Occlusal splints have become common practice in the dental office. They can predictably manage TMJ pain, the severe wear of enamel, or the long-term effects of bruxism and parafunction. However, choosing the right occlusal splint in various situations can be somewhat confusing. We have to capture the occlusal scheme, protect the opposing dentition, and make the appliance comfortable, all with the hopes of achieving patient compliance.

What are the different types of occlusal splints, what case is each best suited for?
Acrylics (methyl mathacrylates)
 These types of occlusal splints have been the standard. They offer rigidity, with either clear or tooth colored materials.
The major drawback for acrylic splints have been the polymerization shrinkage that happens around undercut, causing rocking of the splint when seated in the mouth. To counter this shrinkage, these splints have to be cut short of the undercuts and embrasures, which decreases their retention. To avoid this lack of retention, ball clasps have to be inserted, which can cause papilla damage. A main complaint with these splints is discomfort and excessive tightness felt between the teeth.

Pressure Molded Technologies (PMT) (Biocryl – Great Lakes Orthodontics)
 These devices use plastic bases, which offer less rigidity. This means they can be better molded to patient’s occlusion and offer more comfort. Due to their flexibility, we don’t have to worry about undercuts. Moreover, light cured composites (Primosplint) can be added to the plastic bases to better replicate occlusal anatomy, or create retention in specific undercut areas. As well, light cured composites have better biocompatibility than methyl mathacrylates.
PMT and Composite Splint.
Thermoplastics (Clearsplint – Astron Dental)
These splints offer the most comfort for the patient. Because they become more flexible under hot running water before use, the clinician can add retention by using dental undercuts. These undercuts won’t be an issue when removing the appliance, due to the patient’s intraoral temperature – still allowing some flexibility to the appliance. Thermoplastic material act like a shock absorber, disseminating the forces produced during parafunction.

Clear acrylics such as Splint Acrlyic Resins (Great Lake Orthodontics) can be cured to the surface of these thermoplastic splints. These offer a more rigid/ durable occlusal surface. This combination offers the best of both worlds: patient comfort and long term durability with the hard external acrylic layer.
Thermoplastic/Hard Acrylic Combination.
Splint Design
 Many different alterations can be made to the design of the splints for better performance and comfort. Appliances can be made with or without anterior tooth coverage for better airflow and speech. This also eliminated tightness discomfort by removing the lingual directed forces on the anterior teeth. For increased strength to appliance, braded mesh or wires can be incorporated in the appliance, usually on the lingual surface. Furthermore, splints can be made with posterior occlusal guiding grooves, or cuspid guidance. 
No Anterior Coverage Reinforced Splint.

Today’s Morning Huddle is brought to you by Ron Klausz, RDT – Klausz Dental Lab

Category: MH