splint therapy Flashcards
insurance authorization of splints
billing code splint device
D7880
when can splints not be covered with insurance?
Orthopedic Appliance Therapy
◦ Commonly referred to as:
◦ Nightguards
◦ Occlusal guards
◦ OCCLUSAL ORTHOTIC DEVICE
◦ Interocclusal splints
◦ Bite guards or bite planes
◦ Orthotics or orthoses
◦ Bruxism appliances
◦ Splints
principles of Orthopedic Appliance Therapy
Centric Relation (CR) =
Centric Relation (CR) = Retruded Contact Position (RCP)
Point of initial tooth contact when
the condyles are guided along the
posterior slope of the articular
eminence into their most superior
position on jaw closure
what positon are splints made in?
MIP
CR could impinge posterior attatchment
Centric Occlusion (CO)
Centric Occlusion (CO) = Intercuspal Position (ICP):
mandibular position with the most complete interdigitation of opposing teeth independent of condylar position
taking impressions for splints
Recording Bite Registration – in MIP (ICP)
wax should be 2.5 mm thick
Lab steps to produce splint
Trios Scanner
Bite registration needs to
open posterior bite by?
Can use what to obtain bite?
Bite registration needs to open posterior bite by 3- mm POSTERIORLY
Can use SomnoMed bite fork with or with-out horseshoe wax to obtain bite
Functions of Appliance
Therapy:
* Treats ?
* Alters ?
* Prevents?
* Reduces bruxism & parafunction ?
- Treats masticatory muscle & TMJ pain and dysfunction
- Alters functional relationships in the TMJ
- Prevents tooth wear & mobility
- Reduces bruxism & parafunction ? NO
bruxism definitions
- Sleep bruxism (SB) is a masticatory muscle activity during sleep that is characterized as rhythmic (phasic) or non- rhythmic (tonic) and is not a movement disorder or a sleep
disorder in otherwise healthy individuals. - Awake bruxism is a masticatory muscle activity during wakefulness that is characterized by repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible and is not a movement disorder in otherwise healthy individuals
occlusal splints abd tmj strain
Occlusal splints can minimize the
strain on the TMJ by lowering the
intensity, frequency, or length
of time spent on non-functional
oral activities and protect the
teeth and restorations.
Occlusal splints are typically
fabricated using ?
Occlusal splints are typically
fabricated using two primary
material types, distinguished by
their level of firmness. 8
benefits of hard acrylic splints
Hard acrylic resins splints are less
likely to stain and are less
susceptible to the buildup of
food particles.
splint materials
soft/hard acrylic, dual laminated
dual laminated material
A combined material, referred
to as dual-laminated, merges
these characteristics, consisting
of a hard acrylic resin on the
occlusal surface and a softer
interior liner.
Splint Therapy: 4 TYPES
MC splint
stabilization splint
how can posterior teeth be discluded with stabilization splints
ant guidance
do we place splints on mx/mn
depends, mainly mx but can be used on mn if splint to be used during day (better function/speech)
posterior clearance with stabilization splint
3mm
SPLINT TYPES FOR ADULTS
- Acrylic flat plane stabilization splint
- Anterior Repositioning Splint
Acrylic flat plane stabilization
splint
◦ Treats?
◦ Treats muscle and TMJ Disorders :
myalgia, myofascial pain,
arthralgia and clenching
Anterior Repositioning Splint:
◦ Treats?
◦ Has indexing or indentations
holding ?
◦ Treats anterior disc displacement
without reduction & intermittent
non-reduction by unloading
posterior attachment
◦ Has indexing or indentations
holding jaw anteriorly to reduce
inflammation on the posterior
attachment reducing acute pain
Splint therapy – full coverage appliance
◦ The full-coverage flat plane stabilization appliance, also known as? .
◦ The optimal positioning of a stabilizing appliance should result in?
◦ common? oral structure risks?
◦ The full-coverage flat plane stabilization appliance, also known as the Michigan splint, is custom-made for
either the maxillary or mandibular arch.
◦ The optimal positioning of a stabilizing appliance should result in only slight modification to the maxillomandibular relationship, apart from the minimal
effect caused by the thickness of the appliance’s material.
◦ This kind of oral appliance is the most widely used, and when constructed accurately, it carries the smallest
risk of negative consequences to the oral structures.
Splint therapy – full
coverage appliance study success
- majority of pts saw improvement
- lower success with displaced discs
Stabilization Splint
Indications:
◦ Myalgia or Myofascial Pain
◦ Capsulitis/synovitis
◦ Osteo/Rheumatoid Arthritis
◦ Anterior disc displacement with reduction
◦ Attrition prevention
Stabilization Splint Patient Instructions
* When removing splint from mouth?
* The patient should be accustomed to appliance within?
* Pain & Symptoms should begin to improve within?
- When removing splint from mouth, tell patient that it may take a few minutes to “find their normal bite”
- The patient should be accustomed to appliance within 1 to 2 weeks
- Pain & Symptoms should begin to improve within 3 to 4 weeks (but may take longer)
Stabilization
Splint Patient
Instructions
◦ Keep appliance where when not wearing?
◦ Keep appliance moist?
◦ HIDE from ?
◦ Keep appliance in case when
not wearing
◦ Keep appliance moist by
placing small amount of
water in case
◦ HIDE from DOGS
SPLINTS FOR ADULTS
SHOULD BE?
OVER THE COUNTER SPLINTS
ARE?
SHOULD BE CUSTOM MADE
BY DENTIST
OVER THE COUNTER SPLINTS
ARE SOFT- THE PATIENT BOILS
THE APPLIANCE AND BITES
INTO IT WHILE WARM THEREFORE CALLED “BOIL & BITE” NIGHT GUARD
Stabilization Appliance (flat plane, gnathologic, or muscle relaxation splints
1. types?
2. Must cover?
3. Hard appliance advantage?
4. Good for?
5. Reduces symptoms in % of
TMD’s
- Acrylic (hard) splint with flat-plane occlusion; clasps add retention OR acrylic with flex liner (hard/soft splint)
- Must cover all of the maxillary or mandibular teeth
- Hard appliance reduces symptoms more quickly & effectively than soft splint
- Good for bruxism/clenching
- Reduces symptoms in 70-90% of TMD’s
Stabilization Appliance
Functions
Stabilization Splint Patient Instructions:
* wear how long?
* when to wear at night?
* when to wear during day?
* appliance cleaning
Symptom Improvement with stabilization splint:
Failure to show an initial positive response may be related to
Anterior Repositioning
Appliance
◦ Also known as:
s
◦ Anterior positioning splint
◦ Mandibular orthopedic repositioning
appliance (MORAs
ant repostioning splint indexing purpose
Indexing holds jaw anteriorly to unload posterior attachment,
improve pain and Possibly improve Disc position to seat onto condyle
BITE REGISTRATION for ant repositioing splint:
BITE REGISTRATION IS TAKEN BY moving?
LISTEN WITH STETHOSCOPE TO SEE IF?
BITE REGISTRATION IS TAKEN BY MOVING MANDIBLE FORWARD BY 1-2 MM.
LISTEN WITH STETHOSCOPE TO SEE IF CLICK IS ELIMINATED TEMPORARILY WITH OPENING & CLOSING.
MANDIBULAR ANTERIOR REPOSITIONING SPLINT:
HAS INDEXING ON? may improve?
HAS INDEXING ON OCCLUSAL SURFACE TO HOLD MANDIBLE FORWARD. MAY IMPROVE DISC CATCHING OR
LOCKING OF THE DISPLACED DISC BUT NO GUARANTEE
Anterior Repositioning Splint
Indications
Anterior Repositioning Appliance MAY Affect TMJ Disc Displacements in 3 Ways:
1. TMJ
1. condyle-disc relation?
1. mm?
- Alters adverse loading in the TMJ (unloads the posterior attachment)
- Alters the structural condyle-disc relationship
- Reduce associated muscle splinting
Anterior Repositioning Splint
Not always successful in?
Not always successful in recapturing disc or eliminating TMJ noises
Anterior Repositioning
Splint: nightime wear indicated when?
Night time wear is indicated if
jaw locking primarily occurs on awakening
day time wear with ant. repositioning splints is indicated when
Day time wear is indicated if
locking with pain primarily occurs
in daytime
Anterior Repositioning splint replacement
Replace with stabilization splint in
6-12 weeks once joint
pain/dysfunction is controlled
Partial Coverage splint
◦ NTI :called the Nociceptive Trigeminal Inhibition Tension Suppression System (NTI-tss), which involves a small segment of the maxillary anterior teeth,
typically 2 to 4 incisors.
NTI-tss negative dental effects?
The Risk of negative dental effects from the use of the NTI- tss over an extended and continuous duration is considerable. 8
negative dental effects associated with NTI-tss
- may lead to irreversible changes in the occlusion
- overeruption of the unopposed premolars and molars which may lead to anterior open bite.
- Mobility of the mandibular anterior teeth
- The displacement of the maxillary anterior teeth from occ forces
- may lead to mouth dryness during sleep
- could be swallowed or inhaled
Evaluation of the efficacy of the full
coverage stabilization splint and the
partial coverage appliance (NTI-tss)
After 3 months, there were no noted differences in treatment outcomes between
the two types of splints.13
Partial Coverage Splints
* done at UMKC SD?
* loading forces?
* occlusion?
- NEVER done at UMKC SD
- Do not evenly distribute loading forces
- May cause occlusal problems (i.e. super-eruption of teeth not covered by acrylic)
Soft Splint
* Effective in? Less effective in?
* Protects teeth from?
* bruxism?
* May be helpful for?
* cost?
- Effective in pediatric patients/Less effective in adults
- Protects teeth from trauma
- Does not decrease bruxism; may increase bruxism in adults
- May be helpful for short-term use
- Inexpensive
whay are soft splints good for peds
Effective in pediatric
patients and used for
MIXED DENTITION
because it is SOFT and
will not block the
eruption of the
permanent teeth
conditions were soft splints are useful
Myalgia, Arthralgia,
and clenching/bruxism
Why can ONLY a SOFT SPLINT
be used in pediatric patients?
erupting teeth can alter the fit of a hard splint
Appliance Home Care
Instructions
Splint Therapy “Do’s”
* occ record
* limit wear hrs?
* always have?
* experiment with?
* ant repositioning should be worn?
* occ recheck?
Warn your patient
◦ Do NOT wear how often? what happens? which types of splints?
Warn your patient
◦ Do NOT wear 24 hours per day on long-term basis or Major changes in occlusion (OPEN BITE) may occur
◦ Occurs especially with partial-arch coverage- NOT RECOMMENDED
Splint Follow-
up Appointments time frame
◦ 2 weeks
◦ 1 month
◦ 3 months
◦ 6 months (as long as patient
wears splint)
splint follow-ups, what to examine
◦ Check fit and occlusal balance
◦ Check fit and LOOK for OCCLUSAL WEAR. Show patient wear patterns- EDUCATION.
◦ Follow-up with pain & adjust medications, f/u with physical therapy
What to Look For During the
Adjustment
1.Wear patterns on the splint to determine how heavily your patient is clenching or grinding. Side- to- side markings indicate bruxism.
2. Fractures in splint due to heavy clenching.
3. Delamination of soft line
What are the complications
with excessive or incorrect use?
- Occlusal changes (i.e. open bite)
- Speech difficulties
- Caries
- Gingival inflammation
- Malodor
- Psychological dependence
Splint Adjustments
WHY ADJUST ?
arthitis use?
- It is your LEGAL RESPONSIBILITY
To correct for changes in occlusion as pain, muscle activity, inflammation, edema, or soft tissue relations change. - Malocclusion due to arthritis must be monitored once per month for 6 months and the splint serves a diagnostic purpose to see if occlusal contacts on splint are stable over time
SUMMARY FOR SPLINTS:
* Limit wear to?
* May improve? but?
* Do NOT promise the patient that it will?
* Should decrease ?
* Adjust splint?
* Evaluate patient’s occlusion to?
- Limit wear to 8-12 hours long term
- May improve clicking but not necessarily eliminate it
- Do NOT promise the patient that it will “cure” their symptoms
- Should decrease pain, tightness, & locking
- Adjust splint on regular basis
- Evaluate patient’s occlusion to ensure that it is not changing due to splint wear
