OCCLUSAL
APPILANCE THERAPY
occlusal splint is a removable appliance covering
some or all of the occlusal surfaces of teeth in
either maxillary or mandibular arches
A non-invasive and reversible biomechanical
method of managing pain and dysfunction of the
tmj and its associated musculatures.
Classification of splints
Okeson classification of splint
Anterior repositioning splints
Anterior bite plane
Posterior bite plane
Pivot splint
Soft splint
According to dawson
Permissive splints
Directive splints
Functions and uses of occlusal splints.
To relax the muscles
To allow the condyle to seat in cr
To provide diagnostic information’
To protect the teeth and associated structures
from bruxism,
To mitigate periodontal ligament proprioception,
and
To reduce cellular hypoxia levels
Permissive splints
Allow the teeth to glide unhindered over the
biting or contact surface.
These are also known as muscles deprogrammer.
Examples are anterior deprogrammer and
stabilization splint
Stabilization splint
Fabricated for maxillary arch.
When it is in place condyles are in most
musculoskeletal stable position at time that
teeth are contacting evenly and
simultaneously.
The treatment goal is to eliminate any
orthopedic instability between the occlusal
position and joint position, thus removing
instability.
Indications:
1. Muscle pain disorders.
[Link] activity in stress
[Link].
[Link] soreness or chronic , centrally
mediated myalgia.
[Link] secondary to trauma.
Fabrication technique :
Can be used on either arches.
Maxillary devices is more common because it
is
1. usually more stable and covers more tissue
area, more retentive , less likely to break.
[Link] versatile
[Link] class – 2 ,3 patients , achievement of
proper anterior contact and guidance is often
difficult with mandibular appliance.
[Link] stability as all mandibular contacts
are on flat surfaces ( not possible in
mandibular devices especially in anterior
region.)
[Link] to locate musculoskeletal stable
relationship of condyles in fossae.
Mandibular device – easier for patient to
speak with it in place .
Method of fabrication – autopolymerizing
or heat cure acrylic resin are used .
Procedure : impression making and cast is
poured.
1.A 2.5mm thickness is required.
[Link] sheets – hard clear resin sheet or
dual-sided sheet.
[Link]-sided sheet – has soft side -for teeth
Hard side – for developing
occlusion.
[Link] border – end at the junction of the
middle and incisal third.
[Link] border – is at the level of
interdental papilla.
[Link] border – extend 10 to 12 mm
from the gingival border .
[Link] adaptation of resin leads to
poor retention.
[Link] can be done by using self cure
resin ( for solid acrylic sheets only , not
possible for dual surface sheets.)
Anterior positioning appliance
This appliance is used to temporarily position the
condyles more anterior then Musculo skeletally
stable position to relieve symptoms
Indications
Disc derangement disorders
Joint sounds
Intermittent or chronic locking of the joints
Inflammatory disorders like retro discitis
The goal of treatment is not to alter the
mandibular position permanently but only to
change the position temporarily so as to enhance
adaptation of the retro discal tissues.
However, the maxillary arch is preferred because
a guiding ramp can be more easily fabricated to
direct the mandible into the desired forward
position.
Locating the correct anterior position. The key to
success ful fabrication of an anterior positioning
appliance is finding the most suitable position for
eliminating the patient’s symptoms.
The anterior stop is used to locate it. The surface
of the stop is adjusted so it will be flat and
perpendicular to the long axes of the mandibular
incisors.
The stop should not significantly increase the
vertical dimension (the appliance should be as
thin as pos sible). As with the stabilization
appliance, the patient repeatedly opens and
closes on the stop.
Posterior bite plane
It is a hard acrylic appliance which covers the
posterior mandibular teeth and is connected by a
cast lingual BAR
The objectives of this appliance is to bring about
the changes in the vertical dimension and the
mandibular positioning
