we've got a patient that we fabricated an occlusal splint for and before we go ahead and insert the
splint and make any adjustments and deliver it to the patient let's take a closer look at the
condition on his teeth this patient is only 27 years old and you can see we've got somewhere
here on the lower anterior teeth already got somewhere on the lower cusp is as we pull in you
can see there's some chips on the incisal edges of the lowers here's the the maxillary anteriors
and you can see the ragged look to those teeth as well and you know the teeth otherwise look pretty
decent you can tell that he's you know probably not 60 or 70 years old but that's a lot of wear
for the age group that he's in considering that he's he's 27 and I just wonder what it's going to
look like 30 or 40 years later so this is exactly the kind of person who we're going to show this
to and say hey look here's what's going on in your mouth in fact here we've got him holding a mirror
so he can see some look at that and look how that upper and lower cuspid come together which is what
they are you know supposed to do as he slides into excursions but you can see we've got the lower
lateral hitting the upper lateral which is part of the wear pattern there we're already into group
function the first bicuspid is hitting the lower first bicuspid and you know we checked the other
side and we kind of show him what it looks like and you could see there he was biting together
in those were fitting together like puzzle pieces and there you go slides back over and bingo we've
got the two cusps it's hitting each other and then we've got the laterals hitting each other as well
and you know he's going to continue to wear these teeth down why not offer him an occlusal splint
why not offer him the opportunity to save wear and tear on his teeth over the next 20 years why
not put the burden of responsibility on to him by making a splint for him and now it's up to him to
wear it at night if he wants to save his teeth and it's not up to us and whether or not we're
going to give him the option of doing this is an easy thing for the assistants to look out
for especially the hygienist who are spending all that time with the patient as well so the
splint is in and because it's a hard soft splint there's literally I can't think of one time where
this hasn't fit if you take a good accurate impression so we're drawing the splint off here
with a couple of cotton rolls and then putting articulating paper on both sides you could use
an arch of articulating paper if you wanted to to be able to get the anterior at the same time
so we're just making some marks and taking it out and I mentioned earlier that we want to have one
opposing tooth mark for each of the opposing teeth an occlusal stop for each opposing tooth
and you can see we've got a few good ones on the one side and not as many on the other side
I can see a couple on the anterior so using a pear-shaped burr in an electric handpiece this
is a lab handpiece and this is really an easy material to work with this acrylic material on
the hard soft splint and I still prefer using a high torque low speed electric handpiece can you
do this chair sign with a high speed handpiece yes you can with an air turbine but I just don't like
the way that a carbide burr tends to dive into the material at those higher speeds so I like
to really do it slowly if you've got an electric high speed handpiece that's fine you can use it
with that but otherwise you know a lab handpiece and they're not all that expensive just to get an
electric handpiece that can sit chair side or sit in your laboratory you know if you want to get up
and move this back you know and take the splint back to the lab to make the adjustment so we made
one more small set of adjustments here and then we're going to go ahead and check the excursions
and see how the splint looks there do we in fact have the cuspid rise that we'd like to have those
cuspids obviously can handle a lot of stress in a lateral direction and so we're okay and we'd like
to see a cuspid exclusion on both sides of this splint and the hope with the hard soft splints
it's like I said with the delivery I've rarely had one that hasn't gone down into place and if there
is one that doesn't seem to want to go into place we put it into some I wouldn't say boiling hot
water but some really hot water and we'll put this splint in there for about 30 to 45 seconds take
it out shake it a few times and then push it onto the patient's teeth and that soft material on the
inside will readapt itself around the patient's teeth so unlike that full hard splint that I
talked about that we made for each other in dental school we have a material that will adapt itself
to the teeth so it's not so much hit and miss like it might be if we were using that full heart
splint where at either fits or it doesn't fit and we're going to check the interior here just
one more time as the patient bites down together for us so we can check and see what the marks look
like here and then we can go ahead and make any additional adjustments that need to be made and
then do any additional polishing that we need to do so we can see we've got some nice spots in the
area the cuspid had the patient slide forward and Patricia I can see some marks going forward
on the anterior teeth as well so this is pretty much doing what we want it to do for the patient
again this is a preventive occlusal splint this is not a patient who's having any problems with this
temporal mandibular joint so we just want to keep the teeth apart and him grind on the plastic if
he grinds on anything this is the Lisco disc this green disc you see me using it looks a little bit
like a scot bright scotch brite sponge that you might use in the kitchen these Lisco discs are
available from us from Glidewell direct I don't know anybody else actually who sells them here in
the States but they do a great job on this acrylic and other acrylics in terms of polishing them
they're not extremely abrasive and any marks that you've made with a carbide burr from an electric
camp piece can be smoothed out rather easily with this Lisco disc and you can go beyond that if you
want certainly you can use a felt wheel on a straight handpiece like that and move up and
use an acrylic polish if you want to but one of the things to keep in mind is that the patient is
going to be grinding on this surface so you know polishing it to a high shine like it was a veneer
or like it was a crown it's really not necessary and you can see there I really had to kind of grab
onto that and pull that out we make sure the patient knows how to put it in and take it out
themselves and here's my dental assistant Jennifer going over with the patient about how to take care
of it how to maintain it and when to wear it and we tell pretty much every patient the same thing
we want them to wear it every night and during the day during periods of high ecological stress
you