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Fabricating Splints in the Office
Fabricating splints in your office can save money: You will have more control over the product, thus reducing lengthy and repeat patient appointments. For example, you have probably encountered the frustration of trying to place a splint that was inaccurately made. Usually you use more than the allotted appointment time trying to alter an appliance, and then the splint still needs to be sent back to the laboratory to be remade. Consequently, the patient is unhappy about returning for another appointment, and your entire day is spent catching up, while apologizing to your other patients for the delay. Then you will need to see the patient again to attempt to refit the splint that should have worked the first time. This costs more of your valuable time.
The true benefit of fabricating splints in your office is your direct understanding of the needs of the patient, which is how you produced the design in the first place. Imagine fabricating that splint to your modifications and testing your design on a set of mounted models. That way, you will know if your design is working before the patient arrives for the placement appointment. Of course, you may be thinking that you don’t have a lab or the time to make appliances—or the energy to add yet another task to your day. However, there is a simple, cost effective way to fabricate an appliance: Your assistants can fabricate splints in your office. As an assistant at The International Center for Complete Dentistry, this author fabricates splints for five dentists.
This article provides some ideas to start, but for more detailed information about the correct concepts of the fabrication of splints, this author highly recommends taking a course on splint fabrication, such as “Occlusal Splint Therapy: Rationale, Indicators, and Fabrication Workshop,” taught by DeWitt Wilkerson, DMD, at The Dawson Academy.
A splint can be fabricated with a simple thermal vacuum machine. This author uses a Biostar® (Great Lakes Orthodontics, Ltd, Tonawanda, NY), along with 1.5-mm clear Biocryl material (Great Lakes Orthodontics, Ltd), and clear splint acrylic powder and monomer.
A pressure pot is used to heat-cure the acrylic. The most important part of making a splint is starting with a set of mounted study models. Most of the problems that occur at delivery appointments are the result of laboratories’ not mounting the models with an articulator.
The type of splint primarily used at the author’s office is called a B or bruxism splint (Figure 1). To make this splint, the doctor takes a set of measurements that will determine the ramp’s length, width, height, and arch on which the splint will be fabricated. Upper and lower full-arch impressions, a facebow, and wax bite are needed to mount the study models. After the models have been mounted, block out any undercuts on the model on which the appliance will be fabricated. Using a thermal vacuum machine, heat the Biocryl to the specified times according to the manufacturer’s directions and form over the model.
The next step is to form the ramp using the clear splint acrylic. It may take a couple of attempts to learn the consistency of the acrylic needed to manage the material while forming the ramp. Place monomer in a dapping dish, and place powder until the powder has incorporated all of the liquid. Wait for the acrylic to lose its glossy appearance and form to make the ramp. Use a small amount of monomer to smooth and adjust the ramp. Place in the pressure pot to cure. After the acrylic hardens, remove from the pressure pot and trim excess Biocryl to allow the model to be placed on the articulator. Make adjustments to the ramp and articulate the models to ensure the measurements given will accommodate all excursions while providing minimal height to avoid discomfort to the joints and muscles. Use a bur to smooth all junctions where the acrylic and Biocryl meet.
Remove the splint from the model and use a green stone to trim the facial and lingual heights of the splint. The splint is now ready to be polished using a wet muslin wheel (eg, Dimo® Grinding & Finishing Wheel, Great Lakes Orthodontics) and pumice with a loose muslin buff. The author prefers to use the clear splint acrylic because, when used properly, it will cure completely clear with no visible junctions between the Biocryl and the acrylic. This office does occasionally use flat plane splints for our patients. The same process and materials can be used to fabricate this type of splint. At the seat appointment any modifications, if needed, can be done while the patient waits.
The use of mounted models to fabricate your splints will result in exceptionally accurate splints. Over the long term, this will save the practice both time and money.
About the Author
Lora Ambrosio, CDA
The International Center for Complete Dentistry
St. Petersburg, Florida