The Ultimate Guide to Occlusal Splints

The Ultimate Guide to Occlusal Splints image

As the global cosmetic dentistry industry expands to $30.1 billion by 2025, increasing patient desire to protect cosmetic dental work is driving demand for dental splints.

Occlusal splints have long been used to effectively treat a range of TMD and TMJ disorders, bruxism, headaches and neck pain. While dental splints certainly remain a useful treatment for these conditions, more dentists are seeing occlusal splints as a preventative treatment to protect and preserve dentition in patients that are not necessarily afflicted with a TMD or TMJ disorder.

That approach makes occlusal splints a natural fit for the long-term protection and preservation of many cosmetic cases — including crowns and implants. And with the growing global cosmetic dentistry market forecast to be worth a staggering $30.1 billion by 2025, there is a significant business opportunity for savvy dentists to package dental splints as part of a long-term dental protection and preservation plan for patients who have invested in cosmetic dentistry.

Occlusal splints are not just helpful for protecting cosmetic work. While regularly occurring sleep bruxism affects around eight percent of people, almost everyone will experience isolated incidences of stress-related teeth grinding. That makes dental splints an excellent solution for diligent patients who have committed to good general oral health, and care about protecting their natural enamel from the threat of generalised night grinding and clenching — particularly during stressful times.

In fact, at Avant dental laboratory, we saw a 71% growth in splints in the last quarter of 2020 compared to the same period in 2019. We recorded a staggering 129% growth in splints for the first quarter of 2021 as even more dentists in Australia are embracing the versatility of occlusal splints for the protection and prevention of general dentition in addition to effectively treating patients with diagnosed TMD, TMJ and bruxism.

What are the latest in splint materials and technology?

Dental splints were historically manufactured from hard acrylic materials that were prone to warping during the curing process. This made a precise fit difficult to achieve, and poor fitting occlusal splints often caused patient discomfort. This has been largely corrected today with more advanced manufacturing techniques and more sophisticated materials including hard resins used in conjunction with acrylics. That continues to make acrylic hard splints still very useful today in treating severe teeth grinding or clenching where strong protection of opposing dentition is required.

Thermoplastics — sometimes used with hard acrylic or resin — have been introduced in more recent years to improve patient comfort and fit. Thermoplastics are made from a liquid monomer and powder polymer that are heat cured. This gives thermoplastic occlusal splints greater flexibility to drastically improve patient comfort while also retaining its original shape. Thermoplastic dental splints also deliver superior contouring ability, which further improves patient comfort and ensures a more precise fit.

While soft dental splints tend to be manufactured solely from thermoplastic, some occlusal splint types retain a hard acrylic or resin layer. This is particularly useful in treating TMJ. The hard acrylic layer is used to provide a more durable surface that maintains rigidity and protection against opposing dentition, while the thermoplastic base is more comfortable for the patient.

Perhaps the greatest advancement in dental splints has come in manufacturing. CAD/CAM milling, and more recently 3D printing, now provide much more precise contouring. This achieves a much better fit, which not only improves the treatment outcome, but also boosts patient comfort and therefore patient compliance. These more sophisticated manufacturing techniques have also drastically reduced clinical time with far less chair-side adjustments required.

The dentist simply takes an intraoral scan or physical impression. Physical impressions are 3D scanned and digitised at the dental lab, or intraoral scans are sent directly to the dental laboratory for review. The dental lab then uses specialised software to analyse the splint dimensions to minimise the occlusal thickness and reduce the risk of perforation or over bulking.

Once the digital splint design is approved, the dental splints are milled from a solid block of thermoplastic material or 3D printed.

What are the differences between occlusal splint types?

Type of Splint Hard Splint (traditional) Hard Splint (milled) Hard Soft Soft (3D Printed)
Material Hard acrylic Hard acrylic Thermoformed dual laminate material KeySplint Soft
Method of manufacture Heat processed CAD Milled Thermoform 3D Printed
Add on options Yes Yes No No
Design options Flate Plane, Michgan, NTI, Gelb Flate Plane, Michgan, NTI, Gelb Flate Plane, Michgan, NTI, Gelb Flate Plane, Michgan
Recommended Use Bruxism, Long Term Wear, TMJ Disfunction.
Not recommended for patients with cosmetic restorations
Bruxism, Long Term Wear, TMJ Disfunction.
Not recommended for patients with cosmetic restorations
Bruxism, Long Term Wear, TMJ Disfunction.
Best suited for protection of cosmetic restorations
Bruxism, Long Term Wear, TMJ Disfunction.
Best suited for protection of cosmetic restorations
Ease of fit Medium Medium Medium to Easy Easy
Comfort Medium Medium Medium to soft Soft
Repairable Easy Limited Limited Easy to be reprinted
Longevity Long term Long term Medium long term Medium long term
Records needed Upper or lower model with relevant antagonist.
Bite registration highly recommended
Upper or lower model with relevant antagonist.
Bite registration highly recommended
Upper or lower model with relevant antagonist.
Bite registration highly recommended
Upper or lower model with relevant antagonist.
Bite registration highly recommended
Repair instructions Consult with laboratory with sufficient records Consult with laboratory with sufficient records Consult with laboratory with sufficient records Consult with laboratory with sufficient records
Type of Splint Hard Splint (traditional)
Material Hard acrylic
Method of manufacture Heat processed
Add on options Yes
Design options Flate Plane, Michgan, NTI, Gelb
Recommended Use Bruxism, Long Term Wear, TMJ Disfunction.
Not recommended for patients with cosmetic restorations
Ease of fit Medium
Comfort Medium
Repairable Easy
Longevity Long term
Records needed Upper or lower model with relevant antagonist.
Bite registration highly recommended
Repair instructions Consult with laboratory with sufficient records
Type of Splint Hard Splint (milled)
Material Hard acrylic
Method of manufacture CAD Milled
Add on options Yes
Design options Flate Plane, Michgan, NTI, Gelb
Recommended Use Bruxism, Long Term Wear, TMJ Disfunction.
Not recommended for patients with cosmetic restorations
Ease of fit Medium
Comfort Medium
Repairable Limited
Longevity Long term
Records needed Upper or lower model with relevant antagonist.
Bite registration highly recommended
Repair instructions Consult with laboratory with sufficient records
Type of Splint Hard Soft
Material Thermoformed dual laminate material
Method of manufacture Thermoform
Add on options No
Design options Flate Plane, Michgan, NTI, Gelb
Recommended Use Bruxism, Long Term Wear, TMJ Disfunction.
Best suited for protection of cosmetic restorations
Ease of fit Medium to Easy
Comfort Medium to soft
Repairable Limited
Longevity Medium long term
Records needed Upper or lower model with relevant antagonist.
Bite registration highly recommended
Repair instructions Consult with laboratory with sufficient records
Type of Splint Soft (3D Printed)
Material KeySplint Soft
Method of manufacture 3D Printed
Add on options No
Design options Flate Plane, Michgan
Recommended Use Bruxism, Long Term Wear, TMJ Disfunction.
Best suited for protection of cosmetic restorations
Ease of fit Easy
Comfort Soft
Repairable Easy to be reprinted
Longevity Medium long term
Records needed Upper or lower model with relevant antagonist.
Bite registration highly recommended
Repair instructions Consult with laboratory with sufficient records

What are the different occlusal splint types?

There are many different occlusal splint types currently on the market. From hard to soft — or a combination of both — the type of occlusal splint you choose depends on the severity of the condition you’re treating and the outcome your patient wants to achieve. Here are some common occlusal splint types and how to use them:

Hard splint

Hard splints are typically manufactured from hard acrylic materials, and are made to fit over the upper or lower arch. Hard dental splints are fabricated with a flat occlusal plane to ensure a tight fit. This also provides even contact with the opposing teeth, which is particularly useful for protecting dentition in patients with moderate to severe bruxism, or in patients who frequently grind or clench their teeth. Hard splints are typically designed to be worn at night, and help to keep the jaw in a neutral position to reduce pressure. Hard splints will wear down over time, and may chip or fracture in extreme bruxism cases. As such, hard splints should be assessed for wear and replacement in regular patient check-ups.

Soft/hard splint

Soft/hard dental splints tend to be made from a combination of hard acrylic and softer thermoplastic material. Typically, a layer of hard acrylic is sandwiched together with a layer of softer thermoplastic to create a two-layer occlusal splint. The hard acrylic creates a durable outer shell to protect teeth from grinding and clenching. The inner thermoplastic layer fits directly over the teeth to improve patient comfort. Soft/hard splints can be made to fit over the upper or lower teeth, and are useful in the treatment of mild to moderate bruxism. As soft/hard splints are generally more comfortable than hard splints, they are also helpful for improving patient compliance. As such, soft/hard splints could be considered for use with patients who are particularly sensitive or apprehensive about using hard splints.

KeySplint Soft (3D printed)

KeySplint Soft dental splints and night guards have changed the game. KeySplint Soft dental splints utilise a fully biocompatible soft resin that is ideal for use in 3D printing. The soft DLP-optimised resin is an exceptional printing material for manufacturing flexible occlusal sprints. This delivers the strength needed to protect dentition against bruxism while improving patient comfort and avoiding chipping and fracturing. KeySplint Soft dental splints are fully compliant with international medical device regulations and standards, and are colour stable, transparent, polishable and stain resistant. KeySplint Soft also provides superior durability and wear resistance, and avoids fracturing over time. According to an independent study:

“KeySplint Soft’s unique modulus change with temperature adds a significant feature and benefit compared to heat processed acrylic as the latter material are known to become more brittle and prone to fracture over time. Thus the overall clinical longevity of these materials cannot be only characterised by wear resistance but also by overall function and utility.”

Customised splints

A good dental laboratory will be able to custom design a range of occlusal splint types — such as Michigan or NTI dental splints — to suit specific patients and active particular treatment outcomes for bruxism, TMD, TMJ and generalised teeth grinding or clenching disorders. Your dental lab will be able to call on a range of materials and draw on elements from different occlusal splint types to craft a custom dental splint that is highly personalised to each individual patient. For example, at Avant, we create customised dental splint designs prescribed to the clinician’s preference. All occlusal splint types are professionally designed by expert technicians in our dental laboratory and splint designs can be sent through to a clinician for approval if required.

Flat plane hard splint

Flat plane hard splints are typically manufactured from a hard acrylic material for superior rigidity and durability in patients with moderate to severe cases of bruxism or where other chronic teeth grinding or clenching behaviours are present. Flat plane hard splints enable full coverage with a flat occlusal table, and can be manufactured for the upper and lower arches. Your dental lab should be able to use digital milling to customise your indentation and coverage preferences for a more personalised and precise approach to protecting cosmetic dentistry, for preventing wear and treating teeth grinding and clenching-related disorders.

Flat plane hard/soft splint

Much like in the case of a flat plane hard splint, flat plane hard/soft splints use a flat occlusal table to enable full coverage, and can be manufactured for the upper and lower arches. The key difference comes in the use of materials. Flat plane hard/soft splints are generally constructed from a hard acrylic layer and a softer thermoplastic layer. The hard acrylic layer is used above the gum line to protect opposing dentition, while the softer thermoplastic layer is used underneath to improve patient comfort and provide a more precise fit. Flat plane hard/soft splints are particularly useful for treating moderate to severe bruxism where patient discomfort is limiting compliance with the use of a flat plane hard splint.

Michigan hard splint

The Michigan hard splint is a variation of the standard flat plane hard splint. It is typically designed for the maxillary or mandibular arch, and enables full contact of the opposing arch. The Michigan hard split can also be customised with the appropriate anterior or canine guidance. Some studies suggest that this approach is more effective to reduce muscle activity in TMD-related disorders, and has the lowest impact on oral structures when manufactured correctly. The Michigan hard splint is also typically used to provide joint stabilisation, protect dentition, redistribute occlusal forces, and relax the elevator muscles in the treatment of bruxism.

Michigan hard/soft splint

While the Michigan hard splint is typically manufactured from a hard resin material, the Michigan hard/soft splint adds a softer thermoplastic layer to improve patient comfort and therefore compliance. The hard resin outlet layer ensures the Michigan hard/soft splint is robust enough to withstand heavy bite forces in moderate to severe bruxism cases and not fracture under pressure.  Your dental lab can also customise the bite surface with precise spot grinding. Michigan hard/soft splints are generally used to protect the teeth from damage associated with bruxism. Full-coverage Michigan splints are typically used where chronic teeth grinding is present, while partial covered splints tend to be favoured for teeth-clenching conditions.

How can a dental lab help with occlusal splints?

Whether your patients want to protect cosmetic or restorative dentistry, save their teeth from preventable wear and tear, or treat chronic disorders such as bruxism, TMD and TMJ, your dental laboratory can help connect you with many different occlusal splint types.

You should be able to rely on your dental lab to help ensure the perfect dental splint fit and function for each and every patient. They should be able to provide expert advice on the best materials and occlusal splint types for individual cases to help you provide the personalised treatment solutions and outcomes that your patients expect.

Partnering with Avant will help you to better manage patient expectations and reduce clinical time while delivering the best dental experience to all. We are a full-service dental lab with a wide range of splint solutions available to ensure you’re always providing highly personalised treatments that are designed to achieve the best outcomes for your patients.

From expert pre-planning to real-time design reviews in our virtual lab, our expert technicians will be by your side to make sure the entire splint design and manufacturing process is a success.

We believe in industry-leading communication and you’ll have direct access to our expert technicians to make on-the-spot alterations. At Avant, we’ve also invested heavily in the latest digital technology and can support an entirely digital workflow.

And with more than 40 years’ experience working directly with dentists, we understand the pressure you’re under to meet patient expectations on tight timelines. We’re dedicated to taking the stress out of the process, and only manufacture dental splints in the best state-of-the-art facilities around the world, including right here in our Sydney dental lab.

That’s how we can deliver quality you can trust at competitive prices and on flexible turnaround-times to suit your needs and budget.

Want to find out more about partnering with Avant for all your dental lab needs?
Please email [email protected] or phone 1800 287 336.

This regular newsletter will deliver articles and information for business-minded dentists looking for ways to improve patient care and their businesses.

    Contact us