What are the indications of occlusal splints?
Occlusal splints are indicated in the following situations:
- Diagnosis and management of parafunction, severe bruxism and Pain Dysfunction Syndrome (PDS) caused by increasing muscle relaxation (relaxation splint).
- Determination of the central jaw relationship (RCP) following reduced muscle hyperactivity and mandibular repositioning (relaxation/internal derangement splint).
- Diagnosis and treatment of traumatic occlusion to any part of the masticatory system.
- Assessment and successive alteration of the vertical dimension of occlusion.
- Protection of the teeth and restorations from undue deflective parafunctional activity which could excessive occlusal/bite forces.
- Temporary disclusion of arches during orthodontics to avoid clutches during jaw movements.
- Post-orthodontic tooth stabilisation, used as a retention device.
- Reduction of the masticatory forces and treatment of patients with tension-headache (relaxation splint).
Michigan occlusal splints
Michigan splints are full-coverage heat-cured hard acrylic occlusal splints which are most commonly prescribed stabilisation splints. Maxillary stabilisation appliances known as Michigan splints and mandibular stabilisation appliances known as Tanner appliances are full-coverage heat-cured hard acrylic occlusal splints.
Stabilisation appliances based on the upper arch are known as Michigan splints and the ones based on the lower arch are known as Tanner appliance.
The case presented below was treated for the following indications:
- Diagnosis and management of parafunction and bruxism.
- Management of Pain Dysfunction Syndrome (PDS) by increasing muscle relaxation.
- Management of severe attrition before the prosthodontic rehabilitation phase.
What are the advantages of the Michigan occlusal splint?
- As it is a cost-efficient full-coverage appliance, it is considered a reversible and efficacious treatment modality as it does not induce unwanted tooth movement and malocclusion.
- It produces an ideal removable occlusion that may be used effectively in the management of TMJ dysfunction as well as pre-and post-restorative phases in the treatment of the worn and mutilated dentition.
- It offers dimensional adaptability as it does not interfere with swallowing, normal lip seal and speech.
- It is well-retained, covers the minimum amount of soft tissue compatible with biological health.
- It provides adequate strength, function and patient tolerance.
- It can protect all types of restorations.
- It allows the condyles to seek an optimal position in centric relation before definitive occlusal therapy.
- The patient usually becomes pain-free after a few days or weeks.
- It can be used for an indefinite time without causing a change in occlusal relations.
What are the disadvantages of the Michigan occlusal splint?
The occlusal adjustment may be time-consuming and require long sessions.
May develop dependence tendency in patients with TMJD.
What are the clinical and laboratory procedures for planning and fabrication of the Michigan occlusal splint?
Impressions from upper and lower arches are taken and the bite registration at the desired vertical and natural jaw relation. A minimum of 2mm thickness at the thinnest point is required to allow for necessary adjustments. The splint should provide adequate retention while comfortable to insert and remove. The splint should offer multiple bilateral posterior even contacts with equal intensity in different jaw positions to allow interference-free jaw movement. During the lower jaw lateral excursive movement, canine guidance/protection should be provided while maintaining posterior teeth disclusion. During the protrusive excursion, a smooth and shallow anterior guidance should maintain a lasting posterior disclusion. A shallow, smooth and concave ramp in the anterior region provides posterior disclusion during mandibular excursive movements. The appliance is fabricated and sent to the dentist for try-in and final bite adjustment.
The patient should be monitored monthly thereafter for control of discomfort, and possible adjustment. The duration of treatment of patients with pain dysfunction syndrome should not exceed 6 months. In some instances, a trial period without the splint is indicated. Careful control of patients with aggressive bruxism is mandatory.
FAQ – What do patients usually ask about occlusal splints?
- Class III jaw relationship or under-bite to avoid a large anterior projecting labial surface of splint which would not be tolerated.
- Mobile teeth in the lower arch.
- Several missing teeth in the lower arch.
- Myo-clench inhibitor (MCI) is a comfortable occlusal splint designed to reduce headache, bruxism, and TMJ disorders.
- MCI protects the teeth from wear and attrition and prevents teeth and restorations from cracking and chipping.
- MCI does not interfere with sleep while preventing nocturnal teeth, grinding alleviating jaw and neck pain.
- In porcelain or implant-supported restorations, MCI could be fabricated with an extra internal soft-lining layer acting as a shock-absorber and providing more efficient protection against biomechanical overloading as well as patient comfort.
- The occlusal scheme is designed so that the splint contacts mainly the lower incisors and, to some extent, canines during the anterior and lateral excursive contact movements (anterior resp. canine guidance) while minimising the occlusal contacts on the 1st premolars.
- In the anterior region, the splint is designed with a “guidance ramp” to encourage patients to bite into the correct bite, while its unique shape of comfort plane allows more tongue space.
- Patients are treated based on their presented complaints from minor TMJDS caused by nocturnal parafunctional activities.
Occlusal Splint Case Studies
See our occlusal splint before and after photos from our happy patients.