A New Occlusal Splint for Treating Bruxism and TMD During Orthodontic Therapy

A New Occlusal Splint forTreating Bruxism and TMD During Orthodontic Therapy TERENCE C. SULLIVAN, DDS, MSD N ightguards or occlusal splints are widely used any impressions or lab work and is easily adjust­ for treatment of bruxism and associated ed at chairside by dipping it in hot water and TMD.1-15 In general, clinicians prefer to use full­ bending the clips to conform to the patient’s arch, flat-plane splints as opposed to reposition­ fixed appliances (Fig. 2). Archform can be cus- ing splints.16-20 Holmgren and colleagues found that full-coverage splints do not stop bruxism, as evidenced by wear facets on the occlusal sur­ faces of the splints, but that they can reduce the signs and symptoms of TMD.20 Explanations for this effect include: the splint puts the mandible in a more open position, thus stretching the jaw ele­ vator muscles and reducing postural activity of those muscles21; the splint “unlocks” the mandible and permits it to move freely in a more comfortable postural position22; or the splint dis­ tracts and unloads the TMJ.23,24 When bruxism and TMD occur during A orthodontic treatment with fixed appliances, con­ ventional splints that conform closely to the teeth are difficult to use because of tooth movement and interference from the appliances. Previous methods for treating bruxism during orthodontic treatment have included anterior biteplanes and loose-fitting mouthguards. Some clinicians sim­ ply postpone treatment of the problem until fixed appliances are removed, even though this can result in extensive wear of incisal edges and cusp B tips. New Occlusal Splint The new Bruxism “S” Splint* is unique in that it attaches directly to fixed orthodontic appliances. This full-coverage, flat-plane occlus­ al splint allows tooth movement to continue while preventing excessive tooth wear. It can be used in either the maxillary or mandibular arch (Fig. 1). C The Bruxism “S” Splint does not require Fig. 1 A. Unmodified Bruxism “S” Splint. B. Splint *Glenroe Technologies, Inc., 1912 44th Ave. E., Bradenton, FL fitted to maxillary arch. C. Splint fitted to mandib­ 34203. ular arch. 142 © 2001 JCO, Inc. JCO/MARCH 2001 The two posterior clips. 4 Occlusal surface of splint adjusted with bur. A B C Fig. tomized somewhat. S. inner flanges. but the standard form of the splint seems to fit most patients. 4). C.. The distal ends. WA 98012. 3). Dr. Fig. Clinical observations and reports from patients in my practice indicate that the appliance is comfortable and effective when properly adjusted. VOLUME XXXV NUMBER 3 143 . Sullivan is in the private practice of orthodontics at 805 164th St. Some patients have reported that they Fig. 3 Distal end of splint. Clips adjusted to fit over fixed appliances. and retentive clip edges of the splint can be trimmed with a scissor for further patient comfort (Fig. Mill Creek. He has a financial interest in the product described in this article. 2 A. and retentive clip edges trimmed for fit and patient comfort. B. Clips bent inward with pinching motion. usually provide ade­ quate retention for the appliance. Splint dipped in 180°F water to soften clips for adjustment. and the anterior clip can also be cut off if the patient feels it is uncomfortable. Suite 200. when properly adjusted. The occlusal surface of the splint can be modified with an acrylic bur if necessary (Fig.E. inner flanges. P.M.T. and Nemir.: Influence of occlusal splints 137-163. 3rd ed. 1995. 1997. J. 18. 1981. Assoc.J. 56:823-833.E. Ramfjord. B. Lund. Clin.R. 71:150.: Effect of a 4. Pierce.: A preva­ 40:347-353.A New Occlusal Splint for Treating Bruxism During Orthodontic Therapy have to take the appliance out during the night at lence study of symptoms associated with TM disorders. Dent. Almond... J. C. 1966. J. nocturnal bruxism. tromyographic study of the immediate effect of an occlusal 7.B.: A REFERENCES Textbook of Occlusion. J. Dijkstra...Y. and Janson.J. Glaros. Quintessence splint in the postural activity of the anterior temporal and mas­ Publishing Co. Dent. Quintessence Dent. 1979.A.. 2. T.C. 38:149-157.. and Houston. Mosby Co.J. Prosth. Res. Sheikholeslam.: Fundamentals of Occlusion and Temporo­ al input.M. and eventually 15.. Prosth. Am. and Lavigne. Dent.M.P.. Okeson. K. Oral Rehab. Zhu. and Riise. M. A. Redding.M. and Gale. J.. and Riise. 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