Splint Therapy

Splint Fabrication
Incorrect Splints 

This section is based on my experiences for the past 22 years of dealing with maladies associated with both bruxism and TMJ therapy. Most of this information runs counter to the "current literature", most often I find "current literature" to be much less than accurate. There is some redundancy in my writing... I feel it will help reinforce the most important aspects of this topic. If there is something you find confusing about this section please email me and let me know how I may further clarify my writings.

Just as it is in the area of TMJ therapy, splints are another controversial topic. In my office over the past 2 decades, I have had a patient come in with a box literally full of splints, others with splints that were made directly in a United States Dental School and many from other dentists. Yet, when I check, almost all of them are made/designed incorrectly. I have seen "pieces of acrylic" that were claimed as being a splint by the patient that were so poorly designed that I would not even classify them as splints. I have seen TMJ patients very confused about their treatment options, even confused as to how to wear their splints - "at night only, during the day only, both day and night, only when under stress, one week on - one week off, etc, etc, etc". Why so many opinions, why such confusion from the medical and dental professions? Why not a standard of care? This is unfortunately just the way it is.

 There are a few things that must be defined, clarified and explained.

  1. The device I am writing about can go by many names. Some of these include:
    • Nightguards
    • Bite guards
    • Night splints
    • Bite appliances
    • Splints
    • Bite splint
    • Mouthpiece
    • Brux guards
    • and various others

  2. The only two terms I will use to describe this device are "splint" and "nightguard".

    Nightguards - worn only at night and is primarily a way to decrease muscular activity and continuous wearing of the teeth. It is not a "cure" for bruxism - it is ONLY a band-aid, people do clench during the day and slightly grind. But none-the-less, a nightguard can make a difference for a lot of people.

    Splints - worn full time - that is 24 hours a day / 7 days a week. Once every few weeks the splint is checked and adjusted to follow the jaw joint "settling" into its proper physiological position. The person wearing a full-time splint is most often doing so to treat a TMJ dysfunction problem that nighttime wear alone can not take of. The end of therapy occurs when the patient achieves a jaw joint position that is stable and pain-free. The final step then is to alter the teeth to a correct bite for the jaw joint so that the splint will be no longer necessary.

  3. What is the difference between a splint and a nightguard ?
    They are fabricated and delivered/adjusted identically for the patient The only difference is the times they are worn (night only vs. full time). Therefore a nightguard changes names to a "splint" simply when it is decided (usually due to ongoing TMD symptoms) to go to "full time" use.

    This does (as stated above) require weekly checks to secure a stable and comfortable jaw joint position.
    NOTE - Night time use only does not allow for determining an ultimately correct jaw joint position due to the fact that the person has it out 16 hours a day.

  4. To really understand splint therapy, you must be able to picture within your mind the jaw joint (seated into socket) and the teeth all coming together at the same time. This is the most correct relationship. If you cannot grasp this fundamental concept, the remaining discussion is almost meaningless.

  5. Fundamentals - The jaw joint should be in socket when all the teeth come together.
    • All the teeth should come together at the same time.
    • If I or anyone else is going to help someone, then it is imperative to produce a bite (occlusion) that does do the 2 things listed above.
    • The easiest way to instantly establish a proper bite that coexists with the jaw joint being in a correct socket is by making a splint.
    • A splint is really just an artificial bite. When the jaw closes, the opposing teeth strike the surface of the splint and this establishes a bite different from that which the teeth do.

So now a basic question:


What is the purpose of a splint/nightguard?
Is your answer like that of most people? It is meant to keep my teeth from touching when I grind my teeth at night.

This answer is only partially (very partially) correct.

The correct answer is this:
A splint/nightguard is meant as a physiologically correct bite that allows the jaw joint (TMJ) to assume it's most correct and least traumatic position. This position will allow for a stable base that will decrease both muscular activity and damaging forces to the joint. What I mean by a "physiologically correct bite" is that built into the surface of as it contacts teeth in closure is a bite that is absolutely correct for proper function of the teeth in harmony with the TMJs and muscles that operate the joint.

Conclusion
There is GREAT debate and lack of generalized agreement on the efficacy and even the need at all for splints. Yet they are very successful in the hands of those who are properly trained to fabricate, deliver and adjust them. Most of the studies that point to the failure of splints to help with TMJ dysfunction are flawed by the fact that MOST splints are incorrectly made in the first place.

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Dr. Maury Hafernik
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