all-ceramic restorations
Guarding Occlusion

Written by Andrew Sedler

Written by Andrew Sedler

Written by Andrew Sedler

Guarding Occlusion
WHAT IS REQUIRED TO ACHIEVE THE DESIRED RESULTS?
Bite Soft - Burbank Dental Lab - Best Dental Lab in US

Labs are often asked a variety of questions regarding occlusal guards, splints, such as:

  • What design type to use?

  • What materials are best?

  • What clinical records should be taken?

The goal of this article is to highlight what are desirable occlusal guard designs and what clinical records are required to achieve the desired end results. This article will provide a concise checklist for clinical records and Rx instructions for the lab. The basic design considerations will be covered; however, there is no such thing as a benign occlusion appliance. Any change to occlusion can affect the TMJ, head/neck muscles, and even the airway. By following some basic design rules you can safely and effectively deliver an occlusal guard on asymptomatic patients.

What You Will Learn In This Article

  • What are desirable occlusal guard designs
  • Basic design considerations
  • Why consider an occlusal guard as a treatment
  • Purposes of occlusal guards
  • Types of occlusal guards
  • Recommended designs
  • Appliances to consider using

Occlusal therapy is both an art and a science.

Every "Night Guard" should be regarded as a form of occlusal therapy. We must remember that any alteration of occlusion affects the entire mastication system and has potential effects on overall health. One size fits all does not exist!

Occlusal therapy is both an art and a science. Many patients will adapt and tolerate virtually anything you put in their mouth. However, on many other patients, you may have to use a series of appliances to discover that patient's specific appliance formula. This can be a diagnostic process.
Bite Soft - Guarding Occlusion

Basic Design Principles

On Which The Majority of Clinicians Agree

  1. Occlusal Guards should be fabricated on a flat plane occlusion with minimal interferences.
  2. No posterior function - at most, light contact at rest and immediate disclusion in lateral.

Options that some clinicians prefer:

  • Anterior glide plane - parallel to the occlusal plane - Kois Deprogrammer
  • Maxillary Lingual ramp to restrict lingual movement of mandible - BiteSoft
  • "Cuspid guidance" - to facilitate posterior disclusion - Ruiz

Why consider an occlusal guard as a treatment?

It is estimated that nearly one-third of people in North America are bruxers and clenchers. The forces generated during bruxism can be as much as six times the maximal force generated by normal chewing. Signs or symptoms of bruxism should be countered with a nocturnal CR-balanced splint prior to and after any restorative intervention.
 

Purposes of Occlusal Guards Include: 

(The purpose of this article is only to address "protective" occlusal guards. We will address the treatment of symptomatic TMD and Sleep Apnea in later articles. You should consider screening for sleep apnea and TMD. If patients present with symptoms of these conditions, they will require an advanced approach and may require the involvement of a medical professional in order to fully diagnose and treat.)

Types of Occlusal Guards

  • Permissive splints allow the teeth to glide unimpeded over the biting surfaces. Flat plane occlusal splints is an example.
  • Permissive guards are also referred to as muscle deprogrammers. These appliances facilitate condyle seating during a clench and will eliminate lateral pterygoid resistance to the Masseter and temporalis muscles, and provide relief from myofascial pain. 
 

 

Designs that have ramps or indentations that limit the movement of the mandible. 

 

Clinical Records Required

  • Recommended - Use a deprogrammer in order to take a CR Bite; Use Lucia Jig

    Lucia Jig - Fig. 1

  • Take a bite in CR Relationship

  • Use leaf gauge (see image below), Lucia Jig or cotton roll seat in their most anterior-superior position (CR).

    Leaf guage - Fig. 2

  • With the patient in this open centric relation, inject bite registration into the posterior and anterior openings.

  • Construction bite

  • Vertical opening to where you want the final appliance made - (3-6 mm anterior open bite, 1-2 mm posterior)

    Construction bit - Fig. 3

  • Impression

  • Accurate, void-free impression of both arches. For a precise fit, ensure that no tears or bubbles are present in the impression material. Alginate replacement PVS is recommended as it allows the lab to make duplicate models for verification of fit. Increase accuracy by using light body PVS on the occlusal surfaces to capture more details.

    Impression model - Fig. 4

Burbank Dental Lab
Burbank Dental Lab Laminated Success Guide

REQUEST YOUR FREE IMPLANT SUCCESS GUIDE BELOW

Success Guides

Recommended Designs

  • Facilitates condyles seating in their most anterior-superior position (that is centric relation (CR).

    Seat condyle - Fig. 5

  • Anterior Glide plane table - Smooth occlusal surface removes sensory feedback from interfering with tooth contacts and allows elevator muscles to move the mandible so that the condyles can slide posteriorly for complete seating in CR.

    Anterior glide plane table - fig. 6

  • The guard should not have any occlusal or cuspal indentations into which opposing teeth can lock and exert heavy lateral or thrusting forces.

  • Provides posterior disclusion ("canine guidance") NO posterior contact in excursions.

    Figure 7

  • Maxillary guards are preferred as they are better tolerated, more stable, avoid crowding the tongue, and achieve occlusal contact with all opposing teeth regardless of the maxillomandibular relationship.

  • Posterior open 1.2 to 2 mm. - anterior open 3-6 mm. (May need to be more in symptomatic patients.)

Burbank Dental Lab

Optimal Designs

  • Maxillary anterior repositioning ramp, to minimize the possibility of the mandible moving lingual and restricting the airway.

Appliances for Consideration

  • Kois Deprogrammer (no posterior occlusion, anterior glide plane)

    Kois Deprogrammer - Fig. 8

  • Ruiz Golden Rule Night Guard (equal occlusal contact spots, canine guidance - posterior disclusion in excursive)

  • BiteSoft® - (with lingual ramp & anterior glide plane)

    BiteSoft - Fig. 9

Occlusal guards are very important considerations for restorative and cosmetic treatment plans. A very high percent­age of patients have some sort of para-functional activity. A well-designed occlusal guard can facilitate a longer life for restorations and reduce the probability of future bruxism-related occlusal disease.

Did you like this article?

Let us know by giving us a clap!

4+

Top 10 Most Clapped Articles

Resource Center

Products

Slide 1

Fabrication
of the future
is here!

Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

Our New
State-Of-The-Art
3d Printers

Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.

Fabrication
of the future
is here!

Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

Our New
State-Of-The-Art
3d Printers

Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.