Occlusal Appliance

Dr. Romanita Ghilzon
Authored by:
Dr. Romanita Ghilzon

Indications:

  1. To retard tooth wear in bruxers
  2. To protect  restorations from the effects of bruxism
  3. As means of assessing the patient’s tolerance for an increase in VDO
  4. As non-invasive early-stage therapy for painful TM joints. 

Regarding TMJ pain, evidence suggests that, in most instances, it subsides without treatment.  However, once the TMJ pain has become chronic, surveys also show that it is less likely to resolve spontaneously.

Occlusal appliance adjustments:

Occlusal appliances can be fabricated for either the arch.  Most patients find mandibular appliances more comfortable.  For periodontal patients, however, maxillary appliances are more beneficial because they act as retainers which prevent the maxillary incisors from extruding or splaying.  Hard acrylic is used in the fabrication of these appliances, and the occlusal surface is adjusted, so that as many opposing posterior stamp cusps (lingual cusps of maxillary posteriors or buccal cusps of mandibular posteriors) as possible contact evenly in centric occlusion.

 As with the natural occlusion, the goal of adjusting the occlusal appliance is to achieve anterior disclusion, when the mandible moves into lateral and protrusive excursions.

Follow-up occlusal appliance therapy:

If the appliance is used to retard tooth or restoration wear, follow-up appointments are scheduled at 6-12 month intervals, in order to ascertain that the occlusion, with the appliance in place, continues to be stable.

If the appliance is used to assess the patient’s tolerance for an increased VDO, appliance therapy is continued until such tolerance is confirmed.

If occlusal appliance is used as early-stage therapy for TMJ pain, follow-up appointments for additional adjustments and/or to assess the patient’s progress are scheduled at varying intervals, depending on the severity of the pain.  Occlusal appliance therapy is continued until the symptoms improve or subside, but no longer than three months, after which other modalities of treatment or alternative diagnoses are explored.

 

References: 

List T., Axelsson S., Management of TMD: evidence from systematic reviews and meta-analyses. Journal of Oral Rehabilitation 2010;37:430-451.

Manfredini D., Favero L., et al., Natural course of temporomandibular disorders with low pain-related impairment: a 2-to- 3 year follow-up study. Journal of Oral Rehabilitation 2013;40:436-442.

Okeson J.P., Management of Temporomandibular Disorders and Occlusion. 7th edition Elsevier, Mosby 2013.

Rollman A., Visscher C.M., Gorter R.C., Naeije M., Improvement in patients with a TMD-pain report. A 6-month follow-up study. Journal of Oral Rehabilitation 2013;40:5-14.

Stefanac Stephen J., Nesbit Samuel Paul, Treatment Planning in Dentistry. 2nd edition, Elsevier, Mosby, 2007.

Article Reviewed By

Dr. Limor Avivi-Arber & Dr. Howard Tenenbaum