Method and device for treatment of temporomandibular dysfunction syndrome and facial/dental deformities

5- A surgical method for treating the cranial base to mandibular axis discrepancies in a patient comprising:

• (a) constructing a model of an upper dental arch of the patient with a base, which is parallel on all sides to the upper dental arch model and is delineated with horizontal and vertical reference lines, and a model of a lower dental arch of the patient with a base;
• (b) mounting the upper dental arch to an upper plate with mounting stone of an artificial jaw simulator and mounting the lower dental arch to a lower plate with mounting stone of the artificial jaw simulator such that the true axis of rotation of the temporomandibular joints of the patient with the temporomandibular joints in the stable condylar position has been maintained and wherein the sides of each base is parallel and confluent to the artificial jaw simulator mounting stones;
• (c) determining on the artificial jaw simulator mounted with the upper and lower dental arch models an amount of maxillary bone to be removed from the patient's maxilla in a surgical procedure wherein the maxilla is cut along a transverse plane superior to the maxillary dentition to separate the maxilla into an upper and a lower part which is sufficient to allow a jaw position in the patient when the upper and lower parts are joined after the amount of maxillary bone has been removed wherein the dentition of the patient is re-approximated into a functional bite wherein the anterior maxillary teeth provide anterior guidance of the mandible in excursive movements by contact of the lingual surface of the anterior maxillary teeth with the superior surface of the mandibular anterior teeth while allowing complete disclusion of the posterior maxillary and mandibular teeth during eccentric jaw movements and which at the same time maintains the temporomandibular joints in the stable condylar position;
• (d) constructing a surgical stint of the functional bite in which the temporomandibular joints are in the stable condylar position to act as a guide for relating the maxilla to the mandible during the surgical procedure for removing the amount of maxillary bone from the patient determined in step (c);
• (e) fitting the surgical stint into the mouth of the patient and performing the surgical procedure for removing the amount of maxillary bone from the patient's maxilla determined in step (c);
• and
• (f) immobilizing the patient's jaw following the surgical procedure with the surgical stint fitted to the patient's teeth so as to maintain the functional bite wherein the temporomandibular joints are in the stable condylar position and fixating the patient's mouth shut for a time sufficient for the upper and lower parts of the maxilla to heal, which treats the cranial base to the mandibular axis discrepancies in the temporomandibular joints.

7- A method for stabilizing the condylar positions in the temporomandibular joints of a patient with temporomandibular dysfunction syndrome comprising:

• (a) providing an orthotic to the maxillary teeth of the patient so as to allow full coverage of all the maxillary teeth, wherein the orthotic is designed with an anterior ramp to provide anterior guidance of the patient's mandible in excursive movements by contact of the superior surface of the central and lateral incisors of the patient with a posterior surface of the anterior ramp of the orthotic so as to allow for complete disclusion of the posterior mandibular teeth from the orthotic of the patient during eccentric jaw movements which enables deprogramming the temporomandibular joints into stable condylar position;
• (b) fitting the orthotic into the patient's mouth for a period of time sufficient to deprogram the temporomandibular joints into the stable condylar position;
• (c) modifying the orthotic when needed to maintain complete disclusion of the posterior maxillary and mandibular teeth of the patient during eccentric jaw movements during the period of time for deprogramming the temporomandibular joints into the stable condylar position;
• and
• (d) measuring during the period of time for deprogramming the temporomandibular joints into the stable condylar position pain caused to the patient by the temporomandibular dysfunction, reproducibility of the patient's bite on the orthotic, neuromuscular tension of the patient's facial muscles, and the patient's condylar position indices, wherein the condylar positions in the temporomandibular joints of the patient are determined to be stabilized when the patient is free of the pain and has a reproducible bite on the orthotic, there is complete release of neuromuscular tension whereby the patient's facial muscles upon palpation show no signs of guarding, splinting, or tension, and the patient's condylar position indices are less than about 1 mm.

8- An orthotic for stabilizing the condylar positions in the temporomandibular joints of a patient with temporomandibular dysfunction syndrome comprising a base portion with an upper and a lower surface, an anterior and posterior surface, and having a generally U-shaped plan form and including opposite integrally formed side arms adapted for location between the orthotic and mandibular teeth of the patient, the base having an inner flange along its trailing edge and an outer flange along its leading edge wherein the inner flange and outer flange extend upward from the base so as to form a channel for accepting the maxillary teeth of the patient wherein the bottom surfaces of the maxillary teeth are in contact with the surface of the channel, and wherein the width of the channel is adapted to the width of the maxillary teeth of the patient, and wherein the base has a vertical thickness sufficient that when the maxillary teeth are engaged in the orthotic there is complete disclusion of the posterior maxillary and mandibular teeth during eccentric jaw movements, and wherein the thickness of the base in the position where the anterior maxillary teeth are engaged defines a downwardly extending ramp with anterior and posterior surfaces of sufficient thickness to allow the superior surface of the central and lateral incisors to glide freely along the posterior surface of the ramp to simulate the guidance of normal central and lateral incisors against the lingual surface of normal anterior maxillary teeth in a condition of no wear and normal vertical anatomy and to provide anterior guidance of the patient's mandible in excursive movements by contact of the superior surface of the central and lateral incisors with the posterior surface of the ramp so as place the posterior maxillary and mandibular teeth out of contact.

10- An apparatus for planning a surgical method for treating the cranial base to mandibular axis discrepancies in a patient comprising an artificial jaw simulator including an upper member with a downwardly facing surface and having a pair of spaced sockets at one end, which represent the sockets of the patient's glenoid fossae, pivotally mounted on a pair of spaced spherical styluses, which represent the simulated horizontal or hinge axis of the patient's condyles, on a frame vertically mounted on one end of a lower member with an upwardly facing surface, and a model of an upper dental arch of the patient with a base, which is parallel on all sides to the upper dental arch model and is delineated with horizontal and vertical reference lines, mounted with a separating media to a mounting stone mounted on an upper plate which is mounted to the downwardly facing surface of the upper member of the artificial jaw simulator, and a model of a lower dental arch of the patient mounted on a mounting stone, which is parallel on all sides to the lower dental arch model and is delineated with horizontal and vertical reference lines, mounted using a settable material on a lower plate which is mounted to the upwardly facing surface of the lower member of the artificial jaw simulator, wherein the relative motion between the upper and lower plates with the models mounted thereon is the same as the relative motion between the patient's upper and lower jaws, and wherein the true axis of rotation of the temporomandibular joints of the patient have been maintained.