In situations where a Michigan splint or bite guard would be indicated, and in the well chosen cases, it has become apparent that mandibular advancement appliances (MAA) previously in the form of functional appliances have proven to be successful in pain relief and reduction of symptoms. It would appear that reprogramming the TMJ apparatus, and holding the mandibular condyles in a more forward balanced position might account for this.
Whilst management of TMJD remains a grey area given the multi-factorial etiology, nevertheless anecdotal evidence suggets that MAAs have beneficial effects. As part of the clinical records for the Somnowell MAA we insist on a facebow for mounting on an articulator, and we are training practitioners in the techniques of recording a forward postured position without introducing lateral jaw displacements, encouraging symmetrical balanced forward postured bites.
As an orthodontist Dr Simon Ash and amongst orthodontic colleagues, it is well known that patients who wear functional appliances (posturing the jaw forward) frequently report a resolution of the TMJ problems. This finding has been particularly noticeable when using MAAs for patients with snoring and obstructive sleep apnoea.
Over the last 3 years Dr Simon Ash has been undertaking combined clinics with an Oral Surgeon who specialises in TMD. As their first line of treatment they are now using functional appliances as a means of pain relief, confirmation of diagnosis, and deprogramming the TMJ muscles. In situations where in the past they would have tried soft splints, hard splints, or Michigen splints, they are now using functional appliances. Furthermore they are doing MRI scans on these patients joints before and after this splint therapy.
In those patients who do not want protracted orthodontic treatment and are looking for long term splint therapy, they are recommending the Somnowell. It is worth noting however that in many of these cases there may not be the need to posture the jaw forward. But if the bite is taken in a non-laterally displaced position, so that at sleep the jaw is held in a comfortable non-displaced position, this can give great relief of symptoms and prevent further bruxism.