Splint/Nightguard Fabrication-Delivery

I often get questions about how to recognize whether a splint is made correctly.  There is not a standard for splint fabrication just as there is no standard for TMJ therapy. Why do I and other practitioners like myself believe that the method described below is the most correct? Because the method follows VERY sound physiological/orthopedic principles....such as your jaw joint wants to be in socket (like every other joint in your body).

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INITIAL  RECORDS
Before a splint can be made, correct records must be obtained.

	A record of how the upper jaw relates to the jaw joint (TMJ) is taken. This is called a facebow transfer. The reason for placing the facebow into the ears is because the ear opening are just 1/4 inch behind the joint - therefore a great reference point. NOTE - Soft wax on the facebow adapts to the upper teeth.
	The facebow is now adjusted to place and ready to remove.
	Wax bites - special wax softened in warm water. The manipulation of the lower jaw is the MOST important technique for proper records. The instructions are to relax the jaw as completely as possible and the doctor then guides the jaw into its most correct position - at that point the teeth are pressed into the wax. The patient does NOT squeeze into the wax.
	On the left - wax tabs before taking records. On the right - wax bite records.
	An articulator is an instrument that duplicates jaw joints. Here the facebow (with ear extensions removed) is attached to the articulator. The upper model is placed onto the wax of the facebow. Stone is mixed to attach the upper model.
	Stone sets hard, the articulator is turned upside down and the wax bites are used to relate the upper model to the lower. Stone is mixed to attach the lower model.
	The models are related NOT to where all the teeth touch, but rather to where they first contact when the jaw joint (TMJ) is in its most correct position.
	The models are ready for a splint to be made. A splint is rock hard and most often made of heat/pressure cured clear acrylics.

SPLINT  DELIVERY
When the splint returns from the laboratory it is imperative that adjustments be made to "fine tune" the splint to the correct position for the jaw joint. 

	Make sure the splint fits onto the upper teeth with ABSOLUTELY no movement or rocking.
	The lower jaw is manipulated (just as when taking the wax bites) to a correct jaw joint position. Using red bite paper the lower teeth are tapped against the hard splint surface. This will mark the first point of contact.
	The arrow here points to the first point of contact.  NOTE - the biting side of the splint is absolutely smooth.
	The splint is taken to the mouth numerous times and marked with bite paper. The splint surface is adjusted with burs until there are even  marks for all lower teeth striking against the acrylic.
	When the splint is in place and the jaw is moved left, right or forward the front six teeth should cause separation of all back teeth off of the surface of the splint. This is accomplished by means of a ramp built into the front part of the splint. With bite paper placed, the lower jaw is moved left, right and forward - this leaves marks represented by lines rather than dots.
	A correctly adjusted splint that shows proper guidance by the front 6 teeth. NOTE - A lower splint can be successfully designed and delivered.

NOTE - There are variations from the delivery method outlined above that can be used to deliver a splint. 
              They ALL should finish with the marks shown above.

All these steps are important to a correctly constructed splint/nightguard. 

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