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Orthodontic intervention for dental changes induced by ‘off the shelf’ and custom-made occlusal splint therapy for bruxism: a report of two cases Ayesha Banu Kader Meeran Antonio Garrett Parmjit Singh Orthodontic Update 2025 18:2, 72-80.
Authors
Ayesha Banu KaderMeeran
BDS (TNMGRMU), Stat Exam (UK), MSc (Ulster), Dentist with special interest in orthodontics, Whitecross Dental Care
BDS (Ncl), MFDS (RCS Edin), MSc (Lond), MOrth, (RCS Eng), FDS (Orth) RCS, CILT (Lond), AFHEA, Professor, College of Medicine and Dentistry, University of Ulster
Occlusal splint therapy for bruxism can be provided in a professional setting by a dentist; however, patients can also purchase ‘off the shelf’ appliances. Where appliances do not cover all the occlusal surfaces, overeruption of uncovered teeth can occur, leading to changes to the occlusion. Two patients are presented who noticed significant changes to their occlusion by way of lateral/posterior open bites and sought orthodontic treatment to reverse these. The changes had occurred after short- and long-term use of ‘off the shelf’ and custom-made occlusal splints, respectively. The patient in Case 1 was treated with pre-adjusted edgewise appliances and inter-maxillary elastics, while the patient in Case 2 completed treatment with Invisalign aligners (Align Technology, CA, USA). When patients seek occlusal splint therapy, they should be advised to see a dentist to have an appropriate custom-made device fitted to cover all teeth to reduce the risk of unwanted changes to the occlusion.
CPD/Clinical Relevance:
Occlusal splint therapy for bruxism is best provided in a professional dental setting to avoid overeruption of uncovered teeth and other occlusal changes.
Article
The International Classification of Sleep Disorders classifies sleeprelated bruxism as an oral activity characterized by teeth grinding or clenching during sleep.1 It occurs as the muscles of mastication and other jaw muscles contract. This can lead to muscle hypertrophy, tooth surface loss, fracture of teeth, hypersensitivity and loss of periodontal support.2
Different therapies have been used to manage bruxism, such as intra-oral devices, intramuscular injections, biofeedback and drug therapy.3 Occlusal splint therapy is thought to be a non-invasive, reversible management option for temporomandibular disorders and bruxism. These can be custom made or purchased ‘off the shelf’.4
While clinical effectiveness and costeffectiveness of occlusal splint therapy have been extensively evaluated, adverse effects are generally not reported, and when they do occur, they are thought to be infrequent.5,6 Therefore, there is a scarcity of literature reporting the negative effects of occlusal splint therapy, although given that the mandible is positioned away from the maxilla, some of the changes seen with long-term mandibular advancement device therapy78910 could also occur in long-term occlusal splint therapy. Where appliances do not have full occlusal coverage, there is the added risk of overeruption of teeth that are not captured by the device.11
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