The document discusses the clinical significance of first phase treatment for temporomandibular disorder (TMD) patients. It summarizes that first phase treatment aims to eliminate or reduce patients' symptoms by stabilizing the mandible in the physiologic rest position using a removable neuromuscular orthosis. The summary analyzes data showing high improvement rates for TMD symptoms related to muscles, joints, and the autonomic nervous system following this first phase treatment approach.

1. Clinical Significance of First Phase Treatment
for TMD Patients.
16th International Congress, October 20, 21
Vancouver Canada
Toshihiko Abey D.D.S,MICCMO
© 2011, Toshihiko Abey, DDS,MICCMO

2. Four Categories of TMD Symptoms
1.Pain of myogenous origin (muscle spasms)
Neck & Shoulder pain, Back pain, Facial pain, Tension Headache, etc.
2.Symptoms related to TMJ
Clicking, Popping, Difficulty opening, Jaw tiredness, Jaw stiffness, etc.
3.Symptoms effected on the autonomic nervous system
Insomnia, Dizziness, Short breath, Constipation, etc. ( Dysautonomia )
4.Mental disturbances
Depression, Anxiety, Insomnia, Nervousness, Despair, etc.

3. Etiology of
Temporomandibular Disorder
Muscle hyper function Myogenous TMD disorders
Musculoskeletal disorder
• Nerve and Vascular Entrapment
• Muscle Ischemia
• Distalization of the condyles
© 2011, Toshihiko Abey, DDS,MICCMO

4. 3 Kinds of Mandibular Torque

5. Etiology of Temporomandibular Disorder
Pitch Torque Cause Internal Derangement of TMJ
Articular disk displacement
Physiologic Rest Position Pathologic Intercuspal Position
© 2011, Toshihiko Abey, DDS,MICCMO

6. Craniomandibular Disorder
Influence of PITCH Torque
TMJ injury and loss of muscle co-ordination
Rest position of the mandible Distorted mandibular position

7. Diagnosis of TMD Patients
Habitual intercuspal position Physiologic rest position

8. Habitual Intercuspal Position
Physiologic Rest Position
© 2011, Toshihiko Abey, DDS,MICCMO

9. Prescription to a TMD Paｔient:
１） Match Habitual Path of Closure to
Neuromuscular Path of Closure
２） Adjust torque of mandible to meet
Relax musculature and TMJ
３） Establish Stable mandibular Position
© 2011, Toshihiko Abey, DDS,MICCMO

10. First Phase of TMD Treatment
 eliminate or reduce patient’s symptoms
 stabilizing the mandible
 physiologic rest position.
“Removable Neuromuscular Orthosis”

11. Neuromuscular Orthotic Therapy
Aligning Body Part to improve Function
Orthosis:  An orthopedic appliance or apparatus
 support, align, prevent or correct deformities
 improve the function of movable parts of the body
© 2011, Toshihiko Abey, DDS,MICCMO

12. MYOGENOUS
TMJ
BITE DYSAUTONOMIA

13. Please check Box below , and circle the Number which indicate your level of pain
ＴＭＪ ＆ ＢＩＴＥ “0” = No Pain, no discomfort
“1” =Sometimes Bothered
“2” = All the Time Bothered
“3” =Severe Pain and Discomfort
MYOGENOUS section DYSAUTONOMIA section

14. Distribution of the Pain Intensity Score of ３２ Symptoms
complained by the 40 TMD Patients
© 2011, Toshihiko Abey, DDS,MICCMO

15. Ｈｏｗ ｔｏ ｃａｌｕｃｕｌａｔｅ Ｉｍｐｒｏｖｅｍｅｎｔ Ｒａｔｅ ？
© 2011, Toshihiko Abey, DDS,MICCMO

16. Improvement Rate of Pain Intensity Scores
after the Neuromuscular Orthotic Therapy
© 2011, Toshihiko Abey, DDS,MICCMO

17. Improvement rate of each TMD Symptoms
Related to TMJ disorder

18. Improvement Rate of TMD Symptoms related to
Muscle Disorder before and after Treatment
Symptom before after Improve . Rate (% )
Facial pain 19 3 84 %
Back eye pain 34 8 76 %
Headache 54 19 65 %
Back pain 47 17 64 %
Fingertip numbness 18 7 61 %
Pain in the hips 45 18 60 %
Stiff shoulder (s) 76 32 58 %
Cervical pain 75 34 55 %
© 2011, Toshihiko Abey, DDS,MICCMO

19. Improvement Rate of Symptoms
Related to muscle disorders
© 2011, Toshihiko Abey, DDS,MICCMO

20. Improvement Rate of TMD Symptoms related to
Autonomic Nervous System before and after Treatment
© 2011, Toshihiko Abey, DDS,MICCMO

21. Improvement Rate of Individual Patient
Pｔ. A
Pｔ. B
Pｔ. C
Pｔ. Z
Individual patient Improvement Rate (%) = (SumA - SumB)/SumA x 100

22. Improvement Rate of Individual Patient
= Patient’s Satisfaction Rate
０～３９％
Improvement Rate No. of Patients ５
７０～８４％
７０～８８％ 16 40% （１３％）
６０～６９％ 7 18% ４０～４９％
６ １６
５０～５９％ 6 15% （１５％）
N-40 （４０％）
４０～４９％ 6 15%
０～３９％ 5 13% ５０～５９％
６
TOTAL 40 100% （１５％）
７
（１８％）
© 2011, Toshihiko Abey, DDS,MICCMO ６０～６９％

23. Duration for individual Patient
First Phase Treatment
2-month
Ｍｏｎｔｈ Ｎｏ．of Ｐｔ． %
14～month
５
2 5 13% ７
3 6 15%
4 6 15% 3-month
5 3 8% 13-month ６
6 2 5% ４ N=40
7 1 3%
10 5 13% 12-month
12 1 3% ５
13 4 10%
６ 4-month
１４～ 7 18% 10-month ３
40 100 ２
6-month 5-month

24. Conclusion
 The curability of TMD symptoms
 Importance of quantitative data
 The validity of Neuromuscular Theory.
© 2011, Toshihiko Abey, DDS,MICCMO

25. Thank you for your Kind Attention !
© 2011, Toshihiko Abey, DDS,MICCMO

26. The rate of response to First phase Treatment
© 2011, Toshihiko Abey, DDS,MICCMO