Oral Orthosis (splint) Failure

Tags

Asymmetry, Bruxism, condylar asymmetry recognition, Dentistry, Occlusal device, Occlusal splint, Oral Stability, Retruded Position of the Mandible, TMJ rehabilitation

is a fact when the patient does not get any relief despite a faithful wearing of the splint. Numerous adjustments made by the dentistIt are reported by many patients and yet no positive result. It is my clinical experience and it is therefore my opinion that the failure is mostly due to an unsuccessful registration of the mandibular position in which the orthosis is supposed to be made as most orthoses seem to arrive from the dental laboratory in perfect condition. This unfortunate dilemma seems to happen very often when the intercuspal position has been chosen in the registration at the presence of a vertical temporomandibular joint condylar asymmetry.

To avoid unnecessary disappointments and frustrations for both parties (patient and the dentist) I therefore would like to emphasise the importance to recognise the vertical dimensions of the two temporomandibular joint condyles.The analysis of a panoramic X-ray is an easy tool to use. At a vertical dimensional difference between the two temporomandibular joint condyles the difference can easily be transferred into the Maaxloc by Dentatus. That instrument visualises the vertical difference in the intermaxillary relation between the the two sides of the mounted casts at the occlusal level and thereby may assist in finding the clinically correct mandibular position for the fabrication of the oral orthosis. In this way the thickness of the orthosis may be different between the two sides of occlusion. What is missing in vertical dimension on the shorter condylar side must be compensated for at the level of the teeth.Much less adjustments of the orthosis may be the result not to say adjustments of the orthosis will not be necessary at all.