NTI Tension Suppression System

The FDA has cleared for marketing for the first time, a device that prevents medically diagnosed migraine pain, tension-type headache, and jaw disorders ("TMJ"), without drugs or surgery, through the reduction of trigeminally innervated muscular activity.

The N.T.I. Tension Suppression System is a prefabricated polycarbonate matrix that a dental practitioner retro-fits to the patient's teeth .  It is completely different from any other type of mouthpiece. 

Chronic symptoms of the head and neck can often be attributed to:

A) Headache -- the temporalis muscle (it closes and clenches the jaw)
B)  Sinus pressure and pain -- the lateral pterygoid muscles (it moves the jaw side to side and/or forward)
C)  Neck stiffness and pain -- trapezius muscle (it stabilizes the skull during jaw clenching and grinding)

 

How an NTI-tss works

This is a simple demonstration of the efficacy of the NTI-tss device.

A) Begin by gently biting on the moon portion of your fingernail, using your central incisors. Only be forceful enough to create slight discomfort.

B)    Now attempt to use the same amount of force, but this time bite with a canine tooth on the same spot of your fingernail as you did with the central incisors. 

What happens?  Biting with the canine tooth is suddenly more painful than with the incisors... Why? 

The incisor teeth are intended to not only incise food, but to be "hardness monitors" of what you're biting into.  They are under your control and tell you if something will be to hard to chew.

The canine teeth are designed for grasping and pressing into what it is that you're trying to hold on to (carnivores specifically use the canine teeth for this purpose). The intensity of muscular activity created once the canine teeth have been engaged is under less voluntary control. In fact, the message to the brain is: "We've opened our mouth to grab something and have caught it...hold on!" The contacting of canine teeth encourages jaw clenching!

1) A full coverage splint, usually a thickness which mimics the intended space between the teeth when the jaw musculature is supposed to be at rest, provides both canine and posterior teeth contact, thereby allowing for perpetuation of parafunctional (nighttime clenching) muscular activity.

2) By increasing the thickness of the splint, clenching intensity may be altered, depending on the amount of pressure applied to particular teeth.  If contacts are "heavier" in the molar region, clenching intensity can be suppressed slightly.  If contacting is prevalent in the canine region, clenching is reflexive and perpetuates.

3) An anterior bite plane reduces parafunctional intensity of the masseters (the muscles on the sides of your jaw, primarily involved in chewing, not clenching), and to a degree, the lateral pterygoids (the tiny muscles at your jaw joints that open your jaw), but still provides canine contact for temporalis clenching.

The NTI-tss device (above) reduces clenching intensity by exploiting the mechanisms of the incisor teeth and by preventing the engagement of the canine and molar teeth when the jaw is centered (A), and when it is in excursive positions (B).

Frequently Asked Questions

What does "NTI" stand for?

Nociceptive (relating to the perception of things that could be harmful); Trigeminal (the nerve that controls the major muscle of mastication; Inhibition

Doesn't  the NTI-tss cause posterior supra-eruptions of the teeth or anterior intrusion?

No.  Since the patient cannot wear the NTI-tss device while chewing food, the posterior alveolar structures receive regular stimulation every day, therefore, there is no opportunity for a functional adaptation of the occlusal scheme, that is supra-eruption of the teeth.. Research shows that alveolar bone requires at least 8 days of  lack of stimulation before bone growth at the apex (supra-eruption) can initiate.  As for anterior intrusion, the lack of continuous apical force does not provide adequate opportunity to intrude an incisor.  However, Changes in the jaw relationship can be observed within 8 days (which is identified as an change in the occlusal scheme), and is a result of the normalization of the musculature.

Isn’t it too small and easily dislodged?

No.  The NTI-tss device is retro-fitted over un-prepared teeth with cold-cure acrylic.  The practitioner must relieve the internals to provide for a snap-in fit, without strain or pressure on the teeth. The patient must make a dedicated effort to remove the device.  If the patient is able to remove the device without using their hands, then it should be re-lined or/and made to fit additional lateral teeth for added retention.

Isn't the NTI-tss only indicated for clenching patients?

No. The NTI-tss is indicated for all types of TMDs.  The only way *any* musculature of the head and neck can contract with significant intensity is to have either canine or posterior teeth (or both) in occlusion.  It is the occluding of these teeth which allows the musculature to exert strain on the alveolar structures, TM joint(s), and sphenoid bone (pterygoid plates).  Without  the occluding of these teeth (i.e., "rest position"), these structures stand the best chance for healing and remodeling.  Therefore, the NTI-tss is ideal for all types of TMDs and MPDs.

Is there a patient with whom the NTI-tss clearly would not be effective?

Assuming the patient has the adequate dentition to support the NTI-tss matrix, the NTI-tss will be effective in the presence of muscular parafunction.  A lack of effect can be used as a diagnostic rule-out method (assuming protocol was followed with no oversights)

Are there age restrictions for treatment with NTI-tss?

While every dentist has certainly heard parents complain of a very young child who grinds their teeth while sleeping, the standard NTI-tss device is best suited for permanent teeth.  However, for children without permanent teeth who are symptomatic resulting from muscular parafunction, a  custom NTI-tss type device can be fabricated.

How long should a patient expect the NTI-tss device to last?

The duration of the NTI-tss device is dependent on the intensity of the patient's grinding, not clenching. If a patient is an intense grinder, over time they may develop a divot in the Discluding Element of the NTI-tss. This situation would simply require periodic filling and smoothing of the divot.

How soon should the patient expect to see the presenting symptoms subside?

Subsiding symptoms are directly related to the degree and longevity of each individual's condition. However, it is not unusual for some patients to report significant relief overnight; others usually within two to four weeks.

Most Frequently Asked Patient Questions/Concerns

Can I accidentally swallow it?

• Made properly, the NTI device cannot be removed without using your hands.

My teeth will supra-erupt . . . because they do not touch in the back

• The device can not be worn while eating;
• Teeth can not supra-erupt since the teeth are stimulated by eating (the NTI-tss matrix is NOT worn during/while eating)
• Periodontal ligament that surrounds the root and holds the tooth in place - if this ligament is stimulated (exercised) it will continue holding the teeth in correct position.