Occlusal appliance therapy involves using removable splints to treat temporomandibular disorders (TMD). There are several types of splints that are used for either diagnostic or therapeutic purposes. Stabilization splints are typically used to treat muscle pain by relaxing muscles and allowing the jaw to rest in the optimal position, while anterior positioning splints are often used to treat disc disorders by encouraging the jaw to move forward. Proper splint selection and patient compliance are important for achieving successful treatment outcomes.
Occlusal appliance therapy involves using removable splints to treat temporomandibular disorders (TMD). There are several types of splints that are used for either diagnostic or therapeutic purposes. Stabilization splints are typically used to treat muscle pain by relaxing muscles and allowing the jaw to rest in the optimal position, while anterior positioning splints are often used to treat disc disorders by encouraging the jaw to move forward. Proper splint selection and patient compliance are important for achieving successful treatment outcomes.
Occlusal appliance therapy involves using removable splints to treat temporomandibular disorders (TMD). There are several types of splints that are used for either diagnostic or therapeutic purposes. Stabilization splints are typically used to treat muscle pain by relaxing muscles and allowing the jaw to rest in the optimal position, while anterior positioning splints are often used to treat disc disorders by encouraging the jaw to move forward. Proper splint selection and patient compliance are important for achieving successful treatment outcomes.
Occlusal appliance therapy involves using removable splints to treat temporomandibular disorders (TMD). There are several types of splints that are used for either diagnostic or therapeutic purposes. Stabilization splints are typically used to treat muscle pain by relaxing muscles and allowing the jaw to rest in the optimal position, while anterior positioning splints are often used to treat disc disorders by encouraging the jaw to move forward. Proper splint selection and patient compliance are important for achieving successful treatment outcomes.
Definition of occlusal appliance therapy Uses of splints • Diagnostic use of splint • Therapeutic use of splint Types of splints: • Stabilization splint • Anterior positioning splint • Anterior bite plane splint • Posterior bite plane splint • Pivoting splint • Soft or resilient splint Which splint should be used? Success of splint therapy Definition – Occlusal Appliance An occlusal appliance is a removable device that fits over the occlusal and incisal surfaces of the teeth in one arch, creating precise occlusal contact with the teeth of the opposing arch - Commonly referred to as: splint, bite guard, night guard, interocclusal appliance, and orthopedic device . Occlusal appliance therapy is “the art and science of establishing neuromuscular harmony in the masticatory system by creating a mechanical disadvantage for parafunctional forces with the use of occlusal appliance” Used in treatment of TMD, bruxism, and headache TMD “Umbrella term covering pain and dysfunction of the muscles of mastication and the temporomandibular joints” Difficult to diagnose, as presenting symptoms can be variable Treatment is challenging for both dentist and patient Splint treatment is reversible and non-invasive Splint treatment provides diagnostic information and relief USES OF SPLINTS To temporarily provide an occlusal condition that allow the TMJ to assume the most orthopedically stable joint position (centric relation) To introduce an optimum occlusal condition that reorganises neuromuscular reflex activity To protect the teeth from abnormal forces CENTRIC RELATION “the most retruded relation of the mandible to the maxillae when the condyles are in the most posterior unstrained position in the glenoid fossae from which lateral movement can be made at any given degree of jaw separation” “the relation of the mandible to the maxillae when the condyles are in the uppermost and rearmost position in the glenoid fossae” SPLINT-DIAGNOSTIC Splints help to determine parafunctional habits Splints help to determine the causative factor of TMD Splints help to rule out certain causative factors of TMD Help in management of the symptoms of many TMDs: • Muscle relaxation • Protecting teeth and jaws from bruxism • Allow condylar seating in the most orthopedically stable joint position (CR) TYPES OF OCCLUSAL APPLIANCES (SPLINTS) 1. Stabilization splint: also called muscle relaxation splint 2. Anterior positioning splint: also called orthopedic repositioning appliance 3. Anterior bite plane 4. Posterior bite plane 5. Pivoting splint 6. Soft or resilient splint STABILIZATION SPLINT Is a full arch hard acrylic splint Generally fabricated for the maxillary arch Allows condylar seating in the CR when splint is in place Provides an optimal occlusal relationship Canine disocclusion of posterior teeth in excursions Treatment goal: to eliminate any orthopedic instability between the occlusal position and the joint position STABILIZATION SPLINT INDICATIONS Generally used to treat muscle pain disorders: 1. TMD that relates to muscle hyperactivity : Wearing stabilization splint >>> decreases parafunctional activity e.g. bruxism >>> muscle relaxation and pain relief 2. Local muscle soreness 3. Chronic centrally mediated myalgia Also helpful for treatment of retrodiscitis secondary to trauma: Wearing stabilization splint >>> minimises forces to damages tissues >>> permits more efficient healing RETRODISCITIS Stabilization splint maxillary versus mandibular Maxillary: • More stable and covers more tissue • More retentive and less likely to break • More versatile (allows opposing contacts to be achieved in all skeletal and molar relationships) • All mandibular contacts are on flat surface (increased stability) • Help to locate the CR Mandibular: • Easier to speak with • Less visible (more aesthetic) Anterior positioning splint Is a full arch hard acrylic splint Preferably maxillary arch Has ramps or indentations that encourages the mandible to assume a position more anterior to the intercuspal position Treatment goal: is to temporarily change the position of the mandible in relation to the cranium Anterior positioning splint indications Used in management of disc derangement disorders: Wearing anterior positioning splint >>> anterior positioning of condyle >>> better condyle-disc relationship >>> tissue adaptation or repair 1. Disc displacement 2. Disc dislocation with reduction 3. Patient with joint sounds 4. Intermittent or chronic locking of the joint Also useful in treatment of some inflammatory disorders e.g. retrodiscitis “The goal of treatment is not to alter the mandibular position permanently but only to change the position temporarily so as to enhance adaptation of the retrodiscal tissues” Anterior positioning splint maxillary versus mandibular Maxillary: • A guiding ramp can be more easily fabricated to direct the mandible into the desired forward position Mandibular: • The guiding ramp does not achieve the desired forward position easily • Patient can more easily position the mandible posteriorly because it is not controlled Anterior bite plane splint Is a hard acrylic splint worn over maxillary teeth Provides contact with only the mandibular anterior teeth Primarily intended to separate posterior teeth and thus eliminate their influence on the masticatory system Anterior bite plane splint indications Suggested for treatment of: 1. Muscle disorders related to orthopedic instability or an acute change in the occlusal condition 2. Parafunctional activity Anterior bite plane splint complications Complications may arise as it covers only a portion of one arch Unopposed posterior teeth might supraerupt Wearing the appliance for long periods increase the chance for supraeruption The result will be anterior open bite Treatment must be closely monitored and used only for short periods Stabilisation splint is a safer alternative posterior bite plane splint Hard acrylic splint Usually fabricated for mandibular teeth Located over posterior teeth and connected by a cast metal lingual bar Treatment goal: to achieve major alterations in vertical dimension and mandibular positioning posterior bite plane splint indications In cases of severe loss of vertical dimension When there is a need to make major changes in anterior positioning of the mandible May be helpful for certain disc derangement disorder May be used by athletes to improve athletic performance posterior bite plane splint complications Complications may arise as it occludes with specific parts of the dental arch Unopposed anterior teeth might supraerupt Occluded posterior teeth might intrude Wearing the appliance for long periods can cause posterior open bite Constant and long-term use should be discouraged Anterior positioning splint is a safer alternative for treatment of disc derangement disorders Pivoting splint Is a full arch hard acrylic splint Provides a single posterior contact in each quadrant (bilateral) Contact is established as far as possible Theory? : Anterior teeth are moved closer >>> Fulcrum is created around the posterior contact >>> condyle is pivoted downward and backward away from fossa >>> articular surface is unloaded and interarticular pressure is reduced Unilateral pivot splint Unilateral pivot is usually placed in the second molar region Closing the mandible on the pivot will load the contralateral joint and distract the ipsilateral one (increase the discal space) The only appliance that can routinely distract a condyle from the fossa Used for treatment of acute unilateral disc dislocation without reduction Should not be used for longer than 1 week because it is likely to intrude the molar Soft resilient splint Fabricated from a resilient material Usually adapted to maxillary teeth Treatment goal: is to achieve even and simultaneous contact with opposing teeth (?) Most of soft materials can’t be accurately adjusted to the exact requirements of the neuromuscular system (splints can’t be balanced) Soft resilient splint For protection during athletic activities For patients who suffer from repeated or chronic sinusitis For patient who exhibit high level of clenching or bruxism: • help to dissipate some of the heavy loading forces • Soft splints have not been shown to decrease bruxing activity • Can exacerbate bruxism • Hard appliances have been shown to be more efficient in reducing symptoms Which type of splint should beused?
Hard splints are more documented in literature than soft
splints Splints that cover a portion of one arch might cause supraeruption of uncovered teeth and/or intrusion of covered teeth (anterior bite plane, posterior bite plane, and pivoting appliances) Stabilization splint is usually used for treatment of muscle pain disorders Anterior positioning splint is usually used for treatment of disc derangement disorders Both types are useful for retrodiscitis In both types, maxillary splints are preferred over mandibular Success of splint therapy Proper appliance selection: Identify the major causative factor >>> select the appliance that is aimed to affect the specific causative factor Fabrication and adjustment of the splint: splint must be fabricated and adjusted until treatment goals are met Patient cooperation: Splint therapy is reversible and is effective only when the patient is wearing the appliance as instructed
