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Treatment: Lower Anatomical GNM Orthosis (Not a “splint”)

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GNM Anatomical Lower Orthosis (Orthotic)

Purpose:  To orthopedically realign the mandible to the cranium back to a position that provides relief from pain and dysfunction after a significant physical trauma.  It stabilizes the temporomandibular joints and restores them back to normal physiological function while at the same time reduces contracted (spastic) craniofacial and cervical muscle activity, normalizing function and resting modes to pre trauma conditions.

“Several studies have concluded that TMD patients experience the greatest clinical success after receiving treatments that involve restoration of optimum function of the mandible, muscles and TM joints, through use of intraoral orthotic appliances of various designs”. (Cooper B: Temporomandibular Disorders: A Position Paper of the International College of Cranio-Mandibular Orthopedics (ICCMO)., Journal of Cranio Practice, July  2011,  Vol.  29,  No.  3., pp. 237-244).

The GNM orthotic is a specifically designed and custom fabricated “orthopedic” appliance where the treating clinician used strict bite (Optimization) recording protocols using both the J5 Myomonitor TENS to establish the occlusal position and K7 kineseograph.  This appliance is unlike other classical appliances in that it implements both gnathologic and neuromuscular principles.  The reader must not confuse this with other neuromuscular (NM) orthotics.  The GNM approach and orthotic design is one that can’t been compared by meerly looking at the external (visual) features as much as to its true physiologic inherent components that support optimal muscles balance, TM joint harmony, occlusal harmony and many other functional features that move physical dysfunctions to physiologic quality health and shifts functional impairments to an improved quality of life.  These are some of the attributes that patients have reported that makes a difference.

Dr. Susan Go (GNM trained dentist), Delta, British Columbia, Canada shares the following:

“I’d recommend that you research the approach that makes sense to you. Every method out there will have some measure of success, mainly because TMJD runs the whole spectrum of super simple to super complex. To me, GNM makes sense because 1) The Phase 1 orthotic is removable. All adjustments are made on the plastic. We do not modify your natural teeth. If you truly feel that it isn’t helping you, then remove it and you’re back to where you were. 2) Proponents of the flat plane splint believe that the flat plane will prevent the cranial bones from getting stuck. What we see is that patients who feel very unstable prefer an anatomical orthotic as they need a “home base” that they can’t find in a flat plane. 3)The full coverage lower anatomical orthotic prevents supra-eruption of the teeth as it is designed for occlusion on all the teeth. 4) GNM is not just in its own little world. We work in conjunction with medical doctors, chiro, PT, massage, osteopaths. 5) We only move into Phase 2 after the patient is happy. We don’t do Phase 2 hoping that the patient will be happy.”

“Optimization is a Measure

The GNM orthosis is used during the following diagnostic and treatment modes:

  1. Phase I – Diagnostic TMJ Pain Therapy, Masticatory Dysfunction, Joint Derangement.
  2. Phase II –  Orthodontic/Orthopedic Restorative Foundation, Facial/Esthetic Development.

More on: Comprehensive Dentistry  

Advanced GNM dentists are trained in the use and management of this appliance to address the following more complex cranio-mandibular and cervical TMD pain problems:

  1. Cervical dysfunction problems – unresolved pain around the facial, temporal, occipital, SCM, shoulder and posterior corner of the mandible.
  2. TMJ primary problems – unresolved click, popping, grating sounds, restricted opening and closing.
  3. Retrognathic Class II division 2 (maxillary incisors tipped back) problems – difficulty for most dentist to find a “physiologic jaw position.
  4. Anterior open bite problems – unresolved TMD pain cases that have minimal to no over jet and over lap of the front teeth.

These are the type of problems most occlusal, TMD and often classical neuromuscular philosophies struggle with establishing and effective resolution.

The following is a jaw tracking recording using the K7 kineseograph and Myomonitor TENS. This is the kind of objective data the GNM dentists uses in addition to many other forms of physiologic recordings to determine a physiologic jaw relationship in establishing a proper mandibular to maxillary relationship for the orthotic to fit the mouth in a stable position.

GNM Orthotic effectiveness in treatment requires attention to the following:

  1. Optimal jaw position to be determined using K7 jaw tracking with TENS,
  2. Detailed micro occlusal adjustment protocols done by the trained dentist,
  3. Time and doctor skills required,
  4. Patient time and understanding of this process,
  5. A realization that changes will occur and will be required to modify the occlusal surface by either adding to or taking away from the orthotic surface to accommodate the positive changes that will occur in order to assist in the healing process of the masticatory cervical system.

Too many professionals do not consider the importance of the patient’s occlusion (how teeth related to one another).  Neither do they understand how the bite is suppose physiologically come together. To other dentists it really does matter. At OC we believe location location location is paramount for any occlusal treatment.

Where do you want your occlusal gears to land? On the runway or off. The plane will land some where. Trajectory leads to a terminal contact, but where?


Read more:


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