6/18/12 innersmile pro © zerobase dynamic semg innersmile pro single track muscle scanner ©
TRANSCRIPT
6/18/12 InnerSmile Pro ©
Zerobase Dynamic sEMG
InnerSmile ProSingle Track Muscle Scanner
©
6/18/12 InnerSmile Pro ©
ATTENTION!There are no teeth in this lecture!There are no specific appliances in this lecture.There is no TMJ cure in this lecture.So what is the purpose of this lecture?
Simply said: Dynamic EMG ......
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Simply said: Dynamic EMG is a tool, not a treatment!
1. Muscles help form and stabilize teeth.2. Balanced muscles stabilize the occlusal plane.3. You can evaluate muscle balance for any appliance, any crown placement, or any surgery.4. You can also assess some swallowing problems.5. You can also assess muscle aspects of TMJ/TMD.
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And
You can do it while a patient is in the chair.
It takes 3 or 5 minutes.
You have a Report immediately.You can do it again as many times as needed.
Appliances Crowns Surgeries
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sEMG SINGLE CHANNEL HAND SCANNER
Simple Muscle Evaluation for Awareness Training
Single Channel sEMG Unit Zerobase Dynamic sEMG
InnerSmile Pro ©
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This devise can be used alone.
Or as a screening devise for...
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Zerobase Dynamic sEMG
Complete Muscle Evaluation and Awareness Training
sEMG 4 CHANNEL
It allows you to do a physiological evaluation of muscle activity and symmetry as well as oral muscle training.
4 Channel sEMG Unit
InnerSmile Pro ©
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Zerobase Dynamic sEMG
Before Training
After Training
InnerSmile Pro ©
Example:
4 Channel sEMG Unit
ZeroBase 4-Channel sEMG Hookup
Cory-san
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PRACTICAL BACKGROUND
“I am afraid of making a fool of myself.”
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• What is the biggest problem in communicating with your patient?
• How much time do you have to communicate with your patient?
• What kind of evidence do you present?
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Structural evidence is objective.
- X-rays, casts, models, tomograms
Functional evidence is usually ignored, or referred out.
- sEMG, TMJ Bite Muscle Analysis, Etc
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STRUCTURAL EVIDENCE:- This is the Outer
Smile
FUNCTIONAL EVIDENCE:- This is the Inner
Smile. InnerSmile Pro ©
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* If the Matrix is Neutral, you will see balanced clench and swallow.
‘OUTER SMILES’are static, teeth-based smiles.They may be genuine smiles or superficial smiles or spontaneous or posed smiles.
‘INNER SMILES’are much different. They are really Gugino’s Functional Matrix.
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KEY POINTS:
1. FUNCTIONAL ESTHETICS & Inner SmileTo neutralize the functional matrix, enhance esthetics
2. CORRECTIVE ORTHO & Inner Smile To neutralize (train) Breathing/Swallowing
To neutralize (train)Muscle To neutralize (train)Posture
How can you neutralize what you can't evaluate?
INNER SMILE >ZeroBase Evaluation
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INNER SMILE> ZeroBase Evaluation
KEY POINTS:
3. PREVENTATIVE ORTHO & Inner SmileDynamic sEMG shoud be done on every patient.
A new Dynamic sEMG should be taken for every re-evaluation
Why?The Functional Matrix is also Dynamic.
InnerSmile Pro ©
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1. Breathing / Swallowing
2. Muscles
3. Posture
4. Elimination of Habits
FUNCTIONAL MATRIXNeutral Zone
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* However if your patient's inner smile [Functional Matrix] is not within the neutral zone, how do you communicate this to the patient?The purpose of this talk is to show how to use the sEMG scanner to communicate whether the inner smile is in the neutral zone.
You can communicate a good outer smile to a patient.
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sEMG BACKGROUND
“What is it and why should I care?”
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History of Oral Muscle
AssessmentBEFORE COMPUTERS -
PALPATION
Done by touch alone.
Interpretation is subjective
You cannot communicate visually.
No objective comparison in possible.
WITH COMPUTERS TODAY-
DYNAMIC MUSCLE ASSESSMENT
Rest-Squeeze-Rest – objective report.
[Our current talk]
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Where? How?
Time per muscle?Make Report?
Time per muscle?Make Report?
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Commercial dynamic muscle evaluation
devices: Are big. Cost a lot of money. Require at least 30 minutes. Are done by a tech with specialized training. Rarely does more than assess simple muscle timing.
*Usually restricted to TMJ.-
Evolution of Dynamic sEMG
Assessment
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3 minute scan:Quick Masseter-Digastric sEMG Evaluation
5 minute scan: Full Head-Neck sEMG Evaluation
TWO LEVELS OF PROCEDURES
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Let’s look at the 3 minute Scan.
We will start with: The Masseter pair Digrastric contractions
... next
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3 minute: Masseter-Digastric sEMG
Evaluation
Left Masseter Right Masseter
Digastic
Results look like this… NEXT
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RESULTS !
“Finally!”
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Left MasseterRight Masseter
Digastric Digastric
Amplitude is in
microvolts
3 minute: Masseter-Digastric sEMG
Evaluation
Clench Clench Swallo
w
Clench
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INTERPRETATION
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“I thought we'd talk about results first!”
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MUSCLE PATTERNS
◦ So, how do you evaluate this
basic sEMG muscle pattern?
There are 5 elements to the sEMG
muscle pattern :
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The five elements in dynamic
muscle evaluation are :1. Resting Muscle Pattern
2. Initial Contraction Pattern
3. Sustained Contraction
Pattern
4. Release Pattern
5. Post-Contraction Pattern
MUSCLE PATTERNS
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HEALTHY PATTERN
RECOVERY:
RETURNS to BASELINEBASELINE
CLENCH
MAINTAIN CLENCH
RELAX
KEY POINTS:
AMPLITUDE LARGE
RECOVERY FAST
MUSCLE PATTERNS
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BRACING AND GUARDING indicates
the muscle is damaged.
How is this determined?
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BRACING & GUARDING
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BASELIN
E
CLENCH
MAINTAIN
CLENCH
RELAX
LATENCY TO
RECOVER
Look
here
UNHEALTHY MUSCLES SHOW #1 - “POOR RELEASE”
RECOVERY:
RETURNS to BASELINEBASELINE
CLENCH
MAINTAIN CLENCH
RELAX
MUSCLE PATTERNS
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BASELINE
CLENCH
MAINTAIN
CLENCH
RELAX
DESCENT
NOTCH
This is what we refer to as a
DESCENT NOTCH
in the release or latency to
return.
Release is slowed.
This is due to bracing
or guarding.
Difficult to return
to baseline
UNHEALTHY MUSCLES SHOW #2 - “POOR RELEASE”
MUSCLE PATTERNS
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sEMG patterns are revealed by movement.
Clench reveals the strength of muscle
activity.
Recovery reveals bracing and guarding.
BRACING AND GUARDING indicates the
muscle may be damaged.
NEXT…
KEY POINTS ABOUT MUSCLES
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MUSCLE BALANCE - CLENCH
Ideally both sides contract equally during a
CLENCH.
So how would this look?
NEXT
SLIDE…
Left Masseter Right Masseter
MASSETER PATTERNS
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HEALTHY MUSCLE PATTERNS
Balanced Clench and Release
Pattern
Left Masseter Right Masseter
In Balance
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MUSCLE ASSYMETRIES - CLENCH
An ideal clench shows balanced
masseters.
Unhealthy patterns are not balanced
during a
clench.
So how would this look?
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SLIDE…
MASSETER PATTERNS
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MASSETER PATTERNS
Asymmetrical Clench and Release Pattern 1
Left Masseter Right Masseter
Left Dominant
UNHEALTHY MUSCLE PATTERNS
6/18/12 InnerSmile Pro ©Left Masseter Right Masseter
Right
Dominant
MASSETER PATTERNS
Asymmetrical Clench and Release Pattern 2
UNHEALTHY MUSCLE PATTERNS
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An ideal clench shows strong
masseters.
Unhealthy patterns also show little
masseter
activity during a clench.
So how would this look?
NEXT SLIDE…
MUSCLE WEAKNESS - CLENCHMASSETER PATTERNS
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MASSETER PATTERNS
Weak Clench and Release Pattern
Left Masseter Right Masseter
Weak Contact
UNHEALTHY MUSCLE PATTERNS
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“I get it. Masseters control the bite. So we don't need to worry about other muscles, eh?”
Well, sometimes a little knowledge is a dangerous thing.
Let's at least include the Anterior Temporalis. OK?
NEXT...
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MUSCLE INTERACTIONS - CLENCHANT. TEMP. PATTERNS
What about the antiorior temporalis
contraction pattern?
An ideal clench shows balanced masseters and
temporales.
So how would this look?
NEXT
SLIDE…
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BITE PATTERNS
Ideal Clench and Release Pattern
HEALTHY INTERACTION PATTERNS
Left Masseter Right Masseter
Balanced Masseter Clench
Balanced Temporalis Clench
Left Ant. Temp. Right Ant.
Temp.
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MUSCLE INTERACTIONS - CLENCHBITE PATTERNS
What does this say about contact points?
When the anterior temporales are
dominant, posterior bite problems
dominate. Teeth contact posteriorally.
When the masseters are dominant,
masseter bite
problems dominate. Teeth contact
anteriorally.
So how would this look?
NEXT SLIDE…
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Left Masseter Right Masseter
Masseter
Dominant
Ant. Temp.
SubmissiveLeft Ant. Temp. Right Ant.
Temp.
BITE PATTERNS
Anterior vs Posterior Clench and Release
Pattern
MALOCCLUSION INTERACTION
PATTERNS
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Left Masseter Right Masseter
Masseter
Submissive
Ant. Temp.
Dominant
Left Ant. Temp. Right Ant.
Temp.
BITE PATTERNS
Anterior vs Posterior Clench and Release
Pattern
MALOCCLUSION INTERACTION
PATTERNS
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MORE RESULTS
'It's about time … again!”
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NOW REORGANIZED AS....
1 2
3 4
1 2 3 4
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Clench
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Clench
Anterior Temporalis
Right Side > Left Side
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Clench Masseters
Right Side > Left Side
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Anterior TemporalisRight Side > Left Side
MassetersRight Side > Left Side
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Instant Replay:
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“Muscle Asymmetry is shown by comparing muscle pairs.”
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“OK. But is it IMPORTANT?”
Yes, it sets practical functional treatment plans.
But …If you can't communicate it, don't do it.
Ask another question:
“Are asymmetries always the same?”
Humm. Take a look at the next slide.
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Masseter M.Right Side > Left SideLeft Side > Right Side
Anterior TemporalisRight Side >Left Side
MassetersLeft Side> Right Side
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Next….
WHAT ABOUT THIS
PATTERN?
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Right Temporalis Muscle
Remains active at rest
Very little amplitude during clench.
Digastric m. also low, until swallow ->
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A simple 3 or 5 minute exam provides
objective
information about stability of the jaw in
action.
A simple clench-release test tells you about
soft-tissues:
1. Does a clench favor one side over the other during a
clench?
2. Does a clench show dominance of the anterior
temporales?
3. or do the masseters dominate?
4. Is the clench stable?
NEXT …
SUMMARYOF BITE
ANALYSIS MUSCLE INTERACTIONS - CLENCH
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“That's hard to swallow!”
TONGUE SCAN EVALUATIONS
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REMEMBER: The task is a clench and a
swallow.
So how would this look?
NEXT SLIDE..
SWALLOWCLENCH
DIGASTRIC MUSCLE SCANS
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Ideal Digastric Muscle
Scans
SWALLO
W
CLENCH
DIGASTRIC MUSCLE SCANS
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CLEN
CH
Contracts during clench [bad]
Contracts during the swallow
[good].
Unhealthy Digastric Activity
SW
ALLO
W
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“So what. I don't understand!”
That's because no one looked at digastrics in this manner.People who contract the digastric muscle while clenching the
masseters need a full swallowing analysis.
Usually they have an undiagnosed breathing-swallowing problem.
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The 5 Minute Scan adds the
CPS
muscle pairs.
The 7 Minute scan that will
adds CPS and SCM
muscle pairs.
Use this before those big
'TMJ' machines costing.
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5 minute:Head-Neck sEMG
Evaluation
Left Masseter Right Masseter
Left Ant. Temp. Right Ant.
Temp.
Left CPS Right CPS
Digastic
Results look like this… NEXT
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5 minute:Head-Neck sEMG
Evaluation
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PART 2-Beyond sEMG
Amplitude
With today’s computers,
you can see more than the
amplitude of a muscle.
NEXT…
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Subjective Pain or Discomfort◦ Detects and recorded pain spots
Muscle Fatigue Signal:Mean-Median sEMG in Frequency [Hz]
◦ Detects local muscle fatigue
Microbreaks in Responses/min◦ Index of muscle health at rest
Other sEMG Signals :
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PAIN GRAPH
Patients rate their pain level (from
0-10) in the areas that are scanned.
THE PAIN LINK
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The Mean and Median Frequency [Hz] is
dynamic. - An inversion of frequencies =
Local Muscle Fatigue
But what does that mean?
MUSCLE FATIGUE
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EXAMPLE OF
INVERSION
Inversio
n or
Local
Fatigue
Spectral
Mean-
Median
wave
colors
INVERT at
fatigue
point. InnerSmile Pro ©
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MICRO BREAKS
Hold in full
tension
Technical : Microbreaks are related to Muscle Spindle
looping – like an auto-reset on the computer to keep it
clear under load.
Healthy Muscles show ‘microbreaks’ –
Split second gaps in contraction that allow blood flow, and sustained endurance.
MICROBREAK
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MICRO BREAKS :
Micro breaks in Responses/min
• This allows you to see if muscles are
healthy, if they have split second gaps in
contraction that allow blood flow, and
sustained endurance.
MICRO
BREAKS
Hold in full
tension
MICROBREAK
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FULL SCAN PROFILE
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Dynamic Oral Muscle
AssessmentWITH COMPUTERS TODAY- DYNAMIC MUSCLE ASSESSMENT
YOU CAN COMMUNICATE VISUALLY
• BEFORE AND AFTER TRAINING - VISUAL REPORT
• SEE THAT YOUR TRAINING GOALS ARE MET
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In Summary,
Dynamic Muscle Scanning
provides rapid, objective
detection of soft-tissue
issues and can help you
bring out your patient's
true inner smile. InnerSmile Pro ©
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Bring out their InnerSmile
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fin