An unusual appliance: detrimental occlusal consequences of a lack of clinical monitoring

Temporomandibular disorders (TMDs) are the most common cause of chronic pain in the orofacial region.¹ TMDs are musculoskeletal disorders predominantly affecting females, and reach a peak incidence in the second and third decades of life.² Guidelines recommend that the firstline management of TMDs should consist of ‘reversible and non-invasive’ interventions of which education regarding self-management is the cornerstone.¹ In 2012, it was reported the treatment preference of UK-based general dental practitioners (GDPs) was for ‘occlusal splint therapy’.³

Occlusal splints have both diagnostic and therapeutic purposes and are removable appliances designed to be placed over some, or all of the occlusal surfaces in the dental arch. They are prescribed for the management of TMD and to control the tooth wear effects of bruxism. They may be constructed from hard or soft acrylic and various designs have been proposed.⁴ The stabilization splint, as described by Moufti et al, is one example, and is a full-coverage hard-acrylic splint constructed for the upper or lower arch that provides a temporary and reversible ideal occlusion.⁴ The features of an ideal occlusion provided by the splint are ‘…multiple even contacts on the posterior teeth in retruded contact position…’ and ‘… canine guidance and disclusion of the posterior teeth in lateral and protrusive excursions…’.⁴ In providing an ideal occlusion, the appliance aims to reduce ‘abnormal muscle activity’, which can be a cause of TMD.⁵