Incorrect Splint Fabrication

Example of incorrect splint fabrication and resulting problems:

This page comes from the frustration of seeing repeatedly the mistakes made by what I must assume are good dentists that have the best of intentions when it comes to trying make splints/nightguards for patients they see. Some I know are simply misguided; a sad but true fact.

This is just such an example: A person has a splint/nightguard made and they do not do well with their TMD problems primarily because the splint(s) are made incorrectly and do not provide a correct position for the jaw socket to remain in.

In this particular case Cathy came to my office with two previously made splints/nightguards. She was to wear one during the day and one at night. The problem is not that she was made two different splints (one upper / one lower), the biggest problem is that neither one of them is made for a physiologically correct joint position. In other words, when she closes into touch the surface of the splint it is natural to seek a contact with the splint that has the most number of teeth touching as possible. Why? Because this is what feels most natural to the person wearing the splint. So in this case shown below, yes Cathy can touch much more solid than the photos reveal, but she must come very far out of a correct jaw joint position to do so. There is the problem. Since she had problems with her TMJ's before wearing the splint and now the splints are not made correctly, she really stands no chance of improving.

It is very easy to demonstrate with Cathy (because of her young age and the ease of seating her joints to correct position via a light touch to the tip of the chin) that the joints are not in a correct socket position when she closes into maximum contact on the splint/nightguard.

YOU MAY CLICK ON THE IMAGES BELOW TO ENLARGE THEM (Use the back button on your browser to return)



This is the lower splint. The thumb on the chin is to verify and hold a correct jaw joint position. The first contact on the splint is in the far rear molar area. If I remove my thumb from her chin and tell her to close.....she will make better contact on the splint (therefore not so open in the front). BUT, when she closes to this better tooth contact, the jaw joints have to come far out of socket to achieve this. The patient said that she had difficulty in finding a comfortable place to rest in this splint.



Pictured here is the upper splint. This attempt at a correct position is a much better try than the lower splint but none the less, it is still not made correctly. The last image of the model simply shows the splint placed onto Cathy's models (which are correctly related on an articulator) - the "offness" is still the same as in the mouth.
NOTE - This photo is taken when there is a first contact on the splint. She is NOT holding open.



This is a physiologically CORRECT splint / nightguard (call it what you wish). The joints are in socket and all the teeth strike the surface of the splint in this exact position.

NOTE - This is actually the splint pictured above (upper) that has been added to and adjusted to the correct position.

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Dr. Maury Hafernik
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