Authors: Dr. Werner Schupp, Dr. Wolfgang Boisserée, Dr. Maria Tabancis,Dr. Julia Steinmaier (née Funke)
The mouthguard as the first step in any TMD
In most cases, the first step in treating temporomandibular disorder (TMD) is the use of a bite splint. This serves as a reversible therapeutic method to alleviate symptoms. Definitive orthodontic treatment can only be performed once functional improvement has been achieved through the splint. In addition to its therapeutic use, an occlusal splint can also serve as a diagnostic tool to determine the physiological, three-dimensional position of the lower jaw.
How effective is a bite splint?
Occlusal splints are scientifically proven therapeutic devices that positively influence not only the craniomandibular system but also the entire musculoskeletal system. They correct occlusal disorders and normalize neuromuscular dysfunctions. At the same time, they allow for a reversible repositioning of the temporomandibular joint without permanently altering the tooth position. We describe in detail how such a splint is digitally planned and fabricated today in our article on digital occlusal splints for TMD.
When a splint alone is not enough
Splint therapy alone is not always sufficient. In certain cases, it must be combined with additional measures:
- Deep bite with upper incisors tilted inward: In this case, treatment with a splint alone would be insufficient, as it could lead to further rotation of the lower jaw.
- Transverse discrepancies with crossbite: In such cases, a combination of functional temporomandibular joint therapy and orthodontic treatment is required.
- Primary joint disorders: In these cases, splint therapy may exacerbate symptoms, making a precise diagnosis via CT or MRI necessary.
Manufacturing and Fitting the Splint
Laboratory production
The splint is fabricated on models mounted in an articulator. The splint should be designed to be as flat as possible to ensure a high level of comfort. Once completed, the occlusion is checked and adjusted using occlusal paper.
Implementation and Monitoring
After insertion, the splint is checked to ensure that it is securely in place and does not allow any unwanted movement. Initial checks are performed after one week to evaluate both static and dynamic occlusion. Adjustments are made by grinding the splint as needed or by remounting it in the articulator.
Conclusion: Rail paves the way
Occlusal splints are an effective means of reversibly treating TMD. They help determine the physiological position of the temporomandibular joint and serve as the basis for further orthodontic treatment. Successful splint therapy typically lasts three to six months. Only once a stable bite has been achieved can further aligner therapy or prosthetic treatment begin.
Source: Schupp, W., Boisserée, W., Tabancis, M., & Funke, J. (2019). Initial therapy of occlusion. Journal of Aligner Orthodontics, 3(1), 31–41.