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An Approach Towards Better Life - Through Splints
An Approach Towards Better Life - Through Splints
Introduction Main reasons for occlusal splint therapy Occlusal splint therapy has been shown to be useful for the diagnosis and management of various masticatory system disorders. A common reason for prescribing an occlusal splint is to protect the teeth from excessive wear in patients with bruxism. Splints are also used frequently to treat patients with internal derangement and other TMDs with associated symptoms such as tension headache and cervical nec! and oral"facial pain. A common goal of occlusal splint treatment is to protect the TM# discs from dysfunctional forces that may lead to perforations or permanent displacements. Other goals of treatment are to improve $aw% muscle function and to relieve associated pain by creating a stable balanced occlusion. Occlusal splint therapy can be recommended for the following purposes& To protect oral tissues in patients with oral parafunction. To stabili'e unstable occlusion.. To promote $aw muscle relaxation in patients with stress related pain symptoms li!e tension headache and nec! pain of muscular origin. To eliminate the effects of occlusal interference. To test the effect of changes in occlusion on the TM# and $aw muscle function before extensive restorative treatment TYPES OF OCCLUSAL SPLINTS According to Okeson: Stabili'ation appliance Anterior repositioning appliances
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Indications Treatment of muscle disorders related to orthopedic instability or an acute change in the occlusal condition. (arafunctional activity associated with unfavorable posterior tooth contacts can also be treated but only for short periods. ,f the appliance is worn continuously for several wee!s or months it is li!ely that the unopposed mandibular teeth will supraerupt. 7hen this occurs and the appliance is removed it results in an anterior open bite. Anterior bite plane therapy must be closely monitored and used only for short periods. ANTERIOR REPOSITIONIN) SPLINT
Indications Anterior repositioning splints can be efficacious for intermittent $aw loc!ing with limited range of motion especially upon awa!ening or for persistent TM# arthralgia not responsive to other therapy *including a stabili'ation splint-. They are recommended only for short%term use because they can cause occlusal changes if worn continuously or chronically.Anterior repositioning splints are used primarily to treat disc% interference disorders.
A&&"ications o, t-e +D ,tcanbeusedforsimplifyingdifficultbite registrations and for accurate mountingofdiagnosticcasts forpatientsthatare difficulttomanipulate into01 andforfacilitatingocclusal ad$ustments*duringwhichtimeit isworn-. The8Dcanbeusedasa diagnostictooltodetermineifthe
todifferentiateamongthreetypesof
grindingtriggeredbyinterferencesontheposteriorteeth. The$awisnotmanipulatedinto01 butisdeterminedbythe patientandisreproducible.This isa!eycriteriontodetermine ifthe patientisdeprogrammed. Thepatientmustbeableto closeintothe sameposition everytime passively without anyguidanceorexternal force. Thepatientcanbeobserved whenclosingintoareproducible01 mar!.Thispositioncan againbeverifiedwhenthebite registrationis ta!en. Thepatient shouldma!ethesamemar!on theapplianceduring thebite registrationaswasmadeduring theinitialrecording. Thebite registrationista!enwiththeapplianceinplace.Thisallowsgreat controlofthe verticaldimensionofocclusion *9DO-duringbite registration.,tisusedtofacilitateanocclusalad$ustmentoncethe deprogrammingiscomplete. Thesameappliancecanbe used.:seof the8Densures occlusal thatthedeprogrammingwillbemaintainedduringthe opened9DOof ad$ustment.,tcanbewornataminimally
thatrequireamuchgreater 9DO.Thisalsoma!estheappliancemore estheticifneededfor daytimeuse. ,tisself%ad$usting.Thereis only oneincisortoothcontact againsttheappliance.Asthe musclesrelax thecondylesarefreetomovewithnoobstaclestopreventthemfrom
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ad$ustment appointments.
FULL CONTACT PERMISSI E SPLINTS The benefits of full contact permissive splints include& ;. elimination of discrepancies between seated $oints and seated occlusion *01 < M,4. a large surface area of shared biting force 5. reduced $oint loading =. ideali'ed functional occlusion >. the opportunity to observe for occlusal and $oint stability over time 3ull contact permissive splints can be made on the upper or lower arch. .ower splints have certain advantages that ma!e them a favorite for many experienced clinicians. These advantages include& ;. fewer speech changes *compared with upper splints4. lower visibility in social settings 5. shallower anterior ramps =. less tooth soreness when retention is gained exclusively on the lingual of the lower posterior teeth >. better patient compliance when instructed to wear their splints during the day as well as at bedtime
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5. ,f combination of muscle and disc disorders are identified *i.e. clic!ing of TM# with muscle pain- stabili'ation splints are the treatment of choice. They provide long%term wear that is usually needed. They also cover the entire dental arch ensuring that the covered teeth do not move. They must be worn continually for 4= hours for as long as required to elimi% nate muscle disc ligament and tooth symptoms. Three to B months of wear is often required. =. ,f advanced disc and muscle disorders are identified *$aw loc!ing and"or noises pain% ful $oints- stabili'ation splints are the treat% ment of choice which must be balanced to accommodate the specific needs of the patient. Splints may need to be worn for B months to 4 years depending on the patient.
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SOFT SPLINT This is the most commonly prescribed splint. ,t is quic! to fabricate and can be provided as emergency treatment for a patient who presents with an acute TMD. This splint is more readily tolerated in the lower arch than the upper arch as there is no satisfactory way of thinning the margins of the splint while !eeping good retention. This means that if the splint is made on the upper arch the patient is sub$ected to a thic! ridge of polyvinyl in the palate which often ma!es the splint difficult to tolerate.
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anterior contacting surface. The same posterior occlusal nocturnal forces are the TM#s and not the posterior teeth because the muscles posterior contact on the splint to continue to close forcefully while there is no
protect the TM#s.MagnussonFs study provided an interesting comparison between a stabili'ing appliance and a popular anterior deprogrammer type appliance.
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CRAN2AM DEPRO)RAMMER
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INDICATION
Tooth wear from bruxing and clenching Muscle pain associated with muscle dysfunction Diagnostic treatment planning The +T,%tss protocol is indicated for the prevention of medically diagnosed migraine pain and $aw disorders through the reduction of trigeminally innervated muscular activity.
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Co$,or.Cr#" 0omfor%0ryl is a combination of a patented thermoplastic elastomeric acrylic called Talon and a lamination of hard acrylic on the occlusal surface. The accurate fit of Talon eliminates the need for metal clasping and extensions onto soft tissue resulting in unaffected periodontium and improved phonetics. ,t provides patient comfort and the absence of orthodontic pressures provides excellent patient compliance and clinical efficacy. The 0omfor%0ryl appliances can be used in nightguards TM# splints and sleep disorder appliances F"at occ"usa" &"ane s&"ints 3lat occlusal plane splints *also referred to as a nightguard bruxism- are used to treat symptoms when no $oint clic!ing is present. 7hen fabricated on the maxillary arch these flat occlusal plane splints are full%coverage splints with an even flat occlusal surface for opposing tooth contact and they utili'e 4 ball clasps for retention. The upper nightguard *:niversity of (ennsylvania- is a flat plane splint that covers all maxillary teeth without any palatal coverage *no tissue contact-. The upper model is surveyed and the splint is fabricated so that the acrylic terminates on the labial buccal and lingual survey lines to ensure maximum retention. This is the most comfortable design for the patient because it reduces the bul! of acrylic used
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