For Specialty Splints,Talk to the Professionalsat Space Maintainers

Your Source for SplintExpertise

Disorders of the jaw joint along withmyofacial pain have become subjectsof great concern for the generalpractitioner today. More and moreadult patients are being seen withTemporomandibular Joint (TMJ)dysfunction, suffering from local (neck,shoulder or sinus) pain, clicking in thejoints, pronounced malocclusion,impaired excursion in opening of themouth or deviant motions of the jaw.Untreated TMJ problems can evenlead to osteoarthritis and generativejoint disease.With the increased attention placed

on the function of the jaws and cranio-mandibular musculature, orthodonticdiagnosis and treatment planninghave progressed markedly. Almostevery day, new results from clinical,anatomical and experimental studiesare opening new perspectives in thetreatment of patients with occlusaldisorders. Orthopedic splint therapyhas become an exacting science — ascience that requires experienced,professional support personnel.Space Maintainers Laboratories —

Pacific Northwest has answered thechallenge. Our outstanding SplintDepartment is staffed with well-trained, experienced and creativetechnical specialists fully versed in thecomplete range of today’s splinttechniques. And, our ongoing stafftraining program keeps them andSpace Maintainers on the leadingedge of splint technology.Your complete source for all the

various styles of surgical, TMJ andBruxism splints available, the SpaceMaintainers Splint Department offersall of today’s popular splint designs.And, our specialists are always readyto take on your special or customrequirements when they arise.Nightguards and Athletic MouthGuards? They do them too!For splints that fit and function

exactly as you prescribed, talk to theprofessionals at Space Maintainers.They’re the specialists in splint design.

Clear-Flex Splint

The special Clear-Flex thermo-elasticmaterial provides splints that become flexibleunder hot tap water. As they cool, the splintreturns to its original shape, conforming tothe teeth so well that clasping is practicallyeliminated and chairtime is drasticallyreduced. When worn, the splints thermo-elastic properties assure optimal patientcomfort.

MORA Appliance

The Mandibular Orthopedic RepositioningAppliance (as described by Dr. Gelb) hasbeen designed to reposition the mandiblewith its condyle (achieves optimal neuro-muscular balance as well as balancedcondyle-fossae relationships). The applianceconsists of clear acrylic bite pads coveringthe molars and bicuspids connected by aheavy, oval lingual bar.

Protective Splint

A simple, inexpensive, vacuum formed splintdesigned to protect tooth structure on eitherthe maxilliary or mandibular arch. Due to thethin nature of the material, a minimum biteopening of 1 to 2 mm. is possible. Occlusalfacets are automatically duplicated in theappliance.

INTACT All Sports Mouthguards

Individually custom-crafted using heat andpressure. Helps to reduce forces that maycause concussions, cerebral hemorrhage,neck injuries and jaw fractures. Palatal braceof hardened plastic transmits shear forcesaway from high risk upper anteriors. Choosefrom: INTACT “Super” (three layers ofinjection-molded vinyl and hardened centerlayer for added protection), INTACT“Regular” (two layers of injection-moldedvinyl) or INTACT “Multi-Purpose (one layerof injection-molded vinyl, normally used forchild in mixed dentition phase).

The Full Range of M

For Specialty Splints, Talk to theProfessionals at Space Maintainers

Modern Appliances Space Maintainers...Check Us Out,We Have a Lot to Offer!

You can rely on Space MaintainersLaboratories — Pacific Northwest foroutstanding personal service —everyday, on every case. Consider allwe have to offer!

On-Target Technical SupportNew techniques. Individual caserequirements. Our highly trained,experienced managers have theanswers you need. Call toll-free.

Unparalleled ServiceFast turnaround time. Special rushservice. Courteous staff. It all adds upto the superb level of service you canexpect from Space Maintainers.

Consistent QualityEvery case is constructed using onlythe finest quality materials, carefullyadjusted and exhaustively checkedbefore shipment to you. At SpaceMaintainers, your case is always right— the first time.

Extensive Free Pick-Up andDeliveryReliable door-to-door service that getsyour case to us and back to you inrecord time.

100% GuaranteedAll work is fully guaranteed for 90 daysagainst defective materials and crafts-manship. No fine print. No conditions.No arguments. Just repaired orreplaced free of charge.Whether you need removable

appliances, retainers, fixed appliances,functional appliances or splints andmouthguards, Space Maintainers isyour Orthodontic Specialist. After all,orthodontics is our only business.

Other DesignsIn addition to the designs shownabove, the Splint Department at SpaceMaintainers fabricates a wide range ofother appliances used in TMJ treat-ment or for occlusal adjustments. Giveus a call!

Horseshoe Splint

A popular bruxism splint, the Horseshoefeatures minimal occlusal coverage formaximum patient comfort. A twisted brassreinforcement wire carefully placed acrossthe lingual anterior position of the applianceprovides added strength. The acrylic occlusalsurface can be either smooth or with occlusalfacets.

Talon™ Splint

Combines the best features of a hard andsoft splint while eliminating the inherentdisadvantages of either type. Soft thermo-plastic polymer covers the buccal, labial, andlingual surfaces. At body temperature, thismaterial is flexible but firm providing superiorretention. Eliminates time spent trying to find“tight spots” on the appliance. Occlusalsurface of the appliance is made of hardacrylic, chemically bonded to the thermo-plastic material. This hard acrylic allowsadjustments to be made to the occlusal sur-face of the splint as needed. Talon™ materialcan be utilized for all splint techniques.

Maxilliary / Mandibular Bruxism Splints

The basic appliance consists of clear acrylic(for esthetics) covering of the entire maxilliaryor mandibular arch, heat cured for maximumstrength. Careful finishing is required so eachopposing tooth bears equally on the acrylicbiting surface. For ease of insertion andremoval as well as proper retention, the modelmust be carefully surveyed and the undercutsblocked out by the laboratory before applianceconstruction. The prescription should indicatewhether a smooth bite plane or occlusal facetsare required. A wax bite must be taken to thecorrect vertical opening desired for the entireappliance.

Dual-Flex™ Splint

Combining the comfort and fit of a soft splintwith the accuracy and adjustability of a hardocclusal surface. Dual-Flex can be utilized forall splint designs (e.g. Gelb, MORA, May,Sears, etc.) The unique thermo-elastic basebecomes flexible when placed under hot tapwater. As it cools, the splint returns to itsoriginal shape, conforming to the teeth andproviding reliable retention without clasping.Hard acrylic is chemically bonded to thisbase to form the occlusal surface allowingfast precise adjustments and proper proprio-ceptive response with opposing dentition.

Implementing Splint Therapy in Your Practice

Screening for craniomandibular disorders isindicated for patients with head pain, at allinitial dental examinations and for patients whoare candidates for extensive dental repair. Thescreening evaluation can be simply accom-plished by a nurse or assistant in less than twominutes by utilizing the following process:

1. FEEL jaw movementUse bimanual technique. From behind thepatient, place your hands so the little fingerrests against the ascending ramus. The otherthree fingers should be against the lower bor-der of the mandible. Ask the patient to openwide, then close slowly. Do this passively andthen with firm pressure applied coronally. Anypop, click, bump, grind or erratic movement willalert you to TMJ problems.

2. ASK the patientSpecifically ask about the following symptoms:• Headache• Grinding noise in TMJ• Neckache• History of Jaw Locking• “Sounds in the ear”• Pain in the TMJ area• History of jaw pop / click• Unable to open mouth

General Rules ofSplint AdjustmentAdjustment Interval

1. Adjust the splint at intervals of 1 week orless for the first month. (This may mean24 hr. intervals on some patients and 7 dayintervals on others.)

2. Adjust when / if there is change detectablewith the shim stock.

3. Adjust when / if there is change visible as aCR-CO shift on the splint.

4. Adjust if the splint is broken.

5. Adjust if there is wear at the border move-ment mark in lateral excursions from thecuspids.

6. Adjust when / if the patient reports any ofthe following:

a. Pain returning to the joint or teeth.b. Headaches returning.c. Soreness in front teeth-especially lowerincisors.

d. “Loose” feeling of the splint.e. Teeth no longer seem to have any placeto rest against the splint.

Grinding Rules

1. If you can’t get back to ideal occlusion in3 minutes — reline the splint. (The three-minute rule)

2. Generally, a thinner splint is a better splint.(within bounds of strength of materials)

3. Generally, the more shallow the disclusion,the better.

4. Severe splinting should be disrupted withsome kind of central bearing or anteriorguidance device which only allows anteriorcontact for a period of time prior to thesplint adjustment.

Stability

1. Stability is never certain.

2. Three months without detectable change isthe minimum to accept as evidence that itis reasonable to begin any irreversiblemodification of tooth position or of theocclusal surfaces of the teeth.

• Arthritis• Pain in the TMJ / ear areaA positive answer suggests a possible cran-iomandibular disorder and requires followup.

3. LOOK at the patientVisually evaluate for the following:• Facial assymetry• Teeth missing• Deviation on opening• Teeth worn• Open Bite• Teeth clash in movement• Short lower jaw• Mandibular dyskinesiaThe presence of one or more of theseconditions requires followup.

4. LISTEN to the TMJWith a stethoscope, listen to the TMJ, first onone side, then the other. Use an open bellwithout a diaphragm to avoid confusion fromskin and whisker sounds.Healthy joints are silent throughout the

entire range of function. Any sounds such asclicks, pops or grating indicate the need forfollowup.

Patient Education and Cooperation

Patient education and cooperation are essential to a successful treatment. Splints are like casts.Although they may be necessary for healing, they are a constant nuisance for most patients.Unless the patient wants the healing, the splint will not be worn continually.Patients must be educated to understand the entire course of treatment that will be neces-

sary to make the splint therapy worthwhile. In some cases, this will entail orthognathic surgeryand full-mouth rehabilitation. Complete treatment planning and careful consultation with visualaids is advised in all cases of splint therapy.Splints are sometimes visible and conspicuous. They are usually a speech impediment for at

least a few days. Eating is difficult with a splint. Diet must be modified. And, wearing a splintoften means multiple visits to the dentist when the joint and associated structures are healing.Acceptance of such “hassle” must be based upon needs felt by the patient if the therapy is goingto continue for the usual 3 to 6 months required in most cases. When the patient clearly can seethat wearing the splint is the best way to avoid a dental problem which is even more undesirablethan the splint, the splint will be worn. Objective, accurate education is appropriate in all splintcases.

© Space Maintainers Laboratories - Pacific Northwest. (2009). Reproduction of this work in whole or in part, by any means whatsoever,is strictly prohibited without the express written consent of Space Maintainers Laboratories - Pacific Northwest. All rights reserved.

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