Authors: Dr. Werner Schupp, Dr. Julia Haubrich,Dr. Julia Steinmaier (née Funke)
Introduction: Importance of the occlusal splint in orthodontics
Occlusal splints are intraoral appliances that are used to change the occlusal relationship between the upper and lower jaw. Their main indications are
- Treatment of craniomandibular dysfunction (TMD)
- Protection of tooth enamel and periodontium
Due to the targeted repositioning of the lower jaw and the temporomandibular joint condyles, they are also known as craniomandibular orthopaedic positioning appliances (COPA) referred to as craniomandibular orthopaedic appliances. Nowadays, they are increasingly fabricated digitally.
Diagnosis and treatment planning
A comprehensive examination of the craniomandibular system is essential. The diagnostics include
1. Manual functional examination
2. Digital functional analysis (e.g. volume tomography, MRI)
3. Standardized screening tests (e.g. "short screening test" according to Meyer)
If two or more positive functional findings are present, a detailed functional diagnostics is carried out. This should always be performed from the physiological condylar position (CR) and not from the habitual intercuspidation (CO).
An initial functional therapy with an occlusal splint helps to determine the ideal jaw position before orthodontic treatment begins.
Digital fabrication of the occlusal splint (COPA)
Thanks to modern 3D technologies the occlusal splint can be fabricated digitally with high precision. The workflow includes:
1. Digital recording of the dental arches using an intraoral scanner
2. Determination of the physiological jaw relation
3. Digital construction of the rail (e.g. with OnyxCeph³™ or Netfabb™)
4. 3D printing of the splint from biocompatible materials
5. Final adjustment and polishing
The use of 3D-printed occlusal splints offers advantages over conventional manufacturing methods such as milling or casting.
Scientific evidence on the effectiveness of occlusal splints
Studies show that occlusal splints contribute significantly to pain reduction in TMD . A meta-analysis by Al-Moraissi et al. found that:
- Arthrogenic TMD improves the most with anterior repositioning splints (ARS).
- Myogenic TMD benefits particularly from hard stabilization splints (HSS).
- Tooth grinding (bruxism) can be reduced with splints.
Mechanical tests also show that 3D-printed polycarbonate rails excellent accuracy of fit and biocompatibility biocompatibility.
Conclusion: Advantages of the digital workflow for occlusal splints
- High precision through 3D printing
- Better patient acceptance through optimized fit
- Increasing efficiency in practice through digital planning
- Individual adaptation depending on the patient situation
The combination of modern diagnostics, standardized test procedures and digital fabrication ensures an optimal treatment strategy for TMD, bruxism and orthodontics.
Source:
Schupp, W., Haubrich, J., & Funke, J. (2021). Treatment with occlusal splints and their fabrication in the digital workflow. ZWR - The German Dental Journal, 130(11), 554-559. https://doi.org/10.1055/a-1676-1320