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SCDL provide splints and appliances used to alleviate the symptoms of TMJ dysfunction. Most of our splints are used primarily in the first phase of treatment to restore functional harmony and are fabricated with clear acrylic occlusal pads which allow for easy adjustment as treatment progresses. Our splints are made on either arch and provide skeletal support for the mandible and its musculature.
Patients that are suffering TMJ pain and symptoms often experience "clicking", locking" or internal derangement of the disc and condyle of one or both TMJ joints.
The patient can experience pain from the joint areas, along with the muscles of mastication. It is a normal relation of the muscles to go into painful spasm to help protect an injured joint or joints.
A stabilization appliance is needed to treat the patient for remission of pain and joint healing. Successful treatment can be accomplished using a prosthetic appliance of some type, splint or double splint (twin block). To be consistently successful with the stabilization appliance, accurate models of the mouth are needed. A proper bite is also required so the mandible can function and rest in the pain free position. A good starting point is taking a bite 2mm forward and 2 mm open.
The appliance (splint, double splint or prosthetic appliance) fabricated to this proper therapeutic construction bite will generally allow immediate remission of pain and symptoms, along with proper joint healing.
This is a popular mandibular splint with acrylic coverage over the posteriors. A metal lingual bar is usually the major connector, which allows for plenty of tongue room. Occlusion on the Gelb splint is upper lingual cusps touching a lower flat or indented occlusal pad. The Gelb splint should be made to a centric bite registration.
The Gelb splint is designed for closed - lock cases and is often used in conjunction with muscle relaxers or anti-inflammatory medication. The patient needs to relax the disc before moving to a pull forward splint. Patients should be seen every 30 days to check the range of motion.
A modified design covers the lower anterior teeth to prevent movement or shifting of lower anteriors.
Michigan Splint-used to prevent clenching and bruxing.
A full coverage splint with a flat occlusal plane
Our standard hard nightguard is used to alleviate clenching and bruxing. A full maxillary coverage splint with a flat occlusal plane and with vertical dimension opened 1.5mm in the posterior.
A Soft or Hard-Soft version is also available for increased patient comfort.
Cushion Bite Splints
The next generation of occlusal therapy
Designed by Dr David Penn BDS MBA
Gelb style cushion splints in Bioflex material
The key to delivering bite splints in an effective manner is to use a material that requires little or no adjustments whilst providing maximum comfort to the patient for best compliance. A material that fits both of these requirements is the SMH BioFlex.
Figure 1. Typical clinical appearance of bruxism
The incredibly soft yet durable and flexible material is the secret to the success of this device. Dr. Gordon Christensen remarked that there are between 500 to 1000 bite splints waiting to be made in every dental surgery. He estimates that one-third of the population either brux or clench their teeth, resulting in tooth damage (Figures 1). He also states that “If a dentists merely ‘watches’ patients as they wear their teeth down, he or she is practicing supervised neglect and contributing to continued tooth destruction.”
Gelb Cushion splint in vivo
Bruxism is most commonly defined as the non-purposeful grinding of teeth in eccentric positions that eventually removes canine rise, incisal guidance, and posterior tooth cusp tips. Most bruxism takes place at night, although patients tend to deny this habit. As a result of their advanced tooth wear, most bruxers have a group function occlusion. The end result of bruxism is usually highly worn teeth,with a relatively flat plane of occlusion, and a group function occlusion in the dentition. If left untreated, many of these patients have unsightly and mutilated dentition by the age of 40.
Clenching is typically defined as the non-purposeful closing of teeth in centric occlusion. Clenchers are also more active at night, but you may notice them clench at any time by observing their bulging, strongly developed masseter and temporalis muscles in action. Typically, clenchers accentuate and deepen centric occlusion tooth contacts. They tend to have steep canine rise, incisal guidance, and posterior tooth cusp tips. Dr. Christensen feels the solution to both of these conditions is a bite splint worn at night, as well as, during periods of psychological stress, in the daytime. In his 40 years of practice, he estimates that 80% of TMD cases have been muscular in nature and have responded well to bite splint therapy, and subsequent occlusal equilibration.
Figure 2. PVS impressions with a light body wash creates accurate master model
While a bite registration is not necessary to construct a bite splint, the best fitting splints are constructed using an accurate CO bite.
The models or the impressions, along with the bite registrations and the prescription requesting a Cushion Bite Splint, with either flat plane occlusion or anterior guidance, are forwarded to SCDL.
As a result of the Cushion Splints material, you should expect there to be no adjustments necessary to seat the splint, and perhaps just a minor adjustment to the bite . Unlike delivery of hard bite splints where the patient often winced when the splint was being placed for the first time, the patient is often able to place the Cushion Splint for the first time by themselves, with no discomfort or feeling that their teeth are being forced out of position.
Michigan Style splint in Bioflex material
This maxillary, pull forward splint is so named because it is an upper splint with an inclined plane in the anterior section. The inclined plane offers a more definite forward repositioning of the mandible and repositions the posteriorly displaced condyles down and forward, relocating them to what is known as a proper pain free, Gelb 4/7 position. Posterior contact is between the buccal cusp of the lower teeth and the upper acrylic occlusal pad.