Occlusal splint therapy, occlusal adjustment, The Dahl Concept Flashcards
Types of splint therapy (5)
Occlusal splint Michigan splint (upper) Tanner appliance (lower Stabilisation splint Interocclusal appliance
What can splints be made out of and which is better? (3)
Hard or soft acrylic
Hard acrylic is much more effective
What is an occlusal splint? (3)
Removable device made of acrylic resin, which fits between the maxillary and mandibular teeth
Indications for splint therapy (5)
TMJ dysfunction and pain Diagnosis of occlusal disharmony Establish centric relation prior to extensive rehabilitation Severe bruxism Protection of extensive dental work
Goals of splint therapy (4)
Isolate the contact relations of teeth from masticatory system
To allow condyles to seat as optimally as possible thus stabilising and improving the
function of the TMJs
To allow optimal function of the neuromuscular system
Protect teeth from attrition and adverse loading
Effectiveness of splint therapy (4)
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 periodically to centric relation, and eliminate
grooves due to bruxism
Features of occlusal splints (4)
Uniform contact in centric relation
Canine guidance to separate posterior teeth in eccentric excursions
Anterior guidance to separate posterior teeth in protrusion
Full coverage
I.e. The splint creates an artificial ‘ideal’ occlusion
Clinical stages of splint construction (3)
Visit 1 – Upper and lower alginate impressions – Jaw registration in centric relation – Facebow Visit 2 – Fit splint Subsequent visits – Review and adjust as necessary
How does the technician make a splint? (7)
Casts mounted, and incisal pin opened to give 2-3mm space
Outline drawn on casts
Two thicknesses wax adapted to cast and then 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
Advantages of soft splints (4)
– Sometimes tolerated better by patients
– Easily constructed
– Cheap
– Useful for protection from trauma
Disadvantages of soft splints (3)
Difficult to adjust. Can encourage patient to brux Research has shown that muscle pain either did not change, or, in 26% cases, it increased (Harkins and Marteney, 1988)
Definition of occlusal adjustment
Adjusting the occlusion to remove unwanted/interfering contacts, especially prior to restorative treatment
Examples of uses of occlusal adjustment (3)
– Eliminating fremitus in a periodontally involved/ drifted tooth
– Reducing a cusp from an overerupted tooth prior to restoring the opposing tooth
eg. ‘plunging’ palatal cusp of upper molar
– Reducing load on a compromised tooth eg non-working side interferences, RCP contact etc
Carrying out occlusal adjustment - tips (4)
Be very careful and do not remove excessive tooth tissue
You must have an accurate record of the occlusion prior to treatment
It is much better to do it before restorative work – otherwise it looks like an excuse!
You must get informed consent
Definition of occlusal equilibration (1)
Reorganising the occlusion to give an ‘ideal’ occlusion by selectively adjusting tooth tissue
Uses of occlusal equilibration (1)
Can be useful as a last resort for patients with TMD symptoms who have tried all other less invasive treatment modalities
Restricted to postgrad practice!
No longer really advocated at all
What is the Dahl concept? (2)
any procedure 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.
Indications for the Dahl concept (3)
– 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 without necessarily requiring restoration of all teeth in both arches
– However, not an excuse to cement any restoration high where it was not previously planned!
Planning a case using the Dahl concept (5)
Impressions, facebow and occlusal records (RCP)
Diagnostic wax-up on articulated casts
Patient information and consent!
(Consider using a hard splint at the increased vertical dimension to check
patient tolerance)
Undertake restorative procedures using the wax-up as your guide
Practical aspects of using the Dahl concept (4)
Warn patients regarding functional problems
for a number of weeks
Movement often occurs quickly with occlusal
contact being achieved in 6-8 weeks, however it can take months
Keep a record of occlusal changes and review the patient regularly
Even very large increases in VD can usually be tolerated
Problems with the Dahl concept (2)
Most patients adapt very quickly but some may not adapt, however this is VERY rare
In a very small number of patients tooth movement does not occur and
therefore these patients may require restorative intervention for the posterior teeth, such as onlays or crowns
