ChairsideSplint is happy to provide complimentary NTI devices to practitioners who are considering adding nocturnal parafunctional control by implementing "NTI Therapeutic/Migraine Protocol" to their practice. (details at end of this page)
There are two main rules that dictate NTI Therapeutic/Migraine Protocol:
1. Minimize muscle contraction intensity (by ensuring incisor contact, only, and ensuring an opposing canine cannot contact the device in extreme excursive position)
2. Minimize joint strain/load (that is, ensure minimal condylar rotation during occluding by keeping the vertical dimension of occluding (the posterior freeway space) at a minimum in ALL excursive/protrusive positions). (ideal posterior freeway space would be no more that 2mm)
Determination of the placement of an NTI device on either the maxillary incisors or mandibular incisors is a factor of the resulting degree of condylar rotation (Vertical Dimension of Occluding) and lack of providing the accessibility of canine contact on the device in excursive movements.
-- The default placement is on the mandibular incisors, as opposing maxillary canine contact on the device is less likely when using the lower device.
-- When excessive incisal overlap results in considerable VDO, the upper device is used, and the Discluding Element is contoured (typically ramped "up" towards the palate) to minimize the VDO.
Click on the diagram below to enlarge, or download the pdf of the Fabrication Protocol Flow Sheet:
Please visit Delivery Protocol Insights
NTI devices are always provided with accompanying ThermoPlasticBeads. TPBs have become the standard method of adapting and retaining oral devices (particularly apnea devices). Modifications and re-adaptations are readily accomplished.
An acrylic (egg-shaped) bur can be used, but only at the highest speed, and with a gentle shaving motion (otherwise, it just gums up), followed by the "flame-brushing" of the shaved surface.
Click here for: ThermoPlasticBead protocol
Delivery insight from Dr. Boyd's presentation: The Where and Why of the NTI
Below is a chairside delivery example of an NTI device for a migraine and jaw pain patient.
Some "insider info" on NTI delivery:
A critical insight in avoiding the most common source of failure:
Many practitioners prefer to have an outside laboratory fabricate the NTI device. Keller Laboratory (and their licensed labs) is the exclusive licensed lab to provide the "NTI-plus".
Keller Lab has produced a fantastic series of helpful videos regarding NTI protocol.
Practitioners can send their request for a Trial Kit of NTI devices to Help.ChairsideSplint@gmail.com. We'll then provide the link to the NTI Trial Kit page and a checkout code for a 100% discount on the kit fee (you'll pay for postage/handling only). We're always interested in how you became aware of the NTI Therapeutic Protocol, so please let us know where you've heard or read about the NTI.
Curiously, there are some "educators" who provide "disinformation" regarding the NTI Therapeutic Protocol. Before is a photograph of a slide presented by Terry Tanaka, DDS, regarding the NTI and "anterior jigs". The audio from the lecture can be heard. The audio is paused occasionally to insert corrections and insights so as to properly inform the viewer.