Eight Questions on Intraoral Splint Concepts: an Interview with Prof. Rudolf Slavicek

Abstract

1. What do you think of a soft splint versus hard resin? RS: My viewpoint is based on the fact that teeth are hard structures. Therefore it makes sense to adhere as closely as possible to this fact when using a splint. A soft splint does not reduce muscle activity, but induces permanent movements. One explanation for the therapeutic mechanism of splints is the pacification of musculature. I personally believe that soft splints are contraindicated. 2. What are your recommendations about the anterior occlusal stop (like some pre-fabricated products)? RS: There is an old rule: hyperactive musculature and especially conditions associated with painful joints cannot be treated with anterior occlusal stops alone. Such devices are contraindicatedinthesecircumstances.TheShorePlate,asa typical example of an anterior occlusal stop device, is designed with an anterior stop and no lateral support. Another concept was the Schulte Interceptor. However, Schulte demands exact observation of the jaw joints – he always warns against the possibility of joint compression. Besides, he limited the use of this device to a maximum of one week. New devices equipped merely with a small anterior support are now available in the market. They may be indicated for short-term deprogramming but how does one prevent the patient from swallowing this little object? Of course an overloadoftheanteriorteethisfeasible.InanycaseIstrongly recommend adherence to Schulte’s rules: temporary therapeutic application and exact observation of the course of treatment. 3. What are your indications for a splint? RS: First, reduction of muscle activity. Such splints are known as Relaxation Splints or Myopathy Splints. Second, unloading joint structures. I do not use the term “decompression” in such situations. It’s not active distraction. Rather, it signifies a release of joint structures. The joint is moved forward and to a small extent downward. Third, a verticalisation splint in those cases in which verticalisation is indicated. The last indication is joint reduction using the so-called reduction splint. The use of such devices has declined in recent years. A discus in good shape and condition is a precondition for the use of such splints with the mandible in protruded position. A new approach to reduction splints is the Delta Y splint introduced by Alain Landry from Canada. Delta Y is defined as transverse displacement of the mandible to the left or the right. This shift must be taken into consideration and appears to be an important diagnostic finding. It exerts a significant impact on the success of a splint. I really do think this approach will increase the success rate in patients with lateral displacement of the mandible.