The B Splint is useful for rapid harmonization of occluso-muscle disorders. Its effectiveness is due to decreased muscle activity of the Lateral Pterygoids, Medial Pterygoids, Masseters, and Temporalis muscles created by malocclusion and/or parafunction (bruxism). Clinical EMG studies consistently show up to an 80% reduction in elevator muscle activity due to clenching.
Design of B Splint:
It is designed on the same principle as the classic anterior deprogrammer but can be used for an indefinite period of time when managed properly. Proper usage will not result in undesirable tooth movement.
Material: Biocryl “blank” (Great Lakes Orthodontics)
1mm thick for short term usage
2 mm thick for long term usage
For daytime use:
1. A single appliance is fabricated on either the upper or lower arch. A Biocryl “blank” sheet of 1 ½ or 2 mm thickness is heated and adapted to an unmounted cast using the Biostar(Great Lakes Orthodontics) positive air vacuum system. Block out any gross undercuts on the casts before processing.
2. Orthodontic acrylic is mixed to a doughy stage and luted with liquid monomer to the incisor surface of the blank appliance. It is hand formed to create a platform that is thick enough to disclude all teeth but the opposing central incisors. This is determined by observation in the mouth on closing and recorded on a communication slip to the laboratory (sample provided).
The platform should be 6-8 mm wide or approximately half the width of the two opposing central incisors combined. It should be long enough to touch when the mandible is in the fully seated joint position as well as extended on a smooth horizontal surface (labially on a upper appliance/lingually on a lower appliance) to stay in contact when the mandibular incisors protrude out to an edge to edge position with the maxillary incisors.
It is very important that the platform be level with the benchtop and thus create a perpendicular contacting surface for the opposing teeth. It is critical that no distalizing forces to the mandible be present when the appliance is in place.
The orthodontic acrylic addition is cured in a pressure pot for 10 minutes.
For nighttime use:
When sleeping we want the patient wearing a “Dual Appliance”, upper and lower together. The benefit of this approach is to cover all teeth at night, thus the patient is wearing muscle deprogramming retainers. This prevents tooth movement/bite changes. This approach also:
- prevents the patient from creating grooves in the B Splint from grinding at night
- levels the incisal edge plane to prevent irregular tooth heights that can create problems of sore teeth
- covers the two incisors that occlude against the B Splint that sometimes become sore
This second appliance opposing the B Splint should create a perfectly level and smooth surface for the patient to touch and function (or parafunction) against.
Design of opposing appliance:
A second Biocryl “blank” (1 ½ or 2 mm sheet) is fabricated on an unmounted cast of the opposite arch (upper or lower).
This will often have a thin addition of orthodontic acrylic, luted with monomer, over the incisors, to create a level incisal edge.
We call this a “runner bar”.
This addition of orthodontic acrylic is cured in a pressure pot for 10 minutes.
Instructions to the patient:
- Wear only the B Splint during the day.
- Take it out during meals which helps not only with eating but also to prevent any tooth movement of the non-contacting teeth of the opposing arch.
- Wear both appliances at night.
- Brush appliances daily with dentrifice.
- If wearing the appliance(s) cause any increased discomfort... take it out and call the office to be evaluated.
Note: This approach can be used for an indefinite period of time with no negative effects.
We typically find that occluso-muscle symptoms can be resolved within 1-4 weeks. At that time the occlusion is evaluated for any needed corrections and the patient will discontinue use of the appliances… unless, parafunction continues at night. If this is the case, even if the occlusion is corrected, then nighttime use of the dual appliances is indicated for an indefinite period of time.
Patients who may be on a “holding pattern” for occlusal/restorative therapy may use the B Splint dual appliances every night, and the daytime single appliance as needed…for as long as needed.
Posted on Monday, May 21, 2007
by Dewitt Wilkerson, DDS
filed under