AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

Introduction Main reasons for occlusal splint therapy Occlusal splint therapy has been shown to be useful for the diagnosis and management of various masticatory system disorders. A common reason for prescribing an occlusal splint is to protect the teeth from excessive wear in patients with bruxism. Splints are also used frequently to treat patients with internal derangement and other TMDs with associated symptoms such as tension headache and cervical nec! and oral"facial pain. A common goal of occlusal splint treatment is to protect the TM# discs from dysfunctional forces that may lead to perforations or permanent displacements. Other goals of treatment are to improve $aw% muscle function and to relieve associated pain by creating a stable balanced occlusion. Occlusal splint therapy can be recommended for the following purposes& To protect oral tissues in patients with oral parafunction. To stabili'e unstable occlusion.. To promote $aw muscle relaxation in patients with stress related pain symptoms li!e tension headache and nec! pain of muscular origin. To eliminate the effects of occlusal interference. To test the effect of changes in occlusion on the TM# and $aw muscle function before extensive restorative treatment TYPES OF OCCLUSAL SPLINTS According to Okeson: Stabili'ation appliance Anterior repositioning appliances
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AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

Other types& Anterior bite plane (osterior bite plane (ivoting appliance Soft"resilient appliance According to Dawson: (ermissive splints" muscle deprogrammer Directive splints" non%permissive splints PERMISSI E SPLINTS: Are designed to unloc! the occlusion to remove deviating tooth inclines from contact. This eliminates the cause and effect of muscle in co%ordination. The condyles are then allowed to return to their correct seated position in centric relation if the condition of the articular components permits. (ermissive splints are often referred to as muscle deprogrammers. The two classic designs of permissive splints are anterior midpoint contact splints and full contact splints. )xamples of anterior midpoint contact splints include nociceptive trigeminal inhibition *+T,- splint .ucia $ig and the / splint and the example of full contact splint is centric relation splint. Directive splints& Are designed to position the mandible in a specific relationship to the maxilla. The sole purpose of a directive splint is to position or align the condyle%disc assemblies. The $aw to $aw relationship that results from maximum intercuspation with the splint determining where the condyles must be at the intercuspal position. Thus
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AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

directive splints should be used only when a specifically directed position of the condyles is required. Anterior repositioning splint is a directive splint. Ma!i""ar# or $andi%u"ar s&"ints' (roviding the requirements of full occlusal cov% erage posterior stability anterior guidance and use of an appropriate material are met it mat% ters little whether a splint is made on the maxil% lary or mandibular arch. ,n 0lass , and ,, incisor relationships it is easier to produce an ideal occlusion on a maxillary appliance while the converse is true in 0lass ,,, situations. STA(ILISATION ERSUS REPOSITIONIN) SPLINTS 1am$ford and Ash originally described the stabilisation or Michigan%type splint for which detailed fabrication and use will be covered in the final section of the paper. ,t is a full coverage maxillary splint made from laboratory processed acrylic resin which provides anterior disclusion and stable ,0( contacts between a generally flat surface and the opposing teeth. ,t does not see! to actively reposition the mandible into a predetermined position. ,t is impossible at the outset to predict the extent and direction of mandibular repositioning and any attempt to guide the mandible more actively with the splint may actually prevent stabilisation of the retruded position. Stabilisation splints through causing muscle relaxation may also aid the repositioning of a displaced meniscus providing the displacement is neither too severe nor too longstanding. The use of splints which see! to reposition the mandible in a predetermined position has been advocated particularly in cases of internal derangement where some studies have shown them to be more effective than stabilisation splints. They possess occlusal surfaces with well%defined fossae into which the opposing teeth locate with the mandible in the desired position.
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AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

The problem with the use of such splints is that they may not achieve the desired masticatory muscle relaxation& also it is excep% tionally difficult if not impossible to predict exactly the position in which the mandible should be located. This position is generally downward and forward from the habitual ,0( the rationale being that the stress on the disrupted $oint components will be relieved per% mitting them to gradually realign. They also have the considerable disadvantage that following repositioning of the meniscus the patient may be left with a posterior open bite. ,f this occurs occlusal contacts may gradually reestablish through supraeruption. Sometimes orthodontic treatment may be necessary to reestablish occlusal stability. /ecause of the difficulties in use and the possible irreversible changes which may be caused to the patient2s occlusion the use of these appli ances in general practice is recommended only with caution and in experienced hands. STA(ILI*ATION SPLINT: Stabili'ation splint is also !nown as the superior repositioning splint the Tanner appliance the Michigan splint the 3ox appliance or the centric relation appliance. The stabili'ation splint is a hard acrylic splint that provides a temporary and removable ideal occlusion. (roviding an ideal occlusion by the use of splint therapy reduces abnormal muscle activity and produces neuromuscular balance. ,t is suggested that patients should wear the splint only at night. The splint needs to be ad$usted *rebalancing of the splint to the new position of the $aw by grinding some of its surface points since the lower $aw will adopt a new position as a result of wearing the splint- over several visits as the masticatory muscles relax until a consistent $aw relationship is reached. The
4

AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

patient should be reviewed at regular intervals. After a period of successful splint therapy *between 4 to 5 months- patients can be weaned off the splint. A stabili'ation splint provides centric relation occlusion eliminates posterior interference provides anterior guidance and gives stable occlusal relationships with uniform tooth contacts throughout the dental arch. Indications: The stabili'ation splint is most efficacious for masticatory myalgia and TM# arthralgia especially if the pain is worse upon awa!ening. This type of splint can also be used during the day for oral habit management. Such splints are designed to provide postural stabili'ation and to protect the TM# muscles and teeth. The centric relation splint is generally used to treat muscle hyperactivity. Studies have shown that wearing it decreases parafunctional muscle activity. (atients with myospasms or myositis are best treated with centric relation splint. The symptoms of patients who experience trauma or suffer an inflammatory $oint disorder and have a co%existent factor of parafunctional activity are managed successfully with centric relation splint therapy. ,t is also used in reducing symptoms from parafunctional activity associated with increased levels of emotional stress. 0areful ad$ustment of the stabili'ation splint is an important step as muscle activity changes and edema subsides.

AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

Acute pain can be caused by inflammation in intracapsular TM# tissues. They may swell or shrin! during different stages of the disease period. 1epeated ad$ustments may have to be made for quite long periods ANTERIOR (ITE PLANE The anterior bite plane is a hard acrylic appliance worn over the maxillary teeth that provides contact with only the mandibular anterior teeth. ,t is primarily intended to disengage the posterior teeth and thus eliminate their influence in the function or dysfunction of the masticatory system. Anterior $ig .ucia $ig 6awley with bite plane anterior deprogrammer and Sved plate are types of anterior bite plane.

Indications Treatment of muscle disorders related to orthopedic instability or an acute change in the occlusal condition. (arafunctional activity associated with unfavorable posterior tooth contacts can also be treated but only for short periods. ,f the appliance is worn continuously for several wee!s or months it is li!ely that the unopposed mandibular teeth will supraerupt. 7hen this occurs and the appliance is removed it results in an anterior open bite. Anterior bite plane therapy must be closely monitored and used only for short periods. ANTERIOR REPOSITIONIN) SPLINT

AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

The anterior repositioning splint induces a therapeutic mandibular position forward to the maximum intercuspation position of the patient and affects the physiological topographical relationship of the disc condyle complex. The anterior repositioning splint places a patients mandible and TM# into an anterior position so as to reduce a TM# clic! that occurs on opening and closing of the $aw. The anterior repositioning splint is typically placed on the maxillary arch with an anterior ramp that first engages mandibular teeth on initial closure and shifts the $aw forward into final closure when all mandibular teeth contact the splint. This position provides a more favorable condyle disc relationship in the fossa so that normal function can be established. The goal is to eliminate the signs and symptoms associated with disc%interference disorders. The treatment goal is not to alter permanently a mandibular position but ideally to alter only temporarily while normal condyle disc complex function returns. Once the function is again optimal treatment consists of gradually eliminating the splint and returning the patient to preexistent normal condition.

Indications Anterior repositioning splints can be efficacious for intermittent $aw loc!ing with limited range of motion especially upon awa!ening or for persistent TM# arthralgia not responsive to other therapy *including a stabili'ation splint-. They are recommended only for short%term use because they can cause occlusal changes if worn continuously or chronically.Anterior repositioning splints are used primarily to treat disc% interference disorders.

AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

(atients with $oint sounds such as single or reciprocal clic!s can sometimes be effectively treated with this type of splint. ,ntermittent or chronic loc!ing of the $oint ,nflammatory disorders *e.g. retrodiscitis+OIS DEPRO)RAMMER The 8ois Deprogrammer *8D- is a palatal%coverage maxil% lary acrylicdevicewithaflatplanelingualtotheanteriorteeth.,tseparates thedentalarchesandprovidesasinglelower%centralincisorcontact againsttheanteriorbiteplane.The8Dcanalsobedescribedasa 6awleyappliancewithamodifiedanteriorbite plane.

A&&"ications o, t-e +D ,tcanbeusedforsimplifyingdifficultbite registrations and for accurate mountingofdiagnosticcasts forpatientsthatare difficulttomanipulate into01 andforfacilitatingocclusal ad$ustments*duringwhichtimeit isworn-. The8Dcanbeusedasa diagnostictooltodetermineifthe

mandibleneedstomoveintheanteriororposteriordirection toreach 01frommaximalintercuspalposition*M,(-. Thedeviceisalsoused abnormalocclusalattrition.

8

todifferentiateamongthreetypesof

AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

0onstrictedpathofclosure*0(0-&Attritionoccursduring closureintoM,(whenanterior interferencescreateadistal thrustthatmovesthecondyles distalto01 Occlusaldysfunction&Occlusal attritionasaresultofexcessive

grindingtriggeredbyinterferencesontheposteriorteeth. The$awisnotmanipulatedinto01 butisdeterminedbythe patientandisreproducible.This isa!eycriteriontodetermine ifthe patientisdeprogrammed. Thepatientmustbeableto closeintothe sameposition everytime passively without anyguidanceorexternal force. Thepatientcanbeobserved whenclosingintoareproducible01 mar!.Thispositioncan againbeverifiedwhenthebite registrationis ta!en. Thepatient shouldma!ethesamemar!on theapplianceduring thebite registrationaswasmadeduring theinitialrecording. Thebite registrationista!enwiththeapplianceinplace.Thisallowsgreat controlofthe verticaldimensionofocclusion *9DO-duringbite registration.,tisusedtofacilitateanocclusalad$ustmentoncethe deprogrammingiscomplete. Thesameappliancecanbe used.:seof the8Densures occlusal thatthedeprogrammingwillbemaintainedduringthe opened9DOof ad$ustment.,tcanbewornataminimally

approximately ;mminthemolarregion. This closedpositionisoftenmore comfortablethanappliances

thatrequireamuchgreater 9DO.Thisalsoma!estheappliancemore estheticifneededfor daytimeuse. ,tisself%ad$usting.Thereis only oneincisortoothcontact againsttheappliance.Asthe musclesrelax thecondylesarefreetomovewithnoobstaclestopreventthemfrom
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AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

achieving anequilibriumpositionin01. Thissavesmultiple

ad$ustment appointments.

FULL CONTACT PERMISSI E SPLINTS The benefits of full contact permissive splints include& ;. elimination of discrepancies between seated $oints and seated occlusion *01 < M,4. a large surface area of shared biting force 5. reduced $oint loading =. ideali'ed functional occlusion >. the opportunity to observe for occlusal and $oint stability over time 3ull contact permissive splints can be made on the upper or lower arch. .ower splints have certain advantages that ma!e them a favorite for many experienced clinicians. These advantages include& ;. fewer speech changes *compared with upper splints4. lower visibility in social settings 5. shallower anterior ramps =. less tooth soreness when retention is gained exclusively on the lingual of the lower posterior teeth >. better patient compliance when instructed to wear their splints during the day as well as at bedtime

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AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

FUNCTIONS OF OCCLUSAL SPLINTS )uide Cond#"e.disc Asse$%"# to More Sta%"e Position The basic function of the occlusal splint is to prevent the existing occlusion from controlling the maxillo%mandibular relationship at maxi% mum inter%cuspation. A properly balanced splint results in an occlusion associated with relaxed positioning elevator muscles allowing the articu% lar disc to obtain its antero%superior position over the condylar head.Splint therapy can utili'e centric%relation as a physiologic treatment position. 7henever reorganisation of the occlu% sion is required it is essential to precede restor% ative procedures with a period of splint therapy to ensure that a stable relationship has been achieved. Musc"e Re"a!ation The tooth interferences to the centric relation arc of closure activate the lateral pterygoid muscles posterior tooth interferences during excursive mandibular movements cause hyperactivity of the closing muscles. Occlusal splints promote muscle relaxation by providing a platform for the teeth that allows for equal distribution of tooth contacts immediate posterior tooth disclusion in all movements *with anterior guidancecomfort. Pro/ide Dia0nostic In,or$ation Occlusal splints provide diagnostic information in different ways. The dentist can determine parafunctional habits anterior guidance requirements as well as obtain information about vertical dimension from patients who wear a splint. 7hether or not bruxing is continuing can be monitored by observing wear facets created on the splint surface.
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and reduced stress on the $oint.

+euromuscular harmony that follows provides for optimal function and

AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

Protect Teet- and 1aw (atients who are prone to nocturnal bruxism *?the grinding or clenching of teeth at other times than for the mastication of food.@- should routinely wear occlusal splints at night because the splints protect the teeth against wear as the wear occurs against the splint. Also the splints reduce stresses on the individual tooth due to more teeth contacts of equal intensity. ,t is important to remember that splints do not prevent bruxismA rather they distribute the force across the masticatory system. These appliances can decrease the frequency but not the intensity of the bruxing episodesB. 7hen capillary perfusion pressure is above 4> mm 6g cellular hypoxia can ta!e place. 7hen the patient clenches without the splint pressure may exceed 4CC mm 6g but pressure remains less than 4> mm 6g when clenching is with the splint. 7ith compression of the vessels the affected area has reduced blood flow which adversely affects normal function and wound healing. Selection of the Occlusal Splint. A careful medical and dental history along with a thorough examination is necessary for those patients with facial pain TMD or bruxism. T2E TYPE OF SPLINT UTILI*ED IS DEPENDENT ON T2E DIA)NOSIS ;. ,f the patient reports bruxism and headaches but no TMD the use of a full% coverage splint at night in which acrylic covers an entire arch of teeth is often adequate to protect the teeth. ,f the patient clenches isometrically a full%cov% erage maxillary guard with all of the teeth in contact is appropriate. ,f the patient demon% strates parafunctional movement in lateral and protrusive directions a splint for the man% dibular teeth will be effective. 7ith parafunctional movement laterally a man% dibular splint that does not touch all
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AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

of the anterior teeth is acceptable *it must touch the cuspids for guidance-. A minimum of a =%mm increase in vertical di% mension is necessary to protect bruxing pa% tients. ,f the patient is wearing a splint = mm in thic!ness and still experiences muscular soreness headache and"or facial muscle tightness immediately after wa!ing splint thic!ness should be increased incrementally until symptoms disappear. 4. 7hen a muscle disorder is suspected in TMD patients bite plane therapy may be used. Muscle disorders are initiated by hyperocclusionA bite planes separate the teeth allowing the muscles to relax. 3ull%coverage stabili'ation splints which are flat plane splints covering the entire dental arch can also be used and may be the treatment of choice for unreliable patients. ,n general muscle disorders are effectively treated with appropriate splint therapy *bite planes and stabili'ation appliances-.

5. ,f combination of muscle and disc disorders are identified *i.e. clic!ing of TM# with muscle pain- stabili'ation splints are the treatment of choice. They provide long%term wear that is usually needed. They also cover the entire dental arch ensuring that the covered teeth do not move. They must be worn continually for 4= hours for as long as required to elimi% nate muscle disc ligament and tooth symptoms. Three to B months of wear is often required. =. ,f advanced disc and muscle disorders are identified *$aw loc!ing and"or noises pain% ful $oints- stabili'ation splints are the treat% ment of choice which must be balanced to accommodate the specific needs of the patient. Splints may need to be worn for B months to 4 years depending on the patient.

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AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

>. ,n acute trauma anterior repositioning appliance for D to ;C days is required to !eep the condyle away from the retrodiscal tissues so that the inflammation can subside. Patient Reca"" ,f an occlusal splint is being used only as a night guard to protect teeth or restorations it is advisable to review the patient after D days to chec! whether their occlusion has remained stable and to read$ust if necessary. The patient must be reviewed and the splint re%ad$usted at wee!ly intervals for as long as is necessary to achieve a stable retruded position if the splint is being used to treat mandibular dysfunction. The time necessary for this to occur may vary from a couple of wee!s to several months. The splint must be continually monitored and ad$usted to ensure equal contacts on all teeth with immediate disclusion of the posterior teeth in all movements. ,f splint therapy was initiated to treat mandibular dysfunction no irreversible alteration to the patient2s occlusion *equilibration- is generally needed. The patient may be gradually weaned off the splint but told to wear it if their discomfort returns which is often at times of stress.

SOFT SPLINT This is the most commonly prescribed splint. ,t is quic! to fabricate and can be provided as emergency treatment for a patient who presents with an acute TMD. This splint is more readily tolerated in the lower arch than the upper arch as there is no satisfactory way of thinning the margins of the splint while !eeping good retention. This means that if the splint is made on the upper arch the patient is sub$ected to a thic! ridge of polyvinyl in the palate which often ma!es the splint difficult to tolerate.
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AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

The only record needed is a lower alginate impression as the splint is not made to a specific occlusal prescription but while cheap and easy to fabricate cannot be readily ad$usted. ,t should be stressed to the patient that in approximately ;CE of cases these appliances will ma!e the symptoms worse. This is especially true in patients who are dedicated bruxists as they are so aware of having something compressible in the mouth they actually increase the activity rather than decrease it. These appliances are usually worn only at night and if they are to be successful will produce some symptomatic relief within B wee!s. They should be replaced after =%B months as they lose their resilience with the passage of time. The appliance is generally made out of 4 mm polyvinyl. ,f a thinner splint is required the laboratory can be instructed to overheat the material before vacuum forming and if a selectively thic!er appliance is required *for instance in a patient with an anterior open bite- then layers can be added in certain areas *i.e. anteriorly- to ensure even occlusal contact. ANTERIOR DEPRO)RAMMERS AND DEPRO)RAMMER TYPE APPLIANCES Anterior deprogrammers and deprogrammer type appliances have gained popularity in the past several years but patients suffer from the same or worse to clench on the TM# problems that they started with if the patient continues now applied to

anterior contacting surface. The same posterior occlusal nocturnal forces are the TM#s and not the posterior teeth because the muscles posterior contact on the splint to continue to close forcefully while there is no

protect the TM#s.MagnussonFs study provided an interesting comparison between a stabili'ing appliance and a popular anterior deprogrammer type appliance.

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AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

?,f you are using an anterior $ig deprogrammer type splint remember the peripheral system *0entral (attern generator- is relatively inactive during sleep and is unable to prevent the patient from biting with great force.@ Day time bite force < ;B4%;G> lbs during the day% +ishigawaA Hibbs .undeen Mahan During sleep < 4.>x%>x greater forces during sleep % +ishigawa A Hibbs .undeen Mahan Hibbs .undeen Mahan #(D ;IG; ;IG= ;IGB Anterior Deprogrammer type splints ?Do not use them if the patient continues to clench and or grind on the anterior deprogrammer type appliance and scratches are seen on the appliances.@ ?This will cause in$ury to the TM#s.@ ?,f a patient continues to clench on an anterior bite plane the biting forces will be directed onto the disc causing in$ury.@ Anterior deprogrammer splints& ?The contacting surface should also be flat. An angled contact will tend to drive the condyle posteriorly as the patient clenches causing pain from the TM# structures.@ MIC2I)AN SPLINT ,ndications for a mandibular Michigan splint J Angle 0lass ,, molar relationship *subdivision4J Accentuated curveof Spee J Accentuated deep bite J Absence of mandibular canines )fficacy of and indications for the Michigan splint The Michigan splint reduces asymmetry in the muscular activity. The signs and symptoms of TMDs are reduced during the therapy with the splint but may reappear after interruption of treatment. The use of an occlusal splint reduces the pain muscular tiring and limitation of mouth opening.A splint of soft resin does not
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AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

seem to reduce the muscular activity with the same effectiveness as a splint constructed of hard resin. Activity of the masseter and temporal muscles electromyographically recorded is reduced after the use of an occlusal splints. The Michigan splint has positive effect over the short term *5 months- on muscular pain and in minor measures of articular pain. 6owever consensus is lac!ing regarding the mechanism of the action of canine guidance& there do not seem to be clinical differences compared with group function guidance. The canine guidance on the splint produces an increase of activity in some muscles and a decrease in others. The Michigan splint is a reversible conservative minimally invasive easy to prepare and low%cost means of therapy. 0onsequently occlusal therapy with a Michigan splint is indicated for dysfunctional patients with either muscular or articular problems. 3or dysfunctional patients who need prosthetic restoration the splint is indicated in the preliminary or provisional phaseA during the restorationA and after the completion of the restoration. /efore an extensive prosthetic restoration occlusal therapy with a splint is used to induce muscular relaxation to create an acceptable level of mandibular manipulation and to reduce or avoid damaging parafunction. During an extensive prosthetic restoration it enables an evaluation of the clinical changes thus limiting errors because it is reversible and simple to use and can be combined with other principal therapies. After an extensive prosthetic restoration a splint may play a protective role for the actual rehabilitation.

CRAN2AM DEPRO)RAMMER

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AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

(alatal bite plate with discluding element Opposing centrals contact only ,deal for equilibrium cases. 9aulted palate or good lingual undercuts necessary for retention NTI3Nocice&ti/e tri0e$ina" in-i%ition s&"int4 The direct stimulation of the periodontal ligament of the lower incisors activates a feedbac! loop which significantly limits the contraction intensity of the closing muscles. This is because of the nociceptive trigeminal inhibition *+T,- reflex.The +T, appliance ta!es advantage of this reflex via an acrylic guard worn on either the mandibular or maxillary incisors. ADVANTAGES

More comfortable. .ess chair time More effective

INDICATION

Tooth wear from bruxing and clenching Muscle pain associated with muscle dysfunction Diagnostic treatment planning The +T,%tss protocol is indicated for the prevention of medically diagnosed migraine pain and $aw disorders through the reduction of trigeminally innervated muscular activity.

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AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

ONTRAINDICATION Advanced periodontal disease Severely worn centrals ,ncompatible occlusal scheme

Co$,or.Cr#" 0omfor%0ryl is a combination of a patented thermoplastic elastomeric acrylic called Talon and a lamination of hard acrylic on the occlusal surface. The accurate fit of Talon eliminates the need for metal clasping and extensions onto soft tissue resulting in unaffected periodontium and improved phonetics. ,t provides patient comfort and the absence of orthodontic pressures provides excellent patient compliance and clinical efficacy. The 0omfor%0ryl appliances can be used in nightguards TM# splints and sleep disorder appliances F"at occ"usa" &"ane s&"ints 3lat occlusal plane splints *also referred to as a nightguard bruxism- are used to treat symptoms when no $oint clic!ing is present. 7hen fabricated on the maxillary arch these flat occlusal plane splints are full%coverage splints with an even flat occlusal surface for opposing tooth contact and they utili'e 4 ball clasps for retention. The upper nightguard *:niversity of (ennsylvania- is a flat plane splint that covers all maxillary teeth without any palatal coverage *no tissue contact-. The upper model is surveyed and the splint is fabricated so that the acrylic terminates on the labial buccal and lingual survey lines to ensure maximum retention. This is the most comfortable design for the patient because it reduces the bul! of acrylic used

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AN APPROACH TOWARDS BETTER LIFE -THROUGH SPLINTS

20