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THOMAS E. BRAMANTI, DDS, PHD, INC
5660 N. Fresno Suite 110
Fresno, CA 93710
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“Chronic Pain / TMJ Dysfunction therapy requires time, patience, and care.”
Dr. Bramanti will discuss your TMJ diagnosis and review possible options to treat your TMJ Disorder after a thorough clinical evaluation and consultation.
During the consultation, Dr. Bramanti will recommend taking jaw relation and bite records, and he may order a Cone Beam CAT Scan of your jaws, jaw joints, airway and neck to assist in any diagnosis and identify any arthritic and/or degenerative bone disease of the TMJs. An MRI analysis of the TMJs may also be ordered by Dr. Bramanti to assess any degenerative disease of the TMJ disc, capsule and associated soft tissues and muscles. Dr. Bramanti will meet with you again to discuss his radiographic and/or MRI findings, to review his diagnosis and treatment recommendations.
1. Functional Bite Analysis
A 1 hour appointment to take diagnostic jaw relation records and a bite registration. The records taken will be mounted on a jaw simulator to assess the unevenness of the bite, wearing of the teeth, and potential areas of strain that may be occurring in clenching, grinding and chewing.
2. TMJ Orthopedic Appliance Insertion
A 1 hour appointment that will balance your new orthotic appliance to your bite. Full time wear of the orthopedic appliance helps reduce strain in the teeth, jaw and neck, day and night. This provides full time relief from many TMJ Disorder signs and symptoms. This orthopedic appliance will provide a balance in your bite and improve the biomechanical strains for the full 24 hours of the day. The orthopedic appliance will usually last 2-3 years before it may need replacement.
3. Follow Up care (20 minute appointment)
As your jaw structure and position begins heal and improve its function and balance, and as your posture improves, adjustments to your orthopedic appliance will be required every 2-4 weeks. These functional orthopedic adjustments will continue to provide balanced support to promote healing of the TMJs, disc, intracapsular soft tissues, muscles and most importantly, alleviate your pain and suffering. Typically most TMJ Disorder sufferers will find the greatest dental improvement to be in the first 2-3 months.
Healing TMJ disorder with a customized dental orthopedic appliance
The custom-made dental TMJ orthopedic appliance utilized by Dr. Bramanti, rebalances the upper and lower jaw position to your improved posture. Your bite will be balanced on the orthopedic appliance which will correct the discrepancy between your lower and upper jaws’ function. The TMJ orthopedic appliance is an effective, non-surgical method of balancing jaw function, healing the masticatory system, improving postural compensations, reduce dizziness and tinnitus, and increasing the range of motion and function of the bite.
Goal of TMJ therapy
Your TMJ disorder and your misaligned bite (occlusion) are not isolated to your head and jaws. Accommodation to an imbalanced occlusion travels down as far as your feet.
How you bite is important to the overall balance of your body. Alterations in your bite has effects that travel throughout the structural chain of your entire body. Studies show that the force and timing of your bite will alter how your head and neck align. Dr. Bramanti will address the TMJ Disorder contributions to your structural chain.
The TMJ Therapy process
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Curtis D. Westersund, Jeffrey Scholten & Raymond J. Turner.2017. Relationship between craniocervical orientation and center of force of occlusion in adults. CRANIO. 35(5):283-289
Ramirez-Yanez GO, Mehta L, Mehta NR. 2015.The effect of dental occlusal disturbances on the curvature of the vertebral spine in rats. Cranio. 2015 Jul;33(3):217-27.
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Karolina Walczyńska-Dragon, Stefan Baron, Aleksandra Nitecka-Buchta, and Ewaryst Tkacz. 2014.“Correlation between TMD and Cervical Spine Pain and Mobility: Is the Whole Body Balance TMJ Related?,” BioMed Research International. vol. 2014, Article ID 582414, 7 pages, 2014. doi:10.1155/2014/582414
Cuccia A, Caradonna C. The Relationship Between the Stomatognathic System and Body Posture.2009. Clinics (Sao Paulo, Brazil). 64(1):61-66. doi:10.1590/S1807-59322009000100011.
Yamaga T1, Yoshihara A, Ando Y, Yoshitake Y, Kimura Y, Shimada M, Nishimuta M, Miyazaki H. 2002. Relationship between dental occlusion and physical fitness in an elderly population. J Gerontol A Biol Sci Med Sci. 57(9):M616-20.
Haralur S, Al-Gadhaan S, Al-Qahtani A, Mossa A, Al-Shehri W, Addas M. 2014. Influence of Functional Head Postures on the Dynamic Functional Occlusal Parameters. Annals of Medical and Health Sciences Research.4(4):562-566. doi:10.4103/2141-9248.139319.
Thomas E. Bramanti, D.D.S., Ph.D.
Board-Certified Diplomate American Board of Periodontology/Implant Dentistry
Board-Certified Diplomate American Board of Oral Implantology/Implant Dentistry
Certified TMJ Expert, The Pankey Institute
Fellow American Academy of Implant Dentistry
Clinical Assistant Professor at UCSF in the Department of Oral and Maxillofacial Surgery
Clinical Assistant Professor UCSF-Fresno Medical Education Program, School of Medicine
Simply put, the goal of therapy is to make YOU the best YOU that YOU can be. It may mean that there is compete recovery, or if there is damage to the TMJs and disc, it may mean there is only a partial recovery. Either way, strain imposed on your bite system resulting in your painful symptoms and headaches will significantly improve along with your posture and mobility.
The goal of the dental TMJ orthopedic appliance treatment is to determine where your jaws, joints and muscles best function in a balanced way, and to identify what healthy function looks like for you. Stability with the TMJ and the body posture is also a good measurement of recovery.
Neck stability and neck freedom, being able to open and close your mouth more evenly, having less pain or headaches are all common goals of this course of orthopedic therapy. It is important to understand that many TMJ problems are years in the making and the resulting damage may only be able to be slowed or controlled depending on the longstanding chronicity of the pain and the extent of damage to hard and soft tissues of the TMJ.
How long does TMJ therapy take?
The initial stage of TMJ treatment can range due to various levels of complexity. Once your TMJ condition is diagnosed, treatment can be planned and discussed. Simple treatment may last only for 4-6 months. But more complex TMD therapy may be ongoing for several months longer or over a year as the inflammation and tension reduces. Understand that since everyone is unique, response to TMJ Treatments will also be unique. Treatments will vary in need and timing.
Some patients may not be able to achieve full recovery due to the length of time the TMJ disorder has been present, or the intensity and damage of the TMJ injury that has occurred.
There are typically two phases of TMD Disorder treatment:
Phase 1: Stability
Diagnosing the scope of the TMJ Disorder and providing orthopedic therapy and referrals (physical therapy, neurologist if needed) to improve stability to improve body function. Some patients require other dental professionals and/or specialists for further care. TMJ Surgery is a very uncommon outcome for treatment but cannot always be ruled out as an option. Of course, all treatments and their risks and potential needs will be discussed during your course of TMJ treatment.
Once you have reached an improved and functionally stable point in treatment, future Phase 2 treatment can be discussed and coordinated.
Phase 2: Final Care and Bite Equilibration
Following stability and recovery from the first phase of therapy, a second phase can begin. Options for final care come after stability has been maximized and a healthier state has been established with the reduction or elimination of headaches, joint problems, facial pain and attenuation of arthritic disorders. The expectation is that your headaches, jaw function and quality of life will significantly improve. The options for Phase 2 will be tailored to developing a stable and balanced health on your teeth, instead of just relying on the orthopedic appliance.
Depending on the crowding or misalignment of your teeth, plans to equilibrate a stable and balanced bite function on the teeth may not be possible. Orthodontic care may need to be considered to create the proper tooth alignment and functional adjustments. Orthodontic treatment can facilitate the development of a stable functional plane in the teeth where the upper and lower jaws come together in contact with each other.
Restorative dentistry may also be an option to provide a stable equilibrium in bite function using composite fillings, crowns, veneers or just simple reshaping of the tooth enamel. Some people have, over time, severely worn or damaged their teeth and Orthodontic care may not be a viable option. Restorative dentistry can often offer a better solution. Various levels of treatment that best serve your health needs will be discussed with Dr. Bramanti. Some patients will require a combination of the above treatments, depending upon their desires and choices, but the main goal is the same, to maintain jaw balance and health to improve TMJ Disorder signs and symptoms throughout the course of your lifetime. There are many options that Dr. Bramanti may tailor to your specific TMJ therapy and treatment.
Call today to schedule a consultation with Dr. Bramanti, your Board-Certified TMJ Dental Specialist, to explore opportunities for how you may regain your health.
Thomas E. Bramanti, D.D.S., Ph.D., is a Board-Certified TMJ Expert.
Dr. Bramanti is the recognized expert in the Central Valley for treatment of TMJ Disorders. He provides complete diagnosis and relief for all types of TMJ dysfunction, muscle and facial pain, and amazing headache relief.
Dr. Bramanti has established premier practice and prestigious academic career providing the best care available for TMJ Disorders.
Dr. Bramanti is a Clinical Assistant Professor in Oral and Maxillofacial Surgery at the University of California San Francisco (UCSF). With unmatched expertise, Dr. Bramanti brings clinical and academic skillsets that offer the most advanced and comprehensive TMJ treatment options that exist today.
Dr. Bramanti is uniquely trained to diagnose and treat a wide variety of TMJ Disorders, headaches and migraines, facial pain and postural changes. His expertise encompasses routine and advanced scopes of therapies to bring pain relief and health to your condition.
Dr. Bramanti makes it his priority to ensure that you are fully informed, have been given the full spectrum of treatment choices, and that you understand your treatment plan and follow-up care. Dr. Bramanti will outline all the treatment options available in a way that you can understand, and take the time necessary to answer any questions so you can make your TMJ treatment decisions with confidence. His focus is on clarity of understanding your condition and treatment paths bringing you peace of mind. From your initial consultation to follow-up, Dr. Bramanti is dedicated to your comfort and care.