Occlusal splints Flashcards
What is an occlusal splint?
Rigid or flexible appliance that overlies the occlusal surface of teeth
Used to treat clenching, bruxism and their sequelae and to provide temporary relief from muscle or TMJ related pain
What are the uses?
TSL:
Diagnostic
Part of tx plan
Prevention
Bruxism:
Control sleep noise
Not a treatment and may need replacement
TMD:
Used initially but discouraged use over a long period of time
Beware of occlusal changes
Muscles of mastication disorders
Myalgia, arthralgia, disarrangement, disclocation of disc
What are the functions of splints?
Alter occlusal forces
Prevent wear and mobility of teeth
Reduce bruxism and parafunction
Tx masticatory muscle pain and dysfunction
Alter the structural relationship of the TMJ
What are the 5 theories of splint therapy?
Occlusal disengagement theory
Maxillomandibular realignment theory
Restored vertical dimension theory
TMJ repositioning theory
Cognitive awareness theory
What is the occlusal disengagement theory?
- Provides an idea occlusion and reduces abnormal muscle activity
- Separates teeth
- Diagnostic wax up to increase OVD
What is the height of an average central incisor?
9-10mm
What is the maxilla-mandibular realignment theory?
Assumes that the existing mandibular position is incorrect
Aims to produce neuromuscular balance
What is the restored vertical dimension theory?
Assumes that the patient has lost vertical height this causing abnormal muscle activity
Restores muscles to their correct length
What is the TMJ repositioning theory?
Assumes that the condylar head needs to be repositioned in some way within the glenoid fossa
Correct post diagnosed with radiographs
What is the cognitive awareness theory
Can be applied to all occlusal splints
Based on the concept that having something in your mouth alter behaviour and allows conscious intervention in subconscious activity
What are the types of splints?
Relaxation:
Soft POC (polyvinyl occlusal coverage)
Localised interference splint
Anterior bite plane
Repositioning splint
Stabilisation splint:
Michigan - hard splint for upper jaw
Tanners - hard splint for lower jaw
Thermoform
Describe a soft POC
Polyethylene/polyvinyl vacuum formed onto cast
No attempt to balance occlusion
Quick, easy and low cost
First line splint
Diagnostic aid if bruxism is in doubt
How far over the gingival margin does a POC extend?
2-3mm
How to make a POC?
Alginate impression
No jaw reg needed
Easy to fit
Worn at night
Cane be made for upper or lower arch
If poorly tolerated, try opposing arch before giving up
MoA of POC
Act as a shock absorber
Cognitive awareness habit breaker
In some pts, may increase parafunction so monitor carefully
Can be used over full dentures to increase face height
MoA of localised interference splint
Designed to deliberately overload the proprioceptive fibres of four teeth and provide feedback to break the neuromuscular pattern
May remove posterior interferences as anterior tooth separation is increased
MoA of anterior bite plane (Lucia jig/deprogrammer)
Partial occlusal coverage splint, disengages anterior teeth
Moves mandible forwards and in lateral excursion - needs to record movements
Anterior guidance
How is an anterior bite plane made?
Easily made chair side
Auto-polymerising acrylic applied to anterior teeth at dough stage like compo
Posterior teeth disclude
Allowed to cure
Smooth guidance is the ground in
When are anterior bite planes used?
Used for patients with acute muscle spasm
Can provide symptomatic relief
Should not be worn at night
Short term only
What are the risks for anterior bite planes?
Over-eruption of teeth - 82% = 1.5mm
15% > 2mm
Inhalation
MoA of stabilisation splint
Provide temporary and theoretical ideal occlusion
Anterior guidance free from posterior interferences
Difficult to make and fit
Fabrication of stabilisation splint
Mainly on arch with most missing teeth
Upper appliances better tolerated
Upper and lower alginate impressions and facebow recorded
Centric relation/RCP recorded
What to check in a stabilisation splint
Fully retentive
Friction fit
Ball end claps may be incorporated to aid retention
Centric occlusion, even contact with opposing teeth and balanced posterior occlusion
Purpose of stabilisation splint
Help to reactive RCP/CR
Night time wear or during periods of clenching/bruxism
Monthly interval review
Pt weaned off splint
What is a thermoform splint?
Halfway between hard and soft splint
Either formed in hard polymer or laminate version
Adjust RCP=ICP
