You may have hear both positive and negative things about all soft occlusal appliances. A common conversation is that they will aggravate muscle signs and symptoms. It is true that some patients will increase the amount of clenching they do in response to the squish of a soft appliance. For patients with muscle signs and symptoms and a healthy condyle disc assembly a soft appliance would not be my first choice. Another factor to consider is the amount of grinding and tooth wear a patient has. Soft appliances will protect the teeth from wear, where hard appliances do still have the ability to cause tooth wear, albeit at a much reduced rate than tooth against tooth. Two considerations for patients with significant wear, will they grind through a soft appliance quickly and will a hard appliance continue to wear their teeth. There is a balance between these two and I have some patients for whom it makes sense to replace a soft appliance annually versus continued tooth wear against hard acrylic.
The major use of soft appliances in my practice is for patients with disc displacements. One group of patients have a lateral pole disc displacement that does not reduce. These patients can suffer from pain of translation from retrodiscal tissues being pinched. Creating balancing side contacts will support the joint in translation and make the patient more comfortable. It can be very difficult if not impossible to create balancing side contacts on a hard appliance depending on the patient’s condylar guidance. On a full coverage soft it is simple to produce this supportive occlusion. Additionally patients who have medial pole disc displacement may also feel more comfortable in a full coverage soft as it creates a fully balanced occlusion and supports the joint.
Full coverage soft appliances can be made from one or two thicknesses of 3mm soft material. You can have them fabricated by a laboratory, or make them in your office on a Ministar. The material is easily trimmed with special scissors designed for this purpose. When delivering the appliance, soften the occlusal tables with a flame while on the model. Place over the teeth and have the patient bite into the softened material, than cool. Once cool, use a silicone polisher to smooth the edges of the material where the occlusion indented it. These appliances are best “polished” with chloroform on a gauze.
I’ve never been too in favor of soft appliances. I worry that they promote more clenching. I prefer the hard Roth splint.
Thank you for this blog.
Lee,
I have this patient that has “pain from the shoulders up”. Some masseter and tempoalis pain. No popping or clicking (joint pain). She has noticible generalized attrition. Furthermore she has “two bites”. One looks like a standard CO bite with no anteror contact. The other looks like she postures to the left in protrusive – which she says is comfortable. I treated her first with a upper full arch splint with only CO contacts. We then tried an anterior bite plane. Nothing has made an impact so far. She has been suffering from these symptoms for 14 years. Other dentists and physcians have told her that her clinching may be a causitive factor. She has no disc displacement. Where should I go from here?
Brad
Brad,
I would start by asking her if there is a spot that she feels comfortable. If so, take a bite record there and fabricate a splint in this occlusion and see if it helps. If she doesn’t have any place she can get comfortable and the classic approaches to appliance therapy aren’t getting the expected results, I wonder if the cause is something else entirely, like temporal arteritis, fibromyalgia, etc.
Brad,
You are correct in utilizing a maxillary hard splint. What seems to be missing, and please correct me if I’m wrong, is the understanding of what to do with the splint once you have placed it. Stabilizing the condyal can take time especially in a pain patient and their road to stabilization can be a bit of a roller coaster at first. But understanding how to adjust the splint meticulously and verify that the joints are stable takes the knowledge of the complete system. We treat patients like yours every day with great success and we would be happy to let you speak to them about their journey to wellness.
Hi. Recently i have got a female patient age 44yrs. She complained of continuous pain on the left side of the face for a long time. Pain is more prominent on the angle of mandible and pain radiates to the head. Only masseter was little tender on palpation. Pt. Has big open bite. Can open bite causes this type of symptoms
The open bite may cause muscle pain, if she is parafunctioning and only has posterior tooth contact. Or the open bite may be a symptom of what is going on at the level of the joint.