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A SIMPLE TECHNIQUE FOR ADJUSTING AND POLISHING A SOFT SPLINT
CLINICAL
DIRECTIONS
A SIMPLE TECHNIQUE FOR ADJUSTING AND POLISHING A SOFT SPLINT EDWARD F. WRIGHT, D.D.S., M.S.
S
oft splints are often fabricated from a thermoplastic vinyl sheet 0.15 inch (3.8 millimeters) thick. Some practitioners report that soft splints are difficult or nearly impossible to adjust,1,2 while it has been speculated that the soft splint’s efficacy may be related to how well its occlusion is adjusted.3 This article describes a technique for adjusting a soft splint easily, using its thermoplastic property to greatly shorten the time needed for the adjustment. THE TECHNIQUE
The practitioner should first evaluate the internal portion of the splint for comfort by inserting it and asking the patient to identify any area of uncomfortable pressure, which is adjusted with an acrylic or round bur. The practitioner then should position both patient and the mandible to achieve the practitioner’s preferred mandibular
relation, and the patient should practice moving his or her
Some practitioners report that soft splints are difficult or nearly impossible to adjust. mandible into right and left lateral and protrusive positions. With the splint on the cast, the practitioner uses an alcohol torch to warm all areas of the splint that the opposing teeth may touch. The practitioner should be careful to warm the splint evenly by repeatedly sweeping the flame from one side of the splint to the other. Clinical experience has demonstrated that when the splint feels slightly tacky, it is ready to be placed in the patient’s mouth. Once the splint is in the mouth, the patient closes into it
at the practitioner’s preferred mandibular relation position. He or she then slides the mandible into the excursive movements previously practiced. This provides occlusal imprints in the softened splint (Figure 1). Next, the practitioner places the splint on the cast and marks the bottom of all stamp cusp indentations with dark ink so they can easily be observed. I design these splints so that the anterior portion of the splint disoccludes the posterior teeth in excursive positions. For this design, I use an acrylic bur to reduce the shear cusp imprints well below their indentations, and I reduce the previously marked stamp cusp indentations to just remove the ink marks. The occlusal surface is contoured to form a flat plane, and the side of the splint is contoured to smoothly flow into the occlusal or incisal surface. As mentioned above, the splint is designed so that the anterior portion disoccludes the posterior teeth. The indentations from the anterior teeth should be retained, but the practitioner should—using an acrylic bur—reduce and contour the material that has extruded around the imprints, enabling the jaw to make smooth excursive movements. Obtaining an indentation from at least one stamp cusp of
JADA, Vol. 129, September 1998 Copyright ©1998-2001 American Dental Association. All rights reserved.
1287
CLINICAL DIRECTIONS to note that some articulating marking agents, although they mark acrylic splints well, mark the resilient material poorly (Parkell’s Accufilm is an example of this). The articulating paper marks on the soft splint are not the point contacts that dentists are accustomed to seeing on the acrylic splint; rather, they are broad marks (Figure 2). Clinical experience has demonstrated that as the occlusion of the splint is perfected, the articulating paper can lose its ability to differentiate heavier contacts Figure 1. Occlusal imprint in soft splint.
Figure 2. Articulating paper markings on the soft splint.
every posterior tooth is desirable, but this often is not achieved with the first warming of the splint. If the first heating does not enable the practitioner to obtain or almost obtain these imprints, he or she should repeat the above steps. If reheating, the practitioner should try to retain the maximum amount of soft material over the occlusal surface by warming the 1288
splint so the last tooth that will make an imprint is only lightly touching or just about to touch. Forming indentations and reducing them as described allows the practitioner to rapidly bring the splint into close approximation of its final form. The final adjustments can be made with articulating paper (such as Bausch Articulating Paper, Pulpdent Corp.). It is important
Obtaining an indentation from at least one stamp cusp of every posterior tooth is desirable, but this often is not achieved with the first warming of the splint. before the patient does. If the articulating paper marks appear even and the patient is able to detect heavier contacts that are confirmed marks on the splint, the practitioner should adjust the splint until it feels even to the patient. Next, the practitioner needs to ensure that the splint causes the anterior teeth to disocclude the posterior teeth in excursive positions. The excursive movements are marked with articulating paper and the new markings on the posterior portion of the splint are adjusted. The simplest technique that provides a smooth finish uses chloroform or halothane, which is the general inhalation anesthetic often used by dentists as a substitute for chloroform. The
JADA, Vol. 129, September 1998 Copyright ©1998-2001 American Dental Association. All rights reserved.
CLINICAL DIRECTIONS practitioner should seat the splint on the cast and firmly rub any rough area of the splint with gauze dampened with either agent; it rapidly provides a smooth finish. Then the splint should be rinsed with water and returned to the patient. CONCLUSION
For almost 20 years, I have successfully used this easy, rapid
technique for creating a soft splint adjusted to the opposing dentition. The procedure has become more streamlined over the years, and it now takes me approximately 20 minutes to perform. ■ Dr. Wright is a colonel, U.S. Air Force, Lackland Air Force Base, Texas, and is the chief dentist for temporomandibular disorders, U.S. Air Force. Address reprint requests to Dr. Wright, 83 Cross Canyon, San Antonio, Texas 78247.
The opinions expressed in this article are those of the author and do not reflect the official policy of the Department of Defense or other departments of the U.S. Government. 1. Attanasio R. Intraoral orthotic therapy. Dent Clin North Am 1997;41(2):309-24. 2. Okeson JP. The effects of hard and soft occlusal splints on nocturnal bruxism. JADA 1987;114:788-91. 3. Wright E, Anderson G, Schulte J. A randomized clinical trial of intraoral soft splints and palliative treatment for masticatory muscle pain. J Orofacial Pain 1995;9(2):116-30.
DO YOU HAVE A TIP TO SHARE? Do you have a time- or work-saving clinical technique to share with your colleagues? Submit it to JADA’s Clinical Directions department. A Clinical Directions item should be a maximum of two double-spaced typed pages and should include no more than one figure or illustration. Submit items to Clinical Directions, JADA, 211 E. Chicago Ave., Chicago, Ill. 60611.
JADA, Vol. 129, September 1998 Copyright ©1998-2001 American Dental Association. All rights reserved.
1289
DIRECTIONS
A SIMPLE TECHNIQUE FOR ADJUSTING AND POLISHING A SOFT SPLINT EDWARD F. WRIGHT, D.D.S., M.S.
S
oft splints are often fabricated from a thermoplastic vinyl sheet 0.15 inch (3.8 millimeters) thick. Some practitioners report that soft splints are difficult or nearly impossible to adjust,1,2 while it has been speculated that the soft splint’s efficacy may be related to how well its occlusion is adjusted.3 This article describes a technique for adjusting a soft splint easily, using its thermoplastic property to greatly shorten the time needed for the adjustment. THE TECHNIQUE
The practitioner should first evaluate the internal portion of the splint for comfort by inserting it and asking the patient to identify any area of uncomfortable pressure, which is adjusted with an acrylic or round bur. The practitioner then should position both patient and the mandible to achieve the practitioner’s preferred mandibular
relation, and the patient should practice moving his or her
Some practitioners report that soft splints are difficult or nearly impossible to adjust. mandible into right and left lateral and protrusive positions. With the splint on the cast, the practitioner uses an alcohol torch to warm all areas of the splint that the opposing teeth may touch. The practitioner should be careful to warm the splint evenly by repeatedly sweeping the flame from one side of the splint to the other. Clinical experience has demonstrated that when the splint feels slightly tacky, it is ready to be placed in the patient’s mouth. Once the splint is in the mouth, the patient closes into it
at the practitioner’s preferred mandibular relation position. He or she then slides the mandible into the excursive movements previously practiced. This provides occlusal imprints in the softened splint (Figure 1). Next, the practitioner places the splint on the cast and marks the bottom of all stamp cusp indentations with dark ink so they can easily be observed. I design these splints so that the anterior portion of the splint disoccludes the posterior teeth in excursive positions. For this design, I use an acrylic bur to reduce the shear cusp imprints well below their indentations, and I reduce the previously marked stamp cusp indentations to just remove the ink marks. The occlusal surface is contoured to form a flat plane, and the side of the splint is contoured to smoothly flow into the occlusal or incisal surface. As mentioned above, the splint is designed so that the anterior portion disoccludes the posterior teeth. The indentations from the anterior teeth should be retained, but the practitioner should—using an acrylic bur—reduce and contour the material that has extruded around the imprints, enabling the jaw to make smooth excursive movements. Obtaining an indentation from at least one stamp cusp of
JADA, Vol. 129, September 1998 Copyright ©1998-2001 American Dental Association. All rights reserved.
1287
CLINICAL DIRECTIONS to note that some articulating marking agents, although they mark acrylic splints well, mark the resilient material poorly (Parkell’s Accufilm is an example of this). The articulating paper marks on the soft splint are not the point contacts that dentists are accustomed to seeing on the acrylic splint; rather, they are broad marks (Figure 2). Clinical experience has demonstrated that as the occlusion of the splint is perfected, the articulating paper can lose its ability to differentiate heavier contacts Figure 1. Occlusal imprint in soft splint.
Figure 2. Articulating paper markings on the soft splint.
every posterior tooth is desirable, but this often is not achieved with the first warming of the splint. If the first heating does not enable the practitioner to obtain or almost obtain these imprints, he or she should repeat the above steps. If reheating, the practitioner should try to retain the maximum amount of soft material over the occlusal surface by warming the 1288
splint so the last tooth that will make an imprint is only lightly touching or just about to touch. Forming indentations and reducing them as described allows the practitioner to rapidly bring the splint into close approximation of its final form. The final adjustments can be made with articulating paper (such as Bausch Articulating Paper, Pulpdent Corp.). It is important
Obtaining an indentation from at least one stamp cusp of every posterior tooth is desirable, but this often is not achieved with the first warming of the splint. before the patient does. If the articulating paper marks appear even and the patient is able to detect heavier contacts that are confirmed marks on the splint, the practitioner should adjust the splint until it feels even to the patient. Next, the practitioner needs to ensure that the splint causes the anterior teeth to disocclude the posterior teeth in excursive positions. The excursive movements are marked with articulating paper and the new markings on the posterior portion of the splint are adjusted. The simplest technique that provides a smooth finish uses chloroform or halothane, which is the general inhalation anesthetic often used by dentists as a substitute for chloroform. The
JADA, Vol. 129, September 1998 Copyright ©1998-2001 American Dental Association. All rights reserved.
CLINICAL DIRECTIONS practitioner should seat the splint on the cast and firmly rub any rough area of the splint with gauze dampened with either agent; it rapidly provides a smooth finish. Then the splint should be rinsed with water and returned to the patient. CONCLUSION
For almost 20 years, I have successfully used this easy, rapid
technique for creating a soft splint adjusted to the opposing dentition. The procedure has become more streamlined over the years, and it now takes me approximately 20 minutes to perform. ■ Dr. Wright is a colonel, U.S. Air Force, Lackland Air Force Base, Texas, and is the chief dentist for temporomandibular disorders, U.S. Air Force. Address reprint requests to Dr. Wright, 83 Cross Canyon, San Antonio, Texas 78247.
The opinions expressed in this article are those of the author and do not reflect the official policy of the Department of Defense or other departments of the U.S. Government. 1. Attanasio R. Intraoral orthotic therapy. Dent Clin North Am 1997;41(2):309-24. 2. Okeson JP. The effects of hard and soft occlusal splints on nocturnal bruxism. JADA 1987;114:788-91. 3. Wright E, Anderson G, Schulte J. A randomized clinical trial of intraoral soft splints and palliative treatment for masticatory muscle pain. J Orofacial Pain 1995;9(2):116-30.
DO YOU HAVE A TIP TO SHARE? Do you have a time- or work-saving clinical technique to share with your colleagues? Submit it to JADA’s Clinical Directions department. A Clinical Directions item should be a maximum of two double-spaced typed pages and should include no more than one figure or illustration. Submit items to Clinical Directions, JADA, 211 E. Chicago Ave., Chicago, Ill. 60611.
JADA, Vol. 129, September 1998 Copyright ©1998-2001 American Dental Association. All rights reserved.
1289