Splint therapy for tmj disc displacement

Dr Altaf Tantray
MDS prosthodontics
Govt Dental College srinagar J&K

1. GOOD MORNING

2. Presenter : Dr Mohd . Altaf Tantray Guide: Dr Sandeep Kour

3. A COMMON-SENSE APPROACH TO SPLINT THERAPY Tim J. Dylina,DDS J Prosthet Dent2001;86:539-45.

4. INTRODUCTION DEFINITION TYPES FUNCTIONS SPLINT CHARACTERISTICS SPLINT FABRICATION CONTENTS

5. Practitioners appreciate a practical approach to all aspects of treatment; splint therapy is no exception. Splint breaks muscular engrams Relaxes masticatory muscles Brings condyle to centric relation INTRODUCTION

6. Splint therapy: Splint therapy may be defined as the art and science of establishing neuromuscular harmony in the masticatory system and creating a mechanical disadvantage for parafunctional forces with removable appliances DEFINITION

7. Splint Defined as a removable appliance used to break neuromuscular engrams to create neuromuscular harmony in masticatory system. DEFINITION

8. All splints are classified as Permissive or Nonpermissive SPLINT TYPES

9. Permissive splint It allows the teeth to move on the splint unimpeded, which in turn allows the condylar head and disk to function anatomically. Boero RP. The physiology of splint therapy: a literature review. Angle Orthod 1989;59:165-80. SPLINT TYPES

10. Examples of permissive splints include bite planes (anterior jigs, Lucia jig, Anterior Deprogrammer). SPLINT TYPES

11. stabilization splints (flat plane, Tanner, superior repositioning, and centricrelation [CR]) SPLINT TYPES

12. Nonpermissive A nonpermissive splint has a ramp or “indentations” that position the mandible inferiorly and anteriorly and secure it there. SPLINT TYPES

13. An example of a nonpermissive splint is A repositioning splint (anterior repositioning appliance [ARA]) SPLINT TYPES

14. Soft splints and hydrostatic splints ( Aquilizer ; Jumar Corp, Carefree, Ariz.) are pseudo-permissive splints, as their functions are extremely different than those of the permissives SPLINT TYPES

15. To seat condyles in CR Relax muscles To provide diagnostic information FUNCTIONS

16. Mitigate pdl proprioception Reduce cellular hypoxia Protecting teeth and associated structures from bruxism FUNCTIONS:

17. The characteristics of a successful splint should stability; balance in CR; SPLINT CHARACTERISTICS

18. immediate posterior disclusion ; a “skating rink” surface; equal intensity stops on all teeth; SPLINT CHARACTERISTICS

19. smooth transitions in lateral, protrusive, and extended lateral excursions (crossover); Comfort during wear; and SPLINT CHARACTERISTICS

20. reasonable esthetics. reasonable esthetics. Patient compliance SPLINT CHARACTERISTICS

21. Depends upon Specific diagnosis of TMD Thorough understanding of anatomy and relation of condyle – disc – fossa relation. SELECTION OF CORRECT SPLINT

22. Muscle in co-ordination is determined by muscle palpation, joint loading, range-of-motion measurements, SELECTION OF CORRECT SPLINT

23. painful facial muscles, headaches, limited ranges of motion, frequent joint inflammation, and occlusal interferences to CR; infrequent clicking on jaw movement also may be present SELECTION OF CORRECT SPLINT

24. Bite plane therapy or permissive splint therapy in Phase I (reversible treatment) with appropriate Phase II therapy (additive or subtractive occlusal therapy, restorative dentistry, orthodontics, Maxillofacial surgery, and segmental alveolar surgery) to restorebalance from/to the CR position SELECTION OF CORRECT SPLINT

25. Advanced muscle and disc inco -ordination jaw locking painful joint noises Increases in pain with splint therapy Pain on loading with bimanual manipulation SELECTION OF CORRECT SPLINT

26. irreversible cases but may be managed to a pain-free state with appropriate medications, Splint therapy , and Phase II therapy SELECTION OF CORRECT SPLINT

27. It should Provide equal intensity of contact on all teeth. Provides immediate posterior disclusion by the anterior teeth and condylar guidance. Be as frictionless as possible for neuromuscular harmony and subsequent healing The splint must allow the condyle to achieve the CR position. FUNCTIONAL CONSIDERATIONS OF SPLINT DESIGN

28. the splint must be continually monitored and adjusted. Relief of symptoms changes occlusal contacts on splint. FUNCTIONAL CONSIDERATIONS OF SPLINT DESIGN

29. A suggested protocol would include adjustments at 24 hours , 54 hours , 7 days, 2 weeks, and 1 month after seating S PLINT READJUSTMENT Holmgren K, Sheikholeslam A, Riise C. Effect of a full-arch maxillary occlusal splint on parafunctional activity during sleep in patients with nocturnal bruxism and signs and symptoms of craniomandibular disorders. J Prosthet Dent 1993;69:293-7.

30. After 3 months with no changes on the splint, a comfortable musculature , and no pain on loading, the patient is ready for evaluation of phase II therapy SPLINT READJUSTMENT

31. SPLINT FABRICATION

32. unload the joint , prevent bruxism , or “heal” the patient WHAT SPLITS CAN NOT DO

33. Splint produces neuromuscular harmony in masticatory system. Dental practitioners have a responsibility to understand and provide this treatment , monitor the condition, and refer the patient to another practitioner if necessary CONCLUSION

34. Manns A, Miralles R, Palazzi C. EMG, bite force, and elongation of the masseter muscle under isometric voluntary contractions and variations of vertical dimension. J Prosthet Dent 1979;42:674-82 . McKee JR. Comparing condylar position repeatability for standardized versus nonstandardized methods of achieving centric relation. J Prosthet Dent 1997;77:280-4 . Holmgren K, Sheikholeslam A, Riise C. Effect of a full-arch maxillary occlusal splint on parafunctional activity during sleep in patients with nocturnal bruxism and signs and symptoms of craniomandibular disorders. J Prosthet Dent 1993;69:293-7. REFERENCES