Occlusal Appliance Therapy

Demo report by: Dr. Ma. Lyn B. Gabayeron

Occlusal appliance (splint)

A removable device usually made of hard acrylic that fits over the occlusal and incisal surfaces of the teeth in one arch Commonly referred to as a bite guard, night guard, interocclusal appliance, orthopedic device (i.e. orthotic)

Uses: oTemporarily provide an occlusal condition that allows the TMJ to assume the most orthopedically stable joint position. oIntroduce an optimum occlusal condition that reorganizes the neuromuscular reflex activity TYPES OF OCCLUSAL APPLIANCES:
1. Stabilization appliance primarily used to reduce muscle pain. muscle relaxation appliance 2. Anterior positioning appliance goal is to change the position of the mandible in relationship to the cranium. orthopedic repositioning appliance

Fabrication of Maxillary Occlusal Appliance

1. Take an alginate expression of maxillary arch and pour with die stone. Trim excess stone labial to the teeth. 2. Adapt 2mm hard, thick clear splint to the cast with the vacuum former. 3. Cut at the level of the interdental papilla on the buccal and labial side with a separating disk. Lingual border of appliance should be 10 to 12 mm from the gingival border.

4. Add self-cure acrylic to the anterior portion of the appliance as a stop for lower incisor. Area of this stop is 4-6mm.

5. Fit appliance to the maxillary teeth. It should be comfortable to the patient and no rocking should occur.

6. Self-curing acrylic is added to the occluding surface of the appliance. All occluding are as, except the contact on the anterior stop, have been covered. The setting acrylic is dried with an air syringe and rinsed in warm water before it is placed in the patient's mouth.

7. The appliance with the setting acrylic is placed in the mouth, and the mandible is closed into centric relation on the anterior stop. Adequate resin labial to the mandibular canines provides for the future canine guidance.

Note: The appliance must be removed well before the resin produces heat. It is then allowed to bench-cure until completely hard. Placing the setting acrylic in a cup of warm water can reduce the amount of bubbles that develop in an appliance.

8. Once the acrylic has set, the impressions of each mandibular buccal cusp tip and incisal edge are marked with a pencil. These represent the finished centric relation contacts that will be present on the finished appliance.

9. Excess acrylic surrounding the centric contacts is removed with a hard rubber wheel on a lathe. All areas, except labial to the mandibular canines, are flattened to the contact (pencil) marks. This area will create the eccentric guidance.

All CR contacts are even and on flat surfaces.

10. Adjust eccentric guidance.

A, The acrylic prominence labial to the canine (lateral view) is demonstrated. B, During laterotrusive movement the mandibular canine disoccludes the remaining posterior teeth (canine guidance).

A, The laterotrusive and protrusive guidances are not continuous, smoothflowing contacts. These should be adjusted to produce smooth, continuous pathways as shown in B.

The mandibular canine provides the laterotrusive (LT) and protrusive (P) guidance. The posterior portion of the appliance should reveal only centric relation (CR) contacts. This appliance, however, also reveals undesirable laterotrusive (LT) and mediotrusive (MT) posterior contacts. These must be eliminated.

11. Evaluate occlusion.

With the patient reclined, the occlusal appliance is adjusted. Then the patient is raised to the upright head position (alert feeding position), and the occlusion is evaluated. The anterior teeth should not contact more heavily than the posterior teeth. If they do, they are marked with articulating paper and adjusted to contact more lightly. Note: The patient can easily protrude the mandible and contact heavily on the anterior guidance. Careful instruction may be necessary to ensure that the patient does not protrude the mandible when asked to close on the appliance. The patient should be specifically asked to close and tap on the posterior teeth.

Final Criteria for the Stabilization Appliance

1. It must accurately fit the maxillary teeth, with total stability and retention when contacting the mandibular teeth and when checked by digital palpation. 2. In CR all mandibular buccal cusps and incisal edges must contact on flat surfaces with even force. 3. During protrusive movement the mandibular canines must contact the appliance with even force. The mandibular incisors may also contact it but not with more force than the canines. 4. In any lateral movement, only the mandibular canine should exhibit laterotrusive contact on the appliance. 5. The mandibular posterior teeth must contact the appliance slightly more heavily than the anterior teeth during closure. 6. In the alert feeding position the posterior teeth must contact the appliance more prominently than the anterior teeth. 7. The occlusal surface of the appliance should be as flat as possible with no imprints for mandibular cusps. 8. The occlusal appliance is polished so that it will not irritate any adjacent soft tissues.

Thank You

Reference: Chapter !5 of Management of Temporomandibular Disorders by Okeson