Dr Altaf Tantray MDS prosthodontics Govt Dental College srinagar J&K

2. Presenter : Dr Mohd. Altaf Tantray
Guide: Dr Sandeep Kour

3. Tim J. Dylina,DDS J Prosthet Dent2001;86:539-45.

4.  INTRODUCTION
 DEFINITION
 TYPES
 FUNCTIONS
 SPLINT CHARACTERISTICS
 SPLINT FABRICATION

5.  Practitioners appreciate a practical approach to all
aspects of treatment; splint therapy is no
exception.
 Splint
 breaks muscular engrams
 Relaxes masticatory muscles
 Brings condyle to centric relation

6.  Splint therapy:
 Splint therapy may be defined as the art and
science of establishing neuromuscular harmony in
the masticatory system and creating a mechanical
disadvantage for parafunctional forces with
removable appliances

7.  Splint
 Defined as a removable appliance used to break
neuromuscular engrams to create neuromuscular
harmony in masticatory system.

8.  All splints are classified as
 Permissive or
 Nonpermissive

9.  Permissive splint
 It allows the teeth to move on the splint
unimpeded, which in turn allows the condylar
head and disk to function anatomically.
 Boero RP. The physiology of splint therapy: a
literature review. Angle Orthod 1989;59:165-80.

10.  Examples of permissive splints
 include bite planes (anterior jigs, Lucia jig,
Anterior Deprogrammer).

11.  stabilization splints (flat plane, Tanner, superior
repositioning, and centricrelation [CR])

12.  Nonpermissive
 A nonpermissive splint has a ramp or
“indentations” that position the mandible
inferiorly and anteriorly and secure it there.

13.  An example of a nonpermissive splint is
 A repositioning splint (anterior repositioning
appliance [ARA])

14.  Soft splints and
 hydrostatic splints (Aquilizer; Jumar Corp, Carefree,
Ariz.) are
 pseudo-permissive splints,
 as their functions are extremely different than those of the
permissives

15.  To seat condyles in CR
 Relax muscles
 To provide diagnostic information

16.  Mitigate pdl proprioception
 Reduce cellular hypoxia
 Protecting teeth and associated structures from
bruxism

17.  The characteristics of a successful splint should
 stability;
 balance in CR;

18.  immediate posterior disclusion;
 a “skating rink” surface;
 equal intensity stops on all teeth;

19.  smooth transitions in lateral, protrusive,
 and extended lateral excursions (crossover);
 Comfort during wear; and

20.  reasonable esthetics.
 reasonable esthetics.
 Patient compliance

21.  Depends upon
 Specific diagnosis of TMD
 Thorough understanding of anatomy and relation
of condyle – disc –fossa relation.

22.  Muscle in co-ordination is determined by
 muscle palpation,
 joint loading,
 range-of-motion measurements,

23.  painful facial muscles,
 headaches,
 limited ranges of motion,
 frequent joint inflammation, and
 occlusal interferences to CR;
 infrequent clicking on jaw movement also may be
present

24.  Bite plane therapy or permissive splint therapy in Phase I (reversible treatment)
 with appropriate Phase II therapy (additive or subtractive occlusal therapy,
 restorative dentistry,
 orthodontics,
 Maxillofacial surgery, and segmental alveolar surgery)
 to restorebalance from/to the CR position

25.  Advanced muscle and disc inco-ordination
 jaw locking
 painful joint noises
 Increases in pain with splint therapy
 Pain on loading with bimanual manipulation

26.  irreversible cases but may be managed to a pain-
free state with
 appropriate medications,
 Splint therapy, and
 Phase II therapy

27.  It should
 Provide equal intensity of contact on all teeth.
 Provides immediate posterior disclusion by the anterior
teeth and condylar guidance.
 Be as frictionless as possible for neuromuscular
harmony and subsequent healing
 The splint must allow the condyle to achieve the
CR position.

28.  the splint must be continually monitored and
adjusted.
 Relief of symptoms changes occlusal contacts on
splint.

29.  A suggested protocol would include adjustments
at
 24 hours,
 54 hours,
 7 days,
 2 weeks, and
 1 month after seating
Holmgren K, Sheikholeslam A, Riise C. Effect of a full-arch maxillary
occlusal splint on parafunctional activity during sleep in patients with
nocturnal bruxism and signs and symptoms of craniomandibular disorders.
J Prosthet Dent 1993;69:293-7.

30.  After 3 months with no changes on the splint, a
comfortable musculature, and no pain on loading,
the patient is ready for evaluation of phase II
therapy

32.  unload the joint,
 prevent bruxism, or
 “heal” the patient

33.  Splint produces neuromuscular harmony in masticatory
system.
 Dental practitioners have a responsibility to understand and
 provide this treatment,
 monitor the condition, and
 refer the patient to another practitioner if necessary

34.  Manns A, Miralles R, Palazzi C. EMG, bite force, and elongation of the
masseter muscle under isometric voluntary contractions and variations of
vertical dimension. J Prosthet Dent 1979;42:674-82.
 McKee JR. Comparing condylar position repeatability for standardized
versus nonstandardized methods of achieving centric relation. J Prosthet
Dent 1997;77:280-4.
 Holmgren K, Sheikholeslam A, Riise C. Effect of a full-arch maxillary
occlusal splint on parafunctional activity during sleep in patients with
nocturnal bruxism and signs and symptoms of craniomandibular disorders.
J Prosthet Dent 1993;69:293-7.