Follow-up Treatment After Initial Splint Therapy

What happens after splint therapy?

An occlusal splint is usually the first treatment step for temporomandibular disorder (TMD, often called TMJ): it relieves pressure on the temporomandibular joint, relaxes the masticatory muscles, and positions the lower jaw in a relaxed, pain-free position. We have described in detail elsewhere how this splint therapy for TMD works. But what happens when the splint has taken effect and the symptoms have subsided? That is precisely what this publication 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 the start of splint therapy, a comprehensive functional re-examination is performed. It compares the current condition with the initial situation and answers the central question: Has the treatment of the bite position actually contributed to improvement — or did the cause of the symptoms possibly not lie (solely) in the occlusion?

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 mandibular model is articulated in the jaw position found with the splint and compared with the initial position. This provides 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 permanently disappeared. In such cases, no orthodontic or prosthetic treatment is required. Often it is sufficient to wear the splint only at night. It is important that the splint is designed to also cover the front teeth—otherwise unwanted side effects such as overeruption of the posterior teeth can occur. A follow-up check is scheduled after six months. If pain returns, the splint should be worn consistently again immediately and the practice contacted. The splint then 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.
• 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 indicated, the true strength of the modern concept becomes apparent. The jaw position found with the splint can be transferred seamlessly into the tooth correction without losing the pain-free position. To achieve this, small fixed buildups (so-called COPA onlays) are bonded to the posterior molars, which continue to hold the jaw exactly in the tested position. On this secure foundation, tooth movement is performed—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.

At the end, your own dentition takes over the function that the splint previously fulfilled: it holds the lower jaw in the pain-free, physiological position. Imaging controls (e.g., via CBCT) confirm that the temporomandibular joints are indeed in the previously established, relieved position after treatment. Because this approach works gently and without visible appliances, it is particularly well-suited for orthodontic treatment of adultsseeking 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.