In this case report, transitional bonding with the aid of a Kois deprogrammer was used to restore a patient’s worn dentition. Finding the centric relation might sometimes seem hard, but with appropriate devices, such as the Kois Deprogrammer it’ll become just obvious. The centric. The Kois Deprogrammer is a palatal-‐coverage maxillary acrylic device with a flat plane lingual to the anterior teeth. It separates the dental arches and provides.

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The centric relation CR can be defined as the physiological position of the condyle in the fossa, when centered and in the most superior and anterior position, and when the meniscus is correctly placed against the posterior incline of the articular eminence.

It is also deprogrammre as the musculoskeletal stable position when it coincides with maximum intercuspation MI and occlusal and temporo-mandibular joint TMJ stability. The correspondence of the CR and MI provides occluso-articular stability and avoids overloading. This is of utmost importance for preventing TMJ lesions related to occlusion. Many studies concerning full-mouth rehabilitation associated with increasing the OVD have shown that it is preferable to plan such cases in a Centric Relation position — this being acceptable and reproducible.

CR has been well-described in the literature and, deprogrammef easy to understand, clinical success is often elusive. A partial list of appliances and techniques to find the CR, includes the Deprogrrammer Jig, the leaf gauge, and the bilateral manipulation technique.

Finding the Centric Relation – The Kois Deprogrammer

However, anyone who has attempted to mount cases in CR knows that some patients can be extremely difficult to manage regarding accurate bite relationships.

The deprogrammer has been found to be an effective device for achieving these bite registrations. The Kois Deprogrammer is a removable, plastic appliance that covers the hard palate and creates a single point of contact between the lower central incisor and the anterior bite plane. Casts are then mounted in the articulator in the maximum intercuspal position MIP.

The face bow and bite records are not necessary. The facial bow of the deprogrammer is made out of wire and extended from the most distal tooth on each side of the arch, in order koix to interfere with any occlusal surface of the tooth. Then the horseshoe palatal coverage is obtained with an acrylic resin and anterior platform opposing the lower central incisors is fabricated. The platform should be trimmed to be 3 mm wide and parallel to the labial bow, and should disclude all remaining teeth approximately 1.


Then, the appliance should be deprograammer in the mouth and checked to establish whether the insertion is passive. Appropriate stabilisation is achieved by means of palatal plate accurately fitted to the palatal surface and by the labial bow.

Kois Deprogrammer

There should be a separation of 1. Then, the patient should lie back deprogeammer the chair, and be asked to occlude on the appliance through the articulating paper and slide forward and back. The contact on the platform should be narrowed so that it touches toward the midline of one of the lower incisors. When the patient closes their mouth and the same initial contact is confirmed — the patient is deprogrammed.

Kois Deprogrammer | Dental Services | Academy Dental

Repeatability is the key criterion to determine when the patient is deprogrammed. For how long should the Deprogrammer be worn? It is worn until the necessary muscle deprogramming is accomplished days or weeks if necessary, usually weeks.

For some patients, it may be necessary to wear the deprogrammer up to 24 hours per day except when eating for old muscle memory to be erased and become deprogramer deprogrammed. It has been has shown that, in patients with a centric prematurity introduced for a short period of time, a percentage of them may take days or weeks to lose the muscular uncoordination in the muscles of mastication once the prematurity is removed. This explains why some patients will not deprogram instantly or in a few hours.

This must be a single spot, and has to be repeatable and achieved spontaneously upon closing the mouth of the patient, not with any manipulation of the mandible.

When the patient closes their mouth and the same deprogrammmer contact is confirmed — the patient is deprogrammed Fig The Kois Deprogrammer has several uses: It can be used as a diagnostic tool to determine if the mandible needs to move in the anterior or posterior direction to reach CR from depprogrammer maximal intercuspal position MIP.

It is an invaluable tool in diagnosing the three most common types of abnormal occlusal attrition: It can be used during bite registration. This procedure, with the Kois Deprogrammer in place, allows control of the vertical dimension of occlusion VDO during bite registration.

It facilitates finding premature contacts — i.

If occlusal adjustment needs to be obtained, the KD ensures control because the deprogramming will be maintained. Are there any contraindications for deptogrammer Kois Deprogrammer? When structural problems of TMJ are suspected positive load test the Kois Deprogrammer is not indicated. In this case, the patient requires posterior support and a Michigan splint is indicated.


Periodontally involved lower incisors. In this case, consider splinting the mandibular anterior teeth or prepare a Michigan koi.

Consider reducing the acrylic palatal plate in order to avoid contact with the extensive part of the soft palate. Testing occlusal management, previewing anterior esthetics, and staging rehabilitation with direct composite and Kois deprogrammer.

Compend Contin Educ Dent. Achieving esthetic and functional objectives with additive equilibration. Author of book edited by Quintessence: Giuseppe Chiodera – 28 Jun Anna Salat – 19 Jun Giuseppe Chiodera – 18 Apr Marie Clement – 22 Mar Giuseppe Chiodera – 15 Jan Stefan Koubi – 31 Dec Marie Clement – 24 Nov Monaldo Saracinelli – 1 Dec Angie Segatto – 2 Oct Anna Salat – 20 Nov Giuseppe Chiodera – 31 Oct Deeprogrammer Pavolucci – 25 Sep Marie Clement – 31 Aug Jordi Manauta – dfprogrammer Jun Giulio Pavolucci – 13 Nov Anna Salat – 22 Aug Stefan Koubi – deprkgrammer Jul koid Filippo Dini – 18 Jul Maciej Zarow – 21 Jun Giulio Pavolucci – 11 Jun Gregory Camaleonte – 7 May Giuseppe Marchetti – 3 May Stefan Koubi – 24 Apr Dimitar Filtchev – 27 Mar Styleitaliano – 18 Jan Engin Taviloglu – 24 May Franco Brenna – 7 Mar Franco Brenna – 22 Feb Roberto Spreafico – 16 Feb Digital Dental Academy – 13 Feb Riccardo Tonini – 12 Mar Riccardo Tonini – 16 Feb Calogero Bugea – 26 Dec Clifford Ruddle – 6 Oct Francesca Cerutti – Riccardo Tonini – 14 Jul Calogero Bugea – 7 Jul Zaher Al-Taqi – 30 Jun Marino Sutedjo – 23 Jun Paolo Generali – 16 Jun Maciej Zarow – 13 Jun Filippo Cardinali – 26 May Calogero Bugea – 12 May Paolo Generali – 19 Apr Stefan Koubi – 29 Oct Stefan Koubi – 12 Sep Stefan Koubi – 4 Jun Stefan Koubi – 9 Sep Stefan Koubi – 27 Jul Monaldo Saracinelli – 3 Aug Patrizia Lucchi – 9 May Monaldo Saracinelli – 21 Oct Patrizia Lucchi – 25 Sep