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How to Choose the Right Occlusal Splint for Your Patient

I want to share with you today a quick tip on selecting the proper splint. That's a very common question that we're asked frequently in our classes and with our students.

And let's try to break it down into options. So there's three basic designs of splints that we use most often.

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The first type is an anterior contact only splint.

We call it a B-splint, or an NTI, you would be familiar with. Why do we use that? The purpose of that is to separate the teeth in the back. So we call that, clearing the dance floor. We're eliminating occlusal interferences. We're allowing the lateral pterygoid muscles to release and the joints to seat fully to centric relation. And in contacting only on the anteriors, we also are shutting down elevator muscle activity for people that clench or grind or have headaches from parafunctional activity. So it can be very, very effective for those cases.

The second type of splint that we commonly use is a centric relation or what we call a superior repositioning splint.

These are most often used when there's a joint problem, in this case where there's a joint problem that can tolerate loading, but there may be an internal derangement, inflammation, and injury, this sort of thing. Then distributing the forces around the front end of the system and emphasizing that may allow the joints in the back, that are inflamed and damaged to a degree, to adapt.

And so it also becomes a way of monitoring the occlusion as we're trying to understand, "Are the joints changing?" Because if the joints are changing, the bite will change too. And we can see that through the appliance.

The third type of splint that we commonly use is an anterior repositioning splint, which is also the identical same type of design as a sleep appliance.

So there's a twofold purpose for that. Number one is if you have a damaged joint that you can't load without pain, short of surgery, you're going to use an anterior repositioning splint to unload the joint, to distract the joint condyle forward away from the retrodiscal tissue to prevent impinging. And so that's an option.

But also, when you do that, you may at the same time be opening the airway. So if there's an airway problem that may be driving parafunction, may be driving headaches and discomfort at nighttime, then using an anterior repositioning sleep appliance would be appropriate.

So I hope this helps you kind of weed through the three types of appliances or splints that we most commonly use and how to think about which one would be most appropriate for your next patient.

When to Use an Anterior Deprogramming Device

Dr. DeWitt “Witt” Wilkerson graduated from the University of Florida College of Dentistry in 1982, the same year he joined the Dawson private practice group in St. Petersburg, Florida. Witt is currently a Senior Faculty member and Director of Dental Medicine at The Dawson Academy. He is Past President of the American Equilibration Society(AES). Witt currently serves as President of the American Academy for Oral-Systemic Health(AAOSH), and is an Adjunct Professor in the Graduate Program at the University of Florida College of Dentistry. He has formerly served as an Associate Faculty Member and Special Lecturer at the L.D. Pankey Institute. Dr. Wilkerson lectures both nationally and internationally on the subjects of Restorative Dentistry, Dental Occlusion, TM Disorders, Airway/Dental Sleep Medicine, and Integrative Dental Medicine.