J CranioMand Func 4 (2012), No. 1 12. Mar. 2012
J CranioMand Func 4 (2012), No. 1 (12.03.2012)
Page 79-94, Language: English/German
Two-stage approach to mandibular splint therapy with craniomandibular orthopedic positioning appliances
Boisserée, Wolfgang / Schupp, Werner
The restoration of normal temporomandibular joint function in static and dynamic occlusion can be the key the successful treatment of temporomandibular disorders (TMD), in many cases. An interdisciplinary approach characterized by close cooperation between the dentist, orthopedist and manual therapist is required for the individual patient. The dentist's job is to adjust the occlusion to the changes in jaw relationships that occur in response to functional normalization of the involved muscles, and to improve the patient's head and body posture. The craniomandibular orthopedic positioning appliance (COPA), a removable interocclusal appliance for reversible correction of the occlusion, is designed to eliminate the pathological interferences associated with temporomandibular joint (TMJ) dysfunction. As such, it is predestined for use as a primary therapeutic instrument in these indications. If the position of the temporomandibular joint changes over the course of treatment, further orthodontic and/or prosthodontic treatment may be needed after the completion of interdisciplinary treatment, to ensure the longterm, interference-free stabilization of the occlusion. If the clinical findings indicate that the occlusal splint has successfully eliminated the problems of infraocclusion, and that further treatment is needed, the removable occlusal splint can be transformed into bonded onlay elements in order to transfer the splint position with the highest possible precision, while maintaining the temporomandibular joint position achieved in the first stage of splint therapy. This approach allows the clinician to simulate the planned therapeutic occlusion before irreversible occlusal treatment measures are performed, in order to obtain the most accurate assessment of the effectiveness of the therapeutic occlusion based on the patient's subjective impression, as well as the results of interdisciplinary functional analysis.
Keywords: biomechanical wax-up technique according to Polz, bonded occlusal splint, craniomandibular system (CMS), dynamic occlusion, functional treatment, musculoskeletal system (MSS), orthodontics, prosthodontics, removable occlusal splint, static occlusion