In this post we will outline the basic principles of the protocol that we are developing for the treatment of the condition which is dignosed by neurologists as Cervical Dystonia with splint therapy. In a future post we will describe the protocol that we are developing.
Although this research project is centered on the treatment of Dystonia, please be advised that the principles that we will describe can be applied for the treatment (we do not claim to provide a definitive cure) of other skeletal and occlusion related disorders and syndromes that may fall short of producing neurological symptoms (postural collapse, sinking skull, bruxism, TMD, Skoliosis) or may be systemic and more severe (Parkinson’s, Tourette’s, Generalized Dystonia).
Characteristics of Splint Therapy
- It is not an alternative to dentists or neurologists
- It is not traumatic
- It is not invasive
- It is a completely reversible process
- It makes the patient learn about what is wrong with his/her body and take matters into his own hands
- It cost PRACTICALLY NOTHING (40$ for hundreds of splint registrations for the rest of the patient’s life instead of thousands for ONE splint from a dentist)
- It is a process lasting months that uses dental splints that produce orthopedic forces that act on the Sphenoid, the Occiput and the upper cervical vertebrae (C1 and C2) to gradually stretch and realign them
We do not claim to have found the definitive cure. However, the extremely positive results that splint therapy has produced on ALL the patients who have undergone this experimental treatment lead us to believe that it should be used as a generalized option for ALL the patients who have been diagnosed with Cervical Dystonia.
The technique to build splints and register bites on them that we developed (and describe in detail in this post) can also be used by dentists as an easy and fast diagnostic tool to understand how a patient’s occlusion works before any prosthetic work.
We have devided this exposition in different points to allow for an easier reading and reference:
- Goal of Splint Therapy
- Progressive and Adaptive Approach
- Do it Yourself and Patient Empowerment
- Cooperative Approach
- The “Correct” Position of the Mandible
- Building the Splint
- Producing Orthopedic Forces with the Molar Lever
- Body Posture for Bite Registration
- Phonetic Bite Registration
- Cross Bite Splints
- Bite Registration Directly in the Mouth
- Condylar Shaped Teeth
A note to the reader: this post is a first draft and it will be changed and improved over the next few months. Your comments as a dentist, neurologist, posturologist or patient are very welcome as they will allow us to improve the contents of this post.
In this post, all patients who wish to try this protocol will be able to find the basic information necessary to start.
PRINCIPLES OF SPLINT THERAPY
Principle 1: the Goal of Splint Therapy
The research line that we are following is based on the hypothesis that Dystonia and other neurological symptoms that bring about movement disorders are strictly related to a postural collapse driven by a sinking skull that does not find adequate support in the dental arches. To learn more about the rationale behind our bio-mechanical approach, please read this post: A Bio-mechanical Approach to Cervical Dystonia
The sinking skull creates compression and subluxation of the upper cervical vertebrae that result in twisting strain on the brain stem.
The pressure can distort and limit the transmission of the nervous signals between brain and body. Moreover, compression of the brain stem will trigger automatic, involuntary and asymmetric muscle movements to ease the twisting strain. In short, it triggers Dystonia.” Lecture[/caption]
Therefore, the goal of splint therapy is to produce orthopedic forces that will progressively stretch and realign the upper cervical vertebrae (C1 – Atlas- and C2 – Axis) with the axis of the spine and the skull.
In the next picture you will see RX evidence of how the orthopedic forces produced by splint therapy can realign the upper cervical and eliminate pathologic compression strain on the brain stem over a period of a few months.
All cases of Secondary Idiopatic Cervical Dystonia that we have treated with this method have resulted in complete discontinuance of neurological symptoms.
The following picture describes how we use orthopedic forces acting on dental occlusion to stretch and un-jam the upper cervical area.
It is also worth highlighting that this approach has resulted in the radical improvement – in some cases complete solution – of other occlusion related disorders like TMJ pain, clicking, disk displacement and bruxism in a matter of days from the beginning of treatment. In all cases, general body posture and symmetry improved dramatically.
And the next picture shows the skeletal and postural effects of 7 months of splint therapy.
Principle 2: Progressive and Adaptive Approach
Splint therapy is NOT about finding ONE position that magically solves all problems.
It is a process that uses orthopedic forces that act on the sphenoid bone and the upper cervical vertebrae to gradually stretch and straighten the cervical spine, in order to achieve alignment between the axis of the plane of occlusion and the axis of the spine.
It takes time, postural reeducation, neurological rehab and many different bite registrations of the splint. That is why we strongly advise against the “one size fits all” protocols based on ONE splint that finds ONE position of the mandible with whatever technique or fancy high tech measurement. It makes no sense to get precise measurements of a skeletal system that is out of balance and not stable.
The body is constantly changing. One minor shift of 1-2 degrees of the inclination of the skull will change dramatically the occlusive balance.
Splint therapy is, in this sense, similar to an orthodontic treatment: different techniques and splints producing different kinds of orthopedic forces are used over time to achieve occlusive and skeletal balance.
It takes months (or even years) to change the shape, length and relative position of joints, muscles and ligaments, to shift bones and vertebrae in order to adapt their function to new biomechanic relations in the body.
In complex biomechanical systems, causation is never simple and one sided. The patient has to carry out posture and neurological rehab during splint therapy.
Principle 3: Do It Yourself and Patient Empowerment
The patient has to learn how to build his own splints at home. At heart, this is a “do it yourself” and cooperative approach between patient and doctor.
Patient empowerment is a fundamental step for a variety of reasons:
- Bite registration on the splint has to be carried out many times over the course of the treatment, approximately every two weeks
- The patient has to learn how to understand what is not functioning correctly in his/her body to be able to cure it
- Propioception is key to registering a functional bite on the splint
- A bite registration may prove to be unbalanced only after the patient has slept overnight wearing the splint. In that case, it is necessary to carry out another bite registration
- The reduction of vertebral subluxations by applying orthopedic forces may happen with sudden “pops” that realign the spine and the skull. In that case, it is neccessary to register a new bite as the occlusion will change massively.
- The registration of the bite in the splint is carried out directly in the patient’s mouth, not on an external model of the mouth (an articulator)
- It is cost effective: with a grand total cost of 40 US$ you can make all the splints that you need for the rest of the patient’s life
- Depending on how serious the condition and the occlusiveimbalance at the begging of treatment, the patient may have to wear a splint to sleep for the rest of his/her life
- The great majority of dentists do NOT understand and have NO experience of complex occlusal issues, NOR the relationship between occlusion, posture, skull stability and neurological disorders
- The mainstream teachings of Dental Schools on some fundamental issues related to skull and upper cervical stability are WRONG. Please read this post for an in depth analysis of some of modern dentistries fallacies: Can you Trust your Dentist?
- The mainstream protocols developed by neurologists for the treatment of Dystonia are based on biochemistry and not on biomechanics. They are targeted at managing and cronifying symptoms with systemic drugs and Botox injections, NOT at the treatment of the cause.
Principle 4: Cooperative Approach
The “do it yourself” approach does not replace the need to cooperate with an excellent dentist and a neurologist trained in this protocol or the need to get advise, guidance and support from a community of patients and dentists who are carrying out the same treatment on other patients.
The patient will have to take matters in his own hands, save money and then work with a dentist from the knowledge and empowerment that knowing how to make splints that work for them will provide.
We strongly advise to join the Starecta Community on Facebook (click HERE to join it) in order to have access to videos and info on how to make dental splints at home.
In the Starecta Community you will be able to find more info on how to start splint therapy and interact for support and advise from people and medical professionals who are currently carrying out the treatment.
Moreover, at the end of splint therapy it may be necessary and advisable to perform some sort of prosthetic work on the patient’s teeth. The final splint at the end of therapy will have to be used as a reference in the mouth while teeth contacts are reestablished with prosthetics, one tooth at a time.
Principle 5: the Correct Position of the Mandible
It is not about finding ONE position of the mandible or the condyles that magically solves all prolems. It is a splint therapy lasting months, coupled with postural and neurological rehab to re-establish skeletal balance.
The final position of the mandible is determined by the patient’s subjective assessment of balance, once he has been symptoms free for a few months.
In the end, the correct position of the mandible is “wherever the mandible wants” provided the patient is symptom free.
For the sake of this post, the description of this principle will be extremely synthetic. To find a more through explanation of the model of dental occlusion on which we base our research, please refer to this POST.
It is worth mentioning that – contrary to what many professionals think, believe and profess – there is great controversy and even OPPOSITE OPINIONS on fundamental issues related to occlusion between multiple occlusion schools and philosophy. Dentistry is not science.
The dominant model of occlusion preaches that the “correct” position of the mandible for occlusion is ONE specific and supposedly fixed skeletal position called Centric Relation, where the condyles work as a hinge in rotation and teeth occlude only with vertical contacts. Technically, you can call it the Semi-Adjustable Articulator in Centric Relation with Mutually Protected Occlusion model.
It is an oversimplified model. The biomechanics of a natural healthy mouths (i.e. never touched by a dentist) are based on TWO very well defined positions and a guided movement between them:
- One position for chewing, which is called Centric Relation (CR). This is the position where teeth make their first contact when you close our mouth.
- A very different second position for swallowing (usually a few mm apart), which is called Max Intercuspation (MAI). This is the position that the mandible adopts when the dental arches come into foricible contact during the act of swallowing.
During the act of swallowing, all postural muscles make an isometric contraction centered around dental occlusion. This is the moment when short term muscle tone memory (enagrams) is programmed into postural muscles.
Nevertheless, the great majority of dentist have such blind faith in the CR model, that they are willing to drill through irreversible damage to a patient’s teeth in order to follow its oversimplified principles.
The problem with this CR oversimplified model is that most patients with neurological symptoms present at the beginning of splint therpay an occlusion in which Centric Relation is LATERAL to Max Intercuspation, similar to the one you can see in the pictures below.
The picture shows how the dental arches meet when the mandible is in Centric Occlusal Relation. This position of the mandible with vertical forces between the dental arches triggers , neurological disorders and postural collapse in patients suffering from Cervical Dystonia.
Therefore, our protocol of splint therapy is based on dental splints that are registered in ways that reproduce a Max Intercupstion position and built in a way that uses simple lever mechanics to transfer the force of the masticatory muscles during the act of swallowing to produce orthopedic forces that stretch and align the upper cervical area.
Principle 6: Building the Splint
The basic tool that our protocol requires to carry out splint therapy is a lower dental splint that will be used as a base. On top of it, a thin layer of polimorph (a plastic that melts at 66 degrees Celsius) is placed to register the bite.
It is worth mentioning that the total cost of the materials can be as low as 40$ for all the splints that will be needed for the rest of then patient’s life.
Lower Dental Base Splint
The patient will need a base splint for the lower dental arch. What works best is a clear orthodontic retainer of 2 mm of thickness. You can ask any dental lab (or even a dental technician student) to make one for as little as 32$. They will take an impression of the patient’s lower teeth and in 7 minutes (!!) produce a clear retainer.
Please watch this video to see the whole process, lasting 7 minutes.
Polimorph to Register the Bite
On top of the base splint it necessary to register a new bite – whenever needed –
with polimorph (a plastic that melts at 66 degrees Celsius). Please watch this video to understand how to place polimorph on the base splint.
Polimorph is a non-toxic plastic material that melts at 66 degrees Celsius. It is possible to find it by googling “buy polimorph”. With 9 US$ you can get by mail delivery a bag with enough polimorph to make thousands of splints.
Principle 7: The Molar Lever
The dental splints are shaped and registered in a specific way in order to produce orthopedic forces by taking advantage of simple lever mechanics.
They establish a fulcrum that allows for the transmission of the force exercised by the muscles of the stomatognatic and masticatory system to the upper cervical a area. The stretching force on the upper cervical area is conveyed with the isometric contraction that takes place during the act of swallowing and by chewing.
In the next two pictures you can see how the Molar Lever works:
By applying force with the hand along the same direction that the masticatory muscles do (red arrows in the picture), you can clearly appreciate how – as the mouth closes – the posterior part of the mouth is subject to a stretching force (green arrows in the picture): the white plastic sustainers slide along the rails and the distance between the mandible and the maxilla in the back side of the mouth is raised about half a cm.
That is how the lever centered along the molar part of the dental arches stretches the back of the cervical spine and lifts the skull.
To understand thoroughly the mechanics, please read this post on the Molar Lever.
Principle 8: Body Posture for Bite Registration
The bite registration will “crystallize” the current skeletal relation between the spine, the skull and the mandible. Therefore, it is important to adopt a specific position when registering a new bite.
Sitting down on a chair (either a dentist’s chair or a common one) with a straight back and looking forward is the most reliable way to achieve a balanced bite registration. But it is possible to register a new bite standing or in other specific positions.
Principle 9: Phonetic Bite Registration
The registration of the bite is carried out by placing the splint in hot water for 30 seconds to soften the polimorph and then placing the splint directly in the patients mouth and closing the dental arches on it.
Please refer to the video above for the exact method of how to prepare the splint for bite registration.
It takes 2 minutes to make a splint. If it is not precise, it is possible to change it in another two minutes. It is even possible to register a new bite every night before going to sleep (if it makes sense for the splint therapy that is carried out). All you need is hot water!
The position of the mandible and mouth that the patient adopts when closing the mouth in the splint will result in splints producing different kinds of orthopedic forces.
Muscular symmetry, a heatlhy balanced condylar positions and the desired orthopedic forces are achieved by “PHONETIC” registration. The patient will close the mouth on the splint to leave pits on the polimorph WHILE he speaks the following sounds:
- “O” position creates a lever effect that stretches the back of the upper cervical spine
- ” E” position creates a lever effect that stretches the front of the upper cervical spine
- “Ah” position crystallizes in the bite the current skeletal balance
Principle 10: Cross Bite Splints
Cross bite splints are achieved by registering a bite on the lower splint that has pits that embrace internal molar and premolar cusps on one side of the dental arch and external on the other.
The resulting splint will produce orthopedic forces that stretch the sides of the upper cervical spine and rotate it.
It is possible to combine the 3 phonetic based bite registration described above with the cross bite method to produce orthopedic forces on every side and in every direction of the upper cervical vertebrae.
In the picture below, you can se an example of how a Cross Bite Splint works.
Cross Bite splints act on the Sphenoid bone.
In the following pictures, you can see how 7 months of splint therapy can change the bone structure supporting the dental arches, maxilla, mandible, skull and cervical vertebrae.
This patient suffered from chronic neck and back pain, difficulty in phonetic expression, broken voice, Chronic Fatigue Syndrome and neurological problems including difficulty to focus and concentrate. 7 months of treatment resolved all the symptoms. Before resorting to splint therapy, this patient had tried many sorts of treatment, traditional and alternative medicine, with no improvement in his condition.
The pictures on the left were taken before the treatment. Pictures on the right were taken 7 months later. All the described symptoms had disappeared.
Principle 11: Bite Registration Directly in the Mouth
By registering a bite directly in the mouth, we avoid all the problems that arise from building a splint on an articulator. In fact, it is a miracle if splints done on an articulator do not produce pain and imbalance because the articulator model is WRONG and does not reproduce the bio mechanics if the jaw.
The reality is that articulators are imprecise, over-simplified models that mis-understand and miss-reproduce the mechanics of the movements of the mandible. They simply don’t work.
Specifically, they do not reproduce diagonal, rotational and torque forces between teeth or the Bennet Movement.
Moreover, the use of the articulator is based on the obviously wrong postulate that the only force that moves the mandible is vertical gravity. It is obvious that the strongest force that moves the jaw is produced by the muscles, and its direction depends on where the muscles are attached to the skull and mandible. That affects the direction of the forces and point of contact between teeth when the mouth closes.
If that was not enough, semi-adjustable articulators have a fixed “hinge” relation between the head of the condyles (the attachment of the mandible to the skull), while the tempo-mandibular joint (TMJ) is NOT a “hinge.” The TMJ is, at best, an elipsoidal joint that can rotate and assume different positions that transfer force in any direction to the skull.
Up until 30 years ago, most dentists used “fully adjustable” articulators. Nowadays, 99% of dentists use “semi-adjustable” articulators. Dental pseudo-science goes backwards with time.
In our cases – in an experiment that can be easily replicated by any dentist or patient – once we started building our own dental splints directly in the mouth, we could achieve occlusal stability in a matter of one hour, where top experts had failed using an articulator during months.
The best articulator is the patient’s mouth.
Principle 12: Condylar Shaped Teeth
The way to build a stable and confortable occlusion with splint registered directly in the mouth to is to make condylar shaped teeth: the lower molars reproduce the curves of the glenoid fossa and then upper molars reproduce the curves of the condyle.
For those readers who are dentists or just understand technical terms: it is a Gerber lingualized splint with condylar shaped teeth.
As soon as we can we will expand this post with more principles and write another post describing the Protocol that we are using for this experimental treatment.
Navigate Through this Blog
Please be advised that this blog is a “work in progress” that is only a few months old and manifestly and evidently needs constant improvement to achieve the accuracy, validity and scientific standards that we wish to maintain.
We are using this blog to report on the progress of the research and experimental treatment that we are carrying out, as we develop it in real time and within the limits of time and resources that bind us.
Your commentaries, peer review, corrections and even financial support are very wellcome.
To further understand our reasearch, approach and method, please read:
A Bio-Mechanical Approach to Dystonia
An introduction to the theory and analysis that support the pilot research project to use an adaptive intraoral appliance to treat and possibly cure Secondary Idiopatic Cervical Dystonia.
The Molar Lever
Our analysis of the bio-machinics of the Molar Lever and how dental occlusion is related to posture and skeletal allignment.
Phases of Lateral Postural Colapse
Our analysis of the descending skeletal and postural effects of a collapsing and twisting skull that does not find adequate support in the dental arches.
A description of the adaptive intra-oral aplliance -dental splint – that we use to treat Cervical Dystonia and the orthopedic forces that it produces by progressively pushing the mandible in retrusion, maxila in extrusion and elevating the skull by stretching and aligning the cervical vertebrae.
Bibliography and links to scientific research on the treatment of Dystonia and other neurological movement disorders with a bio-mechanical approach.
Postural Colapse and Dental Arches
A set of animations that present grafically the type of skeletal and postural effects that we intend to produce over a few months by modifying occlusion and the direction of forces between the skull and the mandible.
Beginning of Treatment
Postural analisys, MR evidence and description of the situation of our patient at the beginning of this experimental treatment.
First Rectifier: Cross-Bite Splint with Lateral Moral Lever Effect
Description of the dental splint that we are using for the first two weeks of treatment and the logic behind the selection of the direction and nature of the orthopedic forces that it produces.
Can you Trust your Dentist?
Our review of how modern dental theories on occlusion oversimplify and misunderstand the biomechanics of the stomatognatic system, leading to a high potential of traumatic dental treatments.
What is Dystonia?
A short description of the symptoms and clinical definition of Dystonia for those who are not familiar with this desease.
Curricula of the team of professionals who are participating and contributing to this research project.
Please read this page if you are suffering from Cervical Dystonia and wish to try this experimental biomechanical treatment and be a part of this research project.
Please read this page if you wish to support this research project financially.