Occlusal splint therapy - DAHL Concept

Question 1

Spint types?

Answer 1

Hard (more effective)

Soft

Question 2

What is an occlusal splint?

Answer 2

Removable device made of acrylic resin, which fits between mx and md teeth

Question 3

Indications for splint therapy?

Answer 3

TMJ dysfunction and pain
Diagnosis of occlusal disharmony 
Establish centric relation prior to extensive rehab 
Severe bruxism
Protection of extensive dental work

Question 4

Goals of splint therapy?

Answer 4

Isolate the contact relations of teeth from masticatory system
To allow condyles to seat as optimally as possible = stabilising and improving the function of the TMJs
Allows optimal function of the neuromuscular system
Protect teeth from attrition and adverse loading

Question 5

Effectiveness of splints?

Answer 5

Effective in muscle pain reduction in 70-90%
Most effective for pain of muscular origin
Pain relief after a few days or weeks, though some require several months
Important to adjust splint periodontically to CR, and eliminate grooves due to bruxism

Question 6

Features of occlusal hard splints?

Answer 6

Uniform contact in CR
Canine guidance to separate posterior teeth in eccentric excursions
Anterior guidance to separate posterior teeth in protrusion
Full coverage
= Splint creates an artificial ideal occlusion

Question 7

Clinical stages of hard splint construction?

Answer 7

U and L alginate imps
Jaw reg in centric relation
Facebow

Fit splint

Review and adjust necessary

Question 8

How are splints made?

Answer 8

Casts mounted and incisal pin opened to give 2-3mm space
Outline drawn on casts
Two thicknesses wax adapted to cast and shaped
Check disclusion in lateral and protrusive excursions
Finished wax up, showing contacts and anterior guidance
Fit splint
Splint seated and checked for retention and even contact (ICP = RCP) (lateral and anterior guidance)

Question 9

Advantages of soft splints?

Answer 9

Sometimes tolerated better
Easily constructed
Cheap
Useful for protection from trauma

Question 10

Disadvantages of soft splints?

Answer 10

Difficult to adjust
Can encourage pt to brux
Research has shown muscle pain did not change or has increased

Question 11

Define occlusal adjustment

Answer 11

Adjust occlusion to remove unwanted/interfering contacts, esp prior to restorative tx

Question 12

Uses of occlusal adjustment?

Answer 12

Eliminating fremitus in perio involved/drifted tooth
Reduce cusp from an overerupted tooth prior to restoring the opposing tooth
Reduce load on compromised tooth e.g. non-working side interferences, RCP contact

Question 13

What to do when making occlusal adjustments?

Answer 13

Do not remove excessive tooth tissue
Must have accurate record of occlusion
Better to do before restorative work
Get informed consent

Question 14

Occlusal equilibration definition?

Answer 14

Reorganise occlusion to give an ideal occlusion by selectively adjusting tooth tissue

Question 15

Uses of occlusal equilibration?

Answer 15

Can be useful as last resort for pts with TMD symptoms who have tried all other less invasive tx
Only undertaken with the pt’s informed consent by a suitably trained and experienced clinician

Question 16

What is the Dahl concept?

Answer 16

Where restorations are
placed in supra-occlusion with the intention for the dentition to adapt to the altered occlusal scheme, in order to achieve even occlusal contact in ICP
through over eruption/intrusion.

Question 17

Dahl concept indications?

Answer 17

Highly applicable to anterior tooth wear cases due to the loss of vertical tooth height
Teeth can be restored to normal contour by increasing the vertical dimension of selected teeth w/o requiring restoration of all teeth in both arches

Question 18

How to plan for a case using the Dahl concept?

Answer 18

Imps, facebow and occlusal records (ICP)
Diagnostic wax up on articulated casts
Pt information and consent
Consider using hard splint at the increased vertical dimension to check pt tolerance
Undertake restorative procedures using the wax up as your guide

Question 19

Practical aspects of the dahl concept?

Answer 19

Warn pts regarding functional problems for a no of weeks
Movement often occurs quickly with occlusal contact being achieved in 6-8 weeks, but can take months
Keep record of occlusal changes and review pt regularly
Even large increased in VD can be tolerated

Question 20

Problems with the dahl concept?

Answer 20

Most pts adapt quickly but some may not

Small no of pts - tooth movement does not occur = require restorative intervention for the posterior teeth (onlay/crown)