A grinding splint is a bite splint used therapeutically in dental practice. On the one hand, it serves to harmonize the interaction of jaw joints and chewing muscles, and on the other hand, it is intended to prevent unphysiological tooth contact in the form of rubbing and clenching during the wearing period and the resulting damage to hard tooth substance, periodontium, jaw joints and musculature. Teeth grinding and clenching (bruxism) are so-called parafunctions (secondary functions in addition to the actual chewing function), in which forces act on the structures involved that are much stronger than in the actual chewing process and which also last significantly longer. They can result from pre-contacts (premature contacts of a tooth or a group of teeth); very often, however, they are faulty behaviors that the patient develops unconsciously as a reaction to stress and strain. If the life situation worsens, pressing and grinding, which until then was not accompanied by pain, can lead to acute phases of pain in the temporomandibular joint structures, masticatory muscles or teeth.
Indications (areas of application)
The treatment concept with a grinding splint consists of freeing the lower jaw from its interlocking with the upper jaw and thus giving it the opportunity to adjust itself, detached from the specifications by the relief of the opposing teeth, in a position resulting from a relaxed muscular and temporomandibular joint situation. Possibly existing pre-contacts (premature contacts of a tooth or a group of teeth) are thus bypassed during the wearing time of the splint. In addition, the irritation of the unconscious automated movement sequences by the splint is a desired effect. Thus, a grinding splint is applied
- To harmonize the functions of the teeth, muscles and joints.
- To release the unconscious automatisms
- To reduce the parafunctions grinding and pressing.
- To eliminate disruptive factors of static and dynamic occlusion (tooth contacts between the upper and lower jaw at rest and in motion, respectively) and
- To protect the tooth hard substances from further attrition (loss of substance by reflexive contact of the teeth) and abrasion (loss of substance by friction).
The procedure
The therapy of bruxism with a grinding splint should be integrated into an interdisciplinary concept such as:
- Physical therapy, heat and cold treatment, manual therapy, and massage to reduce muscle tension and painful muscle nodules.
- Orthopedics for involvement of the spinal structures.
- Psychotherapy for psychological comorbidity such as depression or psychosocial stress situations, among others
- Stress management training
- Relaxation techniques such as autogenic training, yoga, progressive muscle relaxation, etc.
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Work steps in dental practice:
- Education of the patient about the origin and mode of action of parafunctions: Guidance on self-observation is important
- Education of the patient regarding the daily wearing time (at the beginning in the afternoon and at night).
- Clarification regarding the expected duration of splint therapy.
- Impression of both jaws
- Centric bite taking, if possible in the tense initial situation.
- Facebow creation (serves to transfer patient-specific cranial points to the dental laboratory).
Working steps in the dental laboratory:
- Model fabrication of upper and lower jaw
- Transferring the models to an articulator (device used to mimic patient-specific mandibular movements) according to the facebow settings
- Making the grinding splint usually for the upper jaw from transparent hard plastic according to specific design specifications.
Working steps in the dental office:
- Insertion and fitting of the splint on the patient; rocking fit, tight with some tension.
- Control of occlusal contacts with the mandible: evenly in the posterior region on both sides, i.e., no pre-contacts in static and dynamic occlusion; the mandible must not get into a forced bite position, but must be able to be guided in a muscularly relaxed manner
- First control appointment after a week at the latest, in acute pain even earlier
- Regular checks, ideally close in time to the physiotherapy appointments, in order to be able to make necessary splint corrections during the phase of muscular relaxation
Treatment with a splint is reversible (reversible); if successful, irreversible dental procedures may follow:
- Grinding in disturbances in the static and dynamic occlusion.
- Orthodontic treatment
- Reconstruction of individual teeth or groups of teeth of varying degrees.