Seattle Tacoma PPM pure power mouthguard

Slide 1: 

The principles of Makkar PPM

Slide 2: 

POSTERIOR MUSCLE GROUP THE IMBALANCE OF THE HUMAN HEAD The balance point (occipital condyles) of the human head is NOT centered. Also, there is much more bony mass in the front of the head compared to the back. The posterior neck muscles are large and strong to counterbalance the mass of the front of the skull. Without the strong posterior muscles, the head falls forward “Nodding Off” when falling asleep in an upright position is an example of this phenomenon ANTERIOR MUSCLE GROUP There are many differences between the muscles in the front and the back of the neck: The muscles in the front are quite small compared to the back They comprise part of a 5 link chain that connects the skull to the clavicle (collar bone) This chain consists of: The Muscles of Mastication The Mandible (lower jaw) The Suprahyoid Muscles The Hyoid Bone The Infrahyoid Muscles THE BITE IS PART OF THIS CHAIN!

Slide 3: 

Incorrect posture can Cause balance and Flexibility issues

Slide 4: 

The ideal posture, will demonstrate an increase on balance, range of motion, Flexibility.

Slide 5: 

Everything happens from the Top -Down

Slide 6: 

With good posture and Proper alignment, the effects To an athlete are advantageous .

Unbalanced = inefficient : 

Unbalanced = inefficient

Unbalanced = inefficient : 

Unbalanced = inefficient Even muscles tension Head Balanced on Spine Uneven muscle tension Head misaligned on Spine

The head bone is connected to the neck bone … : 

The head bone is connected to the neck bone …

Slide 10: 

With GOOD Posture your heads has an 8 to 16 pound pull on your neck muscles Your head now has a 30 pounds pull to your neck muscles How much does a Head weigh? An unbalanced bite will lead to POOR Posture This extra strain effects shoulder and back muscles Neck and Back Tension starts with an Unbalanced Bite 10 lbs 30 lbs

From Head to Toe, you are all connected by muscles and tendons : 

From Head to Toe, you are all connected by muscles and tendons

Let’s learn some Anatomy : 

Let’s learn some Anatomy

A balanced bite give balanced muscles : 

A balanced bite give balanced muscles

Unbalanced bites lead to head and neck tension : 

Unbalanced bites lead to head and neck tension

This tension tips the head : 

This tension tips the head

This tension tips the head : 

This tension tips the head Causing one shoulder to be lower than the other

Breaking Neural Interference and Balancing Jaw Muscles Activity can improve your bodies ability to tap into it’s natural strength : 

Breaking Neural Interference and Balancing Jaw Muscles Activity can improve your bodies ability to tap into it’s natural strength

Slide 18: 

This is accomplished via a special TENS Machine which is hooked up to the right and left TMJ”s

T.E.N.S.Trans-cutaneousElectricalNeuralStimulation : 

T.E.N.S.Trans-cutaneousElectricalNeuralStimulation

3 Gel patches : 

3 Gel patches

A snapshot of your Balanced Bite : 

A snapshot of your Balanced Bite

Measured to a proportion rightfor you : 

Measured to a proportion rightfor you

Slide 26: 

This special bite is incorporated into the Mouthpiece to give an athlete: -increased balance -increased range of motion -increased flexibility -opens up the airway

Slide 27: 

The TENS Machine

Slide 28: 

THE GOAL - RELAX THE MUSCLES DECOMPRESS THE JOINTS REGARDLESS OF JOINT PATHOLOGY REGARDLESS OF JOINT POSITION GET THE COMPLETE SYSTEM TO A HOMEOSTATIC STATE

Slide 29: 

PHYSIOLOGIC REST -IT IS THAT MANDIBULAR POSITION IN WHICH THE VARIOUS MANDIBULAR MUSCLES ARE SIMULTANEOUSLY AT THEIR RESTING LENGTH AND IN BALANCED TONUS WITH ONE ANOTHER IT IS ALWAYS DEFINED FROM (AND ONLY VALID FROM) THE UPRIGHT POSTURAL POSTION IS THAT POSITION IN SPACE WHERE ALL THE MASTICATORY MUSCLES INCLUDING ALL ANTAGONISTIC MUSCLE GROUPS SUCH AS ELEVATORS AND DPRESSORS ARE IN THE STATE OF MINIMAL ELECTRICAL ACTIVITY NECESSARY TO MAINTAIN POSTURAL REST

Slide 30: 

TENS - GET THE TORQUE OUT!! 6 DIMENSIONS OF THE MANDIBLE: FRONTAL/LATERAL ANTERIOR-POSTERIOR VERTICAL PITCH YAW ROLL TENS

Slide 31: 

DOWN FORWARD When the lower jaw is in a relaxed state , we notice an increase in athletic Performance. The athlete is comfortable at this stage, because the muscles Of the face, TMJ’s and the teeth are balanced.

Slide 32: 

After tensing for 45 minutes, a jaw Tracking device is used To find the proper relationship Of the lower jaw to .01 mm. Also, this will track the EMG’s Of the face indicating that the Muscles are relaxed.

Slide 33: 

A scan of the Bite, derived From the jaw tracking Device. Everyone’s bite is Unique, just like Their fingerprint. We need to define That optimal bite, to allow Them to experience Increased athletic Performance.

Slide 34: 

The following slide is an EMG derived from the use of a regular Mouthguard.

Slide 35: 

Note the tension in the Right and left anterior Temporalis, massetters, and Posterior temporalis. Why? These Mouthguards, do not Have a customized bite, and Therefore, the lower jaw is Fighting to find a comfortable Bite, and thus the tension in The facial muscle. This muscle Activity, is robbing an athlete Of lower and upper body Strength.

Slide 36: 

The next slide will show that with the use of tens machine, and the jaw tracking Device, we can find that “sweet spot”, where all the muscles in the face are Relaxed. Even if an athlete clenches their teeth in this relaxed position, the muscles Will still remain relaxed, allow an athlete to perform at a higher level.

Slide 37: 

TRADITIONAL CUSTOM FITTED MOUTHGUARD CUSTOM FITTED MOUTHGUARD WITH MYOCENTRIC BITE INCORPORATED PPM

Slide 38: 

Next slide demonstrates how the neck from C1 to C5 is relaxed With a perfect bite incorporated into the mouthpiece.

Slide 39: 

before after The clear bars clearly (after shot) Indicate , no tension in the neck area. This is instant, only 2 minutes elapsed between Scans.

Slide 40: 

With a relaxed bite, you will also see on an x-ray, the opening of The airway, which is why most athletes are not winded during Aerobic activity.

Slide 41: 

NO PPM PPM

Slide 42: 

Research

Effects of a Neuromuscular Dentistry-Designed Mouthguard on Muscular Endurance and Anaerobic Power : 

Effects of a Neuromuscular Dentistry-Designed Mouthguard on Muscular Endurance and Anaerobic Power Shawn M. Arent, Joseph Pellegrino, Jennifer McKenna, & Cynthia A. Jaouhari Human Performance Laboratory

Mouthguards & Sports : 

Mouthguards & Sports 3 types available Stock mouthguard Boil-and-bite Custom fabricated Key protective equipment in many sports Decrease injury to teeth & lips; reduced severity & prevalence of jaw fracture (Westerman et al., 1997); reductions in concussions (?)

Performance Effects? : 

Performance Effects? Few studies have examined the impact of mouthguards on performance Important consideration for athletes Most research has involved ventilatory and oxygen consumption measures Bourdin et al. (2006): No impact of CF mouthguard on FIV1, FEV1, or VO2max Francis & Brasher (1991): Stock mouthguards restricted FEV1, but reduced VO2 at higher intensities; appear to improve economy

The Neuromuscular Dentistry Approach : 

The Neuromuscular Dentistry Approach Involves diagnosis & treatment of mouth, jaws, & closely associated structures while emphasizing neural & muscular components (Mahony, 2002) Has recently been applied to a mouthguard designed to enhance sport performance Fitting involves TENS to relax jaw musculature into state of “optimal bite” Targets trigeminal and facial nerves EMG is used to monitor fitting process until muscular activation is at a minimum

Slide 47: 

TRADITIONAL CUSTOM FITTED MOUTHGUARD CUSTOM FITTED MOUTHGUARD WITH MYOCENTRIC BITE INCORPORATED PPM

Purpose : 

Purpose To examine the effects of a neuromuscular dentistry-based mouthguard on muscular endurance and anaerobic power and capacity in competitive athletes

Methods : 

Methods Subjects Anaerobically-trained professional and Division I college athletes (N = 22) Ages 18-34; Mweight = 86.2 + 3.1 kg Familiar with wearing mouthguards Football, lacrosse, basketball, wrestling, MMA Training anaerobically 4+ days/wk for at least the last 2 years

Methods : 

Methods Blinded, crossover design Randomly assigned to order of use of either the experimental (EXP) or custom-fit (CON) mouthguard Matched for material & appearance Fitting plus familiarization session followed by T1 & T2 T1 & T2 separated by 5-7 days Refrained from training for 24 h prior to each session

Methods : 

Methods Mouthguard fitting First involved standard dental impression for the CON mouthguard Fitting for EXP involved 45-60 min of electrical stimulation (TENS) through surface EMG electrodes (Myotronics, Inc., Kent, WA) Muscle activation was monitored via EMG continuously to ensure relaxed jaw position Fast-setting impressions were taken with the jaw in the “optimal” bite alignment All fittings were done by PPM dentists

Methods : 

Methods 10 min systemic warm-up 3 Performance Tests: Vertical Jump (VJ) Just-Jump Mat (Probotics, Huntsville, AL) Best of 3 efforts; 45-60 sec rest between efforts 3 min rest Bench Press (BP) Load equal to bodyweight; Maximal reps completed 5 min rest 30s Wingate Anaerobic Test (WAnT) Monark 894E Anaerobic Test Ergometer (Monark Exercise AB; Sweden) Load set at 0.10 kp/kg BW Peak and Average Power calculated

Results: VJ : 

Results: VJ * Condition Height (cm) VJ significantly higher for EXP (P=.003)

Results: Bench Press : 

Results: Bench Press Condition Repetitions No differences in Bench Press repetitions (P=.48)

Results: Peak Power : 

Results: Peak Power * Peak Power (W·kg-1) Condition Peak Power significantly greater for EXP (P=.038)

Results: Avg Power : 

Results: Avg Power Avg Power (W·kg-1) Condition No differences in Average Power (P=.54)

Discussion : 

Discussion In comparison to a traditional custom-fit mouthguard, the PPM appears to enhance peak power output and performance in explosive, short-duration bouts of exercise. Does not appear to enhance sustainable power output or muscular endurance. May have practical application for many different power-based movements (i.e., football, baseball, MMA, field-events, etc.)

Discussion : 

Discussion Power effects may also translate into daily training benefits Recent research (Duarte-Pereira et al., 2008) on “boil and bite” and custom fitted mouthguards suggests that ventilatory & vertical jump performance was similar to a “no mouthguard” control condition The current findings suggest that the PPM may enhance performance on measures that have relevance to the athletes that commonly wear them.

Discussion : 

Discussion An optimal “bite” conundrum for muscular endurance… Future research considerations: Balance ROM Ventilation/aerobic effects Impact protection

Acknowledgements : 

Acknowledgements This study was supported by a grant from Pure Power Mouthguard Jonathan Nicola Karen Wilson Jonathan Rodger Dr. Anil Makkar, Dr. John Bixby, Dr. Mike Bixby

Slide 61: 

STRAINED PATHOLOGIC JAW STABILITY

Slide 62: 

THE WRONG WAY TO STABILIZE THE HEAD PLACE THE TONGUE BETWEEN THE TEETH

Slide 63: 

LIP BITING IS USED TO COMPENSATE FOR A PATHOLOGIC OCCLUSION (BAD BITE) STRAINED PATHOLOGIC JAW STABILITY