Letters to the Editor

(Dent Update2018; 45: 912−918)

I would like to respond to an article published in the November issue of Dental Update. There are a number of issues with the article in which the authors, Jagger and King, make some comments without adequate references.

The authors report that evidence on splints and efficacy is limited and most articles are opinion based. On this I agree: there are limited clinical studies for occlusal splints.

The authors mention in the section on ‘Anterior bite planes’ that ‘the splint must contact the opposing 4 incisors to prevent overloading teeth’. There is no scientific reference to suggest that the teeth would be overloaded. On the contrary, EMG studies have been shown to reduce forces when posterior contacts are removed.^{1, 2}

The authors suggest that anterior bite planes cause teeth to supra-erupt. This is a common myth that sadly causes much debate and confusion in dentistry. The Dahl appliance is often referenced with regard to supra-eruption, however, this can also be misleading. Bereznicki et al refer to a review of the Dahl concept by Poyser et al ‘the time to achieve intrusion/extrusion of teeth to a new, desired vertical dimension is considered to range from one to 24 months, with continuous 24 hour a day wear of an appropriate, suitably designed appliance. The Dahl appliance is designed to be bonded in the patient's mouth and worn 24/7 with all teeth except those in contact to never be in any function. The idea is to supra-erupt the posterior teeth during a restorative phase of treatment. This is not the same as a patient using a night time splint for a few hours’.^{3, 4} The research by Kinoshita et al would also suggest that teeth are unlikely to supra-erupt.⁵