Follow-up treatment after initial splint therapy

Introduction

Occlusal splints are a widely used therapeutic tool for the treatment of craniomandibular dysfunctions (TMD). The combination of splint therapy and aligner orthodontics offers a comfortable and virtually invisible treatment option. This method is a powerful tool for the orthodontic treatment of TMD. Detailed knowledge of the temporomandibular joint, TMD and the use of removable aligners are crucial for successful treatment. A two-phase treatment - consisting of a splint and aligners - can transform occlusal splint therapy into a permanently stable occlusion with physiological vertical support in the posterior region.

Functional re-evaluation after splint therapy

Approximately 3 to 6 months after the start of splint therapy, the functional therapy is examined again. The initial situation is compared with the current condition. The examination process includes

- Medical history and comparison of symptoms based on a pain questionnaire

- Examination of the craniomandibular system:

- Occlusal contacts in therapeutic occlusion (with splint)

- Palpation of the masticatory muscles and neck muscles

- Checking the temporomandibular joints through movement tests

Possible follow-up treatments

1. no therapeutic success after splint therapy

If the splint therapy was not successful, treatment should be discontinued after six months at the latest. A failure exists if:

- the cause of TMD is not in the occlusion

- psychological factors dominate the disease

- there is a primary joint disease that is aggravated by the splint (e.g. necessary surgical intervention)

2. successful therapy, but no further occlusion therapy required

If the splint therapy was successful and no further occlusal measures are required, in some cases the splint can only be worn at night. An extension of the splint to cover the incisors is necessary to avoid side effects such as intrusion of the posterior teeth. If the pain recurs after six months, the patient should wear the splint again consistently and visit the practice for further clarification.

3. further occlusal therapy necessary

If stabilization of the occlusion is required, various options are available:

- Subtractive measures (e.g. selective grinding)

- Orthodontic corrections to adjust the position of the teeth

- Prosthetic measures for changing the shape of teeth or restoring teeth

Further treatment must be carried out in the therapeutically adjusted condylar position, which requires special experience and expertise. Functional diagnostics and model analysis after re-evaluation form the basis for planning further occlusal treatment.

The orthodontic treatment procedure

Orthodontic therapy with fixed splints was first described in 1993. Treatment begins with a therapeutic splint to create a physiological temporomandibular joint position. This is followed by the second phase, in which the new maxillomandibular situation is stabilized orthodontically. During this phase, teeth are moved and the occlusion is stabilized while the patient continues to wear the therapeutic splint.

A special method of stabilization is the use of Craniomandibular Orthopaedic Positioning Appliances (COPA)which are combined with aligners. This technique has been documented in several case studies and shows long-term stability of tooth movement, especially when correcting the Spee curve by extrusion of the posterior teeth.

Case study 1: TMD with chronic pain

A 24-year-old female patient suffered from bilateral temporomandibular joint pain, cracking and pain radiating to her ears as well as neck and back pain. After successful splint therapy, she was almost pain-free and the long-term medication with painkillers could be stopped. As the occlusal contact distribution did not change over several weeks, the orthodontic follow-up treatment was carried out with aligners. The mandibular position was precisely transferred to the new treatment in order to maintain the pain-free position.

Case study 2: 60-year-old patient with TMD and back pain

A 60-year-old patient complained of unilateral temporomandibular joint pain and frequent back pain. The clinical examination revealed a considerable reduction of the joint space in the posterior region of the right temporomandibular joint. After successful splint therapy, the vertical support of the posterior teeth was restored with aligners, resulting in complete pain relief.

Conclusion

The combination of splint therapy and aligner orthodontics enables precise and patient-friendly treatment of TMD. The transfer of the therapeutically adjusted temporomandibular joint position into a stable orthodontic occlusion represents a sustainable solution. Orthodontic measures with aligners are ideal for stabilization, as targeted tooth movements can be carried out without affecting the position of the temporomandibular joint.

 

Source:

Schupp, W., Funke, J., Haubrich, J., & Boisserée, W. (2019). Follow-up treatment after initial splint therapy. Journal of Aligner Orthodontics, 3(2), 147-164.