I was hoping to get a little help and information regarding a MTJ patient that I am seeing. This 50 year old male patient was referred by a DMD whom is knowledgeable of PRI techniques and principles. Progressive splint/Mago therapy was initiated 8 months ago. There is internal disc derangement on the right, I am not sure about the left. Patient is a tongue biter, and demonstrates patterns typical of a R TMCC. As expected, I have not been able to maintain a ZOA, Left FA IR, Right HG IR and standing posture. Would you please explain why when I placed 2 tongue depressors on the right molars (while wearing his splint) his shoulders were level, his FA IR improved by 10-15 degrees, negative right HG IR, and ZOA and chest expansion were restored? Also he had improved sphenoid flexion and decreased compensatory extension? Should he continue to perform his PRI exercises (Left AIC and brachial repositioning)? With tongue depressors? Should I include any tongue exercises? He has a “flat” looking tongue and is not comfortable sticking it out, he feels like he could dislocate his jaw (which he reports happens frequently). Do you think his splinting is appropriate? Would love any other suggestions.
The tongue depressors temporarily repositions his mandible to his maxilla and allows him to move out of his right TMCC state or pattern and relax his cervical and thoracic stabilizers, possibly through the autonomic nervous system. What’s important here is the need to keep an appropriate splint in his mouth, at least at night, to assist in this autogenic inhibitory process or the establishment of this skeletal muscle and orthopedic realignment state.
The type of oral appliance used is up to you and his dentist, but an acrylic mandibular Gelb-type of splint would be recommended because of the likelihood that he is off his TMJ disc on the right. This splint will help bring the mandible slightly forward without having compressive directive forces placed on the TMJ discs. It will also hopefully relieve some of the stress at the back of the neck and occiput, since the occipital condyle compression forces on the atlanto superior articular facet should be reduced, allowing cervical rotation to resume to the left. You are correct, in my opinion, that cranial flexion will be better permitted, as well as his ZOA, etc.
I would encourage initiating Supine Sacro-Spenoid Flexion, Left Sidelying Knee Toward Knee with Left Trunk Rotation, Seated Adductor Alternating Reciprocal Quad Sets with Right Cervical Sidebending, and bilateral lateral pterygoid activity with slight protrusion; with his new splint in. The splint he uses needs to keep in the same position that the tongue depressors did. I wouldn’t rely on the tongue depressors for correct positioning during PRI activity. I would ask his dentist to work with you in fabricating an appliance that guides, not directs, his mandible slightly forward and decompresses his TMJs