Last week teaching a hands on equilibration course one of the participants told a story about a new patient to his office who was in active appliance therapy and frustrated because the former dentist wouldn’t move to the next step of the treatment plan and the patient felt “stuck” in the appliance. His question to me was whether it was wise to move ahead with definitive restorative therapy. So when is appliance therapy complete? The answer to that question hinges on your reasons for placing a patient in an appliance.
Appliances are made to stabilize joints, muscles or the teeth based on patient symptoms or signs that were discovered during a functional exam. Appliances can also be made to seat condyles so we can work from centric relation or to help patients understand the relationship between their occlusion and what is happening. Based on the reason an appliance was recommended and fabricated we monitor increased stability and the disappearance or management of the signs and symptoms. One way to do this is through patient report, and it is very important to get feedback on how the patient is doing int he appliance and how their experience of any symptoms has resolved. The resolution of signs is monitored by repeating the aspects of the functional exam and recording the improvement.
Appliances should always be fabricated based on certain therapeutic and diagnostic purposes. If an appliance is not achieving these goals we need to evaluate the appliance. Often we need to refine the occlusion on the appliance to enhance it’s effectiveness. We tend to get stuck in this belief and continue to adjust appliances despite the evidence that adjustments are not improving the effectiveness. When well adjusted appliances do not accomplish the goals intended we need to rethink our diagnosis or clinical suspicion. Appliance therapy should be embarked on with specific goals and an expected time frame in mine that both the dentist and the patient understand.