by Clayton A. Chan, DDS
Neuromuscular Technology is ADA and FDA approved and meets the standards of reliability and validity satisfying the requirements of sensitivity and specificity that are essential for clinical diagnosis of individual patients. Dentists have professional and intellectual freedom to practice the best dentistry possible. The technology/equipment does not diagnose! Clinicians make the diagnosis by using information gathered from patient history, examination and supportive objective measured assessments/measured tests and other modalities including imaging technologies. Jaw Tracking/computerized mandibular scanning (CMS), electromyography (EMG) and electrosonographic (ESG) data is useful and has been well documented in scientific literature for over a decade.
Postural muscle activity can be measured objectively and monitored. Hyper active EMGs indicate some muscles are out of balance. Relaxing muscles using low frequency TENS allows the doctor to compare habitual resting activities before and after TENS. Habitual resting EMG activities compared to muscle activity with the teeth touching lightly together.
Scan 11 – Functional clenching EMGs vs. cotton roll test between teeth during biting to compare and identify any muscle imbalances. Low amplitude EMGs indicate occlusal and muscular pathology (abnormal function). Higher amplitude EMGs indicates improved or physiologic muscle recruitment – Health.
Scan 2 – Habitual mandibular Open and close (Jaw Tracking) patterns in sagittal, frontal and velocity of jaw movements are recorded to identify and objectively measure normal vs. abnormal mandibular movements as they relate to muscles and condyle/disc function and or dysfunction. Scan 2 is designated to record the patient’s speed (Velocity) of mandibular movement during open and closing and shows a simultaneous vertical velocity trace and a frontal view of any lateral deviations during opening and closing.
Scan 3 shows the three dimensional movement of the mandible from accommodative (habitual) rest position to centric occlusion (C.O.). Scan 3 is taken in sweep mode BEFORE pulsing and shows the stability of habitual rest position, vertical position from the habitual CO position, AP deviation, and lateral deviations to a closed terminal occlusion.
Scan 6 – Swallow test ( (Jaw Tracking) Measures and identifies objectively whether the human swallow patterns are normal or abnormal. Normal tongue swallowing patterns are important to the clinician to help identify which cases needs retention and which cases don’t need retention. Scan 6 is a simultaneous Sagittal/Frontal view showing mandibular movement during swallowing and to identify tongue activity.
Scan 8 – Functional Chewing movements – Jaw Tracking patterns both sagittally, frontally and horizontally (not shown) can indicate whether the occlusion and jaw movements are normal vs. abnormal, pathologic vs. physiologic.
Scan 13 is designated to record the patient’s jaw tracking range of motion (ROM). Although very similar to scan 1 it displays the additional lateral excursive mandibular movements. Scan 13 is great to show the patient’s range of motion improvement during and after treatment. The range of motion includes the maximum vertical opening, maximum left lateral and right lateral movement and the maximum anterior and posterior movement.
Scan 12 is an electromyographical display of muscle activity displaying mandibular torque, assisting the clinician to identify diagnostically initial deflecting contacts that were not seen previously detectable with articulating paper techniques during voluntary and involuntary closure.
Scan 15 is a combination of jaw tracking and sonography allowing the clinician to correlate the acoustic signature patterns with real-time events within the open and closing cycles of mandibular movements. The sensor array is used to recording mandibular movements for the velocity tracing.
By placing the mouse cursor over a major sound signature pattern and right clicking over it one can display a box over that sound and a more magnified view will display both amplitude and frequency patterns.
Scan 9 before resting EMGs are compared with Scan 10 after TENS resting EMGs to objectively determine what level of muscle response has occured. Scan 9 before resting EMGs are compared with Scan 10 after TENS resting EMGs. Postural muscle activity can be measured objectively and monitored. Hyper active EMGs indicate some muscles are out of balance. Relaxing muscles using low frequency TENS allows the doctor to compare habitual resting activities before and after TENS.
Scan 4/5 Vertical Dimension of Occlusion (Jaw Tracking) during TENS prior bite registration allows the clinician observed the quality of the Myomonitor TENS pulse which produces an upward and anterior rise of the mandible involuntarily as well as assists in establishing a consistent mandibular resting position (the vertical fall between each TENS pulse). Homeostasis can be established.
Taking a bite registration is the one procedure that every dentist does almost routinely. Capturing a “physiologic bite” registration that matches the patients muscle physiology and facial aesthetics is less routine, but possible. Confirming and documenting the patients bite position spatially along with EMGs is a powerful tool and significant technological advancement the clinician has available in treating restorative, prosthetic, orthodontic and TMD patients.
The split screen scan 4/5 is a combined screen displaying both scan 4 and 5 together. It is effective to monitor both the quality of the Myomonitor pulse in the sweep mode (scan 4) with the sagittal and frontal views of mandibular movement (scan 5). Scan 5 is the fundamental scan that relates mandibular positioning during and after TENS in relationship to habitual centric occlusion (CO). Without this scan definitive treatment cannot be confirmed.
The Myotronics instrumentation data you have reviewed here are recorded from an inert measuring devices similar in nature to an electrocardigraom or pulse oximeter. Like EKG or pulse-ox devices, this technology provides real time objective measurements of physiologic responses of the human jaw. These objective measures help document and improve the efficacy of the diagnosis and treatment of patients. The Supreme Court Justice Benjamin Cardoza once stated: “If it can be measured, it is a fact. If it cannot, it is an opinion!”
In today’s world of orofacial (myofacial) TMJ/TMD pain, the Gold Standard is patient self – reporting pain. Pain is entirely subjective. It cannot be objectively measured. Neuromuscular dentistry and instrumentation allows the today’s clinician to advance the abilities to objectively measure physiologic activity as opposed to relying on unreliable and subjective patient self reports.