Splints are removable dental appliances that are used to treat temporomandibular disorders by establishing neuromuscular harmony in the jaw. There are two main types of splints - permissive splints, which allow the jaw to move freely, and nonpermissive splints, which restrict jaw movement. Splints are fabricated based on a thorough examination of the patient's jaw function and musculature to determine the appropriate treatment. They are adjusted over time and used in conjunction with other therapies to relax muscles, seat the jawbone condyles correctly, and reduce jaw pain and dysfunction.

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.