There are four primary elements that form the theoretical basis for an occlusal stabilization appliance:
- It protects teeth from wear
- It stabilizes an unstable bite
- It makes the patient more aware of any oral habit
- It allows you to reduce loading on a specific symptomatic teeth
Before starting, explain the risks, benefits and function of the appliance to your patients including:
- It has a risk of moving from a DDWR to DDNR
- If it is not adjusted regularly or if it breaks, the occlusion can change
- It will not stop bruxism
Related Reading: How to Perform an Occlusal Analysis
How to Insert the Occlusal Appliance
First, make sure the appliance can be inserted fully on the stone model. Teeth should be inserted all the way into the cast without gaps in between the splint and tooth surface so there should be no rocking.
Next, assess the cast to make sure it was fabricated properly (e.g. they have no positive or negative occlusal bubbles, they have no tooth shape distortions, etc.). Finally, ask the patient where they feel tightness or pressure as the appliance is inserted.
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How to Evaluate and Adjust Retention
Retention should be such that the appliance slips in and out easily and smoothly, the appliance is neither too tight nor too loose, and fits snugly. If the appliance doesn’t fit comfortably, try removing acrylic undercuts with a bur and/or adjust the clasp arms to modify retention. After making retention adjustments, ask the patient to take the appliance in and out to check the retention level again.
Related Reading: The Dentist’s Guide: Tooth Erosion, Attrition, Abrasion, and Abfraction
How to Evaluate and Adjust the Shape and Thickness
- Inspect the appliance for any area where it is too bulky
- Inspect the appliance for any area where it is too thin
- Appliance should cover all the incisal and occlusal surfaces with at least 1- 3 mm thickness of acrylic
How to Adjust Excursive Contacts
The occlusal stabilization appliance should have either canine or multiple anterior excursive contacts. Excursive contacts should be adjusted by marking the excursive contacts and ICP contacts in different color using occlusal paper. Then, preserve the ICP contacts and eliminate all excursive contacts in the posterior segments.
Remember, lateral excursive contacts must be tested with at least 5-6 mm lateral movement in each direction, and discluding movement over the canine and anterior teeth should be smooth and unobstructed.
How to Re-evaluate Tooth Contact in ICP
The occlusal stabilization appliance should have evenly distributed tooth contacts in ICP, it should hold mylar strips on all posterior teeth, and if you need to reduce and adjust anterior contacts, consider using a rubber disc wheel to favor posterior contacts. Once the adjustment is finished, polish the appliance with pumice, and be careful not to alter or destroy the occlusal contact while polishing it.
Post-Insertion Patient Instructions
- Demonstrate and have your patient practice how to place and take off the appliance
- Instruct how to use, clean and take care (while not using) the appliance
- Review the importance of oral hygiene
- Set up a follow-up appointment in 1-2 weeks for adjustment
- Instruct long-term maintenance plan
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