Orthodontic splints /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


• An occlusal appliance, called a splint,
is a removable device, usually made
of hard acrylic that fits over the
occlusal and incisal surfaces of the
teeth in one arch, creating precise
occlusal contact with the teeth of the
opposing arch. It is commonly
referred to as a bite guard, night
guard, interocclusal appliance, or
orthopedic device.

Ideal disc - condyle complex should be
In the most antero superior area of
glenoid fossa
Against the articular eminence
Disc interposed
Normal neuromusculature
Without collateral ligament strain.

During mouth opening:
1.Superior LP stays passive
and releases contraction(- )
2.Inferior LP contracts and
pulls the condyle forward.(+)
3. Tension increases in the
retrodiskal fibers to keep it
aligned with the condyle.

During closure reverse
happens

Superior LP maintains (+) a
controlled contraction to
hold the disk forward.
The retrodiskal elastic fibers
maintain a constant tension
against the forward pull of
the muscle.
SLP muscle is attached to
the disk and condyle.
ILP is attached to the
condyle.


OCCLUSAL INTERFERENCE
PROPRIOCEPTIVE PERIODONTAL RECEPTORS

ACTIVATES PROTECTIVE REFLEX SYSTEM
TO GUARD TEETH
LPM POSITIONS THE JAW SO THAT ELEVATORS
CLOSE DIRECTLY INTO MAXIMAL OCCLUSAL
CONTACT
LPM CANNOT RELAX THE PROTECTIVE BRACING
CONTRACTION

DISPLACEMENT OF MANDIBLE TO M. I.

DISPLACEMENT OF CONDYLE DISK ASSEMBLIES

WILLIAMSONS EXPERIMENT (JPD 1983)
WILLIAMSON DEMONSTRATED THE PRECISE EFFECT
OF OCCLUSAL INTERFERNCE ON MUSCLE
COORDINATION AND NORMAL MUSCLE ACTIVITY
Using EMG procedure, he showed that interfering contacts on
the posterior teeth in any eccentric position caused hyperactivity
of the elevator muscles.
But if anterior guidance was allowed to disclude all posterior
teeth from any contact other than CR, the elevator muscles either
stopped or reduced active contraction the moment posterior teeth
were discluded.

HOW SPLINT WORKS ?

Five distinct theories explain it:
1.

Occlusal disengagement theory

2.

Vertical dimension theory

3.
Maxillomandibular realignment
theory
4.
TMJ repositioning theory
5.

Cognitive awareness theory

The neuromuscular protective mechanism causes a person to
accommodate his jaw position to the intercusping of the teeth.
The purpose of an anatomic articulator is to eliminate the
patient’s neuromuscular response to his existing occlusion. This
is the basis for occlusal therapy and TMJ treatment.
The Mandibular Position Indicator (M.P.I.) procedure quantifies
the differences between the joint-dominated position and the
tooth-dominated position of maximum intercuspal position(ICP).
Delta
Delta
Delta
Delta
Delta

H
L
Y
X
Z

Vertical increase or decrease (incisal pin)
Protrusion or retrusive movement (incisal table)
Right or left transverse movement
Protrusive (+) or (-) retrusive (Horizontal)
Compression (+) or (-) distraction (Vertical)


OKESONS CLASSIFICATION OF SPLINT :
1.
2.
3.
4.
5.
6.

Stabilization splints
Anterior repositioning splints
Anterior bite plane
Posterior bite plane
Pivot splint
Soft splint

CLASSIFICATION BY SLAVICEK (JCO 1989 FEB
1.
2.
3.
4.
5.

Myopathic splint
Decompression splint
Compression splint
Verticalization splint
Anterior Repositioning splint

Another way to classify splints based on the arch for which it is
fabricated.
1. MAXILLARY SPLINTS
A. CENTRIC WITH CUSPID AND ANTERIOR GUIDE RAMP
1.
BIOSTAR OR OMNIVAC BASE WITH SELF CURE
OCCLUSAL 2. HEAT PROCESSED WITH CLASPS 3. CAST
METAL - VITALLIUM OR GOLD
B. DISTRACTION OR FORWARD REPOSITIONER
1. BIOSTAR OR OMNIVAC BASE SELF CURE OCCLUSAL
2. HEAT PROCESSED WITH CLASPS
C. BITE PLATE
D. POSTERIOR BITE PLATE
2. MANDIBULAR SPLINTS
A. LOWER CENTRIC SPLINT WITH OR WITHOUR ANTERIOR
RAMP B. LOWER PIVOT SPLINT C. LOWER POSTERIOR
FORWARD POSITION SPLINT 1. PARTIAL COVERAGE 2.
FULL COVERAGE

CLASSIFICATION ACCORDING TO ALEX WILLIS (AJO 1995
MARCH)
1.
Flat Plane Splint
2.
Anterior Repositioning splint
3.
Canine protected splint
Dawson classifies splints in two types only,
1. A permissive splint
2. A directive splint


BILATERAL MANIPULATION

LEAF GAUGE

MESIAL INCLINE

DISTAL INCLINE


ANTERIOR STOP IS FLAT & PERPENDICULAR TO
LONG AXIS OF MANDIBULAR INCISOR

MAXILLARY FULL ARCH STABILIZATION APPLIANCE


DURING LATEROTRUSIVE MOVEMENT MANDIBULAR CANINE
DISOCCLUDES THE POSTERIOR TEETH

DESIGN :
1.In centric relation all posterior mandibular
buccal cusps must contact on flat surfaces
with even force.
2. During protrusive movement, the
mandibular canines must contact the
appliance with even force.
3.In any lateral movement only the mandibular
canines should exhibit laterotrusive contact on
the appliance.
4.The mandibular posterior teeth must contact
the appliance only in centric relation closure.
5.In the alert feeding position, the posterior
teeth must contact the appliance more
prominently than the anterior teeth.

ANTERIOR REPOSITIONING SPLINT

Fabrication:
1. The mandible must be directed by the splint to a position that
aligns the condyle with the disk.
2.The mandible must be prevented from from closing or clenching
distally to the position of disk of alignment.
3.Both anterior and posterior segments should share anchorage for
directing the mandible forward.

Mandible assumes
forward position

Guiding ramp

Ramp shifts the mandible
forward

BITE RECORDS FOR ANTERIOR REPOSITIONING SPLINT

S SPLINT


ICP (black dot) above RCP (red dot) indicates
compression.
Rx : DECOMPRESSION SPLINT

ICP (black dot) below RCP (red dot) indicates
distraction.
Rx : COMPRESSION SPLINT

Posterior pinpoint centric stops and extreme canine rise with
tight vertical element.

CANINE PROTECTED SPLINT

ANTERIOR BITE PLANE

1.
2.
3.
4.

POSTERIORS ARE INTRUDED BY ELEVATOR MUSCLES
UPPER INCISORS STARTS TO MOVE LINGUALLY
LOWER INCISORS MIGHT MOVE LABIALLY & SUPRAERUPT
LINGUALIZED UPPER INCISOR INTERFERE WITH ARC OF
CLOSURE & FORCE THE CONDYLE TO DISTALIZE

POSTERIOR BITE PLANE & EFFECT AFTER 1 YEAR WEAR

Bite Plane anchored in headgear tubes.

Full Arch Maxillary Removable Bite Splint

I. Inclined plane for the alignment of the upper front teeth.
II. Biting splint for the nivellisation of the compensating curve.

POSTERIOR PIVOTING APPLIANCE LOADS THE CONDYLE
IT DOESNOT DISTRACT THE CONDYLE

GIC PIVOT SPLIT

Four balanced points of maxillomandibular contact in centric relation:
two articular disc assemblies and
two glass ionomer padswww.indiandentalacademy.com
on lower first molars.

GIC PIVOT SPLINT

Case with deep overbite and advanced attrition of incisal and cusp
tips.
Glass ionomer splint allows immediate placement of full fixed
appliances while opening bite and establishing centric relation.

DAWSONS CLASSIFICATION OF SPLINT

PERMISSIVE SPLINT

DIRECTIVE SPLINT


FOUR TYPES OF PERMISSIVE SPLINT

A. ANTERIOR B PLANE
B. POSTERIOR B PLANE
C & D UPPER AND www.indiandentalacademy.com
LOWER FULL OCCLUSAL SPLINT

All tooth inclines are separated or covered with
smooth plastic
Occlusion is blocked because of smooth gliding surface
Neuromuscular reflex controlling the closure into
maximum intercuspation is lost
Muscles function according to their own coordinated
interaction (muscle deprogrammers )
If the condition of articular components permit condyle is
then allowed to return to their correct seated position
( centric relation ).

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Orthodontic splints /certified fixed orthodontic courses by Indian dental academy

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