Dr. Marc Doctors and I, who have a combined 60 years of occlusal and clinical experience in observing treatments to control TMJD symptoms, decided to do a survey of occlusal devices and therapies that treat bruxism within the neuromuscular and occlusal systems of the head and neck. We were looking specifically at therapies that were effective and repeatable for the many clinical signs and symptoms related to jaw movement, function, dysfunction and disharmony.
Our survey led to a review of several therapeutic modalities:
1. Palliative treatment that is reversible utilizing medication, biofeedback, TENS, etc. for relief of pain or stress.
2. Occlusal equilibration and/or restoration that considers centric relation, eccentric movements and vertical dimension through the cycles of functional movement.
3. Occlusal devices that attempt to dissipate and/or change forces on the teeth and periodontium through the placement of anterior or posterior inter-occlusal barriers. These devices essentially attempt to lessen the damage to the teeth and TM joint with fabricated inter occlusal barriers. None of these devices prevent bruxism to the point where parafunction, stress and pain cease to occur.
In the survey, we included various posterior/anterior full or partial coverage splints to create disclusion while attempting to redistribute maxillary and mandibular forces on the teeth. Other devices also broadly included Hawley designs with or without canine guidance and barriers to allow posterior disclusion during centric or excursive movements.
As we studied occlusal and myofunctional movements, we observed that bringing the mandible to rest was the only physiologic solution to break the cycles of parafunction, in particular, bruxism.
It became obvious that the best way to achieve bringing the mandible to rest at the Physiologic Rest Position was to create a device that prevented contact of the posterior teeth while not encroaching on the inter-occlusal freeway space. Once these parameters were defined, the design of the NiteBite® evolved into a small, thin, anterior appliance that fit within the freeway space of all patients. Should the patient close on the NiteBite centrically or eccentrically the posterior teeth are prevented from touching.
By building and designing the NiteBite to fit firmly over only the four upper anterior teeth, and to be as thin as possible at the incisal edge of these teeth, it was observed that the NiteBite triggered the jaw opening (relaxation) reflex, allowing the mandible to return to the Physiologic Rest Position and allowing relaxation of the jaw muscles.
Key NiteBite goals:
– We decided to focus on a device with these features that would fit the majority of patients with limited or no adjustments
– The device would not require a lab for delivery or fabrication and could be fit by a dentist, hygienist or trained auxiliary.
– The device would take only a few minutes (5-10) to fit for 90-95% of the patients without additional alteration.
– The device would take advantage of the best and latest FDA approved materials, computer aided design and manufacturing.
– The device would need to be inexpensive to produce while creating the best profit margins for practitioners attempting and/or being educated to treat TMJD
The NiteBite® was born from these considerations. The research and development cycle of design and manufacturing began.