After the initial splint phase, we check whether symptoms have decreased and whether the occlusion was the cause. Correction with aligners can then follow.
Re-evaluation after initial splint and transition to aligner-based follow-up therapy.
What happens after splint therapy?
An occlusal splint is usually the first treatment step for temporomandibular disorder (TMD, often called TMJ)1: It relieves pressure on the temporomandibular joint, reduces strain on the masticatory muscles, and positions the lower jaw in a relaxed, pain-free position. We have described this TMD splint therapy in detail elsewhere. But what happens once the splint has achieved its effect and symptoms have subsided? That is exactly what this professional article addresses: the planned follow-up treatment that permanently stabilizes the result achieved with the splint.
The key principle: A splint keeps the jaw in the favorable position only as long as it is worn. For lasting success, the tested, symptom-free jaw position must be converted into stable occlusion — either through orthodontic correction of tooth alignment, through selective grinding, or through dental restorations. Only then does the patient’s own dentition permanently support the jaw in the way the splint previously did.
The re-evaluation: assessment after three to six months
About three to six months after splint therapy begins, a new comprehensive functional examination is performed.2 It compares the current condition with the initial situation and answers the central question: Has treatment of the bite actually contributed to improvement – or was the cause of the symptoms possibly not (solely) in the occlusion at all?
The re-evaluation includes several components:
- History and pain comparison: Current symptoms are compared with the symptoms initially documented in the pain questionnaire.
- Examination of the craniomandibular system: Verification of contacts in the therapeutic bite position (with splint), palpation of the masticatory and neck muscles as well as the temporomandibular joints, movement and joint play tests.
- Connection with the musculoskeletal system: Since TMD is often associated with tension in the neck and back, the musculoskeletal system is also included.
- Occlusal diagnostics: A new lower jaw model is articulated in the jaw position found with the splint3 and compared with the initial situation. This allows an objective assessment of which bite position was achieved during therapy.
Three possible paths after the splint
The result of the re-evaluation determines how to proceed. There are basically three scenarios.
1. No therapeutic success — the bite position was not the cause
If symptoms remain absent while the splint is properly adjusted, occlusal therapy should not be continued indefinitely but should be discontinued after six months at the latest. A lack of success indicates that the cause does not lie (solely) in the bite—for example, when psychological stress plays a significant role in the symptoms or when a primary disorder of the temporomandibular joint is present. In such cases, further interdisciplinary evaluation may be appropriate. This honest pause protects patients from unnecessary treatments.
2. Success—but no further correction needed
Sometimes the re-evaluation shows only minor changes in the occlusion, and the symptoms have disappeared permanently. In that case, no orthodontic or prosthetic treatment is necessary. It is often sufficient to wear the splint only at night. What is important here is to design the splint so that it also covers the front teeth – otherwise unwanted side effects such as overeruption of the posterior teeth can occur.4 A follow-up examination takes place after six months. If the pain returns, the splint should be worn consistently again immediately and the practice contacted. The splint takes on the role of a long-term stabilization and retention device.
3. Success—with subsequent stabilization of the occlusion
The most common and most demanding path: the splint has resolved the symptoms, but the new, relaxed jaw position is not yet supported by the natural bite. To secure it permanently, three tools are available that can be used individually or in combination:
- Subtractive measures: targeted, conservative occlusal adjustment of interfering contact points.
- Orthodontic correction: moving the teeth into a position that supports the tested jaw position.5
- Prosthetic measures: altering tooth shape or rebuilding teeth to create stable contacts.
What is crucial is that each of these measures is performed in the jaw position previously established with the splint. This position is transferred on a 1:1 basis—that is, exactly the position in which the patient was free of symptoms. This requires experience and careful functional diagnostic planning.
From tested bite to stable occlusion
When orthodontic correction is needed, the true strength of the modern approach becomes clear. The jaw position found with the splint can be seamlessly transferred into the tooth correction without losing the pain-free position. To achieve this, small fixed overlays (so-called COPA onlays) are bonded to the posterior molars, continuing to hold the jaw precisely in the tested position. On this secure foundation, tooth movement6 takes place – comfortably and almost invisibly with clear aligners.
The treatment proceeds in two phases. In the first phase, the front teeth and canines are aligned and the bite is prepared, while the molars are intentionally not moved—they continue to secure the jaw position. In the second phase, the molars are then adjusted so that all teeth meet evenly at the end and stable vertical support is established in the posterior region. Studies show that support achieved in this way remains stable long-term.7
In the end, the natural dentition takes over the role previously fulfilled by the splint: it holds the lower jaw in the pain-free, physiological position. Imaging controls (e.g., via CBCT) confirm that the temporomandibular joints actually rest in the previously adjusted, relieved position after treatment.8 Because this approach is gentle and works without visible appliances, it is particularly well suited for orthodontic treatment of adultswho seek a discreet solution.
Two treatment examples from the practice
A 28-year-old patient with long-standing complaints
A 28-year-old patient had suffered for years from bilateral temporomandibular joint pain with clicking sounds and pain radiating into the ears. In addition, she had recurrent neck and back pain, for which she had to take pain medication over an extended period. The functional examination showed a clear connection between her temporomandibular joint problems and the bite position: premature contact in the anterior region and lack of support in the posterior region pushed the lower jaw and the condyles backward.
After successful splint therapy, the patient was nearly pain-free, and the pain medication could be discontinued. Since the achieved bite position remained stable over several weeks, the tooth position was then corrected with aligners—the pain-free jaw position was precisely transferred. After treatment was completed, all posterior teeth met evenly again, and the result remained stable over a follow-up period of several years.
A 60-year-old patient with unilateral complaints
A 60-year-old patient complained of unilateral temporomandibular joint pain, especially on the right side, as well as frequent back pain. The examination and imaging diagnostics confirmed a significantly narrowed joint space in the right temporomandibular joint—the result of missing support in the posterior region. For him, the fixed splint and aligner treatment were combined directly. After therapy, the vertical support of the posterior teeth was restored, and the previously compressed joint space had measurably increased; the patient was symptom-free.
Both cases show that the method works regardless of age and proves effective even with long-standing symptom patterns—provided the cause actually lies in the bite position.
We have documented the treatment course of this 28-year-old patient for those interested: Treatment example: First splint, then aligners.
When post-treatment begins
The splint is not the end of TMD treatment, but the beginning of a well-considered approach. It identifies the pain-free jaw position and makes it verifiable — but lasting results only emerge once this position is permanently secured. Transferring the therapeutically established jaw position into stable occlusion, gently achieved with clear aligners, is a particularly well-tolerated solution: teeth are moved precisely without compromising the achieved jaw position. This transforms temporary relief into a lasting, stable outcome.
Sources
- Schupp, W., Haubrich, J., & Hermens, E. (2013). Möglichkeiten und Grenzen der Schienentherapie in der Kieferorthopädie. Zahnmedizin up2date, 2013(2).
- Schupp, W., Funke, J., Boisserée, W., Heller, R., & Haubrich, J. (2018). Continuing diagnostics of the temporomandibular and musculoskeletal system (TMS/MSS). Journal of Aligner Orthodontics, 2(3), 199–213.
- Schupp, W., Funke, J., & Boisserée, W. (2018). Continuing diagnostics and therapy of the temporomandibular and musculoskeletal system. Journal of Aligner Orthodontics, 2(4), 267–281.
- Schupp, W. (Hrsg.). (1993). Funktionslehre in der Kieferorthopädie. FDK.
- Schupp, W., Haubrich, J., & Neumann, I. (2010). Invisalign® treatment of patients with craniomandibular disorders. International Orthodontics, 8(3), 253–267. https://doi.org/10.1016/j.ortho.2010.07.010
- Rossini, G., Parrini, S., Deregibus, A., et al. (2017). Controlling orthodontic tooth movement with clear aligners: An updated systematic review regarding efficacy and efficiency. Journal of Aligner Orthodontics, 1(1), 7–20.
- Bernstein, R. L., Preston, C. B., & Lampasso, J. (2007). Leveling the curve of Spee with a continuous archwire technique: A long term cephalometric study. American Journal of Orthodontics and Dentofacial Orthopedics, 131(3), 363–371. https://doi.org/10.1016/j.ajodo.2005.05.056
- Dziedzina, G. (2011). Vermessung und vergleichende Darstellung der Gelenkspaltbreite von physiologischen und dysfunktionellen Kiefergelenken mittels digitaler Volumentomografie.
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