Joint Vibration Analysis (JVA)

2. Joint Vibration Analysis (JVA) Fast, Non-invasive recording of vibrations that occur in the TMJ during movement or loading. JVA can give the clinician a detailed description of TMJ function prior to appliance therapy and can be used to test the appliance’s impact on TMJ health, prior to splint production.

3. “All occlusal analysis starts with the temporomandibular joints (TMJs).” Dr. Peter Dawson Functional Occlusion: From TMJ to Smile Design Page 33

4. Dr. Jim Carlson “A comprehensive occlusal analysis includes the thorough evaluation of … the anatomical form and position of the condyles and articular eminence and function of the temporomandibular joints.” Occlusal Diagnosis 2004

5. Joint Vibration Analysis • 3 minute • Non-invasive • Accurate • Objective • No recording of room noise (sounds) • ADA Accepted

6. How Does It Work?

7. JVA Operates on a very simple principle of motion and friction

9. Joint Vibration Analysis (JVA) Each TMD pathology creates it’s own unique vibrationSignature.

10. Normal TMJ - JVA Trace

11. Joint Vibration Analysis (JVA) Each TMD pathology creates it’s own unique vibrationSignature.

12. JVA Trace showing Antero-Medial Disk Displacement w/ Reduction

13. Joint Vibration Analysis (JVA) Each TMD pathology creates it’s own unique vibrationSignature.

14. Joint Vibration Analysis (JVA) Each TMD pathology creates it’s own unique vibrationSignature.

15. JVA’s Office Impact • 10 second screening test • 2 minutes to interpret • Generates income via insurance reimbursement • Puts you in control of pt. joint health • Allows you to assess the potential for success with your appliance or bite position.

16. JVA’s Office Impact • 10 second screening test • 2 minutes to interpret • Generates income via insurance reimbursement • Puts you in control of pt. joint health • Allows you to assess the potential for success with your appliance or bite position.

17. JVA’s Office Impact TMJ condition today in 1 min 5 minutes 5 years of history Creates complete care conversation Like attracts like Honest risk assessment

18. Normal TMJ’s In their proper relationship, the condyle of the TMJ rests centrally in the fossa with the disk attached superior and slightly anterior to the head of the condyle. As the patient opens their mouth, the condyle simultaneously rotates and translates. The disk remains between the condyle and eminence to protect and cushion the bony structures. This movement creates very little friction/vibration Video Courtesy of Palla et. al.

19. TMJ Pathology There are many pathologies of the TMJ. These can include ligament injuries, displaced or moving disks, perforations, and degeneration.

20. The Piper Protocol

21. Diagnostic Modalities • Subjective Modalities Accuracy • 50% Patient report** • 49% Palpation* • 46% Doppler * • 43.8% Auscultation* • 14% Clinician Agreement*** * Brooks, C.P.: Joint Vibration Analysis in 314 Patients Presenting with TM Dysfunction: Correlation with Clinical and Tomographic Data. Presentation, 8th International Congress, International College of Craniomandibular Orthopedics. Banff, Alberta, Canada, October 1993. **Christensen, L.V., Donegan S.J., McKay, D.C.: Temporomandibular Joint Vibration Analysis in a Sample of Non-Patients.J Craniomandib Prac, 1992, Vol. 10; 35-41 ***Eriksson, L., Westesson, P-L., Sjobert, H.: Observer Performance in Describing Temporomandibular Joint Sounds.J Craniomadib Prac 1987;5:32-35

22. Diagnostic Modalities • Objective Modalities Accuracy • Joint Vibration Analysis • 100% Mensical Perforations** • 100.0 % Meniscal Displacement with Degenerative Joint Disease** • 96.60% Early Meniscal Displacement w Reduction* • 91.80% Late Meniscal Displacement w Reduction* • 87.00% Meniscal Displacement with Perforation** • 88.90% Mensical Displacement w/ DJD and Perforation** *Ishigaki, S., Bessette, R.W., Maruyama, T. Vibration Analysis of the Temporomandibular Joints with Meniscal Displacement With and Without Reduction. J Craniomandib Prac, 1993, Vol. 11 Number 3; 192-201. **Ishigaki, S., Bessette, R.W., Maruyama, T. Vibration Analysis of the Temporomandibular Joints with Degenerative Joint Disease. J Craniomandib Prac, 1993, Vol. 11 Number 4; 276-283.

23. JVA interpretation made easy. The following 6 questions and flow chart can be used to quickly and easily transform the numeric measurements of a vibration into an indication of the pathology that could be the cause of the vibration.

24. Piper Protocol Questionaire • What is ROM of patient?  (Slant, lateral and protrusive)  Less than 40 mm for Females or 42 mm for males is restrictive. • Is there a lateral deflection > 3 mm on opening?   If so, it should coincide with a reduced lateral ROM to the opposite side. • Is there a visibly obvious facial asymmetry?  (skeletal mid-line mal-alignment)  This can result from an injury during growth. • Does the patient report a history of joint injury, noise, pain or locking or have any current joint discomfort?  (Acuteness Vs Chronicity) • What is the age of the patient?  (Since an older patient's joint condition is more likely to be stable, a younger patient's more likely to be progressive, this bit of information will alter the prognosis) • Has the patient received previous treatment(s) for joint problem(s)?  (If so, what and when?)  Patients with previous joint surgery will have conditions (like adhesions) that are not associated with untreated joints.

26. JVA interpretation made simple X Right Joint X Left Joint x x x x x x x Use the enclosed flow charts to interpret the following JVA Traces.

27. Your Patient’s ATM status today

28. Your Patients ATM status in 2009

29. Your Patient’s ATM status 2009

30. Trace 4

31. Trace 5

32. Staff Friendly data aquisition • Fast and Easy: The average staff person can be trained to take quality Joint Vibration Analysis date in less than 15 minutes. • The procedure is extremely simple. • Place the headset over the TM joints • Record and enter range of motion • Record and enter lateral deflection at maximum opening • have patient open and close in time with the animated face • accept trace • save

33. The one and only JVA BioRESEARCH Assoc. Inc. of Milwaukee WI is the only company to design and build a JVA system for the measurement of vibrations emanating from human joints. No other company in the world designs an EVG Joint Vibration Analysis unit. Several companies have attempted to compete by making ESG or Electrosonography units.

34. Measurement in Paschals: • Ensures that JVA is recording the pressure wave (tissue borne vibration) emanating from the joint. Its symbol is “Pa” which is the International Standard unit of pressure. It is equivalent to one Newton per square meter. • Relationship of Paschals to other units of pressure: • 1 bar = 100,000Pa • 1 Barye = 0.1Pa • 1 millibar =100Pa • 1 atmosphere = 101,325 Pa • 1 mmhg = 133.322 Pa

35. Electrosonography ESG: • ESG systems do not use a measurement of pressure but rather use the microvoltage from a microphone equivalent to an EMG signal. • There is no known relationship between microvots and newtons per square meter.

36. Sonography Sensor Design A Sonography Sensor is made of a microphone behind a plastic membrane. This design reduces microphone sensitivity to tissue borne vibrations and increases recording of room noise.

37. Joint Vibration Analysis(sensor design) A Vibration Transducer (pressure wave sensor) is imbedded in silicone. This design increases sensitivity to joint vibrations, and reduces room noise interference.

38. Vibrations must be very strong to be recorded by sonography When a vibration occurs in the TMJ, it must be strong enough to create a pressure wave that will transmit to the air in the sensor and make it to the microphone.

39. JVA Records the most subtle vibrations. The silicone in the JVA sensor transmits the vibration directly from the flesh to the accelerometer and allows you to record the pressure wave created by the joint vibration.

40. Sonography records room sounds Because the microphone is designed to record room sounds, sonography is hampered by the fact that it records air borne vibrations. (room sounds)

41. JVA Reflects room sounds The JVA accelerometer is buried in silicone, that reflects the vibrations that occur in the thin medium of the air. JVA can be used with out interference from room sounds!

42. Thank You! 1-800-251-2315 www.BioRESEARCHinc.com