Treatment Example: Splint First, Then Aligners – The Two-Stage TMD Treatment

This treatment example shows how successful splint therapy for TMD can lead to a lasting result – first the splint, then aligners.

Anonymized presentation of a real treatment professionally published by our practice. Every case is different: the treatment approach, duration, and outcome of this individual case cannot be transferred to other patients.

With temporomandibular disorder (TMD, often called TMJ) – an imbalance between the jaw joint, chewing muscles, and bite – an occlusal splint is usually the first step. It can help find a pain-free jaw position. But: A splint only keeps the jaw in this favorable position as long as it is worn. This treatment example shows the two-stage approach we used at our practice in Cologne to turn successful splint therapy into a lasting result.

The Initial Situation

A 28-year-old patient came to us with long-standing complaints: temporomandibular joint pain on both sides, clicking sounds, pain radiating into the ears, and recurring neck and back problems. She had been taking pain medication for an extended period. The functional examination revealed a clear connection to her bite position: Premature contact in the front tooth area and lack of support in the back tooth area were pushing the lower jaw and condyles backward.

First Stage: The Splint – Diagnosis and Therapy Combined

We first fabricated an individual occlusal splint. It is reversible – it does not permanently change the teeth – and serves two purposes: It relieves the joint and muscles, and it tests which jaw position is actually pain-free. After three to six months, a comprehensive functional re-examination follows. For our patient, the result was clear: She was nearly symptom-free, pain medication could be discontinued, and the jaw position found remained stable over several weeks.

Second Stage: Aligners Stabilize the Result

Now came the point that determines whether the success holds: For the jaw to maintain the position found even without the splint, the teeth must be moved to where they support this position on their own. To ensure the pain-free position is not lost in the process, small fixed build-ups are bonded to the back molars, which continue to hold the jaw precisely in the tested position. On this foundation, we worked with clear aligners in two phases: first, the front and canine teeth were aligned while the molars secured the jaw position; then the molars were also adjusted so that in the end all teeth meet evenly again.

The Result

After completing the aligner phase, the patient carried the favorable jaw position in her own bite: The posterior teeth supported the jaw evenly, the symptoms resolved – without having to continue wearing the appliance permanently. Over a follow-up period of several years, the result remained stable. What had been temporary relief became a solid foundation.

Why we show this case

The two-stage approach – first diagnostic-therapeutic splint, then definitive stabilization – is the professional core of two publications from our practice: Occlusal splint for TMD: the start of every treatment and Follow-up treatment after initial splint therapy, in which this case is documented. Important and honestly stated: Not every TMD requires orthodontic correction – often the splint alone is sufficient, and the causes of TMD are diverse. If symptoms persist despite a correctly adjusted splint, the cause did not lie in the occlusion; then occlusal therapy is discontinued rather than continued indefinitely. When sleep-related breathing disorders or other underlying conditions are suspected, we work interdisciplinarily with ENT and sleep medicine specialists. For you, this means: Whether a two-stage treatment makes sense is determined by functional diagnostics – we are happy to discuss this in detail. More on our page about TMD pain therapy in Cologne.

Frequently asked questions about two-stage TMD treatment

Why isn’t the splint alone sometimes enough?

A splint holds the jaw in the favorable position only as long as it is worn. For the position to be maintained permanently without a splint, the teeth must be positioned so they support this position on their own – for example, with aligners.

How long do the two stages take?

The splint phase usually takes about three to six months until a stable, pain-free position is found. The subsequent aligner phase depends on the degree of misalignment. More precise information can be given after diagnostics.

Do I have to keep wearing the splint after the aligners?

The goal of the second stage is precisely to anchor the favorable position in your own bite. A protective or retention splint is often recommended at night – this depends on the individual case.

Does every TMD case need this two-stage treatment?

No. For many patients, splint therapy alone is sufficient. The second stage makes sense only when the bite itself contributes significantly to the dysfunction.

Does health insurance cover the costs?

For medically justified functional disorders, statutory and private health insurance often contribute to the functional therapeutic splint, depending on diagnosis and plan. The subsequent aligner treatment is usually a private service. We clarify this transparently with you.