Facial pain, TM joint pain, bite difficulties (occlusal pain), muscle soreness and tooth pain are all conditions that dentists see, and are expected to solve, on a daily basis; all too often, the treatment path is neither clear nor certain. Most dental patient treatment involves restorations, endodontic therapy or surgery. In the ideal situation, the end result is a comfortable, functioning, pain-free patient.
Diagnosis is often the most difficult component in addressing clinical situations. There are many available diagnostic tools to assess tooth pain: periapical radiographs, percussion testing, temperature testing, pulp testing, the periodontal probe, etc. Muscular pain, occlusal pain and bite problems, on the other hand, are much more difficult to analyze as the available diagnostic tools are greatly limited. The Aqualizer is a hydro-dynamic fluid system that allows the oral musculature to “self-adjust” in developing bite balance and stability through a minimally invasive approach to TM joint treatment, occlusal treatment and muscle pain. It allows a balancing of the neuromuscular and skeletal systems of the mouth and cranium. On the one hand, the Aqualizer provides a cost-effective diagnostic aid, while simultaneously providing treatment for these patients.
Essentially, the Aqualizer is a cost-effective, pre-fabricated, temporary or emergency self-adjusting splint. It can be used to assist in providing a differential diagnosis for TMD and occlusal issues, effectively separating joint pain from muscle pain from “bite”/occlusal pain. It also can be used as part of a system to obtain a physiologically balanced bite registration prior to impression-taking for dental appliances. If the Aqualizer is successful in relieving the pain, the appropriate occlusal treatment plan is identified and selected for the patient’s needs (splint, equilibration, restorative procedures, orthodontics etc).
Over the years, there have been many dental appliances designed to treat the problems mentioned above: the flat plane splint, the anterior deprogrammer design appliance, anterior repositioning splints, etc. These all involve laboratory procedures, a waiting time for the appliance to be returned to the practice, and additional costs for the patient. The Aqualizer first determines which of the dental appliances will be most suitable for the patient’s specific condition, based on their response to Aqualizer treatment. In many instances these patients cannot open their jaws sufficiently to allow for proper impressions. The Aqualizer technique allows for the relaxation of affected muscles and a decrease of TM joint inflammation, resulting in an increased opening that is suitable for proper impressions.
The purpose of this clinical article is to offer a quick and simple method to develop a diagnosis that allows the treating clinician to proceed with the appliance of choice. It is not to discuss all appliance choices, bite registration techniques etc. Both research and practice experience over many years indicate that anterior deprogrammers (anterior only contact appliances) are excellent for decreasing muscle activity in clenchers. Full coverage splints can actually increase muscle activity over time and may have a negative effect on the patient’s airway (further complicating breathing patterns in patients with obstructive sleep apnea). Anterior repositioning splints are excellent choices for patients with TM joint loading issues and disc displacements. The Aqualizer can provide valuable information that assists in appliance choice.
The bite registration technique for the Aqualizer is as follows:
Step 1. Insert the appropriate size Aqualizer for the patient (refer to Figure 2 for sizes and selection). Have the patient wear the Aqualizer for at least 20 minutes. Pain relief with the Aqualizer confirms that the pain that originates from the occlusion could be either muscle related, TM joint related, or both. If there is no pain relief, look for other causes of pain (Figure 3).
Step 2. After 10-20 minutes with the Aqualizer in place intraorally, have the patient bite down naturally while injecting a PVS bite registration material from cuspid to cuspid (Figure 4).
Step 3. After the anterior bite registration has set, remove the Aqualizer while keeping the anterior bite registration in place. Now inject the PVS bite registration between the occlusal surfaces of the posterior teeth and have the patient bite into the previously established anterior bite registration (Figure 5, 6).
Step 4. Remove the entire one-piece bite registration from the mouth.
Step 5. Mount the dental casts on the articulator with the two-step bite registration. Fabricate the appropriate dental appliance and proceed with treatment.
The Aqualizer provides a quick, accurate differential diagnosis of facial pain that can be occlusally related as well as being a conservative, reversible, inexpensive test to assist in diagnosing a pain problem. It allows the clinician to preview the achievable symptom improvement prior to proceeding with a custom dental appliance. OH
Dr. Marangos is a graduate of the University of Toronto, Faculty of Dentistry, 1986. He maintains a private practice in Toronto with emphasis on aesthetic and restorative dentistry and orthodontics. He is the principal doctor at the Yorkville TMJ Centre, a practice that focuses on the management of head, neck and TMJ related pain. He has been trained in ETPS Neuromechanical Therapy for pain management as well as Motor Reflex Testing Autonomics for improved diagnostics in chronic pain. Dr. Marangos is a certified Ivoclar speaker and has spoken on behalf of Clinical Research Dental and BioResearch Inc. He has written numerous articles on restorative dentistry, orthodontics and craniofacial pain. Presently, he is the founding President and Immediate Past-President of the American Academy of Craniofacial Pain, Canadian Chapter. Dr. Marangos can be reached at 416-465-9343, 416-456-9310 (fax) or by email at dmarangos@rogers.com.
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