SPLINTS IN TMJ DYSFUNCTION. HOW EFFECTIVE? A REVIEW
Table 1. Classification of occlusal appliances Type of occlusal appliances Activity Recommendations
Reflex appliances e. g. Interceptor, Anterior Plateau, NTI-tss
Prevent habitual tooth contact prevent gnashing and clenching
Acute symptoms that can be attributed to overloading of the tissues
Stabilization appliances e. g., Michigan type splint
Synchronous tooth contact in a centric condyle position in static occlusion and an anterior tooth position with disclusion in the lateral teeth region in dynamic occlusion.
For acute or chronic symptoms and also in psychological and physiological overloading reactions.
Repositioning appliances e. g., Anterior repositioning splint
The temporomandibular joint or joints is / are set in a therapeutic position by the splint to support healing and to maintain a symptomfree joint posture.
Anterior disc displacement with and without reduction, temporomandibular joint compression, retral displacement of the condyle and osteoarthritis. Can be used as a short-term or long-term therapy.
Superior repositioning appliance
To allow complete reseating of the condyle disk assemblies up the eminence to the superior centric relation axis.
Establish the correct skeletal relationship before the correct occlusal relationship is determined.
Anterior bite plane
To disengage the posterior teeth and thus eliminating their influence on the function of the masticatory system.
For treatment of muscle disorders related to orthopedic instability or an acute change in occlusal condition. Parafunctional activity may also be treated with it but only for a short period.
Posterior bite plane
To achieve major alterations in vertical dimension and mandibular positioning.
Advocated in case of severe loss of vertical dimension or when there is a need to make major changes in anterior positioning of the mandible. For disc derangement disorders.
Soft and resilient appliance
To achieve even and simultaneous contact with the opposing teeth.
Protective device for persons likely to receive trauma to their dental arches e. g. athletic splint. For patients exhibiting high levels of clenching and bruxism, they help dissipate some heavy loading forces encountered during parafunctional activity. precisely described by Ramfjord and Ash Jr. 17 This splint could be used in both dental arches, but preferably in the maxilla. The mandibular splint is used when the posterior area misses teeth in the mandible and unwanted tooth movement must be avoided. The main purpose of this device is to disengage the occlusion, place the condyle in the centric position, relax the masticatory muscles and prevent further tooth wear due to nocturnal parafunctional activity. The main features of this splint are freedom in centric and canine guidance. It is important to note that the relation of the maxillary and mandibular arches may differ after the treatment when compared to the initial state, especially when partial coverage splints are used. 14, 18 The occlusal splints are also used in the initial phase of treatment in patients with mouth overclosure caused by a pathologic deep bite. Before the prosthetic rehabilitation of the severe tooth wear, one should remember that initially, splint therapy should be applied to adapt the stomatognathic system to the new occlusion. 20 A classification of the occlusal appliances with activities and recommendations is presented in Table 1. Normally, it is suggested that patients wear the splint only at night. The splint needs to be adjusted( rebalancing of the splint to the new position of the jaw by
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