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บางกอกสปลิ้นท์ สำหรับคุณหมอ (About The Bangkok Splint for Doctor)

About The Bangkok Splint

The Bangkok Splint (บทความเกี่ยวเนื่อง)

The Bangkok Splint is an orthopedic appliance designed by Schwan Somsiri, D.D.S. for elimination of signs and symptoms of TMD patients.

The Bangkok Splint is a full coverage type of splint seated in the mandible to provide orthopedic effect or stretching of the mandibular muscles by providing a spontaneous mandibular position changes e.g. increasing of vertical dimension and advancing the mandible.

Splint therapy should be the introductory treatment in all cases of temporomandibular joint disorders and migraines before other dental cares can be performed.

 

All of the cases share the same clinical characteristics, e.g.

Mutilated dentition

Clicking sound

Difficulties during jaw movement

Limited mouth opening

Deviation of mouth opening and closing

Muscle spasm

Molar loss (Loss of posterior support)

Molar tipping

Molar fulcrum

Trauma from occlusion

Group interferences

No canine guidance

Migraines (20 % of the case)

Condylar resorption & Crepitus

Mandibular entrapment

Mandibular shifting

Unilateral chewing

 

The Course Of Internal Derangements

 

Once the injuries occur to the joints e.g. extraction of molar teeth in different time line, and no restoration took place or after an accident the patient received improper treatment. The condylar head

 

  The normal joint will gradually undergo through these pathological process:

 

Stage 1-2           Started with clicking sound

                        Deviation of mouth opening and closing path

 

Stage 3              Difficulties during jaw movement

                        Limited mouth opening

                        One day the pain came

                        Disc perforation

                        Clicking sound diminished

                        Tinitus

 

Stage 4              Clicking sound disappear

                        Crepitus. Mouth opening regained

 

Stage 5              Crepitus

                        Function without disc

                        Degenerative joint diseases

 

The Bangkok Splint

The description:

1. The Bangkok splint is a horse-shoe shaped mandibular full coverage orthopedic splint.

2. Constructed in the patient’s individual NON-Clicking mandibular position (Stretching position or Orthopedic treatment) by having the patient bite onto the wafer waxed.

3. Raised Vertical Dimension (Thickness): At least 2 mm at the molar area

4. The amount of mandibular advancement approximately 1-3 mm or at edge to edge bite (bite registration in Class III is rare).

5. Mandibular shift is not taken into consideration.

6. It has 6-8 triangle clasps for optimal retention, and it can still function even though 2 clasps are broken.

7. It will program the mandible into –only one maximal centric stop (CO) with freedom of mandibular movement.

8. It has Bilateral Symmetrical Canine Guidance when possible.

9. It has Anterior Guidance when possible.

10. It was born in Frankfurt/M., Germany in 1982 and become the 8th World Wonder.

 

Clinical Management Of The Bangkok Splint

1st visit  Examination and Consultation
           Inform Consent signed
           Impression taking (2 Sets of Dental models are needed)

           Wax bite registration
              1st in CO
              2nd in NON-Clicking mandibular position
2 Weeks after:    2nd visit:  Insertion of The Bangkok Splint 

4 Weeks after:    3rd visit:   Check up. Grinding for better canine guidance and
                                     freedom of movement

6 Weeks after:    4th visit

8 Weeks after:    5th visit

8 Weeks after:    6th visit

6 months later, if ready, the signs and symptoms do not return, move to phase II treatment e.g. orthodontic treatment.

 

Problem with The Bangkok Splint

 

After insertion – Most of the patient become non-clicking immediately on the splint.

24-48 hours later

The patient with muscular pain or acute posterior capsulitis, as well as migraines, supposed to get better in 48 hours without medication.

4 weeks later, in some cases “Clicking” supposed to disappear with “Migraines” or less attack with milder degree.

If this is not the case, the patient  did not wear the appliance as prescribed !

If they say they have been wearing the splint as prescribed ! Go on using the splint !

If they say wearing the splint is uncomfortable, grind the splint for better freedom of movement. 

If muscle fatigue is experienced, the amount of advancement is too great.

3 months after insertion

   Clicking is persisted on one side only.

       Reline that side higher  or  grind the opposite side down (pivoting effect)

   Clicking is still there on both sides.

       Reline the splint for higher VD raised and better canine guidance or

       Fabricate a new splint.

3 months after insertion

     Obvious occlusal changes occur. The bite may get worse due to muscle relaxation

     Bilateral canine guidance is smooth, but at the end of closing path, there is a click in one joint. This means that the healing is getting better, now at the moment, the canine relationship on the splint is OK, but one of the disc (on that side) is medially displaced. Go on using the splint.

4-6 months after insertion:
Everything should be OK. The condylar-disc assembly is stable.

The patient is ready for Phase II treatment.

6 months or more after insertion:
Clicking is still there. This means that the condylar-disc assembly is not stable or the pathology has gone too far (Stage 3-4) or the patient is a nocturnal Bruxism.
   
Reline the splint for more advancement, and hope that it will work.

    Fabricate a new splint
6-8 months or more after insertion:
Light clicking sound or crushing sound is there. This means that the  pathology has gone too far (Stage 4-5)

12 months after insertion:
Clicking disappear. This means that the condylar-disc assembly is stable, but stability test is recommended. The patient is a nocturnal Bruxism.
The patient is ready for Phase II treatment.

 

Another reaction that could be found

       2 mouths after insertion:

         Obvious occlusal changes occur! The patient (Class II division 2) cannot function.  Perform phase II treatment with fixed multiband and bracket appliances (MBB)

        The Bangkok splint should be wearing for another 6 months, in the phase II treatment by cutting the stainless steel triangle clasps off. Grooves should be cut into the splint in the premolar area and use “RAM” elastics to fix the splint with the mandibular brackets.

        Inform the patient that the Bangkok Splint will work when the splint is in the mouth for at least 8 hours up/day. Inconsistent splint wear will not help at all especially the first 84 hours.

 

 

About The Author

Name:  Schwan  Somsiri

Born 13.03.1951 in Bangkok, Thailand

Education

     Triam-U-Dom Suksa School (2511)

     B.Sc., D.D.S.  Faculty of Dentistry, Chulalongkorn University, Thailand

     Department of Orthodontics, Hamburg University, Germany

     Department of Orthodontics, Frankfurt University, Germany

Clinical Practice

1982-1994   Lecturer, Senior Staff, Research Fellow at Department of Orthodontics, Frankfurt University, Germany

Research fields

       Differential Diagnosis and Treatment for Temporomandibular Joint Disorders and development of a new orthopedic Splint

       Dentofacial-Orthopedics. Early Treatment for young children with abnormal growth and development (Class II and III) without surgery

       Treatment for young children with Chronic Allergic Rhinitis and Upper airway obstruction syndrome and mouth breather by Rapid maxillary Expansion 

       Treatment of Migraine without medicine

       Surgical Orthodontic Treatment for Dentofacial-Deformities in 3 Dimension

 

     1996-now   Part time staff at Bangkok General Hospital

     1996-now   Founder and President of the S.O.S. Orthodontic Study Club

      2000-now  Founder and Managing Director of the Orthodontic and Jaw Joint (TMD) Center, Jaeng Wattana Road, Nonthaburi

      2005-now  Part time staff at Medical Unit of Kasetsart University

Author of 7 Clinical Orthodontic Manuals used at the Department of Orthodontics, Frankfurt University, Germany and the S.O.S. Orthodontic Study Club

 

สงวนลิขสิทธิ์     ทันตแพทย์ ชวาล  สมศิริ   

rev.  2012.04.04    

The S.O.S. Orthodontic Study Club

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โทร.  02-574-0555, 02-574-6556, 087-700-9919

More about TMD & The Bangkok Splint visit our

website : www.dental-tmd.com

email : schwansomsiri911@gmail.com

 File : About The Bangkok Splint 2012.03 for Doctor version.doc

Code  BKK Splint 02E

 

ปรัชญาการรักษาของทันตแพทย์ชวาล สมศิริ

กรณีศึกษา : การรักษาความผิดปกติของข้อต่อขากรรไกร ตามปรัชญาการรักษาของทันตแพทย์ชวาล สมศิริ (1987-1994 มหาวิทยาลัยแฟรงค์เฟิร์ต ประเทศเยอรมนี) เรื่อง ปรัญชาการรักษาของทันตแพทย์ชวาล สมศิริ กับกรณีของ Katie G.

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