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Dawson classifies splints into 2 types:

Occlusal splints/orthotics: any removable artificial occlusal surface used for diagnosis or therapy
affecting rls of mandible to maxillae. May be use for occlusal stabilisation for Tx of TMJ disorders, or
to prevent wear of the dentition. Usually made of hard acrylic, that fits over the occlusal & incisal
surfaces of teeth in 1 arch, creating precise occlusal contact w teeth of opposing arch.

Est. neuromuscular harmony in the masticatory styst + creating mechanical disadvantage for
parafunctional forces w removable appliances

Proper constructed splint supports a harmonious relation among => m. of mastication, disk
assemblies, joints, ligaments, bones, teeth & tendons

M. & joint disorders affect occlusal stability & Centric Relation:

All joints, including TMJ undergo remodelling throughout life w thinning of disc & remodelling
(flattening) of the head of the condyle & articular eminence. As the disc space diminishes, the
elevator m. continue to seat the condyle in the fossa => resulting in greater wear of posterior molars.

In pt w oral habits eg clenching & bruxing, a progression of excessive occlusal wear, excessive
interproximal wear, crowding of the mandibular teeth will be seen. W interproximal wear, the arch
shortens & amalocclusion may result and even an anterior open-bite relation. Sustained m.
contraction in clenching & bruxing can lead to m. co-contraction & a shortened resting m. length.

Chronic & acute overloading of condyle/disk assembly when it’s out of normal physiologic position
lead to TMJ disorder (TMJ are load bearing & susceptible to overload).

Centric relation is the optimal arrangement of join, disk & m.

1. Permissive
 Permissive occlusal splints aka muscle deprogrammer, ant deprogrammer, ant jigs,
lucia jig, stabilisation splints
 Have smooth surface on 1 side that allows m. to move the mandible w/o
interference from deflective tooth inclines into centric occlusion
 Designed to eliminate noxious contacts & promote harmonious masticatory m.
function. Pri func => alter occlusion so that teeth x interfere w complete seating of
the condyles & to control m forces
 Flat plane appliances, 2 classic designs => anterior midpoint contact splint & full
contact splints
 Concept of deprogramming => is based on the reflexive relaxation of lower jaw
when posterior teeth are x permitted to engage. They learn which positions of these
m. cause pain & which x, & store all the info in ur brain in the form of ‘engrams’
which are similar to automatic, unconscious computer prg that our body uses each
time we open or close out mouth. Force relaxation of the m of mastication brings
abt relief of pressure on all anatomic structures including the TMJ, m of mastication
teeth & supporting struc. Deprogramming freq brings abt a shift in the position of
the lower jaw, leaving the joint in a > relaxed fuctional position which probably
corresponds fairly closely to Dawson’s def of centric relation => condyles occupy a >
centric & relaxed position in the fossae => position reproducible w/o forceful
manipulation by the dentist
 Ant midpoint contact permissive splint => designed to disengage all teeth except
incisors => accomplish several goals eg remove occlusal interferences to complete
joint seating on closure, simultaneously allows freedom for full seating of
mandibular condyles when the elevator m contract on closure, encourages releases
of lateral pterygoid & ant neck positioning m on closure => m clenching forces are
reduced significantly when contact is isolated exclusively on the incisors. Width of
midpoint contacting platform of splint is limided to the wiedge of the 2 lower
incisors, measuring 8-10mm. Eliminating posterior teeth contact significantly
reduces noxious sensory feedback, through the trigeminal afferents from previously
sore temporalis m which can evoke sympathetic vascular changes intracranially
(which is the premis of the NTI- nociceptive trigeminal inhibition splint)
 Deprogrammer followed by a bruxing guard => bring immediate & permanent pain
relieve of maj of TMD cases => reduction in tension headaches, ear aches, neck
stiffness associated w parafunc, sensitive teeth, pantom toothaches. Crepitus &
popping of TMJ may be lessened or relieved
2. Directive
 Directive occlusal splints aka non-permissive splints, ant repositioning splints ie pull
fwd splint
 Designed to position mandible in a specific rls to maxilla => sole purpose => align
condyle-disk assemblies, thus should be used only when a specifically directed
position of the condyles is req

3. Pseudo permissive spints


 eg soft splints, hydrostatic splints

MORA: Mandibular orthopaedic repositioning appliance

Principle: Most occlusal splints have 1 pri func ie. To alter an occlusion so they x interfere w
complete seating of the condyles in centric relation

A proper

Inidication:

 Stabilisation of weak teeth (or hypermobile) by adaptation of splint material ard axial
surfaces => distribute loading forces over > teeth
 Stabiulising occlusion in pts w ant open bites & other malocclusion
 Distribution of occlusal forces
 Reduction of wear
 Alteration of dentla occlusion
 Stabilisation of unopposed teeth
 Reduction of m contraction & associated forces
 Repositioning of TMJ/ If there’s doubt abt complete seating of TMJ
 Long-standing intracapsular disorder that’s been resolved
 Splints are effective in reducing musculoskeletal pain (myalgia, mysofascial pain,
osteoarthritis & systemic arthritis –RA)