SPLINTS IN TMJ DYSFUNCTION . HOW EFFECTIVE ? A REVIEW
Table 1 . Classification of occlusal appliances Type of occlusal appliances Activity Recommendations
Reflex appliances e . g . Interceptor , Anterior Plateau , NTI-tss
Prevent habitual tooth contact prevent gnashing and clenching
Acute symptoms that can be attributed to overloading of the tissues
Stabilization appliances e . g ., Michigan type splint
Synchronous tooth contact in a centric condyle position in static occlusion and an anterior tooth position with disclusion in the lateral teeth region in dynamic occlusion .
For acute or chronic symptoms and also in psychological and physiological overloading reactions .
Repositioning appliances e . g ., Anterior repositioning splint
The temporomandibular joint or joints is / are set in a therapeutic position by the splint to support healing and to maintain a symptomfree joint posture .
Anterior disc displacement with and without reduction , temporomandibular joint compression , retral displacement of the condyle and osteoarthritis . Can be used as a short-term or long-term therapy .
Superior repositioning appliance
To allow complete reseating of the condyle disk assemblies up the eminence to the superior centric relation axis .
Establish the correct skeletal relationship before the correct occlusal relationship is determined .
Anterior bite plane
To disengage the posterior teeth and thus eliminating their influence on the function of the masticatory system .
For treatment of muscle disorders related to orthopedic instability or an acute change in occlusal condition . Parafunctional activity may also be treated with it but only for a short period .
Posterior bite plane
To achieve major alterations in vertical dimension and mandibular positioning .
Advocated in case of severe loss of vertical dimension or when there is a need to make major changes in anterior positioning of the mandible . For disc derangement disorders .
Soft and resilient appliance
To achieve even and simultaneous contact with the opposing teeth .
Protective device for persons likely to receive trauma to their dental arches e . g . athletic splint . For patients exhibiting high levels of clenching and bruxism , they help dissipate some heavy loading forces encountered during parafunctional activity . precisely described by Ramfjord and Ash Jr . 17 This splint could be used in both dental arches , but preferably in the maxilla . The mandibular splint is used when the posterior area misses teeth in the mandible and unwanted tooth movement must be avoided . The main purpose of this device is to disengage the occlusion , place the condyle in the centric position , relax the masticatory muscles and prevent further tooth wear due to nocturnal parafunctional activity . The main features of this splint are freedom in centric and canine guidance . It is important to note that the relation of the maxillary and mandibular arches may differ after the treatment when compared to the initial state , especially when partial coverage splints are used . 14 , 18 The occlusal splints are also used in the initial phase of treatment in patients with mouth overclosure caused by a pathologic deep bite . Before the prosthetic rehabilitation of the severe tooth wear , one should remember that initially , splint therapy should be applied to adapt the stomatognathic system to the new occlusion . 20 A classification of the occlusal appliances with activities and recommendations is presented in Table 1 . Normally , it is suggested that patients wear the splint only at night . The splint needs to be adjusted ( rebalancing of the splint to the new position of the jaw by
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