Hi,

Could you please help me with a clinical guideline to using the Aqualizer when the occlusion is constant changing because of muscular problems? After having seen the seminar on Occlusal positions, I have tried to implement the Aqualizer as a part of a diagnostic tool at my clinic, but I'm not sure how the procedure exactly should be.

How long should the patients use the Aqualizer, and do you recommend a permanent splint or other device for the group of patients after using treating the patient?

Currently I have two patients with muscular problems and changing bite, and I would be very thank full if you could recommend how to use the Aqualizer in these cases.

Patient nr 1 has had problems with her changing bite for the past 3 years, after her old dentist made her af new bridge. After this restoration, she has had many appointments at her dentists office, correcting her bite on several different teeth. She still didn't feel that her bite felt right when she saw me.

She is currently using the Aqualizer, following the instructions that came with the Aqualizer, I told her to use it 3 days before the next consultation as much as possible.

At the consultation 3 days later, she was very exited about using the Aqualizer, and she did feel her bite getting better, but she still felt that is was changing but not as much as before. Since she's been having this problem for the past 3 years, maybe 3 days with the Aqualizer is not enough to make the muscles relax? So I told her to use it for the next month, and then see me again. I did choose to use the leaf gauge at this consultation to look for any interferences in the bite, and I did find interferences and made some small adjustments.

But I'm a little confused about for how long she should be using the Aqualizer, and is it okay for me to do occlusal adjustments with the leaf gauge so early in the process not really knowing if the muscles still are interfering with the bite. Is it possible to check for this without using the Lucia jig, or should this always be a standard check up after using the Aqualizer? I still don't have the Lucia Jigg at my office, because of temporary problems with ordering the product.

Patient nr 2: Has been to Turkey 5 years ago, and got some very poor fitting metal-ceramic crowns made i the molar region primarily in her left side . The patient herself didn't experience any problems with her bite after these restorations were made, even though the quality of the work is some of the worst I have ever seen. 1 year after the crowns were made, the patient was in a car accident, where she got her head banged in to a car seat. After this accident she experienced her bite starting to change, getting worse over time.

I saw this patient in my practice for the first time a year ago. When she came she had a lateral open bite in her right side about 2 mm big, looking at the wear facets I could see that she earlier had had full occlusion on her right side.

My first assumption was the maybe she had had a condyle fracture, so I referred her to a oral surgeon who concluded that there was no fracture. The conclusion was that the changing bite was due to the restorations made in Turkey. The patient was confused about this, because the problems with her bite first appeared after the car accident 1 year after the crowns were made. And her economy didn't allow her to make new crowns right away.

Then she got pregnant, and cancelled her appointments at my practice. I just saw her again recently, and now she feels her bite is better, but still not good enough. Her lateral open bite is now app. 1/2-1 mm, and I have made no corrections prior to this.

I'm seeing this patient next week, and are planning to let her use the Aqualizer. For how long would you recommend this patient to use the Aqualizer? I don't know if she'll let me do the new crowns in stead of the Turkish ones, but before I dare to do any crowns, I need her bite to be stable. When her muscles are not longer a problem I will try to adjust her bite in to occlusion, and when I can see an occlusion in function over some time, I can recommend her getting the Turkish crowns replaced. Is this a correct procedure with a patient like this?

Thank you for taking your time to answer.

Kind regards

Kathrine Kjær