Why am i having to spend so much time adjusting bite splints on insertion day? On occasion i will have a client call and ask that very question. I explained to the dentist that every thing on my end was done correctly and all was verifiable. I knew this client cared about what he was doing and had taken the needed courses to understand the concepts and mechanics behind bimanual manipulation and splint fabrication. I then asked the normal questions. Did you deprogram the muscles if they needed? Yes i did. Did you mount the casts on a calibrated instrument? Yes again. Was the appliance fully seated with no rocking. Yes. The preliminary bite record seemed fine and muscles were being deprogrammed. The mounted casts show a posterior point of contact and could be shifted to maximum intercuspation, a good indicator of an accurate record and mounting. So why so much adjustment time? I asked the dentist to reveal to me the entire patient visit from start to finish. Sometimes asking the all the right questions can make all the difference. We discovered that the patient was given an NTI appliance to wear until the full coverage appliance was made. I had my answer. Giving the patient the NTI appliance to wear( in this case for two and a half weeks) may have deprogrammed the muscles further than the original position taken at the original appointment, allowing the condyles to seat more superiorly. Dr. Tarantola commented," This is why it is so important to verify with three increasing levels upon load testing and asking the patient if they feel any sign of tension or tenderness upon loading as Dr. Peter Dawson teaches. If the lateral pterygoid was still contracting the patient most likely would have reported tension upon firm superior compression. Then i thought is the large amount of adjusting at the first splint appointment a bad thing? You may have a lot of adjusting the first appointment but you may be getting to where you need to go in less time? Just a thought. Thanks for reading, Anthony Calonico.