POISE2
Advanced Practical Occlusal Instrumentation, Splints and Equilibration (POISE2) Clinical Course
6 days (3 weekends) of clinical and hands-on training in a small group (maximum 10 participants)
Course Outline:
This is the course where the skills learned on the first SDS POISE or the BSOS Occlusion in Everyday Practice laboratory based courses are revised and expanded upon, working on your own patients in a supportive and controlled environment as part of a small group of like-minded practitioners.
Hands-on Equilibration
You’ll need to bring along two patients, for whom you will supply and adjust stabilisation splints and later, when their symptoms have resolved, we will help you to achieve a full occlusal equilibration to a “neuro-muscular release”, working with a colleague – this is one of the only courses in the world where you can learn these skills in a clinical way on your own patients, rather than just adjust stone casts.
The Apollonia House dental practice where we run this course is ideally designed with five surgeries in close proximity for this type of teaching.
We will also teach you to deliver a number of alternative appliance designs that will help you to offer appropriate solutions for more demanding cases, you will practice mounting cases, learn to equilibrate stone casts and on the final weekend learn to use the Cadiax electronic pantograph equipment to track TMJ movements in order to be able to programme full adjustable articulators such as the Denar D5a or Prof. R. Slavicek’s Reference SL articulator .
Delegate feedback:
Absolutely brilliant tuition from all tutors involved and this was the best postgraduate course I have done since leaving dental school by miles. My clinical approach to almost every patient has a new and essential dimension.
This has been an extremely motivational experience. I can’t understand how I’ve managed to practice over the last 12 years without the information and experience this course has provided. Why isn’t this part of the undergraduate syllabus??
Thank you, M.C.
POISE2a (2-day Clinical Course)
- Review of optimal occlusion
- Review of TMDQ, leaf gauge, CR records, facebow, cast mounting, verification of 1st prematurity
- Review of Stabilisation Splint (SS) design
- Introduction to SDS Upper SS design, construction and delivery on another participant
- Patient 1 – all records plus delivery of an appropriate Stabilisation Splint
- Mounting Patient 1 casts in CR and verify 1st prematurity
POISE2b (2-day Clinical Course)
- Occlusal Equilibration
- Theoretical basis
- Colouring exercise
- Cast equilibration exercise – Standardised + Patient 1
- Records and appliances for Patient 2
- Equilibrate Patient 1 (working in pairs)
POISE2c (2-day Clinical Course)
- Equilibrate Patient 2
- Cadiax, D5a, Reference SL articulator, etc.
Reference SL articulator
- Tying it all together
- Practice management issues
- Where to next?
Instructors: Dr Andrew Lane, Dr Adrian Bennett and Dr Graham Browning
Venue: Apollonia House, 167 Mossley Rd. Grasscroft, Oldham, OL4 4HA
Dates: Commencing January 2012, approx 6 weeks between each session, please enquire
Cost: £500 (+ VAT) per day inclusive of refreshments and full course notes.
Course fees must be paid in advance by credit/debit card or bank transfer.
A non-refundable deposit of £200 + vat (£240) must be paid to reserve your place on the course and will be deducted from payment for the final weekend.
You will be responsible for bringing your own patients along for treatment – without this you will not be able to complete the course fully.
All laboratory work costs are the delegate’s own responsibility.
Some items of equipment will be essential for this course, such as articulators and face-bows. We may be able to arrange discounted prices with suppliers based on bulk purchase by the group. Some items may also be available on a loan basis at reasonable cost for some participants but we cannot guarantee this.
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SDS Instructors
Roy Higson and Andy Lane
SDS Occlusion Blog 
Dear Andy,
For the second Equilibration patient, would it be alright for the patient to wear an anterior deprogamming device – the jig for 3 weeks and go straight to Oldham Apollonia House for equilibration?
The patient is a lady with post-orthodontic retainer for 8 years and has a side shift from left to her right on closure from CR to MIP, I happened to be the orthodontist for her extraction of 4s and fix braces.
That’s fine Wallace, at least you’ll confirm the occlusal cause of any symptoms and eliminate internal derangements, but I’d be much happier if you could make her a stabilisation splint in CR. She could then have nearly 6 weeks’ wear and you’d find her much easier to equilibrate in April. After your difficulties manipulating the patient into CR yesterday I thought you might have learned the lesson of how much easier to treat the cases were that had been wearing a SS first. 🙂
Thanks Andy. That’s right. I will go ahead with the CR appliance.
Dear Andy,
It happens that my crown and bridge lab did not know about CR appliance, so has to send to S4S.
For the laboratory instruction to Solutions4Snoring, is that like this:
1. cast a set of study casts
2. cast a set of working casts for CR appliance
3. mount the working casts on Denar articulator
4. fabricate a upper splint in CR with centric stops and anterior and canine guiding slopes
while providing
1. Kois facebow record
2. Rubber upper and lower impressions
3. CR in 26 leaf guages ( if 6 leaf guages for the 1st premature contact just clear, adding 20 leaf guages for the thickness of the appliance ) bite records
Best Regards
Wallace Lam
Hi everyone,
I have seen my TMJ patient today and she is doing very well. Her TMJ pain has disappeared and she is coping very well with both splints. Amasingly she she is eating probery with the lower one as well.
I feel very proud of myself treating TMJ. Special thanks to Andy and his team.
Helmi
That’s fantastic news Helmi, thanks for letting us know. I can’t wait to hear how everyone else’s patients are doing after the last (TMD) weekend.
Andy
Andy, I have a patient that has lost the UR2, UL2 and UL3, the UL4 has moved into the potition of the UL3, she has been wearing a denture for the UR2 and UL2 for 5 yrs and can’t afford implants and wants to go for bridge.
The question is can I change the shape of the UL4 as a a canine.
She has nice Canine guidance on the right side and nothing on the left side.
Is it easy to do as I have never tranform the 1st premolar to a canine and what I have to bear in mind?.
Thanks
Hi Helmi, hard to say without more information – it would be nice to see some photos and mounted study casts really. In principle though, what you’re saying can be done (I suspect you mean 2 x 3-unit bridges) but if you’re using a first pre-molar in place of a canine you’re going to need to spread the lateral forces over more teeth as the crown:root ratio is against you – you should aim to keep the guidance as far forward as possible see if it’s going to be possible to have group function on the left side. If you’re careful with the forces, and you’re not dealing with a bruxer, all should be well. If you have any doubts though, before you commence treatment, I’d stress the need for an upper stabilisation splint to be worn at night in the long term to protect the patient’s investment! Build it into your treatment plan and you won’t be found at fault if the bridge fails later.
Hope this helps, Andy
Hi Helmi, hard to say without more information – it would be nice to see some photos and mounted study casts really. In principle though, what you’re saying can be done (I suspect you mean 2 x 3-unit bridges) but if you’re using a first pre-molar in place of a canine you’re going to need to spread the lateral forces over more teeth as the crown:root ratio is against you – you should aim to keep the guidance as far forward as possible see if it’s going to be possible to have group function on the left side. If you’re careful with the forces, and you’re not dealing with a bruxer, all should be well. If you have any doubts though, before you commence treatment, I’d stress the need for an upper stabilisation splint to be worn at night in the long term to protect the patient’s investment! Build it into your treatment plan and you won’t be found at fault if the bridge fails later.
Hope this helps, Andy
Hi Andy,
I totaly forgot about the crown:root ratio…thanks
Its 2 x 3-unit bridges. She is not a bruxer, but I will find that out for sure when I see her next week. I will try to take couple of pictures, email them to you, and see what you think.
Helmi
Dear Andy,
For your advice.
Chief complaint
Headache, on temporalis muscles and masseter muscles, both sides, worst in the morning, been 2 years. Moderate headache, not change before and after braces.
Background
18 years old girl. ******* is going to Oxford U in this September for History and Politics.
She has just finished fix braces orthodontic treatment for 16 months.
Clinical
Tooth 41, LR1 is missing and ******* has only 3 lower front incisors.
All back teeth touching. Front teeth NOT touching from canine to canine with a 2mm gap. 27 teeth present except wisdom teeth.
That is what orthodontics can do, she was told.
Question
1. Will the anterior deprogramming device open her bite as she is now on orthodontic retainer?
2. Do you think Oral Equilibration will help?
Hi Wallace, nice to hear from you.
Let’s go back to first principles. We use the anterior jig/deprogrammer to help us establish whether the teeth/muscles are playing a part in the headaches.
At this age, and as she is in orthodontic retention, a full-coverage appliance might be best. I showed you on the course how to add an anterior bite plane to a standard Essix type retainer – do you think you could try that in this case?
You would then be able to convert this appliance (after 1 – 2 weeks) to a stabilisation splint, using cold-cure. Again, this is the technique we showed you on the first POS weekend. If this works well and you want a more permanent appliance you could then make a clear, heat-cured acrylic appliance, and then consider the need for equilibration once you have established that you can remove the headaches by removing the occlusal imbalances and interferences.
Remember, we don’t want to make permanent changes to the occlusion until we have established the need for those changes with a reversible approach.
Hope this helps!
Warm regards, Andy Lane
Excellent advice. Back to POISE 1. I have to be a thinking dentist.
Thanks Andy. Wallace
Hi Everybody,
26 years old female, co headache and toothache and cant chew on the LL7
O/E: worn dentition, LL7 has old amalgam filling and is vital and slight ttp
very difficult to manibulate her in CR and after biting on a cotton roll for few min and managed to get her in CR and the prematurity was on the LL7
headache totaly gone with ethyl chloride.
NTI had been made to her for 2 weeks and ther result was 80% pain relife from the LL7 and now can eat and the headache has reliefe by 50%
I have arranged to do a long term splint mainly lower as she miss the LR7
Has anybody got any comments?
Hi Helmi, sorry for delay in replying, just back from short break, well away from the Internet! Sounds like you’re doing everything right to me. Are you thinking of restoring the lost vertical later? Cheers, Andy
Hi Helmi,
Great to hear from you, hope you’re keeping well.
Not sure why you would want group function, but otherwise it sounds fine.
Can’t you use the lower canine against the new upper canine for guidance? You know we don’t approve of group function distal to canines don’t you??? 😉 Also, don’t forget to make sure you allow a little extra “freedom in centric” for the implant-retained crowns to compensate for the lack of periodontal membrane.
Cheers, Andy
Hi Andy.
You wont know me. I got your link through GDP(UK).
I attended the POS course with Roy Higson in 2005/2006…and learnt about occlusion after 23 years in Practice!
I attended a recent BDA Hospitals Group Scientific Meeting (Nov 2010) and the main topic was TMD.
The Speakers were all Hospital Consultants – restorative, orthodontics, oral surgery.
Surprisingly they had a pretty unified approach to management of their patients……do very little.
They placed emphasis on “councelling”, “awareness” and “relaxation”. Basically telling the patient to stop bruxing!
I do not recall this being touched on during the POS course and it may be worth while including it.
What would be more worthwhile (IMHO) would be to get these guys together and get them to do the POS course.
Best wishes to Roy when you next see him.
Regards and hope to meet you one day.
Shiraz
Hi Shiraz, welcome to the blog.
We see this approach from the hospital sector all the time, and it has very little to offer the kind of patients we all see in practice. Of course the patients never return to them so they chalk it up as a success every time! If only we could get some of the maxfac surgeons to come along on courses – we’ve been trying for 25 years now and had absolutely zero success, even when you offer them a free place on a Mark Piper course. I’ll certainly pass your regards on to Hig when I speak to him.
With warm regards, Andy