Executive Summary: In this post we will briefly describe ideas for Phase 3 of the Protocol for the Bio-Mechanical Treatment of Dystonia, as well as finishing techniques to create prosthetics to adjust the new bite.
The End of Phase 2
When dystonic symptoms (involuntary muscle movements, spasms, brain fog, blocked rib cage, etc.) are a long gone memory, a patient can move to Phase 3.
At this point, TMJ disks should have recovered a physiological position. TMJ disks should not be displaced medially or anteruorly any longer. TMJs should be sound, healty and strong.
Spinal alignment could still be unstable: the spine and cervical vertebrae can be straightened or twisted even multiple times within the same day… but it should always be possible to end up recovering spinal alignment every day with stretching exercises.
From Phase 2 to Phase 3
At this stage, a patient can use polymorph or resin add-ons that push the 2nd molars up and the 1st molars forward.
This video shows a DIY technique to make polimorph add-ons directly in the patient’s mouth.
In Phase 3, the bite should be registered in A or E phonetic.
As a reminder: Phase 1 and Phase 2 use mainly O phonetic registration and ALF to allow TMJ disks to recover a healthy position from a medial displacement and level cranial bones by putting condyles in the Gelb 4/7 position.
The following picture shows a medially displaced TMJ disk: the disk has been pushed towards the inside of the skull and presses against the trigeminal nerve causing neurological movement symptoms.
A Gelb splint positions the mandible down and forward to alliviate pressure on the TMJ and create space for the disk to recover a healthy position on top of the condyle. The following picture shows TMJ condyles placed in the Gelb 4/7 position.
At the onset of Phase 3, TMJ disks should be in the physiological position and patients can gradually move towards A and E phonetic registration without causing any strain to the TM joints.
The Pivot-ALF Technique
The best way to carry out phase 3 of the protocol is with resin add-ons fixed and attached to the upper ALF. The resin should cover upper molar teeth and be registered in the mouth in E or A.
This is how an upper ALF with resin crown add-ons look like.
Phase 3 is a treatment lasting a few months to stabilize the bite. Every week, new polimorph add-ons like the ones described above should be made.
If the TMJ suffers and becomes painful, it is necessary to go back to O registration.
It is important to keep in mind that for most dystonia patients, TMJ disks may be too compromised and injured and this technique might not be adecuate or effective.
In the case that the patient responds favorably to E and A registrations, he/she can move on to final prosthetics: add-ons crowns can be reproduced in a solid material like zirconia, composite, resin or porcelain by a dental lab.
Premolar teeth can be brought into contact with direct composite additions.
How does it work?
The efect we are looking for is described in the picture below.
The effect on spinal alignment is very positive. By pushing the mandible forward against the back side of 1st molars, you can support the skull using a different set of muscles. The upper thoracic spine tends to go forward, the pelvis recover the neutral tilt, the chest opens up and the belly goes in.
On the other hand, E registration can be harmful for injured and deranged TMJs.
Dr. Lee’s functional therapy for dystonia calls for the use of a splint registered in E for a maximum of 10 minutes every day and right before sessions of cranial and upper cervical ostheopathy.