Occlusal Splints Used in Prosthetic Management of TMJ Disorders

Seminar - IV
Occlusal Splints Used in
Prosthetic
Management of TMJ Disorders
CONTENTS
INTRODUCTION
DEFINITION
PURPOSE
WHAT OCCLUSAL SPLINTS CAN DO? AND CANNOT DO?
VARIOUS UNEXPLAINED THERAPEUTIC CLAIMS
CLASSIFICATION
GENERAL CONSIDERATIONS
MUSCLE RELAXATION APPLIANCE
ANTERIOR REPOSITIONING APPLIANCE
ANTERIOR BITE PLANE
POSTERIOR BITE PLANE
PIVOTING APPLIANCE
SOFT/ RESILIENT APPLIANCE
RELATED ARTICLES
SUMMARY
DEPT. OF PROSTHODONTICS
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BIBLIOGRAPHY
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OCCLUSAL SPLINTS USED IN PROSTHETIC MANAGEMENT

OF TMJ DISORDERS
INTRODUCTION:
An occlusal appliance (often called a splint) is a removable
device, usually made of hard acrylic, that fits over the occlusal and
incisal surfaces of teeth in one arch, creating precise occlusal
contact with the teeth of opposing arch.
It is commonly referred to as a bite guard, night guard, inter
occlusal appliances, intra-oral arthotic, or even orthopaedic device.
These are extensively used in management of TMJ disorders.
They shown considerable control in myofacial pain, however no
clear hypothesis about the mechanism of action has been proved.
It has more of diagnostic value, for example, if a patient
responds favorable to an occlusal device then the response to the
same restorative permanent treatment should be positive. So it
serves as an important diagnostic value before going to an fixed
prosthodontic therapy.
DEFINITIONS
Temporomandibular joint:
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The
articulation
between
the
temporal
bone
and
the
mandible. It is a diarthroidal, bilateral ginglymus arthroidal joint.

The articulation of the condylar process of the mandible and
the interarticular disk with the mandibular fossa of the squmous
portion of temporal bone; movement in upper joint compartment is
mostly translational, whereas in the lower joint compartment is
mostly rotational.
The joint connects the mandibular condyle to the articular
fossa of the temporal bone with the temporomandibular disc
interposed.
Temporomandibular Disorders:
Abnormal, incomplete, or impaired function of TMJ.
Occlusal Splint/ Occlusal Device/ Orthotics:
Any removable artificial occlusal surface used for diagnosis
or therapy affecting the relationship of the mandible to the
maxillae. It may be used for occlusal stabilization, for treatment of
TMJ disorders, or to prevent wear of the dentition.
Occlusal Pivot:
An elevation placed on the occlusal surface, usually in the
molar region, designed to act as a fulcrum, thus limiting
mandibular closure and inducing mandibular rotation.
Occlusal Prematurity:
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Any contact of opposing teeth that occurs before the planned
articulation.
Bruxism/ Tooth Grinding/ Occlusal Neurosis:
The parafunctional grinding of teeth.
An
oral
habit
consisting
of
involuntary
rhythmic
or
spasmodic non-functional gnashing, grinding or clenching of teeth,

in other than chewing movements of mandible, which may lead to
occlusal trauma.
PURPOSE:
The purpose of occlusal treatment is to make the teeth
conform to a correct skeleton-related position of the condylar axis.
The purpose of occlusal splints is to provide an indirect
method for altering the occlusion until the correctness of the
condylar axis position can be determined and confirmed.
WHAT OCCLUSAL SPLINTS CAN DO?

1. Stabilization of weak teeth: An occlusal splint can effectively
stabilize weak or hypermobile teeth by the adaptation of the
splint material around the axial surfaces.
2. Distribution of occlusal forces
3. Reduction of wear
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4. Stabilization of unopposed teeth
WHAT OCCLUSAL SPLINTS CANNOT DO?

Occlusal splints cannot cause effects that are in violation of
mechanical laws. Thus an occlusal splint does not unload the
condyles. The popular claim that a posterior occlusal splint serves
as a pivot for distraction of the condyles is in violation of facts of
anatomy, laws of physics, and clinical data.
VARIOUS UNEXPLAINED THERAPEUTIC CLAIMS:

1. Occlusal splints increase the wearers strength
2. Occlusal splints cause remission of unrelated diseases
3. Occlusal splints can cause a purging of system poisons
4. Occlusal splints cause a regulation of multiple bodily
functions.
TYPES:
According to Okeson
1) Muscle relaxation appliance/ stabilization appliance used to
reduce muscle activity
2) Anterior repositioning appliances/ orthopedic repositioning
appliance
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Other types:
a) Anterior bite plane
b) Pivoting appliance
c) Soft/ resilient appliance
According to Dawson:
1. Permissive splints/ muscle deprogrammer
2. Directive splints/ non-permissive splints
3. Pseudo permissive splints (e.g Soft splints, Hydrostatic splint)
MORA mandibular orthopedic repositioning appliance
Types of Occlusal Splints:

1. A permissive splint or
2. A directive splint
Permissive Splints: Are designed to unlock the occlusion to

remove deviating tooth inclines from contact. The condyles are then
allowed to return to their correct seated position in centric relation
if the condition of the articular components permits.
Permissive
splints
are
often
referred
to
as
muscle
deprogrammers. A properly made centric relation occlusal splint is

a permissive splint.
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If a centric relation splint is made with deep fossae and
inclines that are too steep, it can be turned into a directive splint
that limit condylar access to centric relation only.
Directive splints: Are designed to position the mandible in a

specific relationship to the maxilla. The sole purpose of a directive
splint is to position or align the condyle-disk assemblies. Thus
directive splints should be used only when a specifically directed
position of the condyles is required.
Contraindications for Directive Splints:

1. The condyle and the disk can be aligned correctly.
2. The correctly aligned condyle-disk assemblies can move to the
most superior position against the eminentiae without
derangement.
3. The disks can maintain their alignment with the condyles
during function.
Verification that the condyle-disk assemblies are capable of

normal function in the most superior position can be achieved on a
tentative basis by testing in the following manner:
1. Load testing the joints with bilateral pressure
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2. Clench testing with the teeth separated
3. Doppler auscultation
Superior Repositioning Splints:

The purpose of anterior repositioning therapy is fulfilled when
the retrodiskal tissues have healed sufficiently to regain a
backward pull on the disk. However, either the condyle or the disk
may have difficulty moving back to centric relation after being held
forward. There is reason to suspect that the inferior lateral
pterygoid muscle is shortened by long-term use of anterior
repositioning devices. This makes it more difficult for the muscles
to release the condyles to their most superior position. Deformity of
the displaced disk may also require time to adaptively remodel to a
stable contour.
The purpose of a superior repositioning splint is to eliminate
the effect of the neuromuscular reflex that directs the mandible to
close repetitively into the maximum intercuspation position. By
covering the occlusal surfaces with plastic to provide a smooth
surface, you can eliminate the reflex and the mandible can have
free access to the seated position.
The goal is a true skeletal relationship of the mandible to the
maxilla and not one that is influenced by the maximum
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intercuspation
of
the
teeth.
The
purpose
of
the
superior
repositioning splint is to establish the correct skeletal relationship

before the correct occlusal relationship is determined.
The fabrication of a superior repositioning splint is identical
to the centric relation splint. It is especially important that the
anterior guidance on the splint must disclude all posterior teeth in
all jaw positions except centric relation.
The time required to achieve superior positioning of the
condyle-disk assembly varies from patient to patient. It may occur
in a few days, or it may take several months. The determining
factors appear to be related to the amount of deformity of the
recaptured disk, and the condition of the inferior and superior
bellies of the lateral pterygoid muscles.
Prolonged
anterior
disk
displacement
often
results
in
shortening of the superior lateral pterygoid muscle, which controls

the alignment of the disk.
Even when the disk will not be released all the way to centric
relation, the superior repositioning splint may be beneficial. It
offers an alternative when the disk cannot stay aligned and the
patient elects against reparative surgery.
GENERAL CONSIDERATIONS:
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Appliance therapy has several favorable qualities that render
it extremely helpful for the treatment of many TM disorders. An
appliance can affect a patients symptoms in several ways. It is
extremely important that when it reduces symptoms the precise
cause-and-effect
relationship
be
identified
before
irreversible
therapy is begun.
Occlusal appliances are equally helpful in ruling out certain
etiologic factors. When a malocclusion is suspected of contributing
to a TM disorder, occlusal appliance therapy can quickly and
reversibly introduce a more desirable occlusal condition.
They are a reversible non-invasive modality that can help
manage the symptoms of many TM disorders. The success or
failure of occlusal appliance therapy depends on the selection,
fabrication, and adjustment of the appliance and on patient
cooperation.
1. MUSCLE RELAXATION APPLIANCE/ Flat Plane, Share

(maxillary), Tanner (mandibular), Superior repositioning Muscle
Deprogramming, or CR Splint:
Description and Treatment Goals:
The muscle relaxation appliance is generally fabricated for the
maxillary arch. When it is in place, the condyles are in their most
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musculoskeletally stable position at the time that the teeth are
contacting evenly and simultaneously. Canine disocclusion of the
posterior teeth during eccentric movement is also provided.
Treatment goal eliminate any orthopedic instability between the
occlusal position and the joint position.
Indications:
1) Treat muscle hyperactivity
2) Decrease the parafunctional activity
3) Bruxism
4) Local muscle soreness or myositis
5) Retrodiscitis secondary to trauma.
Simplified fabrication technique:
An alginate impression is made of the maxillary arch. It is
poured immediately with a suitable gypsum product. With a
pressure or vacuum adapter, 2-mm-thick hard, clear resin sheet of
material is adapted to the cast.
The outline of the appliance is then cut off the cast with a
separating disk. The cut is made at the level of the interdental
papilla on the buccal and labial surfaces of the teeth.
The lingual border of the appliance extends 10 to 12 mm from
the gingival border of the teeth throughout the lingual portion of
the arch. The labial border of the appliance terminates between the
incisal and middle thirds of the anterior teeth.
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A small amount of clear self-curing acrylic resin is mixed in a
dappen dish. It is added to the occlusal surface of the anterior
portion of the appliance. This acrylic will act as the anterior stop. It
is approximately 4 mm wide and should extend to the region where
a mandibular anterior central incisor will contact.
Locating the musculoskeletally stable position:

Bilateral manual manipulation technique.
In the other technique, a stop is placed on the anterior region
of the appliance and the muscles are used to locate the
musculoskeletally stable position of the condyles. (This technique
uses the same principles employed with the leafgauge).
The contact on the anterior stop is marked with articulating
paper and adjusted so it provides a stop that is perpendicular to
the long axis of the mandibular tooth being contacted.
If a distal inclination exists on the stop, clenching will force
the mandible posteriorly away from the musculoskeletally stable
position. The anterior stop should not be mesially inclined and
create a forward shift or slide of the mandible, because the
clenching will tend to reposition the condyle forward, away from the
most musculoskeletally stable position.
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Developing the Occlusion:
When the CR position has been located, the patient should
become familiar with it by wearing the appliance for a few minutes.
Instructions are given to tap on the anterior stop.
The appliance is removed from the mouth and self-curing
acrylic is added to the remaining anterior and posterior regions of
the occlusal surface.
The appliance is then returned to the mouth, and the patient
either closes or is guided into CR. The mandibular teeth should
sink into the soft acrylic until the incisors contact the anterior
stop.
Adjusting the CR Contacts:

The occlusal surface of the appliance is best adjusted by first
marking the deepest area of each mandibular buccal cusp tip and
incisal edge with a pencil.
The acrylic surrounding the pencil marks is removed so the
relatively flat occlusal surface will allow eccentric freedom.
All contacts, both anterior and posterior, should be carefully
refined so they will occur on flat surfaces with equal occlusal force.
Adjusting the eccentric guidance:
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The acrylic prominences labial to the mandibular canines are
smoothed. They should exhibit about a 30- to 45-degree angulation
to the occlusal plane and allow the canines to pass over in a
smooth
and
continuous
manner
during
protrusive
and
laterotrusive excursions.
It is important that the mandibular canines move freely and
smoothly over the occlusal surface of the appliance. If the
angulation of the prominences is too steep, the canines will restrict
mandibular movement and may aggravate an existing muscle
disorder.
Eccentric contacts of the mandibular central and lateral
incisors also must be eliminated so the predominant marks are
those of the mandibular canines.
During a protrusive movement, guidance by the maxillary
canines, not the mandibular central and lateral incisors, is the
goal.
Final criteria for the muscle relaxation appliance:

The following eight criteria must be achieved before the
patient is given the muscle relaxation appliance:
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1. It must accurately fit the maxillary teeth, with total stability
and retention when contacting the mandibular teeth and
when checked by digital palpation.
2. In CR all posterior mandibular buccal cusps must contact on
flat surfaces with even force.
3. During protrusive movement the mandibular canines must
contact the appliance with even force. The mandibular
incisors may also contact it but not with more force than the
canines.
4. In any lateral movement only the mandibular canine should
exhibit laterotrusive contact on the appliance.
5. The mandibular posterior teeth must contact the appliance
only in the CR closure.
6. In the alert feeding position the posterior teeth must contact
the appliance more prominently than the anterior teeth.
7. The occlusal surface of the appliance should be as flat as
possible with no imprints for mandibular cusps.
8. The occlusal appliance is polished so it will to irritate any
adjacent soft tissues.
Instructions and adjustments:
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The patient is instructed in proper insertion and removal of
the appliance.
Finger pressure is used to align and seat it initially. Removal
is most easily accomplished by catching it near the first molar area
with the fingernails of the index fingers and pulling the distal ends
downward.
When bruxism is the problem nighttime use is essential while
day use may not be as important. When the disorder is
retrodiscitis, the appliance may need to be worn most of the time. It
has been demonstrated that myogenous pain disorders respond
best to part-time use (especially nighttime use) while intracapsular
disorders are better managed with continuous use. If wearing
causes increased pain, the patient should discontinue wearing and
report the problem immediately for evaluation and correction.
On certain occasions fabrication of a mandibular muscle
relaxation appliance may be desirable. Evidence suggests that
maxillary and mandibular appliances reduce symptoms equally.
The primary advantages of the mandibular type are that it affects
speech less and aesthetics may be better.
ANTERIOR REPOSITIONING APPLIANCE

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The anterior repositioning appliance is an interocclusal device
that encourages the mandible to assume a position more anterior
than the intercuspal position. its goal is to provide a better condyledisc relationship in the fossae so normal function will be
reestablished. The goal of treatment is not to alter the mandibular
position permanently but only to change the position temporarily
so as to enhance adaptation of the retrodiscal tissues.
Indications:
To treat disc derangement disorders. Patients with joint
sounds (e.g., a single or reciprocal click) can sometimes be helped
by it. Intermittent or chronic locking of the joint (e.g., retrodiscitis).
Simplified fabrication technique:

Like
the
muscle
relaxation
appliance,
the
anterior
repositioning appliance is a full-arch hard acrylic device that can

be used in either arch. However, the maxillary arch is preferred
because a guiding ramp can be more easily fabricated to direct the
mandible into the desired forward position.
Fabricating and fitting the appliance:
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The
initial
step
in
fabricating
maxillary
anterior
repositioning appliance is identical to that in fabricating a muscle

relaxation appliance. The anterior stop is constructed and the
appliance is fitted to the maxillary teeth. Acrylic extending over the
labial surfaces of the maxillary teeth is not needed for occlusal
purposes.
Locating the correct anterior position:

The
key to
successful anterior
repositioning appliance
fabrication is finding the most suitable position for eliminating the

patients symptoms. The anterior stop is used to locate it.
The patient is instructed to protrude slightly and to open and
close in this position. The joint is reevaluated for symptoms and the
anterior position that spots the clicking is located and marked with
red marking paper as the patient taps on the stop.
Once this has been marked, the appliance is removed and the
area of the contact is grooved approximately 1 mm deep with a
small round bur. The appliance is then returned to the mouth and
the patient locates the groove and taps into it.
There should be no joint sounds during opening and closing.
Joint pain during clenching should also be reduced or eliminated.
Myogenous pain originating from the superior lateral pterygoid,
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however, will not be eliminated since this muscle is active during
clenching.
When the joint symptoms have been eliminated and verified
by the anterior stop, the appliance is taken out of the patients
mouth and self-curing acrylic is added to the remaining occlusal
surface so all occlusal contacts can be established.
The anterior stop must not be covered by the acrylic.
When the anterior teeth are felt to contact in the groove on
the anterior stop, the position is verified by opening and closing a
few times. With the teeth resting together, the patient should gently
place his tongue on the setting resin lingual to the anterior teeth
and press. This will adapt the resin to the lingual surfaces of the
mandibular anteriors and provide the needed ramp for guiding the
mandible into the forward position.
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Adjusting the occlusion:
The difference with this appliance is the anterior guiding
ramp, which requires the mandible to assume a more forward
position to ICP.
Flat occlusal contacts are developed for the posterior teeth,
and the large lingual ramp in the anterior region is only smoothed.
The ramp is developed into a smooth sliding surface so as not to
promote catching or locking of the teeth in any position.
Final criteria for the anterior repositioning appliance:

The following four criteria should be met by the anterior
repositioning appliance before it is given to the patient:
1. It should accurately fit the maxillary teeth, with total stability
and retention when in contact with the mandibular teeth and
when checked by digital palpation. In the established forward
position all the mandibular teeth should contact it with even
force.
2. The forward position established by the appliance should
eliminate the joint symptoms during opening and closing to
and from that position.
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3. In the retruded range of movement the lingual retrusive
guidance ramp should contact and upon closure direct the
mandible into the established forward position.
4. The appliance should be smoothly polished and compatible
with adjacent soft tissue structures.
Instruction and Adjustments:

Instructions regarding insertion and removal of the anterior
repositioning appliance are given. Instructed to wear the appliance
at night and during the day as needed to reduce symptoms. On
occasion a patient may need to wear this appliance all the time
depending on the severity of the symptoms.
ANTERIOR BITE PLANE/ ANTERIOR JIG LUCIA JIG, HAWLEY

WITH BITE PLANE/ ANTERIOR DEPROGRAMMES:
The anterior bite plane is a hard acrylic appliance worn over
the maxillary teeth providing contact with only the mandibular
anterior teeth. It is primarily intended to disengage the posterior
teeth and thus eliminate their influence on the function of the
masticatory system.
Indications:
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Muscle disorders related to orthopedic instability or an acute
change in the occlusal condition.
Disadvantages:
If the appliance is worn continuously for several weeks or
months, there is a great likelihood that the unopposed mandibular
posterior teeth will supraerupt. When this occurs and the
appliance is removed, the anterior teeth will no longer contact and
the result will be an anterior open-bite.
Anterior bite plane therapy must be closely monitored and
used only for short periods.
POSTERIOR BITE PLANE
Description and treatment goals:
The posterior bite plane is usually fabricated for the
mandibular teeth and consists of areas of hard acrylic located over
the posterior teeth and connected by a cast metal lingual bar. The
treatment goals of the posterior bite plane are to achieve major
alterations in vertical dimension and mandibular repositioning.
Indications:
Severe loss of vertical dimension or when there is a need to
make major changes in anterior repositioning of the mandible.
Some therapists have suggested that this appliance be used by
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athletes to improve athletic performance. However, scientific
evidence does not support this theory.
Disadvantages:
Potential supraerutpion of the unopposed teeth and/or
intrusion of the occluded teeth. Constant and long-term use should
be discouraged.
PIVOTING APPLIANCE
The pivoting
appliance is a hard acrylic device that covers
one arch and usually provides a single posterior contact in each

quadrant. This contact is usually established as far posteriorly as
possible. When superior force is applied under the chin, the
tendency is to push the anterior teeth close together and pivot the
condyles downward around the posterior pivoting point.
Indications:
The pivoting appliance was originally developed with the idea
that it would lessen interarticular pressure and thus unload the
articular surfaces of the joint.
Unfortunately, the forces of the elevator muscles are located
primarily posterior to the pivot, which therefore disallows any
pivoting action.
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In fact, the pivoting appliance has been advocated for the
treatment of symptoms related to osteoarthritis of the TMJs. For
the treatment of an acute unilateral disc dislocation without
reduction.
SOFT OR RESILIENT APPLIANCE

The soft appliance is a device fabricated from resilient
material that is usually adapted to the maxillary teeth. Treatment
goals are to achieve even and simultaneous contact with the
opposing teeth.
Indications:
1) Protective device for persons likely to receive trauma to their
dental arches
2) Protective athletic splints decrease the likelihood of damage to
the oral structures when trauma is received.
3) Clenching and bruxism
Okeson demonstrated that nocturnal masseter EMG activity

was increased in 5 to 10 subjects with a soft appliance; in the same
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study 8 of the 10 subjects had significant reduction of nocturnal
EMG activity with a hard muscle relaxation appliance.
Common Treatment Considerations of Appliance Therapy:

However, much controversy exists over the exact mechanism
by which occlusal appliances reduce symptoms. Most conclusions
are that they decrease muscle activity (particularly parafunctional
activity).
Before any permanent therapy is begun, one needs to be
aware that there are six general features common to all devices that
may be responsible for decreasing muscle activity and symptoms.
1. Alteration of the occlusal condition
2. Alteration of the condylar position
3. Increase in the vertical dimension
4. Cognitive awareness
5. Placebo effect: 40% of the patients suffering from certain TM
disorders respond favorably to such treatment.
6. Increased peripheral input to the CNS: Any change at the
peripheral input level seems to have an inhibitory effect on
this CNS activity.
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SUMMARY
Despite
the
unanswered
questions
on
the
physiologic
mechanisms that explain the effectiveness of intra-oral appliances

on reducing symptoms of TMD, there is still a plethora of
documentation
that intra-oral appliance when used in the
management plan accurately, can contribute to the relief of TMD

symptoms. The clinician is encouraged to evaluate fully each
particular patient case in an effort to develop a differential
diagnosis that leads to effective management plan.
Before commencing any appliance therapy for a TMD, the
clinician should be confident that the patient will benefit from the
therapeutic approach. If the symptoms reduced that will provide
additional diagnostic information.
The clinician also needs to consider that 40% of patients
suffering from TMD demonstrate favorable response to therapy
from a placebo effect. As with any treatment, a good patient-dentist
relationship and concomitant with patent education, can alloy
patient feelings and anxieties.
It can contribute to a positive and favorable response to intraoral occlusal splint therapy.
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BIBLIOGRAPHY:
Management of temporomandibular disorders and occlusion, 4 th
edition, Jeffrey O Okeson.
Evaluation, diagnosis and treatment of occlusal problems,
Dawson.
Science and practice of occlusion. Mc Nail.
Contemporary fixed prosthodontics, 3 rd edition, Rosenstiel, Land,
Fujimoto.
Fundamentals of fixed prosthodontics, 3rd edition, Shillenberg,
Hubo, Whitshell, Jacob, Bracketti.
Berkits. Oral Medicine.
Tylman. Theory and practice of fixed prosthodontics, 8 th edition,
Malone, Koth.
Albert Solonit/ Cornutte. Occlusal correction; Principle and
Practice.
Journal of Prosthetic Dentistry 2001; 86(5):539.
Journal of Prosthetic Dentistry 1989; 59:165-180.
Cranio 1993; 11:184-191.
Journal of Prosthetic Dentistry 1982 48 : 708-712.
Journal of Prosthetic Dentistry 1981; 45 : 438-445.
Aust Dent J 1990; 35 : 266-276.
Journal of Prosthetic Dentistry 1985; 53 : 717-721.
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Journal of Prosthetic Dentistry 2000; 83 : 2.
Journal of Prosthetic Dentistry 1990; 63:52.
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Seminar - IV

Occlusal Splints Used in

Occlusal Splints Used in

Occlusal Splints Used in

OCCLUSAL SPLINTS USED IN PROSTHETIC MANAGEMENT

Occlusal Splints Used in

mandible. It is a diarthroidal, bilateral ginglymus arthroidal joint.

Occlusal Splints Used in

spasmodic non-functional gnashing, grinding or clenching of teeth,

WHAT OCCLUSAL SPLINTS CAN DO?

Occlusal Splints Used in

WHAT OCCLUSAL SPLINTS CANNOT DO?

VARIOUS UNEXPLAINED THERAPEUTIC CLAIMS:

Occlusal Splints Used in

Types of Occlusal Splints:

Permissive Splints: Are designed to unlock the occlusion to

deprogrammers. A properly made centric relation occlusal splint is

Occlusal Splints Used in

Directive splints: Are designed to position the mandible in a

Contraindications for Directive Splints:

Verification that the condyle-disk assemblies are capable of

Occlusal Splints Used in

Superior Repositioning Splints:

Occlusal Splints Used in

repositioning splint is to establish the correct skeletal relationship

shortening of the superior lateral pterygoid muscle, which controls

Occlusal Splints Used in

1. MUSCLE RELAXATION APPLIANCE/ Flat Plane, Share

Occlusal Splints Used in

Occlusal Splints Used in

Locating the musculoskeletally stable position:

Occlusal Splints Used in

Adjusting the CR Contacts:

Adjusting the eccentric guidance:

Occlusal Splints Used in

Final criteria for the muscle relaxation appliance:

Occlusal Splints Used in

Instructions and adjustments:

Occlusal Splints Used in

ANTERIOR REPOSITIONING APPLIANCE

Occlusal Splints Used in

Simplified fabrication technique:

repositioning appliance is a full-arch hard acrylic device that can

Fabricating and fitting the appliance:

Occlusal Splints Used in

repositioning appliance is identical to that in fabricating a muscle

Locating the correct anterior position:

fabrication is finding the most suitable position for eliminating the

Occlusal Splints Used in

Occlusal Splints Used in

Final criteria for the anterior repositioning appliance:

Occlusal Splints Used in

Instruction and Adjustments:

ANTERIOR BITE PLANE/ ANTERIOR JIG LUCIA JIG, HAWLEY

Occlusal Splints Used in

Occlusal Splints Used in

appliance is a hard acrylic device that covers

one arch and usually provides a single posterior contact in each

Occlusal Splints Used in

SOFT OR RESILIENT APPLIANCE

Okeson demonstrated that nocturnal masseter EMG activity

Occlusal Splints Used in

Common Treatment Considerations of Appliance Therapy: