Splint Therapy (TMJ Splint)

Occlusal splint therapy may be defined as “the art and science of establishing neuromuscular harmony in the masticatory system.  It is the primary and most important therapeutic device for many TMJ conditions. Splints may be used for stabilizing the bite, for treatment of temporomandibular disorders, or to prevent wear and trauma to the dentition.”

A common goal of occlusal splint treatment is to protect the TMJ discs from dysfunctional forces that may lead to perforations or permanent displacements. Other goals of treatment are to improve jaw-muscle function and to relieve associated pain by creating a stable balanced bite.

There are many bite plates and night guards marketed for clenching, grinding (bruxism) and TMJ and facial pain. There are also over the counter night guards which many patients use. TMJ pain and click can be a sign of a more serious condition and Dr. Bolourian discourages use of non-prescription oral appliances.

Our practice’s primary focus is to provide scientifically proven TMJ treatments. An effective TMJ appliance is part of the overall treatment for TMJ disease and pain. Based on our 20 years experience treating TMJ disease, we have learned that for specific conditions, namely TMJ disk displacements, degenerative joint diseases and TMJ arthritis, an anterior positioning appliance is the most effective splint. 

Indications for TMJ Splint Therapy:

  • Pain in TMJ area
  • Difficulty with opening your mouth (Due to muscular pain or TMJ disk dislocation)
  • Facial pain originating from Myofascial areas in the face (AKA: Myofascial Pain Disorder)
  • To prevent clenching and grinding (Bruxism).                                                                                                                                                                                                                                                                                                                                                                           

Most common TMJ splints used today:

Anterior Repositioning Appliance

The anterior repositioning appliance (also known as an orthopedic repositioning appliance) purposefully alters the jaw relationship so that the mandible (lower jaw) assumes a more anterior (forward) position. This position does not change your bite and shift your teeth, when in use, it simply brings the entire lower jaw forward and relieves the pressure on the TMJ disk. Dr. Bolourian recommends anterior repositioning appliances be used primarily as a therapeutic measure. This device effectively controls painful TMJ pain symptoms and helps with internal derangements (TMJ disk displacement) and to recapture or reposition the TMJ disk. Dr. Bolourian believes TMJ anterior repositioning appliance is a very important step in the overall management of TMJ conditions. 

Below are other appliances prescribed by some practitioners. They should primarily be utilized for clenching, grinding and altering the bite for orthodontic reasons, and not TMJ therapy. 

 

The flat plane stabilization appliance (also known as the Michigan splint, muscle relaxation appliance, or gnathologic splint, occlusal guard)

This appliance is generally fabricated for the upper arch. Ideally, when a stabilization type of appliance is placed intraorally, there is minimal change to the jaw relationship. This is the most commonly used type of intraoral appliance, and when properly fabricated it has the least potential for adverse effects to the oral structures.

Anterior bite plane appliance

In general, they are designed as a palatal (roof of the mouth)-coverage horseshoe shape with a platform covering six or eight upper teeth (e.g., Hawley, Sved, Shore). They prevent clenching, because posterior teeth are not engaged in closing or in parafunctional activities.

Mini anterior appliances

This is an oral appliance that engages only a small number of maxillary anterior teeth (usually two-four incisors). There have been several variations that have appeared on the market. They include the nociceptive trigeminal inhibition tension suppression system, the best bite, and the anterior midline point stop devices. Dr. Bolourian believes that these appliances may not be as effective in TMJ therapy.

                                                 Neuromuscular appliances

Advocates of so-called neuromuscular dentistry have claimed that the use of jaw muscle stimulators and jaw-tracking machines enables them to produce an oral appliance at the ideal vertical and horizontal position of the mandible relative to the cranium. After using these appliances to treat a TMD patient, proponents of this methodology usually recommend dental reconstruction at the new jaw relationship. Please ask Dr. Bolourian if you are a candidate for neuromuscular appliances.

 

Posterior bite plane appliances

Posterior bite plane appliances (also known as mandibular orthopedic repositioning appliances) are made to be worn on the mandibular (lower) arch. The purpose of this appliance is to produce changes to the vertical dimension and alter the horizontal maxillomandibular relationship. The concern regarding this appliance design is that the back teeth touch, thereby allowing for over-eruption of the unopposed anterior teeth and/or intrusion of the opposing posterior teeth, resulting in an iatrogenically created posterior open bite. We do not recommend this appliance for TMJ therapy.