For temporomandibular disorders (TMD, often called TMJ), an occlusal splint is usually the first treatment step. This article shows how such a splint guides the mandible into a relieving position.
Initial occlusal therapy using a splint to reposition into centric relation.
The Splint as the First Step in Every TMD Treatment
The first treatment measure for temporomandibular disorder (TMD, often called TMJ) is, in most cases, an occlusal splint.1 This serves as a reversible therapeutic method to achieve an improvement in symptoms. Definitive orthodontic treatment can only take place once functional improvement has been achieved through the splint. In addition to its therapeutic use, an occlusal splint can also be used as a diagnostic tool to determine the physiological, three-dimensional position of the lower jaw.4
How Effective Is an Occlusal Splint?
Occlusal splints are scientifically validated therapeutic instruments2that positively influence not only the craniomandibular system but also the entire musculoskeletal system.3 They correct occlusal disturbances and normalize neuromuscular dysfunctions. At the same time, they allow a reversible redefinition of the temporomandibular joint position, without permanently intervening in tooth alignment. How such a splint is digitally planned and fabricated today is described in detail in our article on digital occlusal splints for TMD.
When a Splint Alone Is Not Enough
In some cases, splint therapy alone is not sufficient. In certain initial situations, it must be combined with additional measures:
- Deep bite with inwardly inclined upper incisors: In this case, isolated splint therapy would be insufficient, as it could lead to further rotation of the lower jaw.
- Transverse discrepancies with crossbite: In such cases, combined functional temporomandibular joint therapy and orthodontic treatment is required.
- Primary joint diseases: Here, splint therapy can intensify the symptoms, so precise diagnostics using CBCT or MRI is necessary.
Fabrication and Fitting of the Splint
Laboratory Fabrication
The splint is fabricated on models that are mounted in an articulator. The splint should be designed as flat as possible to ensure high wearing comfort. After fabrication, the occlusion is checked and adjusted using occlusion foil.
Insertion and Control
After insertion, it is checked whether the splint fits securely and does not allow unwanted movements. Initial controls take place after one week to evaluate both static and dynamic occlusion. Adjustments are made through targeted grinding of the splint or remounting in the articulator.
The Splint Paves the Way
Occlusal splints are an effective method for the reversible treatment of TMD. They enable the determination of a physiological temporomandibular joint position and serve as a basis for further orthodontic measures. Successful splint therapy typically takes three to six months. Only once a stable bite position has been achieved can further aligner therapy or prosthetic treatment begin.
Sources
- Fricton, J., Look, J. O., Wright, E., et al. (2010). Systematic review and meta-analysis of randomized controlled trials evaluating intraoral orthopedic appliances for temporomandibular disorders. Journal of Orofacial Pain, 24, 237–254.
- Ordelheide, A., & Bernhardt, O. The effectiveness of occlusal splints in the treatment of craniomandibular dysfunctions: An overview of national and international publications. Journal of Craniomandibular Function.
- Kopp, S., Friedrichs, A., Pfaff, G., & Langbein, U. (2003). Beeinflussung des funktionellen Bewegungsraumes von Hals-, Brust- und Lendenwirbelsäule durch Aufbissbehelfe. Manuelle Medizin, 41(1), 39–51. https://doi.org/10.1007/s00337-002-0200-1
- Freesmeyer, W. (1993). Zahnärztliche Funktionstherapie. Hanser.
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