Initial therapy of occlusion

Initial treatment of the occlusion

Introduction

Die erste Behandlungsmaßnahme bei einer craniomandibulären Dysfunktion (CMD) ist in den meisten Fällen eine Aufbissschiene. Diese dient als reversible therapeutische Methode, um eine Verbesserung der Symptome zu erreichen. Eine definitive kieferorthopädische Behandlung kann erst dann erfolgen, wenn durch die Schiene eine funktionelle Besserung eingetreten ist. Zusätzlich zur therapeutischen Anwendung kann eine Okklusionsschiene auch als diagnostisches Werkzeug genutzt werden, um die physiologische, dreidimensionale Position des Unterkiefers zu bestimmen.

Effectiveness of occlusal splints

Okklusionsschienen sind wissenschaftlich belegte Therapieinstrumente, die nicht nur das craniomandibuläre System, sondern auch das gesamte muskuloskelettale System positiv beeinflussen. Sie korrigieren okklusale Störungen und normalisieren neuromuskuläre Dysfunktionen. Gleichzeitig ermöglichen sie eine reversible Neudefinition der Kiefergelenksposition. Wichtig ist, dass die Schiene aus hartem Material gefertigt wird, da weiche Schienen nur vorübergehend zur Muskelentspannung und zur Entkopplung der Okklusion genutzt werden können.

Prerequisites for splint therapy

Splint therapy is indicated after a comprehensive diagnosis of the craniomandibular system and, if necessary, a radiological examination. During functional therapy, it must be ensured that there are no unwanted contacts in the habitual intercuspation in order to avoid unwanted adaptation of the neuromuscular system. The splint should be worn continuously and adjusted regularly after manual therapy or physiotherapy.

COPA splints (craniomandibular orthopaedic positioning appliances)

These specially manufactured splints support the orthopaedic repositioning of the lower jaw. They are preferably made for the lower jaw, as this facilitates both wearing comfort and the possibility of occlusal control. The splints provide stable support in the posterior region, while the incisors are usually not covered to allow free adjustment of the jaw position.

Different types of splint therapy

- Removable splintsThese are the most common form of occlusal therapy, as they offer a reversible treatment option. They are particularly suitable for initial therapy as they allow gradual adjustment of the bite position.

- Non-removable splintsThese are only used after a successful first treatment phase to stabilize the new centric position of the lower jaw. They can provide important support, especially in the case of a one-sided lack of vertical posterior support.

- Directly fabricated COPA onlaysThese onlays are used for patients with acute temporomandibular joint pathologies or in combination with aligner therapy. They can also be used in the early phase of tooth replacement.

Practical procedure

The bite registration is carried out in a therapeutic jaw relation and forms the basis for the model analysis. The diagnostic models are duplicated exactly in order to document an unchanged initial situation. If necessary, further orthodontic or prosthetic treatment is planned in advance.

Contraindications and limitations of splint therapy

- Deep bite with retroclined upper incisorsIsolated splint therapy would be insufficient here, as it could lead to further rotation of the lower jaw.

- Transversal discrepancies with crossbiteIn such cases, a combined functional TMJ therapy and orthodontic treatment is required.

- Primary joint diseasesIn this case, splint therapy can worsen the symptoms, so that a precise diagnosis using DVT or MRI is necessary.

Production of the COPA splint in the laboratory

The splint is fabricated on models that are mounted in the articulator. The splint should be designed as flat as possible to ensure a high level of wearing comfort. After completion, the occlusion is checked and adjusted using occlusal foil.

Inserting and checking the splint

After insertion, a check is made to ensure that the splint is stable and does not allow any unwanted movements. Initial checks are carried out after one week to assess both the static and dynamic occlusion. Adjustments are made by grinding in the splint or remounting it in the articulator.

Conclusion

Occlusal splints are an effective tool for the reversible treatment of TMD. They make it possible to determine a physiological temporomandibular joint position and serve as a basis for further orthodontic measures. Successful splint therapy usually lasts 3 to 6 months. Only when a stable bite position 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.