Unwind MD: The Dental Story by MIK Dental

Unwind MD: The Dental Story by MIK Dental

Articles Blog


Hi friends, welcome once again. I am Dr. Moez Khakiani
from Mumbai, India. Today I will be
talking to all of you about a new product that has been designed and
launched by MIK Dental. The product that is
closest to my heart. This is UnWIND MD. What you see in front
of you, friends, is a specimen of the very same. Friends, this is a prefabricated
anterior deprogramming splint. It is to be realigned with
any material that sets hard. This could be a bite
registration paste or cold cure acrylic. and it is supposed to
be custom fit to your patients on the maxillary
anterior teeth. What it essentially does is, it deprograms the mandible and allows for muscles to relax, thereby providing for, what we
call as peaceful neuromusculature or coordinated muscle function. Because it works so
brilliantly friends, in relaxing musculature, it has a broad spectrum
of indications. The first of which is diagnosis. How often do we have patients
who come in with orofacial pain and we are not sure exactly
what the origin is. The beauty of this product is – once you have the patient wear the deprogrammer
for a few minutes probably a few hours,
maybe even overnight, it will help you understand whether the problem is an
occluso-muscle disorder, which is a problem
with occlusion and something that
affects the muscles, or is it a true temporomandibular
joint disorder – either of which will require
completely different treatments. What it also tells you is – Is the pain that the patient
feels of dental origin? or is it beyond realms of
our treatment as well. So that’s the first
indication which is diagnosis of orofacial pain. The beauty about this product
is it also works for patients who may have what is called
as, tension type headaches. Frequently termed
as migraine pain. A lot of these patients often suffer
for years and years together, only having taken medication
to symptomatically treat them because medicine per se has no
answer to what the problem is, where does it lie and therefore
there’s no definitive treatment. A lot of times what’s
important to understand is, migraine headaches could be caused
because of an imbalance in the muscles in the pan facial region. A lot of times the etiology or the cause for
this lies in the patient’s actual bite. If the occlusion is not
correct, in technical terms, if the centric relation and
the maximum intercuspation do not coincide with each other, which means if a patient has
a hit and slide occlusion, they are susceptible
to migraine headaches. If the individual who has
these kind of headaches were to wear this deprogrammer
through the night and probably even
through the day when they are in stress, which means when they are
clenching or grinding and they know it, this could be when you’re
driving a car in traffic, this could be when you’re
watching television or a serial or a sports activity, you may start clenching
and grinding – that’s when a lot of
these headaches begin. Even if these headaches
were to begin as those where… [patient says] “I get up in the morning
and I have a headache, doc.” That’s where something like
this works brilliantly. So migraine prevention
is again one of the primary mandates of this
particular appliance. The next indication
for this appliance is patients who are
bruxers or clenchers. We are aware of the
fact that most of these activities
are night time. A lot of these patients who need aggressive full mouth
rehabilitations may probably not be
able to afford or get the treatment
done at that time. In such patients
it’s very important for them to protect the teeth, especially at night. We unfortunately, give a
lot of these patients something that are
called as night guards. These are soft
appliances, friends. When you put something soft
into the patient’s mouth, the first thing that a patient
wants to do is chew on them, which means we’re
actually worsening this situation or the condition
for the patient. Also it does not help
improve the bite. It simply merely
acts as a cushion. What happens with this
particular appliance is, it discludes the back teeth, which means it allows only
for the front teeth to touch and separates the
posteriors from contacting; thereby there is
no contact, there is no friction between
the surfaces, so attrition or wear
because of bruxism or clenching
dramatically decreases. But what’s more important is,
it allows the muscles to relax; thereby such patients even get
up feeling more refreshed, they get up feeling
(patient says)- “oh you know what, I have had a
good night’s sleep” which is one of the
primary concerns in lot of these
patients as well. The next indication for
this appliance is – when you plan to do complex full
mouth rehabilitation cases. We are all aware of the
fact that such cases need to be done at ideally a
centric relation position, which is a neutral
position for the body. Having worn this
appliance for a few hours or maybe even
a few minutes, 99-100% of your patients will
go back into centric relation provided the joints are
in a stable condition. It is also beautiful
to protect your full mouth rehabilitation cases. Imagine you’ve done a
complex full mouth, if your patient continues
to clench or brux, which is centrally mediated, after the treatment, your
FMR is going to fail. That’s where the patient essentially
sleeps with this appliance at night, thereby
protecting the teeth. Imagine a situation where you want
to do occlusal equilibration. The patient has to come
in a centric relation. That’s where overnight wear of
this appliance works brilliantly. It’s also indicated,
friends, in those patients who have clicking in the joints, may or may not have pain. It’s important to
understand here that all temporomandibular joint disorders
are progressive in nature. Once there is a
click in the joint, which means the
pathology has begun. If you leave it untreated, it
will progress from stage to stage and cause much more pain
and more aggressive treatment will be
required later in life. If you were to give
this appliance to the patient to
sleep at night, it protects the joint,
it protects the muscles and it prevents from the effects of the imbalance
in the occlusion to cause much damage to the
patient in the long run. In a few patients, friends, the UnWind MD is all
that they need. In a lot of others, this
is usually the first step in achieving peaceful
neuromusculature, after which starts complex
rehabilitative procedure. Let us understand
how first, this appliance is supposed to be used and second, what is
the mode of action. What is the concept behind this
small little piece of acrylic working so beautifully for
so many wide indications. This is a representative
image of the UnWIND MD. Let’s look at the appliance
from different angles to help understand the
construction of the same. First let us look
at the labial view. This is the surface that juts
outside the patient’s mouth when the appliance is seated
in its correct position. A couple of things that I
would want to highlight here, first is the labial face
is absolutely smooth, thereby allowing the
patients to close the lip without jutting and
interfering with the same. The other thing is
the small little notch that has been
provided here, this is so that the labial
frenum can sit here without hurting the soft tissue. Looking at the appliance
from the side view, this is representing the internal
cavity of the appliance. It is this area which is relined
with a hard setting material, which means when the
appliance is in place, this is where the maxillary
central incisor will go and seat. Two things that I want to bring
to attention in this image is, first, the internal cavitation
has been made relatively wide, which means this area will allow
for you to place the appliance in patients who have
a Angle’s Class I, Angle’s Class II or an Angle’s
Class III malocclusion making this in a lot of senses,
a universal appliance. The second thing is the flat
surface that you see here, it’s called as the disoccluding
table or the DT. Now, what is important in a patient
who is wearing the appliance, is that the DT is supposed
to be absolutely parallel to the maxillary occlusal plane. This is achieved intra-orally with the help of what is
called as, a DT aligner. That’s the DT aligner,
you see it in the middle of your
screen right now. Moving ahead to the next view, this is now looking at the
appliance from the rear side. What I would want to
bring to attention in this image again two things – first are these retentive
undercuts that are provided – 2 towards the front and
1 towards the back. This helps retain the material that
is used to reline the appliance. One of two materials
can be used – If an acrylic material is used, these grooves are not
going to help much. But a lot of times, I
do give the appliance to the patient for a
shorter duration. In such a scenario, I may
reline the internal cavity with a bite registration paste. So first I apply tray
adhesive everywhere and then put in the paste. The advantage with
these grooves is, the bite material
will now extend and mechanically get
locked into these thereby holding the material
and not pulling off. The second thing that I would
want to bring attention to here is the labial face
which is nice and tall which allows for
the material to go and lock into natural hard
and soft tissue undercuts thereby retaining the appliance and the appliance does not keep
falling off in the oral cavity. However, the palatal face
here is relatively short. This adds to the
comfort of the patient because it does not
restrict the tongue space, nor does it affect the speech as
much as other appliances would. The last or the
functional surface of the appliance is
the incisal view. What you see here, friends, is the disoccluding table. This disoccluding table
looking right here, is the portion that
you see at the tip. It is on this table where the
lower incisor goes and contacts, thereby separating
the back teeth. A lot of times, patients
come to us with incisors in the lower
arch which are crowded or they may have diastemas
between the same. In such a scenario
if the patient were to make any
excursive movements, the lower teeth may
go and get locked at the edges of the
disoccluding table, not allowing the mandible to
relax the way it desires. What can be done in
such a situation is this disoccluding
table can be widened by reducing it (in height) with
a denture bur. Now, here you can see, the disoccluding table widens
progressively upwards. So if I were to trim
this edge with a bur, what am I doing, I am simply widening the
disoccluding table. Now if I have widened the table, even if the lower anterior
teeth are crooked, they will still have
maneuvering space without getting restricted and the same philosophy
even works for teeth that have large
diastemas between them, or if the patient may have a
mandibular incisor which is missing, that again works
against the appliance. So if you were to simply
trim the surface off, the appliance works
as a flat long, relatively wider
disoccluding table, once again making the entire
appliance universal in indication. In the next segment let
us actually look at how this appliance
is customized. Friends, here we have a patient who has been suffering from migraine
headaches for long, long time. We’re going to attempt at
customizing the UnWind MD for him. The primary goal in the use of the
anterior deprogrammer therapy is, it should separate
all the back teeth. So before you
actually go ahead and reline the internal cavity
of the deprogrammer, first always check if
the deprogrammer is separating the back teeth
adequately or not. So I will seat this
in the midline and have the patient
bite down into this. First make sure you
ask the patient – in static occlusion,
is there any contact in the back
teeth – yes or no. Friends, is there any contact? No. All right, then you
stabilize the appliance and have the patient move
the jaw forward and back. If you could move
forward, please? Forward… Forward… Forward… And back again. Was there any back tooth touching
when you do this movement? No. All right, now if you could
move towards one side? And back again. Move towards the other side and back again. Fantastic! In any of
these sideways movements was there any back
tooth touching? Fantastic! It’s important that in static and
dynamic mandibular movements, no back tooth comes in contact including the canine
teeth on both sides. This is the primary
goal in deprogramming. Separation of the
posterior teeth, allowing only the mandibular anterior
teeth to touch the appliance. So what we will do now that
we’ve checked the appliance, we will reline this internal
cavity of the appliance with a hard setting material. What I prefer is cold cure
if it’s for long duration, which is the case
in this patient. If it’s for a short duration, you could reline it with
some bite registration paste which is again a hard
setting material. So here I have relined this with some cold cure
acrylic material. I’m going to place it on to the
maxillary central incisors. Open, please. Make sure that this
goes into the midline, seated but not all the way. Now it’s important at
this time, friends, that the disoccluding table, which is the portion
of the deprogrammer on which the lower
incisors contact, is absolutely parallel
to the occlusal plane. For the same here at MIK dental, we have come up with
a metallic plate that we call the DT aligner. All we do is, we seat it
onto the occlusal surface and have the patient bite
down into this, please. Just bite down and
press all the way. All right. What this does is – it
automatically aligns the entire disoccluding table
(parallel) to the occlusal plane. Thereby adding
predictability to our work. Now what’s important when you
reline with cold cure acrylic is that you do not allow for the
material to polymerize completely because then it’s difficult
to retrieve the deprogrammer. So the moment it begins
to release heat, that’s when you remove it and you put it in hot water. What this does is – it allows for
the material to polymerize faster and with less
amount of shrinkage and also it decreases the
number of voids inside. So the moment it begins
to generate some heat, open please, all we do is we remove this
deprogram from the patient’s mouth and we put it in hot water. So what we do next is, we trim the excess
acrylic resin. This is how the deprogrammer
at the end should look. There should be no excess flash
coming out from any side. Once again you go ahead
and you seat this in. It should not be too tight, at the same time it
should not be extremely passive for it to
fall down by itself. Have the patient
bite down into this. Bite, please. And tap, tap, tap
your teeth together. And move your jaw
forward and back. Forward and back. Left and right. Left… Back… Right… And back. In any of these
movements, is there any back tooth that is touching? Perfect! So let us understand, friends, what a dental interference
is all about, what are its ill effects and how does the body
essentially adapt or cope to the presence of
an interference. I’m sure all of us will have
related to this one patient where we may have seen a third
molar that is supra erupted or we may have done a composite
restoration on the occlusal surface or we may have cemented a crown
that fits a little high. In all of these,
patients may tell you – “doc, this feels a little high.” Unfortunately, in most
of these circumstances we land up telling the
patients – you know what, just give it a couple of days, it’ll settle down. Let us understand what this
settling is all about. First things first friends, what is an interference? An interference is any
portion of a tooth that prevents the rest of the
teeth from coming into unanimous and uniform intensity
contact at the same time. So what happens is, as an individual tries
to close the teeth together into maximum
intercuspation, this tooth, that kind of stands
above the occlusal plane hits first. This results in what we have read
as Trauma from Occlusion – TFO. The moment a particular tooth comes in contact prematurely, the periodontal
ligament of this tooth which has these proprioceptors
or mechanoreceptors, they immediately send a
signal to the brain, primarily to the
trigeminal ganglion. The moment this signal reaches
the trigeminal ganglion, the trigeminal ganglion
sends a signal to the lateral pterygoid muscle telling the lateral
pterygoid which is a positional muscle
of the mandible to contract very slightly. What this does essentially is, the individual changes the path of
mandibular closure into a pattern which avoids that
premature contact, thereby now
re-establishing a new maximum intercuspation
for our patient and that’s how the crown
actually settles. Settling happens at the level of
the lateral pterygoid muscle. Now simply put, I’m sure all of us have
experienced this one point where the road has a pothole. We may have driven across and
bumped into that pothole. The next time we
walk across that, or we drive across that, we know we don’t want
to hit that pothole, so what do we do? We avoid it by slightly
altering our path, exactly what the mandible does. If the mandible realizes that
there’s one point of one tooth that is in premature contact, it changes the path of
closure to avoid that. And that’s how the
crown settles. A lot of times, this settling
may not be physiologic and an individual may
start developing signs and maybe eventually
some symptoms of what is called as,
muscle discrepancy or a discrepancy
that’s present between physiologic jaw position and
the habitual jaw position that the patient has
developed with time. In such a patient
what is required to get the patient into original
comfortable occlusion is what is called as ‘Deprogramming.’ This can be done with the help of
an anterior deprogramming splint. That’s exactly what
an UnWind MD does. When you place the UnWind MD
on to the anterior teeth, its role is essentially to separate the
posterior teeth. Essentially it disoccludes
the back teeth. The moment the back
teeth are disoccluded, the signal that is
going to the brain from the periodontal
ligament is intercepted. The tooth no longer
hits prematurely because none of the
teeth actually hit. What this does, is it actually tricks the brain, it tricks the brain into believing
the interference is gone. So what does the brain do? The brain no longer sends a
signal to the lateral pterygoid. What does the lateral
pterygoid do? It relaxes! The moment the lateral
pterygoid relaxes, the condyle goes back into home, which is nothing but
centric relation position. Now your patient has what is called
as, peaceful neuromusculature. It’s just a lot of
coordination that is present between the elevators and
the depressor muscle. If your patient comes
in with symptoms, say of migraine headaches
or tension type headaches, deprogramming will
relax the musculature, thereby taking care
of the symptoms. The moment you
remove the UnWind, what essentially happens is – the brain no longer is sending a
signal to the lateral pterygoid which means the path of closure is towards centric relation. As the individual now closes, that premature contact now starts hitting
all over again. If you allow for this to stay, the muscle engram is back because the lateral
pterygoid now begins to protect
the entire system. So what an anterior deprogrammer
essentially does is – by tricking the brain, it helps us clinicians identify
the first point of contact in CR what we call as centric occlusion and that’s the point where
the interference begins. Now imagine a world, where we remove
this interference, this could be let’s say for
example, it’s a high crown we’ll remove the crown; if it’s the high filling,
we adjust the filling; if it’s a third molar
that’s supraerupted, we extract the third molar. What have we done? We’ve removed the cause of slide which is the interference. The moment you do that, the brain no longer
needs to be tricked because it is permanently
deprogrammed. Such a patient is said to have
coordinated muscle function, which means the
centric relation is the same as maximum
intercuspation. Signs of breakdown decrease, most definitely, the
symptoms go away. Here again, what has the
anterior deprogramming done? It has worked as a
diagnostic tool in helping us understand
where the problem lies thereby directing us towards
it’s correct treatment. Thanks, so that is friends,
all about UnWind MD, the anterior muscle deprogrammer from MIK Dental. Give it a try, you
will be amazed at how such a small
little appliance works for such a wide variety
of clinical situations. What’s important to
understand friends is, this is a removable appliance, which means at no
point will it do any irreversible damage
to the patient. As long as the
joints are stable, this appliance will not
hurt the patient at all, it may or may not
improve the condition, thereby helping you
with the diagnosis but it will not hurt the patient as long as the
joints are stable. Do give it a try and
you will be amazed at the beauty and the ease with
which this appliance works. Once again friends, if
you liked this video, please share it with
your colleagues, subscribe to our channel so that you are updated regularly
of our videos and products. And until we meet again, wishing all of you all
the very best in life! B-bye!!

13 thoughts on “Unwind MD: The Dental Story by MIK Dental”

  1. how long does the patient wear this deprogrammer?
    and do we use articulating paper afte that to know the prematurity??

Leave a Reply

Your email address will not be published. Required fields are marked *