BASICS OF FUNCTIONAL CLINICAL AND INSTRUMENTAL DIAGNOSTICS
AND PRETREATMENT BEFORE FINAL ORAL REHABILITATION
Figure 21. With the centric relation record in place,
the mandibular cast is mounted on the articulator
Figure 22. After removing the record, a
considerable occlusal discrepancy is obvious,
which exactly corresponded to the clinical situation
after the “cotton-roll-test”
Figure 23. In the habitual relation, the separated
base of the maxillary cast indicates strong
premature contacts in the molar region
Figure 24. The bite-guard splint, individually
constructed in the articulator, equilibrates the
discrepancy between the centric and habitual
relations (centric splint)
individualized vacuum-drawn heat-treated splint
(which was first trimmed in the articulator to leave
the smallest occlusal height possible) until the
equal support of all posterior teeth results.
This occlusion concept corresponds to that of the
Michigan splint by Ramfjord and Ash.4 In contrast
to natural teeth and restorations, the splint allows
only the respective load-bearingcusps to contact,
which antagonistically occlude with the splint.
With a maxillary splint, this would involve just the
buccal mandibular cusps, and with a mandibular
splint, only the palatinal maxillary cusps would
be involved (Figs. 25 and 26). Fundamentally,
maxillary and mandibular splints each have
specific advantages and disadvantages. This
patient was given a maxillary splint, because this
is the only one which can reconstruct an individual
anterior tooth guidance which has a proven
additional muscle-relaxing effect.12,18 For this we
use the Contour Curve Former (CCF, Whaledent
International, New York, NY, USA), with which
characteristics of anterior guidance can be formed
to the individual patient (Figs. 27 and 28; see also
Fig. 4).
Insertion of splint
The splint was inserted into the patient’s mouth
(Figs. 29 and 30). Attention must be paid to
tension-free seating.
Exactly as in obtaining the centric record, the
relaxed mandible is guided against the splint.
A disclosing paper 10 to 20 µm thick is used to
check whether the load-bearing cusps produce
even contacts on the splint; if necessary, corrections
can be made with a milling cutter.
Subsequently, excentric movements are checked.
In the initial phase, a slight canine guidance should
be aimed for; in the present case, the individually
formed anterior tooth guidance was checked and
corrected.
The patient is advised to wear the splint as often as
possible, especially at night, but not while eating
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