Occlusal Splint Therapy

Technique for Construction 1. Lecture: Bruxism & Occlusal Splint Therapy

of a Maxillary Stabilization Splint. 2. Lecture: Technique for Construction of a Maxillary
Part 1
Stabilization Splint. Part 1
3. Clinic: Maxillary impression & model
4. Clinic: Splint construction 1
5. Lecture: Technique for Construction of a Maxillary
Pei Feng Lim BDS, MS Stabilization Splint. Part 2
Diplomate of the American Board of Orofacial Pain 6. Lecture & Lab: Masticatory Muscle & TMJ disorders
Fellow of the American Academy of Orofacial Pain 7. Clinic: Splint construction 2
Director, Oral & Maxillofacial Pain Program 8. Clinic: Splint construction 3
UNC at Chapel Hill, School of Dentistry
[email protected]

Types of Splints Stabilization Splint

• Stabilization Splint / Muscle Relaxation Splint
• Anterior Positioning or Repositioning Splint /
Orthopedic Repositioning Splint
• Anterior Bite Plane
• Posterior Bite Plane
• When splint is in place,
• Pivoting Splint condyles in musculoskeletally stable position,
• Soft Splint teeth contact evenly & simultaneously
• canine guidance
• Etc. • AIM: eliminate orthopedic instability between occlusal
position & TMJ position

Stabilization Splint Contraindications

• maxillary / mandibular
1. Mixed dentition 2. Orthodontic treatment
Advantages of Maxillary stabilization splint
1. Covers more tissue → > stable, > retentive, < likely to break
2. Easier to achieve occlusion in Class II & III
3. Lower teeth contact on flat surface → > stable
4. Easier to locate CR position

Advantages of Mandibular
stabilization splint
1. Aesthetics

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 Criteria for Stabilization Splint Many Techniques
1. Good fit, stability & retention
2. In CR, mandibular buccal cusps
• None better than the other
contact flat surfaces evenly • Indirect (lab) Vs Direct (chair side)
3. Protrusion on canines
4. Laterotrusion on canines techniques
5. Mandibular posterior teeth
contact splint only in CR
• Technique sensitive
6. Upright position, posterior occlusion
more prominent than anterior
7. Splint occlusal surface is flat The best technique is the technique you are
8. Splint polished
most experienced in & most comfortable with

Indirect Technique Indirect Technique

Less chair-side time (more popular)

1. Maxillary & Mandibular impression & models

2. Bite Registration

Indirect Technique Indirect Technique

3. Face-bow record 4. Send to Laboratory

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 Indirect Technique Indirect Technique

5. Finished product from Lab 6. Splint delivery

Direct Technique Technique Outline

• Is what you will learn in this course 1st visit
• Patient assessment
• Disadvantage: chair time • Maxillary impression
• Advantage: if you can do this, you can make
any splint with any technique on any planet Laboratory Phase

2nd Visit
• Splint delivery

3rd Visit (follow-up)

• Splint adjustment

Visit 1: Patient Assessment Demographics

• Name
• Date
• BP
• Pulse
• Age
• Sex
• Medical Hx: Bruxism secondary to medical condition
(neurodegenerative disorders? Parkinsons? Epilepsy? Sleep
disorder? Anxiety disorder? Chronic pain conditions? TMD?)
• Current Meds: Bruxism secondary to Rx/drug use
• Allergies:

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 Chief Complaint Chief Complaint
• “I have soreness in my jaw when I wake up in the • Bruxism: clenching, grinding, other oral parafunctional habits
morning”
• “Mom thinks I am grinding my teeth in my sleep” • Reported by bed partner
• Jaw soreness/pain in the morning
• “3 of my back teeth have fractured in the past month. • Jaw muscles feel tired in the morning
Do you think I am grinding my teeth?”
• TMJ clicking/crepitus
• “I have fibromyalgia. My rheumatologist thinks I have
TMD and he said a bite splint should help”
• “I have had the TMJ for many years. Lately, my
headaches have worsened. My neurologist says
maybe I’m grinding my teeth. Will a bite splint help?”

Chief Complaint Psychosocial History

• Restricted mouth opening • Caffeine
• History of jaw locking • Alcohol
• Jaw pain • Nicotine
• Headaches • Sleep disorder: snoring, sleep apnea
• Stressors: life events, lifestyle, anxiety
• History of past treatment: multiple splints, tx for
TMD, tx failures

Clinical Examination Clinical Examination

• Mandibular Function & Provocation Tests
• Palpation of Orofacial Muscles • Intraoral Examination: tooth
• Palpation of TMJ wear, tooth mobility, cheek
• Mandibular Range of Motion indentation, tongue
indentations
• Occlusion: intercuspal
position, working contacts, non
working contacts, protrusive
contacts

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 Clinical Examination Additional Tests
Questionnaire
Examine current splint (if present)
• Splint description: maxillary/mandibular, partial/full- 1. Has anyone heard you grinding your teeth at night?
coverage, soft/acrylic 2. Is your jaw ever fatigued or sore on awakening in the
morning?
• Fit
3. Are your teeth or gums ever sore on awakening in the
• Retention morning?
• Stability 4. Do you ever experience temporal headaches on
awakening in the morning?
• Occlusion: centric stops, lateral guidance, protrusive guidance
5. Are you ever aware of grinding your teeth during the
day?
6. Are you ever aware of clenching your teeth during the
day?

>2 positive responses => bruxer

Additional Tests Additional Tests

Polysomnogram EMG Recording

Bader & Lavigne. Sleep Med Rev 2000;4(1)27-43

Additional Tests
Imaging Summary of Findings
• Clinical Impression:
Nocturnal bruxism? Daytime parafunctions?

• Contributing Factors:
Psychosocial stressors? Caffeine?

• Treatment Plan
1. Advised stress mx & reduce caffeine intake
2. Maxillary stabilization splint

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 Armamentarium
Maxillary Impression

A good quality impression accurately capturing

1. all teeth
2. hard palate

Maxillary Impression Making a Maxillary Impression

Look at the palatal arch Select tray

Fabricate stone model

Check Impression
Criteria for good impression
1. All teeth captured
2. Hard palate captured
3. Good quality & accurate

A good quality model accurately capturing

1. all teeth
2. hard palate
Æ Faculty signature

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Armamentarium
Stone Model

Check Model Splint Outline

• Buccal & labial extension –
Criteria for good model
at level of interdental papilla
1. All teeth captured • Distal extension – distal to last tooth (2nd molars)
2. Hard palate captured • Palatal extension – 15mm from gingiva
3. Good quality & accurate

Æ Faculty signature

Draw Splint Outline Draw Splint Outline

Armamentarium • Buccal & labial extension – at level of interdental papilla

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 Draw Splint Outline Draw Splint Outline
• Buccal & labial extension – at level of interdental papilla • Buccal & labial extension – at level of interdental papilla

Draw Splint Outline Draw Splint Outline

• Palatal extension – 15mm from gingiva • Palatal extension – 15mm from gingiva

Draw Splint Outline Write patient’s name

• Distal extension – distal to last tooth (2nd molars) on base of model

Æ Faculty signature

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 Wrap Stone Model
Draw Splint Outline

Recapitulation 23 Feb 8-10am Recapitulation 23 Feb 8-10am

Lab Sheet Instructions

Recapitulation 23 Feb 8-10am
• use hard/soft material
• follow splint outline drawn on model
• create anterior stop

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 Anterior Stop

5mm
10mm
5mm

Finished Product from Lab

Lab Procedure
Checklist
• Splint, model, case for storing splint
• Correct hard/soft material
• Anterior stop

Finished Product from Lab Poor retention & unstable

Checklist
• Splint outline
• Fit
• Retention
• Stability

Æ Faculty signature

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 Visit 2: Splint Delivery Armamentarium

Locating the CR position

Check splint in the mouth Musculoskeletally stable position
Checklist
• Fit
• Retention
• Stability

Locating the CR Locating the CR

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 Check splint in the mouth Check posterior separation

Checklist

Checklist • Posterior teeth separation ~2mm.

• Anterior stop perpendicular to lower incisor

Occlusal
surface of
splint

2mm Anterior Inferior Lubricate

acrylic
stop surface
perpendicular
to lower
restorations
Last molar incisor

Checklist with vaseline

• Posterior teeth separation ~2mm.
** If >2mm, reduce vertical height of anterior stop
** If <2mm, add acrylic to increase vertical height of anterior stop

Building the Occlusion Building the Occlusion

• Seat splint in the mouth

• Mix acrylic
• Guide mandible to CR. Patient close till lower incisors
• Place acrylic on occlusal surface of splint hit anterior stop

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 Building the Occlusion Recapitulation 23 Feb 8-10am

WHY??

Leave splint on model to allow acrylic to polymerize

Recapitulation 23 Feb 8-10am Recapitulation 23 Feb 8-10am

Recapitulation 23 Feb 8-10am Recapitulation 23 Feb 8-10am

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Recapitulation 23 Feb 8-10am

Up next,
23 Feb Clinic 8-10am
Maxillary impression

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