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

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 ......

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.

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

sEMG SINGLE CHANNEL HAND SCANNER

Simple Muscle Evaluation for Awareness Training

Single Channel sEMG Unit Zerobase Dynamic sEMG

InnerSmile Pro ©

This devise can be used alone.

Or as a screening devise for...

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

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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.”

• 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

FUNCTIONAL EVIDENCE:- This is the Inner

Smile. InnerSmile Pro ©

* 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.

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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?”

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?

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

RESULTS !

“Finally!”

Left MasseterRight Masseter

Digastric Digastric

Amplitude is in

microvolts

3 minute: Masseter-Digastric sEMG

Evaluation

Clench Clench Swallo

Clench

INTERPRETATION

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“I thought we'd talk about results first!”

MUSCLE PATTERNS

◦ So, how do you evaluate this

basic sEMG muscle pattern?

There are 5 elements to the sEMG

muscle pattern :

NEXT…

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

KEY POINTS:

AMPLITUDE LARGE

RECOVERY FAST

MUSCLE PATTERNS

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BRACING AND GUARDING indicates

the muscle is damaged.

How is this determined?

NEXT…

BRACING & GUARDING

BASELIN

CLENCH

MAINTAIN

CLENCH

LATENCY TO

RECOVER

UNHEALTHY MUSCLES SHOW #1 - “POOR RELEASE”

RECOVERY:

RETURNS to BASELINEBASELINE

CLENCH

MAINTAIN CLENCH

MUSCLE PATTERNS

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BASELINE

CLENCH

MAINTAIN

CLENCH

DESCENT

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

MUSCLE BALANCE - CLENCH

Ideally both sides contract equally during a

CLENCH.

So how would this look?

SLIDE…

MASSETER PATTERNS

HEALTHY MUSCLE PATTERNS

Balanced Clench and Release

Pattern

In Balance

MUSCLE ASSYMETRIES - CLENCH

An ideal clench shows balanced

masseters.

Unhealthy patterns are not balanced

during a

clench.

SLIDE…

MASSETER PATTERNS

Asymmetrical Clench and Release Pattern 1

Left Dominant

UNHEALTHY MUSCLE PATTERNS

6/18/12 InnerSmile Pro ©Left Masseter Right Masseter

Dominant

MASSETER PATTERNS

Asymmetrical Clench and Release Pattern 2

An ideal clench shows strong

masseters.

Unhealthy patterns also show little

masseter

activity during a clench.

NEXT SLIDE…

MUSCLE WEAKNESS - CLENCHMASSETER PATTERNS

MASSETER PATTERNS

Weak Clench and Release Pattern

Weak Contact

“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...

MUSCLE INTERACTIONS - CLENCHANT. TEMP. PATTERNS

What about the antiorior temporalis

contraction pattern?

An ideal clench shows balanced masseters and

temporales.

SLIDE…

BITE PATTERNS

Ideal Clench and Release Pattern

HEALTHY INTERACTION PATTERNS

Balanced Masseter Clench

Balanced Temporalis Clench

Left Ant. Temp. Right Ant.

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.

NEXT SLIDE…

Masseter

Dominant

Ant. Temp.

SubmissiveLeft Ant. Temp. Right Ant.

BITE PATTERNS

Anterior vs Posterior Clench and Release

Pattern

MALOCCLUSION INTERACTION

PATTERNS

Masseter

Submissive

Ant. Temp.

Dominant

BITE PATTERNS

Anterior vs Posterior Clench and Release

Pattern

MALOCCLUSION INTERACTION

PATTERNS

MORE RESULTS

'It's about time … again!”

NOW REORGANIZED AS....

1 2 3 4

Clench

Anterior Temporalis

Right Side > Left Side

Clench Masseters

Right Side > Left Side

Anterior TemporalisRight Side > Left Side

MassetersRight Side > Left Side

Instant Replay:

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“Muscle Asymmetry is shown by comparing muscle pairs.”

“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.

Masseter M.Right Side > Left SideLeft Side > Right Side

Anterior TemporalisRight Side >Left Side

MassetersLeft Side> Right Side

Next….

WHAT ABOUT THIS

PATTERN?

Right Temporalis Muscle

Remains active at rest

Very little amplitude during clench.

Digastric m. also low, until swallow ->

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

“That's hard to swallow!”

TONGUE SCAN EVALUATIONS

REMEMBER: The task is a clench and a

swallow.

NEXT SLIDE..

SWALLOWCLENCH

DIGASTRIC MUSCLE SCANS

Ideal Digastric Muscle

SWALLO

CLENCH

DIGASTRIC MUSCLE SCANS

Contracts during clench [bad]

Contracts during the swallow

[good].

Unhealthy Digastric Activity

“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.

The 5 Minute Scan adds the

muscle pairs.

The 7 Minute scan that will

adds CPS and SCM

muscle pairs.

Use this before those big

'TMJ' machines costing.

5 minute:Head-Neck sEMG

Evaluation

Left CPS Right CPS

Digastic

Results look like this… NEXT

5 minute:Head-Neck sEMG

Evaluation

PART 2-Beyond sEMG

Amplitude

With today’s computers,

you can see more than the

amplitude of a muscle.

NEXT…

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 :

PAIN GRAPH

Patients rate their pain level (from

0-10) in the areas that are scanned.

THE PAIN LINK

The Mean and Median Frequency [Hz] is

dynamic. - An inversion of frequencies =

Local Muscle Fatigue

But what does that mean?

MUSCLE FATIGUE

EXAMPLE OF

INVERSION

Inversio

Fatigue

Spectral

Median

colors

INVERT at

fatigue

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

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.

BREAKS

Hold in full

tension

MICROBREAK

FULL SCAN PROFILE

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

In Summary,

Dynamic Muscle Scanning

provides rapid, objective

detection of soft-tissue

issues and can help you

bring out your patient's

Bring out their InnerSmile

6/18/12 InnerSmile Pro © Zerobase Dynamic sEMG InnerSmile Pro Single Track Muscle Scanner ©

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