Stretch Beyond Your Expectations.

L L PS (L ow-L oad, Prolonged-D uration S tretch)
technology has successfully treated limitations
of mandibular motion
Mouthpiece is padded to prov ide
maximum comfort and safety
S imple, adjustable
and reproducible bilateral
tensioning system
B alancing bars
prov ide hands
free application
Av ailable for
rent or purchase
E asy to use
B iomechanically
correct
H igh patient
compliance
Stretch Beyond Your Expectations.
HOW TO ORDER
DYNASPLINT SYSTEMS:
®
STEP 1.
Call our toll-free number and ask
for your local sales consultant
STEP 2.
Fax the following information:
Patient information
Insurance information (include
copy of insurance card)
Rx and/or Certificate of Medical
Necessity (CMN)
Most recent chart notes
C orporate H eadq uarters:
8 00.6 3 8 .6 7 7 1 toll-free
8 00.3 8 0.3 7 8 4 fax
C anada:
8 00.6 6 8 .9 13 9 toll-free
9 05 .8 5 1.3 4 9 4 fax
Europe:
+ 3 1 (0)4 5 .5 23 .04 18 phone
+ 3 1 (0)4 5 .5 23 .13 03 fax
www.d y n a s p lin t .c o m
®
The Dynasplint® Trismus System aids in restoring physical function and more importantly, quality of life to patients
suffering from joint stiffness and limited range of motion in the posterior mandibular or temporomandibular region.
Limitations in mandibular motion can be caused by TMJ dysfunction, radiation therapy, infection, surgery, trauma, or
burns. In preliminary clinical trials the Dynasplint® Trismus System has been successful in treating these limitations. The
key to its effectiveness is the low-load, prolonged-duration stretch (LLPS) technology that delivers a correct biological
stimulus to create a permanent length change in shortened connective tissue.
Dynasplint Systems, Inc., the pioneer and market leader in dynamic splinting since 1981, has successfully treated more
than a quarter of a million patients utilizing the proven principles of LLPS. Dynasplint® Systems are simple, yet reliable in
design and function. Developed for home use they are an ideal adjunct to doctors‘ and therapists’ standard protocols.
As a direct result of our years of industry experience, our professional sales consultants provide comprehensive
support to health care providers. This support includes product fitting and instruction, follow-up care, splint adjustment
and protocol development. Dynasplint Systems, Inc. also assists with administrative responsibilities including insurance
verification and direct billing.
Experience, Reliability, Knowledge, Service, Support—Results. Stretch Beyond Your Expectations. ®
C lin ic a l Ad v a n t a g e s o f t h e Dy n a s p lin t ® Tr is m u s Sy s t e m
• U tilizes the clinically proven approach of “ Low-Load, Prolonged-Duration Stretch” (LLPS)
— C onstantly seeks new end range to increase RO M.
— U tilizes the T.E.R.T. principle (Total End Range Time)
— G radually remodels the connective tissue
• Does not require or rely on the patient to squeeze the unit to apply tension
• C an be used for exercise & passive RO M
• Approved by “ Medicare”
• C an be “ customized” for individual patient requirements with “ oral impression” materials
• Dynasplint Systems, Inc. handles all insurance processing
• Dynasplint Systems, Inc. clinical sales consultants perform patient fittings
V ariable & fully reproducible tension settings:
Weight of U nit:
Range of Motion / O ral O pening:
Patent # U S 6 ,4 13 ,2 3 1
0 – 2 .3 ft./lb. or 0 – 3 1.5 kg/cm
.7 5 lb. without counter balance bars
1.3 5 lb. with counter balance bars
Type I: 15 mm – 5 0 mm
Type II: 9mm – 5 0 mm
Stretch Beyond Your Expectations.
DY N A SP L IN T®
TR ISM U S
SY STE M
®
What are Dynasplint® Systems?
Dynasplint Systems, Inc. is the pioneer and market leader of dynamic splinting. Since 1981,
Dynasplint® has aided patients in restoring physical function and gaining range of motion
during rehabilitation.
What is Trismus?
Trismus is an involuntary contraction caused by damage to the muscles of mastication,
temporomandibular joint and the oral and peri-oral connective tissues causing a restriction
of the mouth opening. Trismus occurs when the muscles and connective tissue become
damaged and shortened by physiologic structural changes. Significant functional disabilities
associated with Trismus include: difficulty with eating and chewing, dysphagia, speech and
articulation problems, compromised oral hygiene and difficulty in the fabrication, use and
maintenance of oral prosthesis.
Who is appropriate for the Dynasplint® Trismus System?
Patients who have range of motion (ROM) limitations as a result of impaired muscles of
mastication and the TM are appropriate for the Dynasplint®. Mandible jaw limitation can be
caused by cancer treatments such as: radiation therapy and/or head and neck surgery; oral
and maxillofacial surgery, degenerative TM disease, chemical and thermal burns and any
traumatic injury to the muscles of mastication and TMJ.
When can patients start using the Dynasplint® Trismus System?
The Dynasplint® Trismus System can be used as soon as the doctor releases the patient for
passive range of motion. The sooner after onset, injury, surgery or radiation treatment the
device is implemented; the faster results can be expected.
When is the Dynasplint® Trismus System applied?
Patients take the Dynasplint® home and use it 3 times a day for up to 30 minutes per
session. Dynasplint® Trismus therapy is suggested 7 days a week.
Where is the Dynasplint® Trismus System applied?
The Dynasplint® Trismus is easily worn in the anterior part of the mouth while the patient
relaxes. Proper placement is essential for the ideal stretch of the masticatory muscles. The
patient can hand-hold the device or attach the counterbalance bars for hands-free therapy.
Why should a doctor choose a Dynasplint® Trismus System?
The Dynasplint® Trismus System is the most advanced home therapy treatment available. It
is far superior to the commonly used tongue depressors. The Dynasplint® actively stretches
the muscles of mastication and can be used for patients with openings as small as 9mm.
Patients find it easy and comfortable to use.
How does the Dynasplint® Trismus System work?
The Dynasplint® Trismus System is based on low-load, prolonged-duration stretch (LLPS)
technology. It is spring loaded for simple, adjustable, reproducible tension at each therapy
session. This correct biological stimulus has been clinically proven to permanently lengthen
and remodel shortened connective tissue.
T
CERTIFICATE OF MEDICAL NECESSITY
LANDMARK
Corporate Headquarters: 770 Ritchie Hwy, Suite W-21 Severna Park, MD 21146
Tel: 800-638-6771
A Division of Dynasplint Systems, Inc.
Patient Name_______________________________________________________
(Last, First, MI)
M E D I C A L
M
F
Date______________
D.O.B.___________________________ Date of Onset of Illness/Injury/Surgery:_________________________________
Length of Time Needed:
1 month
3 months
6 months
Other______________________________
Dynasplint Systems aid in restoring physical function to patients with joint stiffness and limited range of motion. The key
to its effectiveness is the low-load, prolonged-duration stretch (LLPS) that delivers a correct biological stimulus to create a
permanent length change in shortened connective tissue. Dynasplint Systems have been clinically proven to reduce time
and cost associated with range of motion rehabilitation– in many cases by more than 50 percent.
Fill as ordered. NO substitutions:
Trismus Dynasplint® System
Diagnosis/Cause of Trismus (limited oral opening)
Arthritis of Joint
(ICD-9 Code)__________________________________
Congenital Deformity
(ICD-9 Code)__________________________________
Cancer of the Head & Neck
(ICD-9 Code)__________________________________
Radiation Induced
(ICD-9 Code)__________________________________
Neurological
(ICD-9 Code)__________________________________
Trauma (accident, surgery, etc.)
(ICD-9 Code)__________________________________
Other:_______________________________
(ICD-9 Code)__________________________________
Current oral opening Range of Motion: (Active/Passive) _______/_______ mm
Does patient require a customized mouthpiece:
Yes
IS THE PATIENT CURRENTLY INVOLVED IN ANY THERAPY PROGRAM?
(Adult Average is 45-50mm)
No
Yes
No
Physician Name:___________________________________________________________________________________
U.P.I.N.#______________________Phone:_____________________________Fax:_____________________________
Address:_________________________________________________________________________________________
________________________________________________________________________________________________
Physician Signature:_______________________________________________________________________________
Attending Therapist:___________________________ Sales Consultant: ______________________________________
This form is needed to bill the patient’s insurance. Please complete and return.
Fax to: 800-380-3784
Attn:___________________________ Sales Consultant: ___________________________
Revision 2/06
Stretch Beyond Your Expectations.®