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When to use an NTI appliance and when not to

Hi, everybody. My name is Dr. Leonard Hess. I am one of the senior faculty members here at the Dawson Academy, and I would like to take a few minutes to discuss with you when to use an NTI appliance and when not to.


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What is an NTI splint?

For some reason in our profession, there still seems to be a lot of confusion about splint therapy and when do you use what type of splint in a predictable way. So a very common, a very popular type of appliance is an NTI appliance. So an NTI appliance, first of all, is an anterior deprogramming device that is segmental. So one of the first things to always remember is to use your ability to perform a complete examination to diagnose what is going on at the joint level.

Make a differential diagnosis by applying the proper splint.

So many times, we get into a point of confusion with the patient to whether or not we are dealing with an internal derangement at the joint level or if we are just dealing with muscular symptoms. Make no mistake, somebody that is having a lot of muscular symptoms, a lot of inflammation, lactic acid build up in the muscles of mastication, this can be painful for our patients as well. We need to be able to make a differential diagnosis, and an anterior deprogramming device like a Lucia Jig or an NTI is a really fabulous and inexpensive way to be able to make a differential diagnosis.

If the symptoms disappear, you know you are dealing with the muscles.

So if you put somebody into an NTI appliance and you deprogram the muscle's mastication, and specifically you deprogram the lateral pterygoid muscle. What's going to happen is now that joint is going to go up and seat, and it's going to help you to very quickly make a differential diagnosis whether or not you have a muscle problem or if you have an internal derangement problem. So if you put a patient into an anterior deprogramming device and their symptoms very quickly start to resolve themselves, you can feel more confident that you're strictly dealing with occlusal muscular type of pain.

If the symptoms increase, you know you are dealing with the joint.

However, if you put somebody in anterior deprogramming device and their symptoms increase, that's a reliable indicator that what you're dealing with is internal derangement and you're dealing with a red joint. Now the last thing that I really want to just make sure that we emphasize is that anterior deprogramming devices that are segmental, like an NTI, are many times overprescribed and over-utilized, and these types of appliances are being used on patients with internal derangement problems.

Make sure you are also doing the Complete Examination.

So always make sure that you are making an effort to perform your complete diagnosis. Make sure you are load testing, evaluating range of motion, listening to the joint with your Doppler auscultation unit. Make sure you're going through your seven questions related to the history of the temporomandibular joint. And you'll be able to use that NTI appliance or a segmental anterior deprogramming device to help you to make a more reliable differential diagnosis. I hope this has helped you today, and I hope I get the opportunity to see you at some courses at the Dawson Academy somewhere down the road. Have a great day

Learn more about Occlusal Splint Therapy in our one-day lecture Demystifying Splint Therapy: Going Beyond the Nightguard.

Occlusal Splint Therapy Quiz

Picture of Dr. Leonard Hess

Leonard A. Hess, DDS is the Clinical Director at The Dawson Academy and joined the faculty in 2009. He owns Union County Center for Comprehensive Dentistry in Charlotte, North Carolina, and practices full time in addition to teaching continuing education courses. He is a member of the editorial board for Inside Dentistry and has had over 17 articles published in peer-reviewed journals. He is also a member of the American Academy of Restorative Dentistry, AACD, ADA, AES, and NCDS. Dr. Hess began teaching continuing education courses in 2005 on topics including occlusion, smile design, treatment planning, preparation design, and practice integration of Complete Care Dentistry. He’s taught full-day continuing education courses at the American Academy of Cosmetic Dentistry’s national meeting, The Greater New York Dental Meeting, AACD National Meeting, Pacific Dental Conference, Ontario Dental Association meeting, and The Yankee Dental Conference. Dr. Hess has taught courses in Japan, Germany, Poland, China, and Canada.