This is achieved by the patient wearing an occlusal splint (orthotic appliance) appliance in one arch (usually the maxilla). The appliance is adjusted so that all teeth contact on a flat plane in centric relation with a long anterior contact to centric occlusion. When in position, the carefully fabricated and adjusted bite plane should allow all excursive movements to occur freely without any interarch tooth to tooth contacts taking place. By this method, occlusal trauma is controlled.
Occlusal splint therapy may have the following additional uses and benefits:
By preventing interarch contacts, "deprogramming" of masticatory neuromuscular reflexes may occur leading to muscular relaxation which could alleviate spasms and tenderness in the masticatory muscles. This would allow the positioning of the condyles in centric relation, widely accepted to be the best position to restore a case due to its reproducibility. Occlusal splints also allow us to test how well the patient can tolerate a proposed opening of the occlusal vertical dimension. Certain occlusal splints may also be modified and equipped to replace missing teeth and to perform or facilitate minor tooth movements.
This is tooth movement therapy to level and align periodontal support, improve direction and distribution of occlusal forces, modify periodontal defects and to create an environment more favorable to plaque control. Uprighting teeth, extrusion of teeth, retracting flared anteriors, de-rotating teeth, repositioning drifted teeth and separating crowded teeth and roots are examples of periodontally oriented tooth movement. It must always be borne in mind that tooth movement forces are equivalent to traumatic forces and should only be applied in the absence of inflammation. Otherwise, attachment loss can be expected and instead of attaining our goal, we will make matters worse. It is imperative that calculus is removed from all root surfaces prior to orthodontic movement. In some cases an open flap debridement is necessary to get access to deep calculus on furcation areas. Similarly plaque levels must be kept low throughout orthodontic movement.
Although occlusal therapy may be initiated during initial therapy, it is often carried over and completed in following phases of therapy.
After completing this initial phase of therapy, an adequate period of time should be allowed for healing to occur. Four to six weeks from the last scaling and root planing appointment is the minimum time period required. Then a reevaluation must be carried out.
There should be considerable resolution of the inflammatory component of the disease with shrinkage of previously edematous tissue and a subsequent decrease in probing pocket depth. Active caries and periodontal breakdown should have been halted and tooth mobility should be decreasing. It is important to evaluate also the patients cooperation, motivation and commitment as well as their ability to perform plaque control procedures.
All this provides information as to the success of initial therapy and the feasibility of proceeding with the next phase of the treatment plan or, if any modifications to it that are required.
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