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Muscle
Programming and
INDIAN DENTAL ACADEMY
Deprogramming
Leader in continuing dental education
www.indiandentalacademy.com
Contents
Introduction
Muscle physiology
Role of Muscles in orthodontics
Muscle programming
Muscle deprogramming
Summary
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Introduction
Paradigm
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Paradigm
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Shift in Paradigm
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N
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Shift in Paradigm
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 Muscular Malocclusion
Cause of Relapse
Imbalance

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Admittedly, the mission of an
Orthodontist is no longer Divine (i.e.
carrying out Nature’s plan) but Human.

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www.indiandentalacademy.com

Muscle Physiology
What is Muscle?

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Elasticity and Contractility

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Myotatic Reflex

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These are reflex contractions of Healthy
muscle which results from a pull on its
tendon.

All or None Law
The intensity of the contraction of any muscle
fiber is independent of the strength of the
exciting stimulus.

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www.indiandentalacademy.com

Role of Muscles
In Orthodontics
Concept By Melvin Moss

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Neurocranial capsule

Orofacial capsule

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Muscles as basis of Myofunctional Therapy

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Post Treatment Retention

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www.indiandentalacademy.com

Muscle Programming
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Muscle Programming is a term
applied to process by which muscles are
trained in a specific way to attain proper
form, function and stability of hard and
soft tissues in surrounding.

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Muscle Programming

Muscle Exercise

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Myofunctional
Therapy
Muscle Exercise

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Alfred P. Rogers, was the first person to
propose Muscle Exercises
He is known for his concept of Muscle as
Living Orthodontic Appliance

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Muscle Exercise as applied to
Orthodontics and Dentofacial
Orthopedics is defined as the
Controlled Rhythmic contraction of
the muscles around the teeth and jaws to
achieve normal function and development
of these structures.

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Muscles exercises are
divided into following
 Lip exercises
 Tongue exercises
 Mastication muscle exercises

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Various Muscle Exercises are

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
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Blowing Baloons
Button Pull Exercise
Gum Drop Exercise
Weighted String
Lip Pull Exercise
Lip Puffer
Mechanical
Stimulator
 Card pull Exercise
 Wooden Spatula
Exercise
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
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

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

Blowing Baloons
Button Pull Exercise
Gum Drop Exercise
Weighted String
Lip Pull Exercise
Lip Puffer
Mechanical
Stimulator
 Card pull Exercise
 Wooden Spatula
Exercise
www.indiandentalacademy.com
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
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




Blowing Baloons
Button Pull Exercise
Gum Drop Exercise
Weighted String
Lip Pull Exercise
Lip Puffer
Mechanical
Stimulator
 Card pull Exercise
 Wooden Spatula
Exercise
www.indiandentalacademy.com
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







Blowing Baloons
Button Pull Exercise
Gum Drop Exercise
Weighted String
Lip Pull Exercise
Lip Puffer
Mechanical
Stimulator
 Card pull Exercise
 Wooden Spatula
Exercise
www.indiandentalacademy.com
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







Blowing Baloons
Button Pull Exercise
Gum Drop Exercise
Weighted String
Lip Pull Exercise
Lip Puffer
Mechanical
Stimulator
 Card pull Exercise
 Wooden Spatula
Exercise
www.indiandentalacademy.com
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







Blowing Baloons
Button Pull Exercise
Gum Drop Exercise
Weighted String
Lip Pull Exercise
Lip Puffer
Mechanical
Stimulator
 Card pull Exercise
 Wooden Spatula
Exercise
www.indiandentalacademy.com
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







Blowing Baloons
Button Pull Exercise
Gum Drop Exercise
Weighted String
Lip Pull Exercise
Lip Puffer
Mechanical
Stimulator
 Card pull Exercise
 Wooden Spatula
Exercise
www.indiandentalacademy.com
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







Blowing Baloons
Button Pull Exercise
Gum Drop Exercise
Weighted String
Lip Pull Exercise
Lip Puffer
Mechanical
Stimulator
 Card pull Exercise
 Wooden Spatula
Exercise
www.indiandentalacademy.com
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







Blowing Baloons
Button Pull Exercise
Gum Drop Exercise
Weighted String
Lip Pull Exercise
Lip Puffer
Mechanical
Stimulator
 Card pull Exercise
 Wooden Spatula
Exercise
www.indiandentalacademy.com
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Blowing Baloons
Button Pull Exercise
Gum Drop Exercise
Patient is asked to hold
Weighted String
the wooden spatula (with
Lip Pull Exercise
little amount of weight)
between upper and lower
Lip Puffer
lips
Mechanical
Stimulator
Holding time –15–20secs
 Card pull Exercise
 Wooden Spatula
Exercise
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For Hypotonicity of Upper Lip

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Ask the patient to stretch the upper lip over the
labial surfaces of upper anteriors and hold it
lingual to the lower incisors.
Holding time – 30 second
Frequency – 15 to 20 times a day
This will improve the tonicity of upper lip

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For Hypotonicity of Upper Lip

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For Hypotonicity of Lower Lip

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Ask the patient to raise the lower lip over the
labial surfaces of upper lip and hold it in close
approximation with the upper lip.
Holding time – 30 second
Frequency – 15 to 20 times a day
This will improve the tonicity of lower lip

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For Hypotonicity of Lower Lip

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Mentalis Muscle Exercise

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Ask the patient to lower down the chin
with the help of forefinger and thumb
Raise the lower lip to contact with upper
lip
Holding time 10-15 secs
Frequency 10 – 15 times a day

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Mentalis Muscle Exercise

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Wilson’s Exercise

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Ask the patient to stand in front of mirror
Close the jaws in centric occlusion
Contract the left corner of mouth so that it will move
laterally and downwards
With the palmer surface of the left hand press the
right cheek medially and close the right nostril with
the forefinger of left hand, simultaneously.
Take deep breath from left nostril and hold it for 10
to 15 secs and then exhale slowly
This exercise is performed 3-4 times on one side
and then same procedure is repeated for the other
side
This whole procedure is done twice a day
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Wilson’s Exercise

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Pterygoid Exercises

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It is indicated in cases in mild mandibular
deficiencies.
Care should be taken that incisors should have
normal inclination
Ask the patient to protrude the lower jaw so as to
engage the lower incisors labial to the upper
incisors
Holding time – 10-15 secs
Frequency – 10 – 15 times a day

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Pterygoid Exercises

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Tongue Exercise

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Ask the patient to touch the tip of the
tongue in the rugae area of palate and
swallow with teeth in occlusion.
( Teeth together Swallow)
Frequency 30 to 40 times a day
This will correct the abnormal swallowing
pattern.

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Tongue Exercise

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Temporalis and Masseter Ex.

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Ask the patient to clench the teeth on right
and left side alternatively.
While doing so patient should feel
(palpate) at the angle of jaws for
massater and at the temple region for
temporalis
Frequency 10 – 15 times a day

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Programming of Face and tongue
muscles using Voice Gym

- Angela Caine

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VoiceGym is designed to correct tongue position
and rebalance face muscles in favor of the tongue
being suspended in the palate.

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Programming of Face and tongue
muscles using Voice Gym

- Angela Caine

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If the palate is underdeveloped however, it may
be necessary to coordinate VoiceGym Exercises
with functional orthodontics to restore the width
of the arch.
Arch width is then maintained by the tongue
articulating against the palate, thus stimulating
bone development

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Studies related to Muscle Exercise

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J.D. English, M. Tran, P. Buschang, and
G. Throckmorton, Baylor College of
Dentistry, Dallas, TX, USA studied Muscle
Exercise Effects on the Early Treatment of
Skeletal Open Bite Malocclusions
Sample - 31
They found that clenching exercises helped
control the vertical dimension and its
effects on facial morphology may help to
reduce aberrant vertical growth patterns
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Studies related to Muscle Exercise

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Orthodontic treatment and masticatory muscle exercises
to correct a Class I open bite in an adult patient.
English JD, Lindsey CA, AJO-DO 2003
Results were similar to their previous study

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Studies related to Muscle Exercise

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Masticatory Exercise as an Adjunctive Treatment for
Hyperdivergent Patients
Laurie R. Parks; Peter H. Buschang; Richard A. Alexander;
Paul Dechow; Paul Emile Rossouwc
The Angle Orthodontist: Vol. 77, No. 3, pp. 457–462
Sample - 50

They concluded that Masticatory muscle
exercise performed during the treatment of
hyperdivergent patients produced greater
increases in overbite than treatment alone.
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Studies related to Muscle Exercise
Urs Thüer and Bengt Ingervall studied the effect of
muscle exercise with an oral screen on lip function

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The European Journal of Orthodontics 1990 12(2):198-208

They drew following conclusions
 The treatment resulted in a decrease of the overjet
and upper dental arch length, but with some
relapse after the treatment.
 The strength of the lips increased during the
treatment, but decreased afterwards.
 The pressure from the lips on the teeth at rest and
during swallowing was unaffected by the lip
training.
 The pressure from the lower lip during chewing
increased temporarily during the treatment period.
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Muscle Deprogramming
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Muscle Deprogramming is a term
applied to process by which muscles are
allowed to revert back to unstrained,
normal functional relationship by the
means of some kind of inter-occlusal
appliance.

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Inter-Occlusal Splints
(Deprogramming Splints)

Diagnostic Splints

Therapeutic Splints

Occlusal splints are removable appliances that are
usually made of hard acrylic and fit over the
occlusal surface of either the maxillary or
mandibular dentition to create a precise occlusal
relationship with the teeth of the opposing arch or
to eliminate occlusal contacts
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Diagnostic Splints

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These type of Splints are used to diagnose
the discrepancy between Centric Relation
(CR) and Centric Occlusion (CO).

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Diagnostic Splints

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If there is an improper relationship between the
upper and lower jaws and/or the upper and
lower teeth, the patient will be required to
wear temporary oral appliances (Splint).
The objective of the splint is to try and establish
the correct position of the mandible to the
maxilla in three dimensions; namely,
transverse, sagittal and vertical

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Diagnostic Splints

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Diagnostic Splints

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A temporary deprogramming splint is
frequently used for breaking Neuromuscular imbalances.
The MAGO (Maxillary Anterior Guided
Orthotic) is just one example of a
modern attempt to aid identification and
then recording of a stable condylar
position
- H. Stean
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Diagnostic Splints

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The "CR" splint captures the orientation of the condyle
during the last few millimeters of closure, when the
condyle has been seated and braced against the slope of
the eminence
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Diagnostic Splints

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Ronald Roth (Functional Occlusion for Orthodontist)
Two greatest causes of failure of orthodontic
treatment
• Failure to stabilize and then capture true centric
relation prior to occlusal therapy.
• Failure to alter the occlusion with a high enough degree
of precision to hold centric and still clear on movement.

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Diagnostic Splints

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Ronald Roth (Functional Occlusion for Orthodontist)

Unmasking the Discrepancy

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Therapeutic Splints

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Therapeutic splints are Interocclusal
appliances generally used to relieve TMJ
pain originating due to some kind of
pathology like Bruxism

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Therapeutic Splints

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Progressive Appliance therapy
Christopher J. Stevens

•Mandibular Decompression Appliance (MDA)
•Hard Pivotal Appliance
•Muscle Rehabilitation Appliance
•Neuromuscular Demand Appliance

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Therapeutic Splints

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Mandibular Decompression Appliance
•May be utilized in the diagnosis & treatment of
all occlusal dysfunctions & cranio-mandibular
disorders
•Bioplast Splint
•Soft Pivot Appliance
•Pain Release Splint
•Temporary Diagnostic Appliance
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Therapeutic Splints

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Mandibular Decompression Appliance
•The primary indication for the MDA is TMJ
pain.
•The secondary indication is dysfunction.
•It can also be helpful in diagnosis.
•The appliance allows proprioceptive
deprogramming of masticatory muscles, and
support of vertical dimension.

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Therapeutic Splints
Hard Pivotal Appliance
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Features of the pivot appliance:
1. Used as an initial follow up to the MDA
2. Provides further decompression of the joints.
3. Assists in reprogramming vertical, A-P, and
lateral orientation of the mandible.
4. It is worn 24 hours, even when eating.
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Therapeutic Splints

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Muscle Rehabilitation Appliance
Features of the muscle rehabilitation appliance:
1. Used as a follow up to the hard pivotal
appliance
2. Improves and rehabilitates muscle tone
3. Improves mandibular stability
4. It is worn 24 hours, even when eating
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Therapeutic Splints
Neuromuscular Demand Appliance

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•This appliance has occlusal anatomy which
maintains the 3-D craniomandibular relationship.
•Features of the mandibular demand appliance:
•Predicts mandibular position for stabilization
procedures
•Can be used for long term maintenance

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Therapeutic Splints
Anterior Repositioning Splint

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•Rationale of anterior repositioning splint is to
diminish TMJ pain by unloading the Articular
Disk

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Therapeutic Splints
Occlusal Splint therapy for Bruxism

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Soft vacuum-formed
polyvinyl splints

The stabilization splint
with canine ramps

The NTI tension
suppression system.

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Therapeutic Splints
Mechanisms Proposed for Oral Splint
Efficacy/Effectiveness

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•Myofacial pain
•Change in the vertical dimension of occlusion
•Repositioning of the temporomandibular joints
•Decrease in the level of muscle activity
•Reducing bruxism
•Removal of occlusal interferences

www.indiandentalacademy.com
Therapeutic Splints
Mechanisms Proposed for Oral Splint
Efficacy/Effectiveness

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•Disc displacement disorders
•"Recapturing" the disc
•“Unloading" the joints
•Arthritis/arthralgia
•"Unloading" the joints
•Sleep bruxism
•Removal of occlusal interferences
•Change in muscle activity

www.indiandentalacademy.com
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Dr. N.R. Krishnaswamy (7th IOS P.G. Convention)
outlined the objectives of Splint therapy as follows
•To find the “true” anatomic relationship of the mandible
to the maxilla by “deprogramming” the muscle to eliminate
the neuromuscular reflexes.
•To test the patient’s response to a change in the occlusion
•To determine if the craniomandible relationship can be
stabilized.

www.indiandentalacademy.com
ARMAMENTARIUM FOR FABRICATION
OF OCCLUSAL SPLINT

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• Vacuum adapter e.g. Omnivac, Biostar, etc.
• Acetate marking pen: e.g. any waterproof felt tip.
• Acrylic trim bur.
• Small metal spatula for mixing acrylic in dappen dish.
• Dropper bottle (½oz.) for acrylic monomer
• Squeeze-type dispenser (3oz.) . for acrylic polymer
powder.
• Articulating paper

www.indiandentalacademy.com
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Fabrication of Splint
Accurate Impressions
Pouring of Stone Models
Construction of splint base with 0.08” Omnivac material
or Biocryl II material on Biostar machine
Trial of splint base in mouth
Splint base should be of minimum vertical dimension and
should extend upto last erupted teeth
www.indiandentalacademy.com
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Fabrication of Splint
Occlusal Lining of Splint using Biocryl acrylic
Polish the splint
Insert the splint in mouth and check for even contact
Adjustment of splint in mouth in subsequent visits

www.indiandentalacademy.com
Some Commercially available
Splints

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DSG Relaxer
Dental Services Group has recently developed a new muscle
deprogramming splint that is designed to use the body ’s natural reflex
protection to relax the muscular components of bite-related migraines,
chronic headaches and jaw disorders.

www.indiandentalacademy.com
Some Commercially available
Splints

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DSG Relaxer

Super Splint
(Dentech Services)

www.indiandentalacademy.com
Some Commercially available
Splints

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Flexible inner Layer
Hard Outer Layer
Thermo-Splint Classic-- Soft thermo-plastic polymer throughout
Thermo-Splint Hard Face --Two layers – the softer, flexible, thermoplastic layer plus an additional harder acrylic layer for added durability on
occlusal and incisal surfaces. (See diagram at right)
Thermo-Splint Custom Fit --Monomer free, reprogrammable, self
aligning, versatility plus
www.indiandentalacademy.com
Some Commercially available
Splints

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Developed by Prof.Dr.Martin Lerman, the Scientific Director at the
Temporo Mandibular Joint Center at the University of Illinois

www.indiandentalacademy.com
Studies related to Splint Therapy

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Solange Mongelli de Fantini et al (Braz Oral Res
2005;19(3):176-82 ) studied effect of occlusal splint
therapy on condylar displacement between centric
relation and maximal habitual intercuspation
Sample – 22 Subjects 11 male – 11 female
They concluded that use of occlusal splints results in
greater mean condylar displacement values, especially
vertically, between CR and MHI positions, which
contributed to a more accurate orthodontic
diagnosis.
www.indiandentalacademy.com
Studies related to Splint Therapy

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John Grubb (Angle Ortho 1999 210-213) presented a
Case report of a Patient suffering from TMJ pain.
Deprogramming Splint was used as Diagnostic as well as
therapeutic device

www.indiandentalacademy.com
Studies related to Splint Therapy

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Donald Joondeph (Angle Ortho 1999 201-209) studied
the Long Term stability of Anterior Repositioning Splint
•Treated 12 patients
•Complete Relapse

www.indiandentalacademy.com
Studies related to Splint Therapy

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Ahlin et al 1991 found that use of splint with only anterior
flat bite plane can cause an open bite

www.indiandentalacademy.com
Studies related to Splint Therapy

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T.T.T. Dao and G.J. Lavigne (Crit Rev Oral Biol
Med 9(3):345-361 1998) from a review of Literature on
Occlusal splints, concluded that true efficacy for oral
splints in treatment of TMJ dysfunction remains unknown
However, the results of a controlled clinical trial
lend support to the effectiveness of the stabilizing splint in
the control of myofacial pain.
Thus oral splints should be used as an adjunct for
pain management rather than a definitive treatment.

www.indiandentalacademy.com
Studies related to Splint Therapy

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Alexander S Fu et al studied the Maxillomandibular
relationship in TMD patients before and after short-term
flat plane bite plate therapy.
Cranio. 2003 Jul ;21 (3):172-9
Sample – 20 with Deviated mandible
•After Flat Bite plane Therapy, the mandibular position of all
subjects shifted toward the midline position
•Significant movement of both condyles in the anterio-posterior
plane as well as the vertical plane
•There was also significant reduction in TMJ pain and clicking
www.indiandentalacademy.com
www.indiandentalacademy.com

Summary
Role of Muscles and soft tissue in
orthodontics is gaining importance in
recent times
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Both, Muscle Programming and
Deprogramming are becoming part and
parcel of Orthodontist’s Life

www.indiandentalacademy.com
www.indiandentalacademy.com

Thank You

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Corticosteriods uses in dentistry/ oral surgery courses  
Corticosteriods uses in dentistry/ oral surgery courses  Corticosteriods uses in dentistry/ oral surgery courses  
Corticosteriods uses in dentistry/ oral surgery courses  
 
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...
 
Diagnosis and treatment planning in completely endntulous arches/dental courses
Diagnosis and treatment planning in completely endntulous arches/dental coursesDiagnosis and treatment planning in completely endntulous arches/dental courses
Diagnosis and treatment planning in completely endntulous arches/dental courses
 
Properties of Denture base materials /rotary endodontic courses
Properties of Denture base materials /rotary endodontic coursesProperties of Denture base materials /rotary endodontic courses
Properties of Denture base materials /rotary endodontic courses
 
Use of modified tooth forms in complete denture occlusion / dental implant...
Use of modified  tooth forms  in  complete denture occlusion / dental implant...Use of modified  tooth forms  in  complete denture occlusion / dental implant...
Use of modified tooth forms in complete denture occlusion / dental implant...
 
Dental luting cements / oral surgery courses  
Dental   luting cements / oral surgery courses  Dental   luting cements / oral surgery courses  
Dental luting cements / oral surgery courses  
 
Dental casting alloys/ oral surgery courses  
Dental casting alloys/ oral surgery courses  Dental casting alloys/ oral surgery courses  
Dental casting alloys/ oral surgery courses  
 
Dental casting investment materials/endodontic courses
Dental casting investment materials/endodontic coursesDental casting investment materials/endodontic courses
Dental casting investment materials/endodontic courses
 
Dental casting waxes/ oral surgery courses  
Dental casting waxes/ oral surgery courses  Dental casting waxes/ oral surgery courses  
Dental casting waxes/ oral surgery courses  
 
Dental ceramics/prosthodontic courses
Dental ceramics/prosthodontic coursesDental ceramics/prosthodontic courses
Dental ceramics/prosthodontic courses
 
Dental implant/ oral surgery courses  
Dental implant/ oral surgery courses  Dental implant/ oral surgery courses  
Dental implant/ oral surgery courses  
 
Dental perspective/cosmetic dentistry courses
Dental perspective/cosmetic dentistry coursesDental perspective/cosmetic dentistry courses
Dental perspective/cosmetic dentistry courses
 
Dental tissues and their replacements/ oral surgery courses  
Dental tissues and their replacements/ oral surgery courses  Dental tissues and their replacements/ oral surgery courses  
Dental tissues and their replacements/ oral surgery courses  
 

Muscle programming /certified fixed orthodontic courses by Indian dental academy