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| The Aqualizer, Is It Magic or Myth? |
Dentistry is full of devices that promise more but deliver less. For every therapy that is founded in good science and reasonable practice, you might call it "evidence based", there are countless others that are endorsed and sold for a great deal of money and whose usefulness is very suspect.
Therapies for TMD are probably the most vulnerable to this kind of quackery. Patients with TMJ symptoms are usually frustrated beyond belief with the pain they
are experiencing that they carry that frustration to the dentist whose care they seek.
For the most part, the pain that these patients have is difficult to diagnose and even more difficult to treat. This is because it is near impossible to diagnose them whilst they are in pain, and certainly impossible to break that cycle.
Fortunately, a prosthodontist at the University of Illinois came up with a simple device consisting of two water pads, connected by an equalizing channel. The device is called Aqualizer™ When placed in the mouth, the effect is to allow both left and right sides of the molar segments to equilibrate with each other, putting the muscles of mastication in repose. Because the water pad separates the teeth, whatever prematurities existed in the occlusion have been eliminated for the time being. Muscle spasm is eliminated by the occlusal-muscular harmony. As this continues over a long period of time the muscles heal themselves.
The occlusal disharmony must be dealt with. The manufacturers of this device offer a three page recipe for doing so with the Aqualizer™. Obviously, occlusal disharmony can only be dealt with in one fashion, equilibration.
If disharmonies are simple, then their recipe works. However, most TMD patients
do not deliver simple problems. This is the point where a high quality, fully adjustable articulator, such as the KaVo Protar comes into play.
The casts must be mounted to the articulator. Minimal records that must be taken are facebow, lateral checkbites and a true centric relation record. Again, the Aqualizer™ is a wonderful tool for preparing the patient for taking this record. A CR can only be taken faithfully when the muscles are at rest and the existing occlusion is not guiding the record taking. Dr. Dawson's method of "…romancing the bone…" is as effective as any other in guiding the mandible to a CR, but it can only work when the muscles are not in spasm. The insertion of an Aqualizer™ 10-15 minutes prior to record taking accomplishes that end. This process is called deprogramming.
Once the records are taken, the case mounted and articulator programmed, a definitive splint can be constructed and properly equilibrated on the articulator. This type of splint, can be worn by the patient for up to three months. When the patient is no longer symptomatic, the records must be repeated on the patient, case remounted and equilibrated on the articulator. The location and extent of equilibration can now be marked on the casts with colour coding. The colour-coded locations can now be transferred to the mouth. The technique is available on video tape.
The Aqualizer™ is an inexpensive, interim therapeutic device for both the straightforward and troublesome patient with TMD. It is also a useful adjunct for record taking in major restorative work, assuring the practitioner of a good and predictable result.
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| Aqualizer Device |
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| Insertion of Aqualizer |
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| Aqualizer in Place from frontal |
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| Aqualizer in Place from side |
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