Male Speaker: This is the first time I have seen this patient and this is my initial examination. I am doing muscle palpation around the head and the neck and you can see the abnormal response this patient has to a palpatory examination. She has uncontrollable muscular movements. This occurred during the palpation of most of -- all of her muscles. However I am not going to show you the whole exam. We are interested in movement disorders. She used to walk with a walker. She has just finished 25 sessions of physical therapy at a local hospital and she considers herself fantastically improved. She walks with a cane now.
One of the things that these motor disorder patients have in common is a very deep bite. As you can see, she has 100% deep bite. You can barely see the very nix of her lower incisors when she bites down.
Now I am going to have the patient get up and walk. This is her walking out of the office without her cane. Though she shuffles her feet, doesn't pick her feet up, has to hold her hands out for balance, her movements are very slow and uncoordinated.
Because of her deep bite, I know an increase in vertical dimension will help. So we put just two cotton rolls in her mouth between her jaws to increase the vertical dimension of occlusion. Notice she is already walking better. The more she walks, the better she does. This tells me that an increase in vertical dimension in any type of plants I put in will help this patient. However, we want to take this a step further and we can use a thick piece of wax and reposition her in an idealized maxillo-mandibular relationship with her dental midlines on and minimum overbite and overjet. And her jaw is now not only vertically increased in height, but moved in anteriorly. Notice she walks still better than when she had the cotton rolls in. Therefore we know that any device we make for this patient is bound to help her.
Okay could you tell the difference in walking?
Female Speaker: Definitely.
Male Speaker: Definitely, okay. We are now going to take impressions and send them out to a laboratory and have a device fabricated. We are now beginning to fit the patient with an appliance. This is two days after I have examined her. We put the substructure in that has come back from the lab and see that it seeks all the way down and has no tips or torques or any other movement in it.
We build up the occlusive surface with acrylic. We have the patient swallow to capture an impression of her swallow while the acrylic is still soft. We remove it from the mouth and we take it back to the laboratory and have a cure under heat and pressure. It has now come from the laboratory. It's been trimmed and polished and is having a final fit in the patient's mouth. She will exit the office with this appliance today.
Okay let's see you walk up and down if you would, see how you're doing it. You feel pretty well balanced?
Female Speaker: Very balanced.
Male Speaker: Very balanced, okay. That's all it took. You are having any trouble getting in the chair?
Female Speaker: Just a little bit. I am doing much better than I - what was originally getting in and out.
Male Speaker: Okay, let's see you walk back so it's photographed from the rear. Now I am going to have the patient walk again up and down to show her that the appliance benefits her. This is how we get the patients to wear the appliance 24/7. You can already see she is walking much better than what she initially presented two days ago. The next time I saw the patient was six months later when she dropped into my office to show me how well she was doing. I shot this footage of her to show you that her improvement continues to hold. Notice how level her shoulders are, how she swings her arms evenly and takes steps that are the same size.
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