# OCCLUSAL SPLINTS **DR JANINA CHRISTOFOROU** ORAL MEDICINE SPECIALIST # CLASSIFICATIONS Okeson classified splints as: 1) Stabilisation appliance/ Muscle relaxation appliance used to reduce muscle activity. 2) Anterior repositioning appliances/ Mandibular orthopedic repositioning appliance 3) Other types: a) Anterior/Posterior bite plane b) Pivoting appliance c) Soft/ resilient appliance (silicone) Dawson classified splints as: 1. Permissive splints/ muscle deprogrammer. 2. Non-permissive splints/ Directive splints 3. Pseudo permissive splints (e.g. Soft splints, Hydrostatic splint) # USES * bruxism/parafunctional habits, * fatigued masticatory muscles, * headaches, * sore teeth, worn teeth, * malocclusion, * noisy and uncomfortable temporomandibular joints (TMJ), * Protection of dentition and restorations. # WHAT SPLINT SHOULD I USE **Depends on:** * Findings from the examination * **The** differential diagnosis * An understanding of the effects of each splint design # MATERIALS **Spiral** **Talon™ Splints** "Soft, clear, custom-fitted, for temporary relief of TMJ pain and signs" * **Hard acrylic resin** * self-cured (by chemical reaction) or * heat cured, * milled * = hard and rigid tooth-borne and occlusal surface. * **Soft or resilient** * = somewhat flexible and pliable tooth-borne and occlusal surface. * **dual laminated** * its occlusal surface consists of hard acrylic resin and the tooth- * borne surface consist of a soft material. # EMERGENCY USE: An electromyography (EMG) crossover study by Okeson found: * Significantly reduced nocturnal muscle activity with the use of hard occlusal appliances. Another EMG study (Savabi O et al), found: * After the immediate insertion of a soft occlusal appliance during maximum clenching it was found that the masseter muscle activity was increased. <!-- Image (55, 599, 164, 858) --> Okeson JP (1987) The effects of hard and soft occlusal splints on nocturnal bruxism. J Am Dent Assoc 114: 788-791. Savabi O, Nejatidanesh F, Khosravi S (2007) Effect of occlusal splints on the electromyographic activities of masseter and temporal muscles during maximum clenching. Quintessence Int 38: e129-132. 1     #### Classifications of Occlusal Appliances **Okeson Classification:** 1. Stabilisation appliance / Muscle relaxation appliance: Used to reduce muscle activity. 2. Anterior repositioning appliances / Mandibular orthopedic repositioning appliance. 3. Other types: - Anterior/Posterior bite plane - Pivoting appliance - Soft/resilient appliance (silicone) **Dawson Classification:** 1. Permissive splints / muscle deprogrammer. 2. Non-permissive splints / Directive splints. 3. Pseudo permissive splints (e.g., Soft splints, Hydrostatic splint). #### Clinical Uses - Bruxism and parafunctional habits. - Fatigued masticatory muscles. - Headaches. - Sore or worn teeth. - Malocclusion. - Noisy and uncomfortable temporomandibular joints (TMJ). - Protection of dentition and restorations. #### Selection Criteria Selection depends on: - Findings from the clinical examination. - The differential diagnosis. - An understanding of the effects of each splint design. #### Materials and Fabrication - **Hard acrylic resin:** Self-cured, heat-cured, or milled. Results in a hard, rigid tooth-borne and occlusal surface. - **Soft or resilient:** Flexible and pliable tooth-borne and occlusal surface. - **Dual laminated:** Occlusal surface consists of hard acrylic resin; tooth-borne surface consists of soft material. - **Talon™ Splints:** Soft, clear, custom-fitted for temporary relief of TMJ pain. #### Research Findings on Muscle Activity - **Hard appliances:** An EMG study by Okeson found significantly reduced nocturnal muscle activity. - **Soft appliances:** An EMG study by Savabi et al. found that masseter muscle activity increased during maximum clenching immediately after insertion of a soft appliance. Clinical photo illustrating the 'USES' of occlusal splints. The image displays two individuals: a man on the left exhibiting signs of bruxism (gritting teeth) and a woman on the right holding her jaw in pain, likely representing symptoms such as headaches or TMJ discomfort. Clinical photo showing an occlusal splint fitted over a dental model. This visual demonstrates the physical design and fit of a splint appliance used for differential diagnosis and treatment planning. Product packaging figure for 'Talon™ Splints' by SPIRANK. The image shows a blister pack containing clear, custom-fitted soft splints, accompanied by text describing them as 'Soft, clear, custom-fitted, for temporary relief of TMJ pain and signs'. Clinical photo of a 'Soft splint' fitted inside a patient's mouth. The image is referenced in the context of an EMG study comparing muscle activity with hard versus soft appliances during maximum clenching. - Permissive - The most commonly used type of - occlusal appliance, - Function, - to provide joint stabilisation, - protect the teeth, - redistribute the occlusal forces, - relax the elevator muscles, and - decrease effects of bruxism. STABILISATION APPLIANCE STABILISATION APPLIANCE Features - The occluding surface of the appliance should occlude - uniformly, evenly, and simultaneously with the opposing - dentition. - Multiple even contacts on posterior teeth in the retruded contact - position with lighter contacts on anterior teeth. - Can incorporate canine or anterior ramps to disocclude the - posterior teeth during eccentric movements. - It has the least adverse effects to the oral structures when - properly fabricated. STABILISATION APPLIANCE • Uses: • May be effective in reducing TMD symptoms Prosthodontics • elimination of discrepancies between seated joints and seated occlusion (CR = CO?) • a large surface area to distribute occluding forces - the opportunity to observe for occlusal and joint stability over time Regular checking of changes to the occlusal contacts on the appliance MAXILLARY OR A MANDIBULAR SPLINT? Mandibular Maxillary Tanner splint Michigan splint If teeth are missing, the splint is usually made in the jaw where most teeth are lost to increase the stabilising effect by creation of additional occlusal points. (Note: This may differ in some situations and should not be a fixed rule). Class III cases Increased incisor overjet (severe Angle class II) Deep curve of Spee Fewer speech changes Lower visibility Reduced airway obstruction THICKNESS OF A SPLINT • Prevention of tooth wear- • minimal thickness for capabilities of the material. • Splints that increased vertical dimension 4.4 mm and 8.2 mm were more effective in producing muscular relaxation in patients with bruxism and myofascial pain dysfunction patients than 1-mm splints. (Manns, J Prosthet Dent. 1983) • On the basis of MRI measurements and clinical outcome, it was recommended that • 4-mm vertical splint thickness for disk displacement with reduction • 6-mm vertical splint thickness for disk displacement without reduction. (Hegab, Oral Surg Oral Med Oral Pathol Oral Radiol. 2018) ANTERIOR BITE PLANE • Engages only 2-4 maxillary incisors. • Different designs • the Nociceptive Trigeminal Inhibition splint (NTI), • Purpose: • to disengage the posterior teeth, thus eliminating the - influences of the posterior occlusion on the masticatory - system. • Thought to be effective in treating TMDs and headaches? NOT ADVISED 2         #### General Characteristics - Permissive appliance. - The most commonly used type of occlusal appliance. #### Primary Functions - Provide joint stabilisation. - Protect the teeth and redistribute occlusal forces. - Relax elevator muscles. - Decrease the effects of bruxism. - Reduce TMD symptoms. - Eliminate discrepancies between seated joints and seated occlusion (CR vs CO). - Provide a large surface area to distribute forces. - Allow observation of occlusal and joint stability over time. #### Design Features - Occluding surface must occlude uniformly, evenly, and simultaneously with opposing dentition. - Multiple even contacts on posterior teeth in the retruded contact position; lighter contacts on anterior teeth. - Incorporation of canine or anterior ramps to disocclude posterior teeth during eccentric movements. - Minimal adverse effects to oral structures when properly fabricated. #### Arch Selection (Maxillary vs. Mandibular) - **Maxillary (Michigan splint):** Indicated for Class III cases, increased incisor overjet (severe Angle Class II), or deep curve of Spee. - **Mandibular (Tanner splint):** Offers fewer speech changes, lower visibility, and reduced airway obstruction. - **General Rule:** If teeth are missing, the splint is usually made in the jaw where most teeth are lost to increase stability through additional occlusal points. #### Thickness Guidelines - **Tooth wear prevention:** Minimal thickness based on material capabilities. - **Muscular relaxation:** Splints increasing vertical dimension by 4.4 mm to 8.2 mm are more effective than 1-mm splints for bruxism and myofascial pain. - **Disc Displacement (MRI-based recommendations):** - 4-mm vertical thickness for disk displacement with reduction. - 6-mm vertical thickness for disk displacement without reduction. #### Anterior Bite Plane - Engages only 2-4 maxillary incisors. - **Purpose:** To disengage posterior teeth and eliminate posterior occlusal influences on the masticatory system. - **Note:** Use is generally not advised due to potential complications. Clinical photo of a stabilization appliance (splint) with multiple even contacts on posterior teeth and lighter contacts on anterior teeth, demonstrating uniform occlusion. Clinical photo showing the occluding surface of a stabilization appliance in contact with opposing dentition, illustrating how it can incorporate canine or anterior ramps to disocclude posterior teeth during eccentric movements. Clinical photo of a patient's mouth with a splint in place, used for reducing TMD symptoms and prosthodontics purposes such as eliminating discrepancies between seated joints and seated occlusion. Comparison table titled 'MAXILLARY OR A MANDIBULAR SPLINT?' comparing features of maxillary vs mandibular splints: Michigan splint (maxillary) vs Tanner splint (mandibular), increased incisor overjet vs class III cases, deep curve of Spee vs fewer speech changes, lower visibility vs reduced airway obstruction. Includes note about tooth loss distribution affecting splint placement. Diagram showing arrows indicating upward force on maxilla and downward force on mandible, visually representing how splints work to stabilize joint function and redistribute occlusal forces. Clinical photo showing a patient's mouth with a splint in place, demonstrating thickness variations and their effect on vertical dimension and muscle relaxation. Clinical photo showing a patient's mouth with a splint in place, illustrating recommended thicknesses: 4mm for disk displacement with reduction and 6mm for disk displacement without reduction. Clinical photo of an anterior bite plane engaging only 2-4 maxillary incisors, demonstrating its design purpose to disengage posterior teeth and eliminate influences of posterior occlusion on the masticatory system. **17/01/2026** --- **The premise of the nociceptive trigeminal inhibition (NTI) splint** - Muscle clenching forces are reduced significantly when contact is isolated exclusively on the incisors. - Eliminating posterior teeth contact significantly reduces noxious sensory feedback, through the trigeminal afferents, from previously sore temporalis muscles, which can evoke sympathetic vascular changes intracranially. --- **NTI VS FLAT PLANE APPLIANCE** - A double-blind randomised parallel trial, compared the NTI to a flat plane appliance in TMD subjects with a headache, - found no differences between appliances over a three month period in respect to - muscle tenderness upon palpation, - patients self-reported TMD-related pain and headache, or - improvement on mouth opening. - In another well-designed RCT, - the NTI was found to be less effective than the stabilisation appliance in the treatment of TMDs. Jokstad A, Mo A, Krogstad BS. Clinical comparison between two different splint designs for temporomandibular disorder therapy. Acta Odontol Scand 2005;63:218-26. Magnusson T, Adiels AM, Nilsson HL, Helkimo M. Treatment effect on signs and symptoms of temporomandibular disorders— comparison between stabilisation splint and a new type of splint (NTI). A pilot study. Swed Dent J 2004;28:11-20 --- **ANTERIOR BITE PLANE** - Adverse effects - occlusal changes - the potential for overeruption of the posterior teeth resulting in an anterior open bite. - intrusion of maxillary anterior teeth which retain the appliance could exaggerate the problem of an anterior open bite. - unfavourable mobility of the teeth supporting the appliance. - Swallowing risk --- **CASE** - 47 year old female - H/O: Clenching which contributed to headaches - Dentist advised on an anterior plane splint - Reduced the headaches - Then …… a referral came - Managing well with splint, but pain has recurred. --- - Supraerupted posterior teeth - Only occluding on the 7s. - Also a periodontal patient - So, what do you do? - Had to wait for supraeruption of the anterior teeth - Then fabricated a stabilisation appliance.    #### Premise of the NTI Splint - Muscle clenching forces are significantly reduced when contact is isolated exclusively on the incisors. - Eliminating posterior contact reduces noxious sensory feedback through trigeminal afferents from sore temporalis muscles, which can otherwise evoke intracranial sympathetic vascular changes. #### Comparative Efficacy - **NTI vs. Flat Plane Appliance:** A double-blind RCT found no significant differences over three months regarding muscle tenderness, self-reported TMD pain, headache, or mouth opening. - **NTI vs. Stabilisation Appliance:** RCT evidence suggests the NTI is less effective than the stabilisation appliance for treating TMDs. #### Adverse Effects of Anterior Bite Planes - **Occlusal changes:** Potential for overeruption of posterior teeth leading to an anterior open bite. - **Intrusion:** Maxillary anterior teeth supporting the appliance may intrude, exacerbating open bite issues. - **Tooth Mobility:** Unfavourable mobility of supporting teeth. - **Safety:** Risk of swallowing the small appliance. #### Case Study: Complications - **Patient:** 47-year-old female with clenching and headaches. - **Initial Treatment:** Anterior plane splint (initially reduced headaches). - **Complication:** Recurrence of pain and development of a posterior-only occlusion (occluding only on 7s) due to supraerupted posterior teeth. - **Management:** Required waiting for supraeruption of anterior teeth followed by fabrication of a full-coverage stabilisation appliance. Clinical intraoral photograph showing the patient's dentition in occlusion. The image demonstrates an anterior bite plane appliance with visible incisal edge disocclusion of posterior teeth and contact on the anterior incisors. Clinical intraoral photographs (left and right views) showing supraerupted posterior teeth. The text notes that only the 7s are occluding, indicating a lack of posterior contact which relates to the periodontal history mentioned. Comparative figure consisting of six panels labeled A through F. Panels A, B, and C show pre-treatment or initial condition of the dentition. Panels D, E, and F show post-treatment results after fabricating a stabilization appliance, demonstrating improved occlusal relationships and alignment. ANTERIOR REPOSITIONING APPLIANCE • Purpose: • to alter the maxillomandibular relationship so that a more anterior position is assumed by the mandible. • Design • Acrylic guiding ramp added to the anterior third of the maxillary appliance that direct the mandible into a more forward position, upon closing. • Occlusal indentations in the protruded position. Short Term Use only ANTERIOR REPOSITIONING APPLIANCE • Use: • treating patients with anterior disk displacement with reduction. • It was supposed that by altering the mandibular position in this manner, the anteriorly displaced disks could return back to its normal position (recaptured), • Acute trauma with retrodiscal oedema and chronic, painful disc displacement disorders • to keep the condyle away from the retrodiscal tissues so that the inflammation can subside. From Okeson JP: Management of temporomandibular disorders and occlusion, St. Louis, 2012, Elsevier, p 19, Figure 1-31. ANTERIOR REPOSITIONING APPLIANCE • Adverse effects: • With long term use of this appliance, there are permanent and irreversible occlusal changes. • Should be used with caution only for short periods of time as a temporary therapeutic measure. ANTERIOR REPOSITIONING APPLIANCE ANTERIOR REPOSITIONING APPLIANCE • Appliances for obstructive sleep apnoea POSTERIOR BITE PLANE APPLIANCE • Made to be worn on the lower arch. • Design: • bilateral hard acrylic resin table located over the mandibular molars and premolars • creates a disocclusion of the anterior teeth, • These appliances are intended to produce vertical dimension and horizontal maxillomandibular relationship changes. • Adverse effects: • occlusion only on posterior teeth • allows overeruption of the anterior teeth • intrusion of the opposing posterior teeth, • = Eventually lead to a posterior open bite.       #### Purpose and Design - **Purpose:** To alter the maxillomandibular relationship, directing the mandible into a more anterior position. - **Design:** Includes an acrylic guiding ramp on the anterior third of a maxillary appliance and occlusal indentations in the protruded position. - **Duration:** Indicated for short-term use only. #### Clinical Indications - Anterior disk displacement with reduction (aiming to "recapture" the disk). - Acute trauma with retrodiscal oedema. - Chronic, painful disc displacement disorders (to keep the condyle away from inflamed retrodiscal tissues). - Management of obstructive sleep apnoea. #### Adverse Effects - Long-term use causes permanent and irreversible occlusal changes. - Must be used with caution as a temporary therapeutic measure. #### Posterior Bite Plane Appliance - **Design:** Worn on the lower arch; bilateral hard acrylic resin tables over mandibular molars and premolars to disocclude anterior teeth. - **Purpose:** Intended to produce changes in vertical dimension and horizontal maxillomandibular relationships. - **Adverse Effects:** - Occlusion occurs only on posterior teeth. - Allows overeruption of anterior teeth. - Intrusion of opposing posterior teeth. - Eventually leads to a posterior open bite. Clinical photo showing a patient's teeth with an anterior repositioning appliance in place. The image displays the occlusion of upper and lower teeth, illustrating how the appliance guides the mandible into a more forward position. Photo of an anterior repositioning appliance on a dental model. The appliance features acrylic guiding ramps added to the anterior third of the maxillary arch, designed to direct the mandible into a protruded position upon closing. Clinical photos demonstrating adverse effects of long-term use of anterior repositioning appliances. Images show permanent and irreversible occlusal changes, including potential overeruption or intrusion of teeth due to prolonged application. Diagram illustrating an anterior repositioning appliance for obstructive sleep apnoea. Shows the appliance design with guiding elements positioned to alter maxillomandibular relationships, typically used as short-term therapeutic measure. Photo of a posterior bite plane appliance mounted on a dental model. The appliance consists of bilateral hard acrylic resin tables located over the mandibular molars and premolars, creating disocclusion of anterior teeth. Clinical photo showing a patient wearing a posterior bite plane appliance. The appliance is visible in the lower arch, demonstrating its placement over posterior teeth to create vertical dimension changes and potentially lead to a posterior open bite. | Spline Type | Main indications | | --- | --- | | **Full arch** | | | Stabilization Splint | Myofascial pain and TMJ pains<br>Bruxism associated toothwear<br>Testing an increase of occlusal VD<br>Tooth mobility from occlusal disharmony | | Anterior Positioning Splint | Disc displacement with reduction (clicking relieved by protrusion) | | **Partial coverage** | | | Anterior bite raising appliance | To create interocclusal space anteriorly | | Posterior bite raising appliance | To create interocclusal space posteriorly | | NTI-TSS (Nonicceptive Trigeminal Inhibition-Tension Suppression System) | An alternative to the stabilization splint for myofasial pain and headaches but proof of efficacy limited | The year is **2026**. **NEUROMUSCULAR APPLIANCES** * Neuromuscular dentistry (NMD) have Advocated that by use of jaw muscle stimulators with jaw-tracking machines to produce an occlusal appliance that is at the ideal vertical and horizontal position of the mandible in relation to the cranium. * Begins by relaxing the muscles around the jaw, using a Transcutaneous Electrical Neural Stimulation (TENS) device. * A K7 machine is then used to find your optimal jaw position. * uses electromyography, sonography, and jaw-tracking scans to record muscle tension and listen to the jaw joint, while at rest and while functioning. **JUST TO PREVENT WEAR** **MAKING AN APPLIANCE-STABILISATION APPLIANCE** * Clinical stages * Initial * Insertion * Recalls **CLINICAL OCCLUSAL ANALYSIS** * Positional relationship of teeth in centric and eccentric jaw positions * Muscle palpation * TMJ assessment * Evaluation of tooth wear **Item number: 963** **TECHNIQUE** * Dental registrations * Impressions * Alginate / silicone impressions * Digital scanning * Bite registration at the anticipated Vertical dimension * Can use * Leaf gauge * Lucia jig * Mounting to check interocclusal separation / Digital software.       #### Summary of Indications by Splint Type **Full Arch Appliances:** - **Stabilization Splint:** Myofascial and TMJ pain, bruxism-associated tooth wear, testing increased occlusal vertical dimension (VD), and tooth mobility from occlusal disharmony. - **Anterior Positioning Splint:** Disc displacement with reduction (clicking relieved by protrusion). **Partial Coverage Appliances:** - **Anterior bite raising appliance:** To create anterior interocclusal space. - **Posterior bite raising appliance:** To create posterior interocclusal space. - **NTI-TSS:** Alternative for myofascial pain and headaches; however, proof of efficacy is limited. #### Neuromuscular Appliances - Based on Neuromuscular Dentistry (NMD) principles using jaw-tracking and muscle stimulation. - Uses Transcutaneous Electrical Neural Stimulation (TENS) to relax muscles. - Employs K7 machines, electromyography, and sonography to find an "optimal" jaw position at rest and during function. #### Clinical Technique for Stabilisation Appliances - **Clinical Analysis:** Assessment of tooth relationships (centric/eccentric), muscle palpation, TMJ assessment, and evaluation of wear. - **Registrations:** - Impressions: Alginate, silicone, or digital scanning. - Bite Registration: Taken at the anticipated vertical dimension using a leaf gauge or Lucia jig. - Mounting: Checking interocclusal separation via physical mounting or digital software. - **Insurance Item Number:** 963 Table comparing Spline Types and their Main Indications. Categories include Full arch (Stabilization Splint, Anterior Positioning Splint) and Partial coverage (Anterior bite raising appliance, Posterior bite raising appliance, NTI-TSS). Key indications listed for each type such as Myofascial pain, TMJ pains, Bruxism, etc. Photo of a person using a K7 machine with a headband device to find optimal jaw position, demonstrating the use of electromyography, sonography, and jaw-tracking scans in neuromuscular dentistry. Figure showing clear dental splints designed just to prevent wear. Includes images of a transparent splint and its application on teeth. Slide outlining clinical stages for making an appliance-stabilisation appliance: Initial, Insertion, Recalls. Clinical photo of a patient's mouth showing occlusal analysis, including positional relationship of teeth in centric and eccentric jaw positions, muscle palpation, TMJ assessment, and evaluation of tooth wear. Technique slide showing dental registrations process. Includes alginate/silicone impressions, digital scanning, bite registration at anticipated vertical dimension using leaf gauge or Lucia jig, and mounting to check interocclusal separation/digital software. **Warning: Several errors occurred during the conversion of this PDF text. The following section may contain corrupted or missing data.** **Extracted text:** 17/01/2026 6 ADJUSTING THE SPLINT • Armamentarium: • Articulating paper- red and blue held in millers forceps • Acrylic bur and exudate burs • Shim stock to check the heaviness of contacts • Ensure that it is fully seated • Check retention and stability • Then check occlusion • Shouldn’t have much adjustment if the bite registration was correctly recorded and the laboratory didn’t have to change vertical dimension. ADJUSTING THE SPLINT • Ensure that it is fully seated • Check retention and stability • Then check occlusion • 1. eliminate premature or deflective contacts • 2. establish uniform occlusion along entire occlusal surface of splint • 3. eliminate interferences in lateral and protrusive movements • Red for excursive contacts • Non-working side • Working side • Then protrusive interferences. • ENSURE MAINTENANCE OF THE HOLDING CONTACT **Solution**      **Cause**      **Problem** Remake      Selective grinding of      Instability acrylic      - Distorted impressions - Air bubbles in cast - Undercuts not blocked out Shorten overlap      Ease the internal tooth      Too retentive fitting areas      - Too much overlap of acrylic - Proclination of anterior teeth - Undercuts not blocked out sufficiently - Polymerisation contraction of splint Remake      Consider provision of      Looseness clasps      - No undercuts - Short clinical crown height RECALL APPOINTMENTS • Important • Rectify problems- • comfort, • occlusal changes • The splint must be continually monitored and adjusted. • When the muscles relax and/or inflammation subsides, the position of the teeth on the splint changes. • Helps to monitor temporomandibular stability RECALL SCHEDULE • See patient 1-2 weeks after the insertion • After 3 months with no changes on the splint, a comfortable musculature, and no pain on loading, the patient is likely in a stable scenario. Then the following treatments can be started : • restorative dentistry, • orthodontics, • maxillofacial surgery, and segmental alveolar surgery. • Longterm reviews • Especially check in youngsters who were yet to have 3rd molars erupted. CASE: • A lower stabilisation appliance was fabricated to reduce dental wear from nocturnal grinding. • Recalled 2 weeks and then 6 weeks = each time had uniform occlusion on the splint. • Recalled 4 months after insertion of a stabilisation appliance • Had noted improvement with the use of the appliance. • Review noted a slight anterior open bite • Patient and her father felt that her occlusion was always like that. • Compared with the initial casts- an anterior open bite occurred.   #### Armamentarium - Articulating paper (red and blue) with Miller's forceps. - Acrylic and exudate burs. - Shim stock for checking contact intensity. #### Adjustment Procedure 1. Ensure the splint is fully seated. 2. Check retention and stability. 3. Eliminate premature or deflective contacts. 4. Establish uniform occlusion along the entire surface. 5. Eliminate interferences in lateral and protrusive movements (using red paper for excursive contacts). 6. Maintain holding contacts. #### Troubleshooting Fit and Stability - **Instability:** Caused by distorted impressions, air bubbles in cast, or unblocked undercuts. **Solution:** Remake. - **Too Retentive:** Caused by excessive acrylic overlap, proclined anterior teeth, or polymerisation contraction. **Solution:** Ease internal fitting areas or shorten overlap. - **Looseness:** Caused by lack of undercuts or short clinical crowns. **Solution:** Consider clasps or remake. #### Recall and Maintenance Schedule - **Initial Recall:** 1–2 weeks after insertion to rectify comfort or occlusal issues. - **Stabilization Check:** After 3 months of no changes, comfortable musculature, and no pain on loading, the patient is considered stable. - **Long-term Review:** Essential for monitoring temporomandibular stability and checking youngsters for erupting third molars. - **Case Example:** A patient provided with a stabilization appliance developed a slight anterior open bite after 4 months, confirmed by comparison with initial casts. Clinical photo of a lower stabilisation appliance (splint) seated in the patient's mouth. The appliance is a full-coverage acrylic splint with visible blue and red articulating paper marks on the occlusal surface, indicating areas of contact during adjustment. Structured table summarizing problems associated with splints, their causes, and solutions. Columns are labeled 'Problem', 'Cause', and 'Solution'. Rows detail issues such as Instability (caused by distorted impressions), Too retentive (caused by too much overlap), and Looseness (caused by no undercuts). **17/01/2026** 7 **= IDIOPATHIC CONDYLAR RESORPTION** * MRI of the TMJs * R TMJ, Evidence of prior erosion and remodelling of the articular surfaces, especially the sclerotic and irregular condylar stump. This either represents the sequelae of idiopathic condylar resorption or juvenile idiopathic arthritis. **SPLINT CARE** * Don’t store in direct sunlight * Keep away from pets * Never use toothpaste to clean the appliance * Liquid soap (see image) * Never clean in hot water * Luke warm water * Weekly soak for 15mins * Diluted white vinegar * Denture cleaning tablets **CONCLUSIONS** * Ensure patients don’t make adjustments to their oral appliances * Occlusal changes * Regular monitoring is required * Casts and photographs are invaluable for comparisons during monitoring and treatment * There are many splints on the market- ensure that they are appropriately used * Correct situation * Patient compliance with instructions **THANK YOU** janinachristoforou@gmail.com  #### Diagnosis and Imaging - **MRI Findings:** Evidence of prior erosion and remodelling of articular surfaces, specifically a sclerotic and irregular condylar stump. - **Differential Diagnosis:** Sequelae of idiopathic condylar resorption or juvenile idiopathic arthritis. #### Patient Instructions for Care - **Storage:** Do not store in direct sunlight; keep away from pets. - **Cleaning:** - Never use toothpaste or hot water. - Use liquid soap and lukewarm water. - Weekly 15-minute soak in diluted white vinegar or denture cleaning tablets. #### Clinical Conclusions - Patients must not make their own adjustments to appliances to avoid occlusal changes. - Regular monitoring is mandatory. - Use of baseline casts and photographs is invaluable for monitoring treatment progress. - Ensure the specific splint type is appropriate for the clinical situation and that the patient complies with instructions. Clinical photo of a dog's face, included in the 'SPLINT CARE' section to visually reinforce the instruction to keep splints away from pets. [^1]: Original PDF page 1: [[L3 Occlusal Splints 2026.pdf#page=1|L3 Occlusal Splints 2026, p.1]] [^2]: Original PDF page 2: [[L3 Occlusal Splints 2026.pdf#page=2|L3 Occlusal Splints 2026, p.2]] [^3]: Original PDF page 3: [[L3 Occlusal Splints 2026.pdf#page=3|L3 Occlusal Splints 2026, p.3]] [^4]: Original PDF page 4: [[L3 Occlusal Splints 2026.pdf#page=4|L3 Occlusal Splints 2026, p.4]] [^5]: Original PDF page 5: [[L3 Occlusal Splints 2026.pdf#page=5|L3 Occlusal Splints 2026, p.5]] [^6]: Original PDF page 6: [[L3 Occlusal Splints 2026.pdf#page=6|L3 Occlusal Splints 2026, p.6]] [^7]: Original PDF page 7: [[L3 Occlusal Splints 2026.pdf#page=7|L3 Occlusal Splints 2026, p.7]]