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การรักษาความผิดปกติของข้อขากรรไกรด้วยสปลิ้นท์ (TMD Splints Treatments)

 
Splints Treatments
Another Aspect of the BKK Splints Treatments
 
Comparison of :
Michigan Splint or a Tanner Appliance or Robin Gray Splint vs.
The Bangkok Splint
 
There are a variety of splints available for use in the management of various temporomandibular disorders. A frequently made appliance is called a Stabilization Splint (also known as a Michigan Splint or a Tanner Appliance). This is an appliance which provides a balanced bite and removes any interferences to smooth jaw movement. When fitted and balanced, all teeth in the opposing jaw will touch the splint at the same time with the same degree of force. This reduces the bite force that the muscles can generate. This splint is used if you have a problem with your bite or if you are a heavy tooth grinder or tooth clencher. It is usually only worn at night. Here is an example of a stabilization appliance.
Attempt has been made to create anterior and canine guidance, but any how the design of the Michigan Splint is not based on the orthopedic principle, this is the reason why the 10 different splint designs including Michigan Splint show no long-term satisfactory respond, as proved by Dr. Somsiri at the Frankfurt University Clinic during 1982-1990.
 
If you have a problem with “Clicking” from your jaw joint and the click disappears when you posture your lower jaw forwards and open and close your mouth, then the splint of choice is an Anterior Repositioning Splint or “The Bangkok Splint” as described by Dr. Schwan Somsiri. This shows that the pathologic process is in the first or second stage. If treatment is initiated now, the chance to be completely cure are high. The BKK Splint is fitted on your lower teeth and guides your jaw downwards and forwards into a “Non-Clicking Position” from which you can open and close the mouth without the clicking sound and this allows the condyles to simultaneously reposition itself back onto the disc and maintain their relationship thru out the whole movement. The BKK Splint is worn full time for the first 48 hours except during eating and brushing. After this period of time, it will be worn as much as possible and is usually worn for six months.
 
The Bangkok Splint is the only Splint, whose design is based on the orthopedic principle. That is “stretching” the mandible and put elevator muscles under a stage of posing forward. The stretched muscles will be relaxed, provide circulation in the capillary system. Patients become “clicking-free” as soon as the BKK splint is inserted in place.
Patients become “pain-free” within 48 hours after the insertion.
 
With the advantage of the design of the Bangkok Splint in the mandible, make it easy to construct greater range of anterior and canine guidance. The mandible do not slip off the splint easily as seen on the Michigan splint, causing jerking movement.
 
 
The bite without an anterior repositioning splint in place.
 
Here is an example of a patient  after using a Bangkok Splint.
 
 
The Soft Splint
Bioplast splint (2  mm) (SCHUE Dental of Germany)
Night Guard or Mouth Guard
 
The frequently made splint is a soft poly vinyl appliance similar to a Boxer mouth guard. These are not made to fit any particular orthopedic prescription and are made with the suggestion that they will “absorb” some of the bite force. What does happen in actual fact is that these appliances allow an increase in the bite force and tooth grinding habit in a significant number of people as they are aware of having a soft compressible material between their teeth. This can often increase (stimulation) the rate of tooth grinding or tooth clenching. These material can wear very rapidly.
 
The Soft Splint can be used temporarily in the “closed lock” condition, where as the patient cannot open their mouth wide enough that make impression taking of the mandibular arch impossible. If the maxillary impression taking can be made, then the maxillary “Soft Splint” is indicated for 4 weeks, when the patient comes back and can open their mouth wide enough to make impression of the mandibular arch, then the Bangkok Splint can be made. The Soft Splint can be made in office. A vacuum molding machine (SCHUE Dental of Germany) will be needed.
 
An Option to increase the amount of the Patient’s mouth opening.
 
In order to relax the elevator group of the muscles of mastication, orthopedic massage as described by Dr. Schwan Somsiri is recommended.
After 30 to 45 minutes of orthopedic massage and 20 minutes of wet & warm compress, any close lock case can open their mouth wide  enough so that impression taking of the mandibular arch is possible.
 
When impression taking of the mandibular arch can be done, then the Bangkok Splint can be fabricated.
 
Orthopedic massage to the masseter muscles and other related muscles (muscle No. 1-6 read “Orthopedic massage technique” in our website) make it convenient for patient who live in a remote province far away from our office. We can make a full set of impression taking possible in the first visit. So the patient can save one trip.
 
Mandibular Orthopedic Repositioning Appliance (MORA or Gelb Appliance)
 
This is one design of splint which must be avoided to treat TMD case as an isolated appliance at all costs. Because it is a partial coverage appliance. These are sometimes made to cover the back teeth only because patients do not like the appearance of the splint covering their front teeth, where it is visible. What inevitably happens with the use of this appliance is, it can permits unwanted (extrusion of the anterior teeth), uncontrolled and unplanned tooth movement (intrusion of both maxillary and mandibular posterior segment) and can severely sink the bite if worn for longer period of time .
Another possibility to use the MORA is, should clicking occur during the intensive phase of orthodontic treatment. The author recommend to use it simultaneously with the fixed full strapped up edgewise appliance. The orthodontic treatment can go on while the clicking is controlled and the patient’s speech is not compromised.
 
Therefore it is recommended to use in conjunction with fixed full strapped up edgewise appliance in case of open bite (the lingual bar will be left out). The bilateral type of fixed mandibular posterior bite plate (PBP) will be bonded directly on the posterior teeth and the patient can function well in compare to the use of isolated composite build-up on the mandibular molars. 
The fixed mandibular PBP is the appliance of choice in treating open bite. It can intrude both maxillary and mandibular posterior teeth at the same time (in teenager or young adult)  and in combination with the use of “Anterior Box elastics”, open bite can be non-surgically closed within 6 months.
The fixed mandibular PBP is the appliance of choice in elimination of cross bite or palatally erupted tooth. When the bite is raised, those tooth can be easily move out into the correct alignment with lower level of energy.
 
 
 
Conclusions for Doctors:
The abovementioned appliances can be used in the following conditions:
 
Temporomandibular Disorders (TMD)
Myofascial Pain Dysfunction Syndrome (MPDS)
Internal Derangements
Degenerative  TM Joint Diseases (Ostearthrosis)
Trauma (Condylar Fracture) - Closed Reduction. Then follow by orthodontic fine tuning of the occlusion.
Treatments of TMJ Dislocation
 
Dr. Schwan Somsiri ’ s Recommendation:
 
Prevention of “Opening Locked Jaw” by 3 Fingers Manipulation
Use 3 fingers (Index, Middle and Ring fingers) of both hands by pressing firmly (hard) on both TM joints during yawning. This will provide additional strength to the capsular ligament and making hypermobility of the TM joint impossible.
 
 
 
References:  
 
File:  Another Aspect of the BKK Splints Treatments.doc
 

 

ปรัชญาการรักษาของทันตแพทย์ชวาล สมศิริ

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

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