Occlusal splints are close to my heart. I wear one. I also often prescribe splints to help protect patients teeth from nocturnal bruxism induced wear.

Splint issue appointments should be a breeze if you have a good lab. However there are few things that it helps to keep in mind to make it a smooth and quick appointment.

Fit and stability

Try it in, make sure it’s seated. Is it tight anywhere? Can they get it in and out? Sometimes a minor adjustment of the intaglio (internal surface) may be necessary if they didn’t quite block out enough of the undercuts.

If the fit is way off then it might be worth throwing some fit checker in there and seeing if the cause is simply excessive acrylic. But don’t get your hopes up, more than likely the alginates shrunk before pouring or the impressions weren’t great to start with.

Adjusting The Occlusion

Mark the contacts with blue articulating paper.

The trick to easily seeing these is to hold a folded tissue behind the splint.

Ideally this is done in centric relation. It’s important to check CR as most of us grind in this position. Have you ever had a patient come back for a splint review and complain of a sore tooth in the morning after wearing the splint, but that tooth is in balanced contact and not high?

More than likely, that’s their initial CR contact and they lean on this all night causing occlusal trauma. This concept is equally important in your restorative work. If you find guiding your patient into CR difficult (which I always have) then try a leaf guage to help get a CR bite.

If you’ve never used a leaf gauge before – they’re pretty easy to use. Just place a number of leaves between the patients front teeth, ask them to move their teeth forward, backward then squeeze. This pushes the condyle into CR. Here’s a video I found about using one to take a bite registration. Use the same principle but less leaves to remove CR interference’s.

Use a piece of red articulating paper to assess for lateral interferences. These occur when a patient slides laterally and the non working side gets in the way. i.e Patient slides left and the right first molar touches. Make sure you remove these, they’re another reason for sore teeth in the morning.

Check out this article How to Make a Well-Fitting Stabilization Splint by Moufti, Adel & T Lilico, Jeff & Wassell, Robert. (2007) for a more detailed explanation of splint construction.

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David is a recent graduate dentist working in private practice in regional NSW, Australia. Read more at www.dentalheadstart.com/meet-david/

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