Oct 16, 2015 - Dr. Ben Sutter portrays the treatment process known as DTR therapy, giving patient examples and a brief description of the software used by the T-scan digital bite sensor alongside EMG for measurement of occlusion synchronized with muscle activity.  He describes DTR as a form of splintless TMD therapy which defines occlusion as one of the most influential concepts in all of dentistry.

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Dr. Sutter's youtube page has countless stories of patients who traveled to his Eugene, Oregon office seeking relief from their suffering.  He has 10 years of videos of patients diagnosed with Meniere's disease, Trigeminal Neuralgia, and other debilitating TMD symptoms.  He is currently publishing literature documenting DTR therapy for patients diagnosed with Meniere's Disease.

Jul 30, 2016 - Drs. Robert Kerstein and Mark Piper recount their respective experiences with measured occlusion and TMJ imaging concepts, finding common answers to the classic debate:  "Are occlusion and TMD related?"  Both prefer MIP as a condylar position for restorative dentistry more often than not, especially in facilitating immediate complete anterior guidance development, which is the goal of DTR therapy. 

 

Dr. Piper shares his perspective as a TMJ surgeon and how his philosophy evolved over the decades, describing his path as a paradigm shift.  He was for many years the oral surgeon affiliated with Dr. Pete Dawson, founder of the Dawson Academy in St. Petersburg, FL.

Nov 23, 2014 - Dr. Robert Kerstein answers Dr. Nick Yiannios's FAQs of DTR therapy for occlusomuscular TMD patients.  Since 1984, Dr. Kerstein has been the leading author and researcher in the field of Computerized Occlusal Analysis.

 

Cited literature indicated ~15% of DTR candidates had maladapted or unstable TMJs.  DTR therapy was considered less predictable if damage to the medial pole of the cartilaginous TM meniscus compromised reduction between condylar head and articular eminence.   

 

Instability found by Joint Vibration Analysis merits MRI and CBCT as additional diagnostic aides in identifying patients who require treatment beyond DTR therapy (such as surgery).

Nov 23, 2015 - Drs. Nick Yiannios and Tom Coleman are co-authors of literature in the Handbook of Research on Computerized Occlusal Analysis Technology Applications in Dental Medicine (Kerstein, DMD). Dr. Yiannios is founder of the Center for Neural Occlusion which emphasizes the multidisciplinary nature of orofacial pain and TMD.  

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Topics discussed include limitations of analog methods, traditional bite "equilibration" vs. DTR therapy, force outlier contacts in periodontal considerations such as PDL attachment loss and mobility, condylar positioning (CR, FSCP adapted & non-adapted), occlusomuscular dystonia, and the prevalence of iatrogenic malocclusion in chronic TMJ microtrauma.

Jul 25, 2016 - Drs. Mark Piper and Nick Yiannios weigh sympathetic influence on dental pain and TMD symptoms.  Dr. Piper describes the connection between malocclusion and trigeminal induction of stomatognathic muscle spasms.

 

Sympathetic fibers accompany the trigeminal nerve along its branches.  They manage muscle tone, dental sensation, and homeostatic mechanisms that also affect heart rate, peripheral vascular resistance, and cerebral vascular tone.  

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Dr. Piper explains his use of greater auricular nerve blocks as a diagnostic aid for patients with atypical pain profile unaccompanied by easily recognized signs and symptoms.

Apr 7, 2020 - Drs. Mark Piper and Nick Yiannios explore limitations involved in adjusting a bite to "treat" symptomatic occlusomuscular TMD.  For complex orofacial pain patients, improving the bite is only one part of a bigger puzzle.  Although DTR therapy can fix dental malocclusion, an interdisciplinary approach may be necessary if compounding symptoms stem from other causes in addition to the dental component.

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Dr. Yiannios's youtube page has garnered worldwide attention.  He has hundreds of stories of patients who traveled to his Rogers, Arkansas office for treatment of their debilitating symptoms, including detailed clinical presentations of Complex Regional Pain Syndrome and sympathetic pain cases which are not candidates for DTR nor orthodontic treatment, instead needing referral for surgical intervention.

Jul 29, 2016 - Drs. Mark Piper and Nick Yiannios consider TMD splint design and the priority of imaging for condylar positioning.  Dr. Piper is founder of the Piper Education and Research Center, an advanced treatment center dedicated to delivering the highest standards of TMJ, occlusion, and facial pain diagnosis & management. 

 

Dr. Piper's peer-reviewed publications focus on TMJ microsurgery, avascular necrosis of the mandibular condyle, MR diagnosis of TMJ internal derangements, and the relationship of malocclusion to damaged TMJs.