JIACD
The Journal of Implant & Advanced Clinical Dentistry
TMD Occlusal splints hard or soft what are preferred?
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TMD splints I perfer hard splints to soft ones
Soft splints in my opinion dont solve the patients grinding habit. In fact I feel soft splint may increase grinding as a soft splint acts like a jelly bean in the mouth and patient tend to chew on them.
So they dont solve the parafunctional habit.
My hard nightguard tips....
I agree, I use hard splint. Have your lab make your hard splints with the thermoplastic liner called "Eclipse". On delivery you just run it under warm water and it shapes to the teeth, making up for any minor inaccuracy of your alginate impressions. Ever since I started using this liner I have not had to do a reline on a single hard guard out of about 25 I have done with it. Makes me much more confident at delivery that the guard will be stable.
Also use a facebow transfer and bite registration that opens the patient to the desired amount the guard will open them to. This makes your arc of closure accurate in the lab and will cut your delivery time to just a few minutes.
Also make guards on whichever arch has the most mobility. I find that patients who intend to wear the guard 24/7 tolerate mandibular guards better than maxillary b/c you can hide them esthetically.
Nick.
5 Second Answer
Soft splints for asymptomatic grinders, hard splints for the pain crowd.
NTI
I used to swing between both hard and soft nightguards without really knowing which one to select for a particular case. hargitai's idea seems interesting and I'll try it next time.
I have started using NTI recently and this works much better than the full mouth guards IMO. The symptoms disappear almost immediately. I line the NTI with a thermoplastic gel.
The only problem I am having with the gel is that it sets too fast.
Srikanth.
It all depends........but hard splints work best for me...
Before I do any treatment on these type of patients, I always have a clear diagnosis of what is going on with the patient and what our goals of treatment will be. By and far, hard splints work best in my hands and soft splints, do in fact, increase the clenching or as the other comment made -it is like chewing on "a jelly bean". The same goes for upper vs. lower splints(although I find most patients tolerate lower much better). In regards to the "soft liners" in the hard splints-I like them them in hard acrylics-there is no "give" and you don't get "false" markings on the splint as the splint compresses in "higher" areas and marking the non-contact areas. This can trigger muscle activity. NTI's and partial bite plates/splints (kois deprogrammers, etc.) all have there place, but my concern is long term implications of wearing a partial coverage appliance. Yes, it is more comfortable for some patients, but I find a properly adjusted hard acrylic splint is very well tolerated, stable, and can serve patients well for years. Main take home point: proper diagnosis and understanding what it is that you are treating and how you are help the patient.
Hard splints for me
I use hard splints. Have seen issues with the soft ones. I think people sometimes steer away from the hard splints because they can be time consuming to deliver. However, I think they produce the best results (for me at least)
Hard Splints in my practice
I stay away from soft splints, they usually chew right through them. I use hard lab fabricated splints only. Much easier to adjust to the patients occlusion.
hard or soft
IMHO soft guards cause a rebond effect and the wearer tends to increase clenching as its like having chewing gum in their. I personally prefer combo hard soft guards, soft on inside to retain it in more comfort and exterior is hard so they have a stable surface to occlude on
Good information.
Good information.