In article <ONk1i.9205$. net>,
"Mac" <> wrote:
[clip]

> I asked about the NTI device during my consult but it was dismissed as
> pseudo-science and not effective.
> Thanks,
> -Mac

It would be nice to know who told you that; by name. But this isn't the
proper place to share that sort of information.

In article <5Bl1i.9220$. net>,
"Mac" <> wrote:

> "The Webby" <> wrote in message
> news:tmjiatroepidemic-...

>
>
> I'm sorry, they didn't use those exact words. It was more like:
>
> "What about this NTI device? It sounds pretty cool."
> "We don't know much about it but we have had patience that have tried it."
> "Did it work?"
> "They came here didn't they?"
>
> It wasn't so much what she said but how she said it.
> My real issue, besides the money, is that I have to wear this splint 24/7
> for four months without knowing if it will work. Anyone dolling out
> reassurance?
> Thanks again,
> -Mac

First of all, I don't know how you define "TMJD". Would you please
define it and then we can begin on that page together.

How much money did you agree to spend on the treatment plan?

What is supposed to have happened at the conclusion of this four month
24/7 treatment? In what way is the success of the treatment determined?

What have you read about the NTI? Do you understand how and why it
works? Likewise, do understand when and why it may not be indicated?

Webby

Mac,
I'm sorry, I don't have any simple advice for TMD treatment. This
field is one of the most complex fields in dentistry. There are high
number of variables that effect symptoms; these variables are
difficult to identify, measure and thus determine the best course of
treatment. Add to this the observation that the majority of cases
improve without any intervention. As a result, many methods of
treatment have developed with little evidence of efficacy.

The best advice I can recommend is to contact the nearest Dental
School and request a referral for a Oral-Facial Pain Specialist. This
is not an ADA recognized specialty, but both dental schools I attended
had instructors that narrowed their practice to TMD management and
were our instructors for Oral-Facial Pain courses. Both instructors
were specialists in another field, one was an Oral Pathologist and the
other was an Oral Radiologist.

I copied a couple of excerpts from the reference listed below. One is
specifically in regards to the NTI appliance.

"A recent investigation attempted to compare treatment efficacy
obtained by a conventional stabilization appliance and a new type of
splint, the Nociceptive Trigeminal Inhibition Tension Suppression
System (NTI), on the signs and symptoms of TMD....The stabilization
splint was judged superior."

"The frustration felt by the clinician is evident by the increasing
availability of focused systematic reviews by sources such as the
Cochrane Central Registrar of Controlled Trials and summary reviews
published in Evidence-Based Dentistry...This thorough, systematic
review identified only 12 studies that qualified for inclusion."

Reference:
T. Magnusson, A.M. Adiels, H.L. Nilsson and M. Helkimo, Treatment
effect on signs and symptoms of temporomandibular disorders-comparison
between stabilisation splint and a new type of splint (NTI). A pilot
study, Swed Dent J 28 (2004), pp. 11-20.
E. Allen, A. Brodine, R. Cronin, Jr., T. Donovan, J. Rouse, J.
Summitt. Annual review of selected dental literature: Report of the
Committee on Scientific Investigation of the American Academy of
Restorative Dentistry. The Journal of Prosthetic Dentistry, Volume
94, Issue 2, Pages 146-176.

I wish you the best.
Sincerely,
Don

In article <_7s1i.10342$ .net>,
"Mac" <> wrote:

> "The stabilization splint was judged superior."
> I think this is what I wanted to hear. I know that in medicine there are
> rarely easy answers, or inexpensive treatments. I suppose, after reading
> too much internet-info, that I was feeling duped (whether intentionally or
> not).
> I'll give this a try, following recommendations, etc. and see where I am
> with this in four months.
> Thanks very much,
> -Mac

I think there will likely be some other comments made into this thread.
Don't go away too quickly, Mac.

Webby

>
>
>
>
> "Triclinic" <> wrote in message
> news: ps.com...

> I've already paid for the splint and treatment, about three grand so I have
> to give it a try.
> Thanks for listening,
> -Mac

An NTI gives postitive results about 80% of the time with a lot less
cost. I've been using them for about 8 years now and can't imagine
using anything else as the first line of defense with TMJ problems.

Steve

In article <>,
Steven Fawks <> wrote:

>
> An NTI gives postitive results about 80% of the time with a lot less
> cost. I've been using them for about 8 years now and can't imagine
> using anything else as the first line of defense with TMJ problems.
>
> Steve

Hey Steve. In your practice, would you say that the NTI is effective
80% of the time or ???? The reason I ask is this: we know that some
people have problems with their devices because of "fit issues". Those
issues may have to do with the technical skill of the dentist and also
may have something to do with what is in the control of the patient (not
returning to have the fit evaluated.) But my question was about your
practice because you (and others of smd) have been using the NTI for
eight years now. Your technical skill for fabrication along with your
increasing knowledge base about NTI application puts you in the position
to offer a unique perspective.

We all know that if "dentist x" makes NTIs and they "just don't work"
for the patients, there must be something wrong with the picture. (We
also need to know what the people want the device to accomplish when
they "work".) Subjective reports of pain complicate the ability to
quantify "success" if it is only about pain. This is an area where
objectivity is not easily accomplished.

Can you share more in-depth information from your experience?

Webby

Isn't it also true that the investigators have been reprimanded by the
Swedish government for their bias and lack of objectivity in their "study".


"Triclinic" <> wrote in message
news: ps.com...

> Mac,
> I'm sorry, I don't have any simple advice for TMD treatment. This
> field is one of the most complex fields in dentistry. There are high
> number of variables that effect symptoms; these variables are
> difficult to identify, measure and thus determine the best course of
> treatment. Add to this the observation that the majority of cases
> improve without any intervention. As a result, many methods of
> treatment have developed with little evidence of efficacy.
>
> The best advice I can recommend is to contact the nearest Dental
> School and request a referral for a Oral-Facial Pain Specialist. This
> is not an ADA recognized specialty, but both dental schools I attended
> had instructors that narrowed their practice to TMD management and
> were our instructors for Oral-Facial Pain courses. Both instructors
> were specialists in another field, one was an Oral Pathologist and the
> other was an Oral Radiologist.
>
> I copied a couple of excerpts from the reference listed below. One is
> specifically in regards to the NTI appliance.
>
> "A recent investigation attempted to compare treatment efficacy
> obtained by a conventional stabilization appliance and a new type of
> splint, the Nociceptive Trigeminal Inhibition Tension Suppression
> System (NTI), on the signs and symptoms of TMD....The stabilization
> splint was judged superior."
>
> "The frustration felt by the clinician is evident by the increasing
> availability of focused systematic reviews by sources such as the
> Cochrane Central Registrar of Controlled Trials and summary reviews
> published in Evidence-Based Dentistry...This thorough, systematic
> review identified only 12 studies that qualified for inclusion."
>
> Reference:
> T. Magnusson, A.M. Adiels, H.L. Nilsson and M. Helkimo, Treatment
> effect on signs and symptoms of temporomandibular disorders-comparison
> between stabilisation splint and a new type of splint (NTI). A pilot
> study, Swed Dent J 28 (2004), pp. 11-20.
> E. Allen, A. Brodine, R. Cronin, Jr., T. Donovan, J. Rouse, J.
> Summitt. Annual review of selected dental literature: Report of the
> Committee on Scientific Investigation of the American Academy of
> Restorative Dentistry. The Journal of Prosthetic Dentistry, Volume
> 94, Issue 2, Pages 146-176.
>
> I wish you the best.
> Sincerely,
> Don
>
>
>

In article
<tmjiatroepidemic->,
The Webby <> wrote:

> In article <>,
> Steven Fawks <> wrote:
>

>
> Hey Steve. In your practice, would you say that the NTI is effective
> 80% of the time or ???? The reason I ask is this: we know that some
> people have problems with their devices because of "fit issues". Those
> issues may have to do with the technical skill of the dentist and also
> may have something to do with what is in the control of the patient (not
> returning to have the fit evaluated.) But my question was about your
> practice because you (and others of smd) have been using the NTI for
> eight years now. Your technical skill for fabrication along with your
> increasing knowledge base about NTI application puts you in the position
> to offer a unique perspective.
>
> We all know that if "dentist x" makes NTIs and they "just don't work"
> for the patients, there must be something wrong with the picture. (We
> also need to know what the people want the device to accomplish when
> they "work".) Subjective reports of pain complicate the ability to
> quantify "success" if it is only about pain. This is an area where
> objectivity is not easily accomplished.
>
> Can you share more in-depth information from your experience?
>
> Webby

P.S. Maybe some other opinions/experiences will be offered in addition
to those from Steve. ;-)

Webby

Mac- This might interest you. This is what the inventor of the NTI
therapeutic protocol has to say:
************************************************** ************************
What is it about the acrylic placed on the teeth that is therapeutic?
Nothing.
What is it about the effect of the shape of the acrylic on the activity of
the masticatory musculature? Everything.

What are the goals of nocturnal splint therapy?
1--To minimize tooth wear during parafunctional occluding activity;
2--To minimize joint strain and disc load during parafunctional occluding
activity;
3--To minimize intensity of muscular activity during parafunctional
occluding activity.

What are the accepted criteria for splint design to achieve the desired
therapeutic result? (which are the same as that for a "good occlusion")
A--Bilateral even posterior contact in COR, with light anterior contact.
(statisfies 1 and 2 above)
B--Immediate posterior disclusion in the event of excursive occluding
movement, made possible by:
--opposing canine contact during the excursive occluding movement, with
transition to;
--incisal contact. (satisfies 1, 2 and 3)

But how do we know that these splint design criteria provide the desired
therapeutic goals? Through prior EMG research and force/load studies.

There are abundant EMG studies and force/load models of A which support its
intended provision of 1 and 2.
There are abundant EMG studies and force/load models of B which support 2
and 3.
(Unfortunately, there are abundant EMG studies to show that A cannot prevent
3).

We expect that a properly made splint or occlusal scheme should minimize
joint strain and disc load and minimize muscular activity in excursive
occluding events, based on the data from EMG and force/load models.

The only difference between an ideal full-coverage occlusal splint and an
NTI-type device is that an NTI-type designed splint can minimize the
intensity of muscular activity in a centric, as well as excursive,
parafunctional act.

So when a study compares a Michigan splint to an NTI on a group of patients
with jaw disorders, (excluding those "primary clenchers" who don''t have any
jaw/joint symptoms but present primarily with headache/migraine) you''d
expect the efficacy to be the same, and in fact, in the Norwegian study,
(one of two studies specifically observing the NTI), that is exactly what
was found.

Knowing what a properly designed Michigan splint and NTI device are supposed
to provide is what makes the Swedish study so curious. If both a Michigan
splint and a properly made NTI provide the same instant posterior disclusion
in excursive movements and incisal-only contact in protrusion, but the
Swedish study showed that nearly ALL Michigan splint subjects saw
significant improvement, while nearly half of the NTI subjects had no
improvement at all, what is one to conclude?

-El There''s-something-fishy-in-Sweden-O~

James P. Boyd, DDS, Developer of the NTI Therapeutic Protocol and Website
The Headache Center of Southern California Clincial Associate
Son of USC Hall of Fame Basketball Coach Bob Boyd
************************************************** ***********
And from a well known Swedish dentist (Hans Lennros) that has participated
extensively in this newsgroup over the years.
************************************************** ***********
Toofy wrote in response to "-El There's-something-fishy-in-Sweden-O~": > So
what is this Swedish "properly made Michigan splint??? Yes, what is it? Good
question! Let's see how they properly made Michigan splints in the Swedish
study (Magnusson et al, 2004):
http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum
To prove that the NTI-splint is clinically worthless they not only
investigated its efficay but also cost-effectiveness measured in minutes.
They did not calulate that the Michigan splint needs TWO visits, that
patients cancel and re-schedule (which costs money), they disregarded cost
of impression material, packaging and stamps/delivery to send to dental
technician and the extra time spent on the Michigan splint compared to the
NTI-splint. In their world dental assistants do not want any sallary and
everything around the office is free of charge! Including the dental
laboratory fee. The result showed that the Michigan splint took a total of
17 minutes and the NTI-splint 27 minutes. The time consumed for the
NTI-splint can be explained by lack of experience (which indicates a risk of
not getting optimal clinical effect). What is more interesting, however, is
the time Magnusson and his fellow investigator Helkimo needed to make the
Michigan splint. In the Swedish textbook "Bite splints in the clinic and
laboratory" ("Bettskenor i kliniken och på laboratoriet", 1987) Magnusson
writes about the normal time needed in average to make a Michigan splint in
the public dental care system: (quote) "It is interesting that the new
government insurance for a splint is based on 34 minutes. During that time
the dentist must during one appointment make impressions of both jaws and
make a jaw registration to obtain inter-occlusal records. The next
appointment, which is also included in this just over half-an-hour, the
splint should be fitted and checked. We sure must have effective methods to
make this work!" (end quote) So he complains that 34 minutes is not really
enough time to do a Michigan splint and all of a sudden, in the scientific
NTI-study, the Michigan splint is made in half that time! Only to show that
the Michigan splint is 10 mintues clinically faster than the NTI-splint!
This can be compared with doping in sports when pride and honor is sold out
to beat someone with seconds or minutes. In this study he sold his
scientific integrity for 10 minutes! The obvious question that arises are:
in how many scientific studies has he done similar cheating before? And to
what degree do results in his previous career depend on concious bias, i.e.
academic dishonesty? I think it is really sad to have to watch how two
outstanding and former respected scientists (Magnusson & Helkimo) are
compromising their reputations in that way. What actually made them to
choose to commit scientific suicide over the NTI-splint? Hans
************************************************** *
More from Hans
************************************************** *
Hi Jim, The Magnusson picture is a mystery ! If you enlarge it enough you
will see the following: The lower jaw can go to the patient's left as far as
the mandibular midline (between the two lower front teeth) is aligned with
the distal surface on the upper left front tooth. But the patient can go to
the right further, in fact half the width of a lower tooth further. Most
likely if the patient has not an unilateral restricted jaw movement the
patient could go just as far to the left, and then would slide off the
discluding element. So they made the patient stop the excursive movement at
that fixed point that looks good on the picture certifying they were
following the NTI-protocol. Hence this is an arranged picture! Either this
is a model patient for presentation purposes only, or it shows to what
extent they actually paid attention to the NTI protocol. Besides, the NTI
does not seem to have a correct horisontal position from front to back as
the back of the discluding element seems lower than the front part. If this
is the best they could do in an educational model picture they knew would be
scrutinized, what does that tell you about the probability of high,
respectively low, quality of the actual NTI-splints used on patients in the
study? I have repeatedly asked to see those they used in the study but the
only answer I get is a legal mumble that they are not required by law to
show me anything. Which per se is wrong! They are obliged by law to show
their basic data so that clinical trials can be examined. So there is no
doubt they are lawbreakers. For a study to be scientific they must let out
information that can be evaluated. Also, the study should be possible to
repeat. If not it is no serious science. When I offered $150 to every
patient that I was allowed to examine, they responded they did have not time
to arrange that. Anyone ever wondered why Magnusson consistently excluded
headache in the study? Especially strange since Magnusson has stated that is
a common TMD symptom and over 25 years ago stated that clenching of teeth is
correlated to the severity of headache!
http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum
and that TMD treatment are beneficial for many patients who suffer from
recurrent headaches:
http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum
Real strange that this large group of typical TMD patients wasn't included
in the study ... maybe fear of the NTI would prove to be far more effective
than the other splint ... Hans the NTI-CSI (crime-scene-investigator)
************************************************** ************
Mac here is some recent research you should take the time to read.
http://www.nti-tss.com/RESEARCH.html

Just because someone posts an abstract that apparently contradicts what
other clincians are seeing in their practices doesn't mean you should hang
your hat on it. Research, research, research, research. I am sorry you
already paid for the splint, but that doesn't mean you have to actually use
it. In fact the frequency and severity of your migraines will likely
increase by using the full coverage design. It simply gives you more
surface area to achieve maximum clenching ability while asleep.

Perhaps some of the others will weigh in on this issue and give you some
sound clinical advice from their perspectives.

"Mac" <> wrote in message
newsmY1i.10750$ link.net...

> Is this true, anyone?
>
>
>
> "Tim Dixon" <> wrote in message
>

>
>

> Hey Steve. In your practice, would you say that the NTI is effective
> 80% of the time or ???? The reason I ask is this: we know that some
> people have problems with their devices because of "fit issues". Those
> issues may have to do with the technical skill of the dentist and also
> may have something to do with what is in the control of the patient (not
> returning to have the fit evaluated.) But my question was about your
> practice because you (and others of smd) have been using the NTI for
> eight years now. Your technical skill for fabrication along with your
> increasing knowledge base about NTI application puts you in the position
> to offer a unique perspective.
>
> We all know that if "dentist x" makes NTIs and they "just don't work"
> for the patients, there must be something wrong with the picture. (We
> also need to know what the people want the device to accomplish when
> they "work".) Subjective reports of pain complicate the ability to
> quantify "success" if it is only about pain. This is an area where
> objectivity is not easily accomplished.
>
> Can you share more in-depth information from your experience?
>
> Webby

Well, at the risk of sounding like a Ronco info-mercial.....

IME, an NTI improves the situation virtually every time it is *used*.

However, as with any removable appliance, patient compliance is not
always perfect. There are patients with jaw pain who go home with
an NTI and wear it for a few weeks or months, have the pain go away,
and stop wearing it. Six months, or even 2-3 years later, they show
up with jaw pain again. I see in the chart when I made them an NTI,
and I ask them how the 'little bite guard' is working. (same is true
when I recommend it for headaches, sensitive teeth, etc.)

Patient:

"Well...er...I haven't been wearing it. I guess maybe I should try to
find it?"

Me:

"Yeah, maybe so. I've never seen anyone miraculously stop clenching."

Then I have a few patients who bring it back in 2 days and say, "I can't
wear that thing". They made a decision not to give it a chance.

These types of patients do probably make up about 20% of the NTIs I
make. Regardless of how my posts read on smd, I really try not to
oversell them. I want the patient to really want to try it so they
will give it a fair shot. It does not always make things better from
the first night. I'm sure there is someone who won't get better
no matter who makes one or how religiously it is worn.

It's also possible to have patients with multiple symptoms who are
back after a month or two and might say, "My jaw still pops". Well,
how is the pain? "Oh it hardly ever hurts anymore, but it still pops".
To me, that's success, but the patient still has a complaint.

Then I have patints who frantically call the office because they can't
find/dog ate/broke their NTI and need a new one before they go to bed
that night!

As I've said before, the NTI is not a 'cure'. It is a device that
interupts the clenching/parafuntion that many patients suffer from.
It only works when it is worn. It will need to be remade at some time.
It may not make *all* symptoms go away completely.

For dentists to begin using them, it is much better to go to a CE course
where they are taught how to make them. It is much more than just
putting a little acrylic in the stock shell. Dr. Boyd does have lots
of pointers on the professional side of his website.

IME, it is still the best clenching interupter available. BTW, it is
possible for a dentist to make an NTI clone from scratch without paying
a penny to the company. It takes more time and isn't really cost
effective, but if you don't want to pay Jim Boyd a thing for his
invention, knock yourself out.

D