A deprogrammer is a diagnostic tool for clinicians, but it is often perceived as a treatment device by patients. Altering the habitual relationship between the mandible and the occlusal plane during sleep provides differential diagnostic information that can be measured with basic force distribution cycles.
The patients’ deprogramming experience often changes their attitude towards dentistry’s ability to promote health, wellness, and hope for the future as well as gives them renewed confidence in their clinician’s skills. A positive change in symptoms motivates patients to seek further treatment.
In our experience, 20% of patients do not have an immediate positive change after the first week of deprogramming. Common observations reported by patients include “my symptoms did not change,” “my mouth is too dry,” “I clench more,” “some of my teeth are sore,” and “I don’t like the feel or change in my bite.” Any observation—positive or negative—is part of the diagnostic process and gives both doctor and patient an opportunity for codiscovery.
Often, patients’ vertical opening created by a deprogrammer is too “open” so the deprogrammer needs to be adjusted. Kois or Drotter deprogrammers may create a better diagnostic position because the mandible is less “open” but I prefer starting with a Neff deprogrammer and adjust it down, as needed. In some cases, the extra vertical opening reduces the incidence of snoring because it alters the tongue/swallow reflex.
Both before and after force distribution cycle movies document an adaptive envelope of function, indicate where the system is unbalanced, identify pathologic sequence of contact points distribution, show when disclusion from MIP is stressed, and locate where the static and/or dynamic bites require an occlusal adjustment.
The T-Scan does not tell you how to treat, but it does tell you where to look. Occlusion is both static and dynamic and requires analog and digital tools to fully grasp form and function over time.