex case uh

sometimes you can just do some TBL stops

in the back there's so many different

treatment plans we could talk in a

different webinar about how many we can

do about those kind of Dr program

patients and I have many cases that have

treated with different techniques and we

can see

all and then we need to reprogram the

patient not our job to

Just DE reprogram them but if we give

them a stable bite with posterior

discusion uh with an anterior bite in

harmony with the envelope of function so

we're going to have the patient um

protecting his his own bite protecting

his own teeth if we have can and

guidance then the muscle activity lowers

a

lot

yeah as a conclusion and some

recommendation we can have some and I

think the programmers can help a lot but

we need to know exactly when to use them

but it can help us with diagnosis it can

help us to know is the joints are

healthy or not it can help us with the

pain and the tension that we got in the

muscles patient do get

better um talking about muscles when we

use

this uh it help us as a starting

point if we have don't have an idea of

where we want to start if we have a big

case don't know do we have to open the

bite here here here not too sure as a

starting point it's really

good with heavy Brees if you have a

patient that they know or their Partners

at home yeah you can hear that patient

that goes to left right they clench a

lot this helps a lot with clenches this

helps a lot with uh heavy bres as well

if we want to use them as a long term

maybe we need to consider something

different and then this help with

headaches headaches not migraines like

the migraines that we can locate here in

the front but more headaches that goes

in the back like here on the side sorry

right we have various options we've seen

them it's the same idea it's something

an interior in the front something in

the front to keep the teeth apart we

need to manage the patient expectation

patient don't know and don't understand

what's going to happen if they wear this

or

not and then we seen how we can

integrate this in a bigger treatment

plan that that's the whole goal really

we can help the patient with pain but

really this helps us to deprogram the

patient but we need to reprogram it

later if we're going to just deprogram

the patient what what's the point really

that's just

the why would we do that and then de

programming it's it's only temp but it's

a is an important step as a as a big

treatment

plan yeah so thank you very much Jenny

uh this is my email wants to send me an

email uh with questions about this

really happy we'll answer them um if you

have any questions Jenny I'm here to ask

any question that you have as

well um I asked every questions that I

wanted to know between the lectures it

was really interesting to see all the

cases it was a real case of yours right

so yes so those cases I've cheated them

here in the practice actually one of

them his name is Hector because he my

father so that's took me that took me a

while to do three

months his name is Hector like me I

think in Spain we like to be called us

our parents if I I don't have kids but

if I have kids

maybe one of them will be called Hector

as well

yeah okay so that's everything about

today right yes I think the we covered

the the programers um let's wait for the

feedback as well see what people think

about these kind of things if we have

any deeper questions into anterior de

programers we can talk a bit more about

it we want to move into achievement

cases we can prepare another webinar

that's no problem with me wow okay thank

you for um preparing such a great

lecture for today so

that's all today so yeah see you next

time thank you for being here doctor

you're welcome bye bye bye

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