We can never gauge where we are and where we are going without reviewing where we have been. A historical review is included to help give this perspective. This chapter documents the uses of intraoral orthotics in the past and how they have changed as philosophies and materials evolved.
This author was challenged by the idea of finding a cost-effective way of providing diagnostic appliance therapy for the great number of patients with temporomandibular joint pain. His answer was remoldable craniomandibular appliances. These appliances provide an increase in both vertical dimension and mandibular AP position. He outlines the uses of these appliances for temporomandibular disk displacement, myofascial pain, and bruxism patients.
A number of diverse symptoms, conventionally diagnosed and treated as individual problems, exist in combination in the craniomandibular pain and dysfunction patient. This chapter explores musculoskeletal dysfunction of the area as a common etiologic factor for head and neck pain. The electronically derived data, reported in 68 case histories, indicate that a common measurable etiology is responsible for the many ostensibly diverse manifestations of craniomandibular pain and dysfunction. Both quantitative and subjective data support the etiologic validity of the diagnosis. The basis for the effectiveness of the reported therapy rests on diagnosis of a skeletal malrelation of the mandible to the cranium that poses sustained accommodative demand on the neuromusculature.
The authors discuss the philosophy, fabrication, and use of the Gelb appliance. They recommend the appliance for daytime use for anterior displacements with reduction, unloading of the temporomandibular joint, and cervical muscular dysfunction where mandibular displacement is a perpetuating factor. This chapter also details their clinical protocol for diagnosis and appliance management.
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