TMJ Treatment · The MORA Appliance
Orthotic Therapy
Once your jaw’s correct physiologic position is established, Dr. Patrice fabricates a custom MORA orthotic in our in-house lab to hold it there while your muscles re-educate.
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Splint Therapy · The MORA
The MORA Orthotic. Custom-built to your optimized bite.
The MORA — Mandibular Orthopedic Repositioning Appliance — is a custom orthotic built precisely to your optimized bite position. Once your jaw’s correct physiologic position has been established through TENS muscle relaxation and K7 jaw tracking, Dr. Patrice creates a prescriptive orthotic in our in-house lab, calibrated to the exact measurements your data revealed. This is not a generic night guard or hand-adjusted splint — it is a precision instrument carrying your specific physiologic data.
Comfortable, removable, and discreet, the MORA maintains your jaw in its ideal position — gradually correcting your bite and providing lasting relief from TMJ symptoms.
The MORA is worn on the lower arch only — this is critical. Upper arch appliances can interfere with the airway and alter maxillary position. The lower MORA repositions the mandible without affecting the upper arch.
- Custom-built to your optimized bite position from K7 physiologic measurements
- Precision 3D milled in our in-house lab — not generic or hand-adjusted
- Lower arch only — never upper arch
- Comfortable, removable, and discreet
- Follow-up EMG measurements confirm muscle resolution
- Does not interfere with the airway or breathing
MORA orthotic
An Important Distinction
A MORA is not a nightguard.
These two appliances look superficially similar — both sit on the teeth, both are worn at night — but they do fundamentally different things. Understanding the difference is critical, because the wrong appliance can make TMJ symptoms significantly worse.
A Repositioning Appliance
The MORA Orthotic
A MORA actively repositions the lower jaw — most often downward and forward — into its correct physiologic position. This decompresses the joint space and provides room for the disc to function properly. The therapeutic effect comes from where it holds the mandible, not just from cushioning the teeth.
- Repositions the mandible into corrected jaw position
- Decompresses the joint space
- Provides room for the disc to function
- Custom-built to your K7 physiologic data
- Calibrated for therapeutic muscle and joint effect
- Designed to resolve TMJ symptoms at the source
A Protective Barrier
A Standard Nightguard
A nightguard does not reposition the lower jaw. It is designed only to cushion the teeth against grinding wear. In fact, what we often see clinically is that a standard nightguard distalizes the mandible — pushing the lower jaw backward into the joint — which can make neck pain, joint pain, and TMJ symptoms significantly worse.
- Does not reposition the lower jaw
- Often distalizes the mandible (pushes it back)
- Can worsen joint compression and disc displacement
- Can make neck and joint pain worse
- Generic shape, no physiologic data behind it
- Designed only to protect against tooth wear
"If you are wearing a nightguard for jaw pain and your symptoms are not getting better — or are getting worse — the appliance itself may be part of the problem."
A nightguard has its place — primarily for patients with bruxism whose joint and bite position are otherwise healthy. But for patients with active TMJ dysfunction, a generic appliance is not a substitute for a precision repositioning orthotic, and using one can delay real resolution or make symptoms progressively worse.
A Critical Clinical Distinction
Why lower arch only Always.
Many TMJ providers fit upper-arch splints because they are easier to fabricate and adapt to. Dr. Patrice does not — ever. The MORA is fabricated for the lower arch only, and the reasoning is clinical, not preferential.
Reason 01
Protects the airway
An upper splint can occupy palatal space and reduce tongue room — pushing the tongue down and back, narrowing the airway, and worsening sleep-disordered breathing. The lower MORA leaves the airway untouched.
Reason 02
Preserves maxillary position
Upper appliances can subtly alter the position of the maxilla over time — affecting bite, facial structure, and nasal breathing. The MORA repositions the mandible without disturbing the upper arch.
Reason 03
Targets the actual problem
TMJ dysfunction is about where the mandible sits relative to the joint. The mandible is the moving piece. Repositioning it directly — with a lower appliance — is the cleanest, most predictable way to restore correct physiologic position.
Reason 04
Allows natural tongue posture
The tongue rests on the palate naturally. An upper splint interferes with that resting position, while a lower MORA leaves it free — supporting both proper oral posture and downstream myofunctional therapy.
Reason 05
Speech remains natural
Patients adapt to the lower MORA quickly because it does not interfere with palatal contact — the area the tongue uses to form most speech sounds. Daytime wear is realistic without compromising how you speak.
The Standard
Clinically sound, always
Every MORA fabricated in Dr. Patrice’s practice follows this standard. The convenience of upper-arch fabrication is never a reason to compromise on airway, maxillary position, or long-term outcome.
An Honest Conversation
Why is there so much confusion in the dental world about TMJ?
TMJ care has been the subject of one of the longest-running professional debates in modern dentistry. Patients caught in the middle deserve to understand it — because this confusion has real consequences for who gets treated, how, and whether their TMJ symptoms ever actually resolve.
The criticism — and the refutation.
A common criticism Dr. Patrice hears from other providers is that the neuromuscular bite does not hold, or that the results are not repeatable. This is false.
Decades of clinical research and long-term studies have documented the efficacy and stability of the neuromuscular bite and the MORA orthotic. The evidence is peer-reviewed and consistent.
What is rarely acknowledged in this criticism is the alternative those critics propose. Do you know how they take a bite? With a bite stent. Not one muscle measurement. They literally place a wedge of material between the two front teeth and call that a bite.
That methodology — palpation (pressing on muscles to identify which one hurts) plus a bite captured with a wedge — is what many orofacial pain specialists rely on. These two opposing philosophies have been at war in the dental profession for far too long. It is time to recognize the science.
The Neuromuscular Method
Measurable. Repeatable.
9-muscle EMG. K7 jaw tracking. TENS muscle relaxation. CT imaging of the joint space. The bite position is captured from objective physiologic data — not from clinical guesswork.
The Bite Stent Method
Palpation & a wedge.
A practitioner presses on the muscles to find what is sore. A wedge of material is placed between the front teeth. That captured position is called the bite. No EMG. No jaw tracking. No physiologic data.
A 30-year debate — and how we got here.
"The treatment should depend on the diagnosis. The diagnosis should come from an evaluation of where the mandible actually sits in the joint space — and that often depends on the bite."
— Dr. Patrice Winterholler
The Gelb 4/7 position — and what the data shows.
Ideally, the joint space should rest in the neutral Gelb 4/7 position. And remarkably, when we use TENS to relax the muscles and K7 to track the resulting jaw position, this is most often exactly where we find the jaw wants to rest.
That is not coincidence. That is the body telling us where the mandible belongs — measurable, repeatable, and visible in every dataset we capture. The argument that bite position has no effect on TMJ is not supported by what we see on the CT scan, what we measure with EMG, or what we track with the K7. It is time for the profession to recognize the science, and time for patients to receive the diagnosis-driven treatment they deserve.
The answer is multifactorial.
In the end, what we are finding is that the answer is often multifactorial. The bite matters. The teeth matter. The muscles matter. And so does the airway and breathing. All of these are critical components of the craniofacial complex — and all are an integral part of solving the pain puzzle.
- Bite
- Teeth
- Muscles
- Airway
What to Expect
Your journey with the MORA.
Every patient’s timeline is different, but most experiences follow a similar arc. Knowing what to expect at each stage makes the journey easier and your progress easier to see.
Dr. Patrice delivers your custom MORA, verifies the fit, and confirms the bite position. Most patients feel an immediate sense of relief as the muscles begin to release. You will receive detailed wearing and care instructions before you leave.
Speech and eating adapt within the first few days. Some muscle soreness may occur as muscles release decades of holding patterns. Headaches and jaw pain often begin to ease noticeably this week.
Dr. Patrice re-measures muscle activity with EMG to confirm the muscles are responding as expected. Most patients see significant reduction in baseline muscle hyperactivity. Small calibration adjustments to the MORA may be made.
Most patients reach 80–90% pain reduction by this point. Headaches, neck pain, and facial soreness continue to improve. Disc recapture — the resolution of clicking and popping — can sometimes take longer than initial pain relief.
As your muscles fully re-educate and the joint stabilizes, you and Dr. Patrice discuss the path forward: continue with the MORA long-term, or move to Phase II for permanent structural correction.
Whether you choose to stay with the MORA or transition to permanent correction, the goal is the same: a stable, comfortable jaw position that holds for the long term — with the muscles, joint, and bite all working in balance.
On-Site Fabrication
The in-house lab advantage.
Most dental practices send appliance fabrication to outside labs — adding weeks of turnaround, multiple shipping handoffs, and a communication gap between the clinician who took the measurements and the technician who builds the device. Dr. Patrice’s practice fabricates every MORA in-house.
What that means for you:
- Delivers gentle ULF-TENS pulses at 1.5 Hz — the body's natural muscle relaxation rhythm
- Small electrodes placed on the face and neck — completely comfortable
- Session takes 45–60 minutes — many patients feel immediate relief during treatment
- Brings muscles to true physiologic rest — ensuring all K7 measurements are accurate
- Same-day adjustments — if your MORA needs calibration during a follow-up, adjustments can often be made on site, the same visit.
For TMJ patients, this matters. The orthotic is not a generic appliance — it is a precision instrument carrying your specific physiologic data. Keeping fabrication close to the clinical chair is part of why outcomes are so consistent.
After Phase I
The Phase II decision point.
Once your jaw has stabilized in its correct physiologic position with the MORA, you and Dr. Patrice will discuss the path forward. There is no single right answer — the decision depends on your symptoms, goals, and how your body has responded to Phase I.
Path 1
Stay with the MORA
Some patients reach a comfortable, pain-free state with the MORA and choose to continue wearing it long-term. The appliance is custom, durable, and built to last with reasonable care.
Best for patients who:
- Repositions the mandible into corrected jaw position
- Have achieved full or near-full symptom relief
- Have achieved full or near-full symptom relief
Path 2
Move to Phase II Correction
For patients who want to make their new jaw position permanent — without wearing the MORA forever — Phase II structural correction is the path. The options vary based on what your specific case calls for.
Phase II options include:
- Have achieved full or near-full symptom relief
- Prefer to avoid more involved treatment
- Find the MORA comfortable for daily wear
- DOME Expander — Distraction Osteogenesis Maxillary Expansion, an advanced surgical-orthodontic alternative to MARPE for adult patients requiring greater skeletal expansion and airway improvement.
There is no pressure either way. Many patients are deeply satisfied with the MORA and never move forward. Others use Phase I as a confirmation step before investing in permanent correction. The data and your symptoms guide the decision.
Explore TMJ Treatment
When the orthotic is not enough.
In some cases, precise additional steps are taken to fully correct the bite and restore function. These include:
Orthodontic Treatment
MARPE expanders and clear aligners to widen the upper maxilla, relieve TMJ-related pain, improve jaw alignment, and enhance facial symmetry — while improving upper airway breathing.
Dental Bite Correction
Precise adjustments including enamel removal and tooth bonding to realign the bite. For more significant adjustments, porcelain crowns are available through our in-house lab — often completed in one visit.
Myofunctional Therapy
We recommend working with a myofunctional therapist to correct tongue posture — crucial for orofacial development, airway function, facial aesthetics, and long-term oral health.
Frequently Asked Questions
About wearing the MORA
How many hours a day will I wear the orthotic?
Most patients begin wearing the MORA full-time — including overnight and during meals — for the first phase of treatment. Continuous wear gives the muscles consistent feedback and lets the bite stabilize more quickly. As you progress, Dr. Patrice will guide you on adjusting wear time based on your symptoms and the EMG data.
Can I eat with the orthotic in?
Yes. The MORA is designed for full-time wear, including during meals. Some patients take a few days to adapt to chewing with it in, but most adjust quickly. Eating with the orthotic helps reinforce the corrected jaw position with every bite — which is part of the therapeutic value.
Will the orthotic affect my speech?
There may be a slight adjustment period of a few days as your tongue and lips adapt. Because the MORA sits on the lower arch only — not the palate — speech adapts much faster than it would with an upper-arch appliance. By the end of the first week, most patients speak normally.
How do I clean and care for my MORA?
Brush the orthotic with a soft toothbrush and mild soap or non-abrasive denture cleaner each time you brush your teeth. Avoid hot water, harsh chemicals, and abrasive toothpaste — these can damage the surface. When not in your mouth, keep the MORA in its protective case. Dr. Patrice’s team will walk you through full care instructions at delivery.
What if my MORA breaks or stops fitting?
Contact the office right away. Because every MORA is fabricated in our in-house lab, repairs and adjustments can usually be made faster than at a practice that outsources lab work. If the fit changes — which can happen as the bite shifts during treatment — small calibration adjustments are part of the normal Phase I process and are anticipated.
How long does a MORA last?
With reasonable care, a well-fabricated MORA can last for years. The materials are durable and the milling is precise. Some patients who choose to remain in Phase I long-term wear the same MORA for many years before needing a replacement. The fit and calibration are monitored at every follow-up.
Will I become dependent on the orthotic?
The MORA does not create dependence — it gives your muscles and joint a stable, correct position to work from. Patients who choose to remain in Phase I do so because they are comfortable and pain-free, not because they have to. Patients who move forward to Phase II make the corrected position permanent and no longer need the appliance. Either path is valid, and the choice is always yours.
Begin Phase I Therapy
Precision relief. Built for your bite.
The custom MORA orthotic is the cornerstone of Dr. Patrice’s Phase I therapy — calibrated from your K7 jaw tracking data, fabricated in our in-house lab, and delivered to hold your jaw in its correct physiologic position. Most patients experience an 80–90% reduction in pain. Schedule your complimentary consultation to see what the data shows about your jaw.
Scottsdale
13825 N Northsight Blvd, Suite 120
Mon–Thu 8–5 · Tue 7–5 · Fri 8–1
(480) 767-8400
Payson
315 E State Highway 260
Mon–Thu 8am – 5pm
(928) 474-2200
