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Wednesday, September 30, 2009

Myo-Trajectory and the NM Clinicians Focus


by Clayton A. Chan, DDS - Director of Occlusion Connections

A more optimal trajectory can be observed with computerized mandibular scanning (CMS) and low frequency Myomonitor TENS alone by following an effective bite taking Scan protocol. Understanding how to interpret the scans and what they mean is also very important, before conclusions are made. That is the essence and beauty of understanding NM at the next level. At the next level the trained NM clinician is aware of the elevators and depressor issues, but also realizes that it is not the key focus to optimization of the NM trajectory along an isotonic path/zone or tunnel as it CLINICALLY relates to establishing a bite for TREATMENT. That is the academic exercise of questioning the NM occlusal paradigm to convince oneself whether NMD is correct or not (no problem with questioning). Certainly we desire and want low EMGs, that is one of the clinical objectives.
Note: the above CMS jaw tracking scan shows various sagittal trajectories all of which present with calm low EMG activities (not shown). Reproducibility of mandibular position can be shown in real time when observing the sagittal and frontal cursors (not seen in above scan).
If the clinician tries to focus on the end point (trying to establish neuromuscularly calm muscles first using EMGs as the tool of choice to find the bite, rather than aim for a optimal occlusal bite position using CMS as the first choice to later establish the calm muscles second, the dentist will get frustrated in the NM teachings and lose confidence that NM truly an effective approach. Working extra hard to determine low EMGs, for example, on a paining TMD patient to establish a bite will cause the clinician to realize that calm muscles are not going to happen until a proper positioning (location with an established bite (myocentric) is first established. Muscles don’t want to become isotonically calm when they know there is pathologic form (a wrong bite). We want to get good bites, but if you are using EMGs to observe proprioceptive cranio-mandibular responses, the NM bite taking methods classically taught will lead you down the path of bewilderment and wonder searching for the calm zone of both diagastric/suprahyoids, temporalis anterior, masseter and cervical group calmness with varying degrees of vertical, AP and frontal positioning.

Where does the clinician set the bite when cervical groups are hyperactive? Where to set the bite when temporalis are hyperactive? One may get one area calm, but the other areas may not be calm….if we keep searching and hoping that the EMGs is the key to establishing the best bites, then why doesn’t the NM minded clinician just use EMGs alone to establish the bite and don’t depend on CMS!?

It is obviously clear that CMS is a superior and very important tool to see what is happening spatially with the mandibular position for any and all NM clinicians. It also becomes further clear in Level 5 NM Bite Refinement/Advanced K7 teaches how to properly interpret scan 4/5 and refine the bite taking protocol so the clinicians realize what is significant in implementing the instrumentation tools to do NM dentistry practically and in what order of importance as to TENS, CMS, EMG and ESG.

Neuromuscular Dentistry

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