See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/343229244

Journal of Prosthodontics Dentistry Occlusal Splints : An Innovative Treatment

Modality in Temporomandibular Disorders

Article · July 2020

CITATIONS READS

0 1,088

7 authors, including:

Sandeep Fere
Maharashtra institute of dental sciences and research Latur Maharashtra India
1 PUBLICATION   0 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Sandeep Fere on 27 July 2020.

The user has requested enhancement of the downloaded file.

Reg. No: RJ17D0105798 ISSN No:2582-0362

HEB JOPD
Journal of Prosthodontics Dentistry
An Official Publication of Bureau for Health & Education Status Upliftment
(Constitutionally Entitled As Health-Education, Bureau)
REVIEW ARTICLE

Occlusal Splints : An Innovative Treatment Modality in

Temporomandibular Disorders

Dr. Ajit S. Jankar1, Dr. Suresh S. Kamble2, Dr. Suraj S. Sonawane3,

Dr. Sandeep Fere4, Dr. Shruti D. Botwe5

1
Head of the department, Department of Prosthodontics, Maharashtra institute of dental science and
research, Latur, Maharashtra, India.
2
Principal and Professor, Department of Prosthodontics, Maharashtra institute of dental science and
research, Latur, Maharashtra, India
3
Post graduate student, Department of Prosthodontics, Maharashtra institute of dental science and
research, Latur, Maharashtra, India.
4
Reader, Department of Prosthodontics, Maharashtra institute of dental science and research, Latur,
Maharashtra, India.
5
Post graduate student, Department of Prosthodontics, Maharashtra institute of dental science and
research, Latur, Maharashtra, India.

Email Id: service.heb@gmail.com

Abstract:
Temporomandibular joint disorder is a disturbance resulting from overworked, uncoordinated muscle
movement that is generated by deflective occlusal interferences to physiologic jaw motions and
parafunctional habits. Occlusal splint therapy has been proved to reduce symptoms by altering the
occlusal equilibrium, distributing forces associated with parafunctional activities and normalizing
periodontal ligament proprioception.
Keywords: Occlusal splints, Parafunctional habits, Temporomandibular joint disorders.

Access this Article Online

Website:http://heb-nic.in/jopd
Received on 09/06/2020
Accepted on 07/07/2020 © HEB All rights reserved

July to Dec. 2020-Vol. 15, Issue-2, (Addendum-1), Journal of Prosthodontics Dentistry, Page No.-35
Reg. No: RJ17D0105798 ISSN No:2582-0362

Introduction: -
Occlusal splints are defined as “Any removable artificial occlusal surface affecting the relationship of the
mandible to the maxilla used for diagnosis or therapy; uses of this device may include, but are not limited
to, occlusal stabilization for treatment of temporomandibular disorders, diagnostic overlay prior to
extensive intervention, radiation therapy, occlusal positioning and prevention of wear of the dentition or
damage to brittle restorative materials such as dental porcelain.1”
Temporomandibular joint disorders (TMDs) are the conditions which affect the TMJ specifically, there
are variety of treatment options available and the use of occlusal splints is one of them.2
Goals of occlusal splint therapy:
1. To protect the TMJ discs from dysfunctional forces, which may lead to perforations or permanent
displacements.3
2. To improve jaw muscle function and to relieve associated pain by creating stable balanced
occlusion.4
Occlusal splints are classified by Okeson as follows of splints: -
1. Muscle relaxation appliance/ stabilization appliance used to reduce muscle activity.
2. Anterior repositioning appliances/ orthopedic repositioning appliance.5
Dawson classified occlusal splints as:
1. Permissive splints/ muscle deprogrammer.
2. Directive splints/ non-permissive splints.
3. Pseudo permissive splints (e.g. Soft splints, Hydrostatic splint).6
Other types:
1. Anterior bite plane.
2. Pivoting appliance.
3. Soft resilient appliance.
Concept behind splint designs: -
A.) Permissive splint:
1. Anterior midpoint contact permissive splint: Complete seating of joint by removing occlusal
interference. When elevator muscles contract on closure it allows freedom of for full seating of
mandibular condyle.
2. Full contact permissive splint:
Uniform contacts are achieved on all teeth when joints are fully seated by the elevator muscles.
Dawson’s bimanual manipulation technique is used to the guide the joints in centric relation.
B.) Directive splints:
It is used when the condyles are needed to be placed in a specific position. The main purpose is to
position or align the condyle-disc relationship.

July to Dec. 2020-Vol. 15, Issue-2, (Addendum-1), Journal of Prosthodontics Dentistry, Page No.-36
Reg. No: RJ17D0105798 ISSN No:2582-0362

Different types of splints:

Stabilization splint: -
It is made of hard acrylic splint which gives a temporary ideal occlusion. This causes to reduce
abnormal muscle activity and produces neuromuscular balance.7 Simultaneous contact occlusally
as well as musculoskeletally.8 It is also called as superior repositioning splint, the Tanner
appliance, the Michigan splint, the Fox appliance or the centric relation appliance. Adjustment of
the splint is needed so that the masticatory muscle relax until a consistent jaw relationship is
achieved.
Indications: Muscle hyperactivity, myospasms or myositis and parafunctional activity.

Michigan splint:
The splint allows free and smooth movement of upper teeth over lower teeth while helping
muscle to break the habit of clenching or grinding.It is a stabilization type of appliance placed
intraorally, there is minimal change to the maxillomandibular relationship other than that
produced by the thickness of the material.Indications: Anterior disc dislocation with reduction,
severe bruxism, establishment of optimal condylar positions in centric relation prior to definitive
occlusal therapy.9

Anterior Repositioning splints: -

It helps to guide the mandible in more anterior position to the centric occlusion which helps the
condyle in achieving more favorable position in glenoid fossa.3 Thus, also helps to reduce the
clicking sound that occurs while opening and closing of the jaws. It is made on maxillary arch

July to Dec. 2020-Vol. 15, Issue-2, (Addendum-1), Journal of Prosthodontics Dentistry, Page No.-37
Reg. No: RJ17D0105798 ISSN No:2582-0362

with an anterior ramp that engages mandibular teeth on initial closure and shifts the jaw forward
into final closure, when all mandibular teeth contact the splint.
Indications: Disc derangement disorders, joint sounds.

Anterior bite plane: -

It is made up of hard acrylic placed over the maxillary teeth that contacts only the mandibular
anterior teeth. The main purpose is to prevent posterior teeth contact thus eliminating the
influence on the function of masticatory function.3,9
Indications: Acute disturbance in occlusion, parafunctional activity such as bruxism.

Soft or Resilient Appliance: -

It is fabricated from resilient material. The main aim is to achieve even and simultaneous contact
with the opposing teeth. This appliance is worn during night time only. They can provide relief
within 6 weeks.10
Indications: Bruxism and clenching, prevention of trauma during sports (athletic splint).

July to Dec. 2020-Vol. 15, Issue-2, (Addendum-1), Journal of Prosthodontics Dentistry, Page No.-38
Reg. No: RJ17D0105798 ISSN No:2582-0362

Hydrostatic appliance (Aqualizer): -

Water is used in this type of splint so that the biting pressure is relieved. Hydrostatic cell is
inserted between the upper and lower arch the occlusal force is reorganized and evenly distributed
throughout the stomatognathic system.11,12 Occlusal forces are equalized and are axially oriented.

B-splint: -
The B-Splint is used for rapid harmonization of occluso-muscular disorders and comprises of an
upper and lower appliance. Supra-eruption of posterior teeth is prevented by fully covering them
which will also aid in its retention. There is no posterior contact because of lower splint having a
flat bite plane along the anterior central incisal region and upper having a ramp.
Indication: It allows the condyle to seat during clench and will eliminate lateral pterygoid
resistance to masseter and temporalis muscles.13

Pivoting splint:
It is a hard splint with single posterior contact on each side introduced by Krogh-Poulsen. The
contact is usually on posterior most tooth. If the mandible rotates forward around the fulcrum of
pivots, the condyle is distracted from the fossa and the joint is unloaded. It causes decrease in
interarticular pressure and helps to relieve pain.13
Indications: Anterior disc displacement without reduction of tmj, it is used to reduce interarticular
pressure and thus unload the articular surfaces of the joint.

July to Dec. 2020-Vol. 15, Issue-2, (Addendum-1), Journal of Prosthodontics Dentistry, Page No.-39
Reg. No: RJ17D0105798 ISSN No:2582-0362

Lucia Jig:
It promotes neuromuscular reprogramming of the masticatory system and allows the stabilization
of the mandible without the interference of dental contacts, maintaining the mandible position in
harmonic condition with the musculature in normal subjects or in patients with
temporomandibular dysfunction. It makes jaw manipulation easier and provides relaxation of
muscles.14,15
Indications: -
Deprogramming of muscles in full mouth rehabilitation cases.

Kois deprogrammer: -
It is a palatal coverage maxillary acrylic device with a flat plane lingual to the anterior teeth. It
helps as a diagnostic tool so as to determine if the mandible is to be placed anterior or posterior
direction to reach centric relation from maximum intercuspation.
Indication: It is used as a diagnostic tool to determine if the mandible needs to move in the
anterior or posterior position.15

Conclusion:
TMDs should be treated like any other musculoskeletal disorder. If it is left untreated it can lead
to worsening of symptoms which can extend beyond the jaws. A conservative approach is the
best for such patients. Different types of occlusal splints are used in diagnosis and treating
different TMDs. The purpose of this article is to make dentists aware of importance of splints in
managing TMDs using simple therapy.

July to Dec. 2020-Vol. 15, Issue-2, (Addendum-1), Journal of Prosthodontics Dentistry, Page No.-40
 Reg. No: RJ17D0105798 ISSN No:2582-0362

References:
1. Glossary of Prosthodontics 9th edition.
2. Kreiner M, Betancor E, Clark GT. Occlusal stabilization appliance evidence of their efficacy. J Am
Dent Assoc. 2001;132(6):770-7.
3. Yadav S, Karani J. The Essentials of Occlusal Splint Therapy-Review article. Int J. Prosthet Dent.
2011;2(1)12-21.
4. Bharadwaj K. The Basics of Occlusal Splints- A Review. Int. J. Adv. Res 2017;5(11):1239-42.
5. Okeson JP. Orofacial Pain: Guidelines for assessment, diagnosis and management for the American
Academy of Orofacial Pain Differential Diagnosis and management considerations of
temporomandibular disorders. Quintessence Pub Chicago,III 1996:120-2.
6. Dawson PE. Evaluation, Diagnosis and Treatment of Occlusal Problems. 2nd ed. St.Louis,
Mosby;1989.
7. Becker I, Tarantola G, Zambrano J. Effect of a prefabricated anterior bite stop on electromyographic
activity of masticatory muscles. J Prostht Dent. 1999;82(1):22-6.
8. M S Lakshmi, Sufiyan M K, Mehta R, Bhangdia M, Rathore K, Lalwani V. Occlusal splint therapy
in temperomandibular joint disorders. An update review. J Int Oral Health. 2016; 8(5):639-45.
9. Ramfjord SP, Ash MM. Reflections on the Michigan occlusal splint. J Oral Rehabil 1994 Sep;
21(5):491-500.
10. Lerman MD. The hydrostatic appliance: a new approach to treatment of the TMJ pain dysfunction
syndrome. J Am Dent Assoc. 1974; 89:1343-50.
11. Lerman MD. A complete hydrostatically derived treatment of TMJ pain-dysfunction syndrome. J
Am Dent Assoc. 1974; 89:1351-7.
12. Deogade S, Nazirkar G. Occlusal Splint Therapy review article. IJDPMS. 2013 Jan-Apr; 1(2):73-83.
13. Wilson PH, Banerjee A. Recording the retruded contact position: a review of clinical techniques. Br
Dent J. 2004 Apr ;196(7):395-402.
14. Nassar MS, Palinkas M, Regalo SC, Sousa LG, Siessere S, Semprini M et al. The effect of a Lucia
jig for 30 minutes on neuromuscular re-programming, in normal subjects. Braz Oral Res. 2012 Nov-
Dec;26(6):530-5.Jayne D. A deprogrammer for occlusal analysis and simplified accurate case
mounting. J. Cosmet. Dent.2006;21:96-102.

July to Dec. 2020-Vol. 15, Issue-2, (Addendum-1), Journal of Prosthodontics Dentistry, Page No.-41

View publication stats