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 an actual treatment published by our practice.

In temporomandibular disorder (TMD) – 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. However: A splint keeps the jaw in this favorable position only as long as it is worn. This treatment example demonstrates the two-stage approach we use 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 chronic 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. Functional examination revealed a clear connection to the bite position: Premature contact in the front tooth area and lack of support in the molar region were forcing the lower jaw and condyles backward.

First Stage: The Splint – Diagnosis and Therapy Combined

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

Second Stage: Aligners Stabilize the Result

Now came the point that determines whether the success lasts: For the jaw to maintain the identified position even without the splint, the teeth must be moved to where they naturally support this position. To ensure the pain-free position is not lost during this process, small fixed build-ups are bonded to the back molars, continuing 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 all teeth ultimately meet evenly.

The Result

After the aligner phase was completed, the patient maintained the favorable jaw position in her own bite: The posterior teeth supported the jaw evenly, the symptoms subsided – without the need to continue wearing the splint permanently. Over a follow-up period of several years, the result remained stable. What had been temporary relief became a sustainable foundation.

Why we show this case

The two-stage approach – first diagnostic-therapeutic splint, then definitive stabilization – is the clinical 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 tooth correction – often the splint alone is enough, and the causes of TMD are diverse. If symptoms persist despite a correctly adjusted splint, the cause was not in the occlusion; in that case, occlusal therapy is ended rather than continued indefinitely. When sleep 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 is appropriate 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 is the splint sometimes not enough on its own?

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

How long do the two stages take?

The splint phase often 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 specific information can be given after the diagnostics.

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

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

Does every TMD require such a two-stage treatment?

No. For many patients, splint therapy alone is sufficient. The second stage is only appropriate when the bite itself contributes substantially to the malfunction.

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 the diagnosis and plan. The subsequent aligner treatment is usually a private service. We clarify this transparently with you.