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occlusal splint dentistry types indications classification comprehensive review 2023 2024

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Michigan splint stabilization splint fabrication materials hard acrylic occlusal splint indications dentistry textbook

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The Importance of Occlusal Splints in Dentistry: Classification, Mechanisms, and Clinical Indications

A Dissertation Review

Abstract

Occlusal splints are removable intraoral devices that modify the occlusal relationship between the maxillary and mandibular arches. They represent one of the most widely prescribed non-invasive, reversible therapeutic modalities in contemporary dentistry. Their applications span the management of temporomandibular disorders (TMD), sleep bruxism, myofascial orofacial pain, parafunctional habits, pathological tooth wear, and serve adjunctive roles in complex prosthodontic rehabilitation. Despite their widespread clinical use, questions remain regarding their precise mechanisms of action and relative efficacy between different designs. This dissertation critically reviews the classification, mechanisms, indications, and evidence base for occlusal splint therapy, drawing upon textbook literature and peer-reviewed publications cited in Vancouver format.

1. Introduction

An occlusal splint, synonymously referred to as an occlusal device, interocclusal appliance, bite guard, night guard, or stabilization appliance, has been defined as "any removable artificial occlusal surface affecting the relationship of the mandible to the maxillae used for diagnosis or therapy." (1) They conform to the prevailing treatment philosophy of using reversible, non-invasive interventions as the first line of management for disorders of the masticatory system before considering any irreversible options. (2)
The clinical prevalence of conditions amenable to occlusal splint therapy underscores their importance. Temporomandibular disorders (TMD) affect an estimated 5-10% of the general population, with a higher prevalence in women. (3) Sleep bruxism affects approximately 8-10% of adults worldwide. (4) Pathological tooth wear is increasingly recognised as a growing public health concern. Together, these conditions place occlusal splint therapy at the centre of modern dental practice.
Despite a vast body of published literature, much of it remains controversial, with heterogeneity in study designs, diagnostic criteria, outcome measures, and splint types making direct comparisons difficult. (5, 6) This review aims to provide a structured, evidence-based account of the role of occlusal splints in dentistry, from their basic design principles to their specific clinical applications.

2. Definition and Classification of Occlusal Splints

Occlusal splints may be classified according to several parameters: the material of fabrication, arch of placement, coverage extent, and most usefully, by the way opposing teeth contact the splint surface during jaw closure. The latter classification, proposed by Davies and Gray, divides splints into three broad groups: (1, 7)

2.1 Partial Occlusal Contact (Relaxation) Splints

These splints cover some or all teeth in one arch but allow limited tooth contacts in any mandibular position, including retruded contact position. Their primary action is believed to be through reducing proprioceptive drive from the periodontal ligament, thereby relaxing masticatory musculature. Prolonged use, however, can result in unintended changes in the dental occlusion due to supraeruption of unopposed posterior teeth. (7)
Subtypes include:
  • Soft splints: Fabricated by thermoforming a polyvinylacetate-polyethylene sheet (3-4 mm) onto a dental cast. No occlusal adjustment is made. They are inexpensive and widely available but evidence for their superiority over hard splints in bruxism management is lacking. (7)
  • Anterior bite plane (Michigan bite plane variant): Covers only the anterior teeth or all teeth but contacts only the anterior dentition. By preventing posterior tooth contact, they disocclude the masticatory elevator muscles during clenching. The Nociceptive Trigeminal Inhibition (NTI) splint is a miniaturised anterior bite plane device.

2.2 Full Occlusal Contact Splints in Retruded Position (Stabilization Splints)

The full-coverage hard stabilization splint (FHSS), often referred to as the Michigan splint (maxillary arch) or Tanner appliance (mandibular arch), is the most extensively studied and widely prescribed design. (1, 7) These splints provide bilateral, simultaneous, even posterior contacts, anterior guidance in excursive movements, and are constructed in hard heat-cured polymethylmethacrylate (PMMA). They aim to provide an idealized, reproducible occlusal scheme and serve as the reference standard against which other designs are often compared. (5, 7)
The mandibular hard acrylic stabilization splint (Tanner appliance) is particularly suitable for patients with Class III incisor relationships, patients with phonetic or aesthetic concerns with maxillary appliances, and where posterior occlusal stability is more readily developed on the lower arch. (1)

2.3 Anterior Repositioning Splints

These splints guide the mandible into a protrusive or anterior position, repositioning the condyle relative to the articular disc. Their principal indication is in the management of disc displacement with reduction (DDwR) to recapture the anteriorly displaced disc. (8) Due to the risk of permanent posterior open bite and irreversible condylar remodelling with prolonged use, their prescription should be carefully monitored and time-limited. (9)
Gelb appliances represent a subtype of anterior repositioning splint fabricated from hard acrylic with metal components for precise jaw positioning in TMJ disc displacement. (7)

2.4 Materials and Fabrication

Stabilization splints are traditionally fabricated from heat-cured polymethylmethacrylate (PMMA), offering durability, dimensional stability, and the ease of chairside adjustment. (1, 7) More recently, computer-aided design and computer-aided manufacturing (CAD/CAM) technologies using tooth-coloured polycarbonate have been introduced, allowing minimum appliance thicknesses of 0.3 mm while maintaining adequate mechanical properties. (1)
Dual-laminate splints incorporate a hard outer acrylic shell with a soft thermoplastic inner lining, combining the protective properties of hard splints with improved patient comfort and compliance. Thermoplastic materials can be modified in hardness by adjusting the liquid-to-powder monomer ratio, allowing clinical customization. (10)

3. Mechanisms of Action

The precise mechanism by which occlusal splints exert their therapeutic effects remains incompletely understood and is likely multifactorial. Several hypotheses have been proposed: (7, 11)
  1. Alteration of occlusal loading patterns: The flat, smooth occlusal surface of a stabilization splint eliminates cusp-fossa interdigitation, reducing proprioceptive feedback from periodontal mechanoreceptors and thereby modulating masticatory muscle hyperactivity.
  2. Condylar repositioning: By establishing a reproducible mandibular position, splints may allow the condyle-disc assembly to adopt a less mechanically disadvantageous position within the glenoid fossa, reducing intra-articular pressure.
  3. Cognitive awareness hypothesis: The presence of a foreign body in the oral cavity may reduce parafunctional activity through a central inhibitory mechanism, making the patient conscious of clenching or grinding behaviour.
  4. Vertical dimension increase: The slight increase in the vertical dimension of occlusion (VDO) created by splint wear temporarily decompresses the temporomandibular joint, reducing pain from arthrogenous sources.
  5. Muscle relaxation through occlusal disengagement: Anterior-only contact splints (e.g., NTI) reduce activity in the masseter and temporal muscles by preventing the elevator muscles from contracting maximally during clenching.
  6. Placebo effect: Some authors have argued that the non-specific benefits of any dental treatment (increased patient attention, expectation of improvement) may account for a proportion of the observed treatment response, supported by findings that non-occluding placebo splints also produce measurable improvement. (5)
Evidence from a 2025 systematic review and meta-analysis by Porntirit et al. demonstrated that stabilization splint therapy produces a significant increase in the superior temporomandibular joint space (weighted mean difference 0.15 mm, P = 0.05), with evidence of forward and downward condylar movement, midline correction of the mandible, and improved bone density in TMD patients - suggesting genuine anatomical remodelling occurs with sustained splint wear. (12)

4. Clinical Indications for Occlusal Splints

4.1 Temporomandibular Disorders (TMD)

Temporomandibular disorders are among the most common conditions managed with occlusal splints. They represent a heterogeneous group of musculoskeletal conditions affecting the temporomandibular joints, masticatory muscles, and associated structures, classified as myogenous (muscle-only), arthrogenous (joint-only), or mixed. (5)
Clinical features include pre-auricular or periauricular pain, deep otalgia, tenderness in the muscles of mastication, restricted mouth opening, joint clicking or locking, and referred pain to the temporoparietal and cervical regions. (3, 13) In population-based studies, up to 82.4% of patients with TMD present with ear pain, making differentiation from otological disease essential. (3)

Evidence for Splint Therapy in TMD

A landmark Cochrane systematic review by Singh et al. (2024) examined 57 RCTs involving 2,846 participants comparing occlusal splints with no treatment, placebo, or other active therapies. (5) The review found that the full hard stabilization splint (FHSS) may reduce muscle pain when chewing compared to no treatment (MD -1.97, 95% CI -2.37 to -1.57, 1 study, 84 participants with disc displacement without reduction), though the overall certainty of evidence was rated as very low for most comparisons. (5)
A systematic review by Zhang et al. (2020) examined 11 RCTs using validated diagnostic criteria (DC/TMD or RDC/TMD) and reported: (6)
  • Positive effect of occlusal splints on mandibular movements in all included studies.
  • Seven of eleven studies demonstrated positive effects on chronic pain reduction and pain intensity.
  • Two studies showed improvement in TMJ clicking and jaw locking.
  • Improvements in mouth opening, depression, and anxiety were reported in four studies.
A network meta-analysis by Al-Moraissi et al. (2020) of 48 RCTs ranked treatment modalities for pain reduction. (11) In arthrogenous TMD, the three highest-ranked treatments were anterior repositioning splint (ARS) at 92%, counselling therapy combined with hard stabilization splint (CT+HSS) at 67.3%, and hard stabilization splint alone at 52.9%. For myogenous TMD, mini-anterior splints ranked highest at 86.8%, followed by CT+HSS at 61.2%, and HSS alone at 59.7%. The authors concluded that multimodal therapy combining counselling with HSS may produce maximum benefit for TMD patients. (11)
A meta-analysis by Zhang et al. (2021) comparing exercise therapy and occlusal splint therapy across 6 RCTs (498 patients) found no statistically significant difference between the two modalities for pain reduction (P = 0.08) or for maximum mouth opening and laterotrusion movements, suggesting equivalent effectiveness. (14)
A 2025 meta-analysis by Isişag et al. comparing occlusal splints with Botulinum toxin injections in TMD found that while Botox produced greater mouth opening in the first week, by 3 months the occlusal splint group showed superior mouth opening; at 6 months and beyond, no significant differences were observed between the two treatments. (15)

TMD Sub-types: Disc Displacement with Reduction

Anterior repositioning splints (ARS) are specifically indicated for disc displacement with reduction. A meta-analysis by Maheshwari et al. (2024) comparing ARS with other occlusal splints in DDwR found no clear difference for short-term TMJ pain or muscle pain, though other occlusal splints showed a small advantage over ARS for long-term TMJ clicking reduction (RR 2.40, 95% CI 1.04-5.55). The certainty of evidence was low to very low, and risks of permanent occlusal change with prolonged ARS use must be weighed carefully. (8)

4.2 Sleep Bruxism

Bruxism is defined as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or bracing or thrusting of the mandible. It occurs during sleep (sleep bruxism) or while awake (awake bruxism) and is considered a multifactorial condition with central nervous system, genetic, and psychosocial components. (4, 16)
Clinical signs include scalloping of the buccal mucosa, flattening and smoothing of the occlusal surfaces of the premolars and molars, tenderness of the masseter and temporal muscles on palpation, and morning jaw fatigue. (3) Tooth wear due to attrition is a cardinal feature, and severe bruxism can result in significant loss of coronal tooth structure, fracture of cusps, and failure of dental restorations.
Occlusal splints - particularly hard stabilization splints - are the most widely prescribed intervention for sleep bruxism, primarily serving a protective function for the dentition rather than eliminating the underlying parafunctional activity. (4, 7, 16)

Evidence for Splint Therapy in Bruxism

A systematic review by Ainoosah et al. (2024) examined 15 studies comparing different occlusal splint types for managing sleep bruxism. (4) Adjustable splints, particularly full-occlusion biofeedback splints, demonstrated superior effectiveness in reducing bruxism episodes and improving patient-reported symptoms compared to conventional hard splints. However, the overall conclusion remained that occlusal splint therapy is a viable treatment approach for sleep bruxism. (4)
A systematic review and meta-analysis by Ferreira et al. (2024) evaluated whether occlusal appliances influence masticatory muscle function in sleep bruxers across 12 studies (3 RCTs). (17) Meta-analyses revealed that neither soft nor hard appliances significantly influenced muscle activity (masseter and temporal EMG) or bite force. The authors concluded that occlusal appliances do not alter masticatory muscle function in sleep bruxers but may be effective in reducing tongue force. The certainty of evidence was rated very low to low. (17)
A randomised controlled trial by Bergmann et al. (2020) investigated full-occlusion biofeedback splints in 44 bruxism patients, finding significant reductions in bruxism motor activity and associated TMD pain over 12 weeks compared to a control period. (18)
An RCT by Chisini et al. (2024) compared occlusal splints versus botulinum toxin-A injections for jaw muscle pain in probable sleep bruxism, finding both interventions produced significant pain reduction with no statistically significant difference between them at 3 months. (19)
An RCT by Tandon et al. (2025) comparing occlusal splint therapy against sleep hygiene and progressive muscle relaxation found the occlusal splint group demonstrated significantly lower perceived stress scores and bruxism severity at 3 months follow-up. (20)

4.3 Myofascial Orofacial Pain

Myofascial pain disorder (MPD) is characterised by localised, dull aching pain in masticatory muscles with tender trigger points, pain on palpation, limited mouth opening, and referred pain patterns. It is closely associated with bruxism and stress-related parafunctional habits. (2, 21)
A systematic review by Orzeszek et al. (2023), examining 13 RCTs involving 589 patients with orofacial muscle pain, evaluated occlusal splint therapy against various comparators including acupuncture, low-level laser therapy, Kinesio Taping, and physical therapy. (21) While all included studies demonstrated improvement, the review concluded that there is insufficient high-quality evidence to determine whether occlusal splint therapy offers a definitive advantage over other interventions for orofacial myalgia and myofascial pain. The authors emphasised the clinical relevance given the high prevalence of orofacial muscle pain in daily dental practice. (21)

4.4 Pathological Tooth Wear and Dentition Protection

Tooth wear is a multifactorial condition involving attrition (tooth-to-tooth contact), erosion (chemical dissolution), abrasion (external abrasive agents), and abfraction (stress-induced cervical lesions). Bruxism-related attrition represents one of the most destructive forms. (22)
Hard stabilization splints serve two roles in managing pathological tooth wear: (1, 7)
  1. Active protection: By interposing a hard acrylic surface between the arches, the splint absorbs parafunctional forces and substitutes for tooth-to-tooth contact during grinding episodes. The splint material wears in preference to natural tooth structure.
  2. Passive (preventive) management: When attrition due to bruxism is a likely significant contributing factor, wearing a stabilization splint at night can slow the rate of tooth surface loss and preserve remaining tooth structure pending definitive restorative care.
Crucially, soft night guards are not recommended in patients with active parafunctional activity, as their compressible surface may exacerbate masticatory overloading and stimulate more forceful clenching rather than reducing it. Hard acrylic Michigan-type splints are preferred in this context. (1, 7)
In complex restorative cases where an increase in the vertical dimension of occlusion (VDO) is planned, a hard stabilization splint functions as a diagnostic tool, allowing the clinician and patient to assess tolerance to an altered occlusal scheme before irreversible restoration. CAD/CAM polycarbonate splints made to 0.3 mm thickness facilitate the fitting of opposing arch splints, enabling a segmented arch-by-arch rehabilitation approach. (1)

4.5 Preoperative Occlusal Stabilization in Prosthodontic Rehabilitation

Before undertaking complex restorative, prosthetic, or implant-supported rehabilitations, it is often essential to locate the mandible reliably in centric relation (CR), assess jaw muscle balance, and diagnose occlusal discrepancies. Occlusal splints fulfil several preparatory roles: (1, 7, 23)
  • Centric relation location: By deprogramming proprioceptive muscle engrams through splint wear, the mandible can be guided passively into a reproducible and repeatable centric relation position for accurate diagnostic mounting of study casts on a semi-adjustable articulator.
  • Diagnosis of occlusal pathology: Splint wear may reveal deflective contacts, premature contacts, or signs of parafunctional activity that are masked when the patient habitually occludes in an acquired intercuspal position.
  • Stabilization of the occlusal scheme prior to definitive restorations: Particularly relevant when patients present with worn dentitions, unstable posterior support, or TMD signs and symptoms that require resolution before restorative work commences.
  • Assessment of altered VDO tolerance: A splint worn at an increased VDO for 4-8 weeks establishes whether the patient can tolerate the new jaw relationship in terms of comfort, phonetics, aesthetics, and muscular adaptation before permanent restorations are placed. (1, 23)

4.6 Occlusal Splints and Headache

TMD is classified as a secondary headache in the International Classification of Headache Disorders (ICHD-3). (3) Myogenous TMD, particularly bruxism and masticatory muscle hyperactivity, generates referred pain patterns that can present clinically as temporal headache, occipital pain, and even migraine-like attacks. (3)
Occlusal splint therapy reduces muscle tension in the temporalis and masseter muscles, which may contribute to a reduction in tension-type headache and TMD-associated headache. Garstka et al. (2023) reviewed accurate diagnosis and management of painful temporomandibular disorders, emphasising the overlap between TMD, headache, and cervical musculoskeletal pain and highlighting the multi-disciplinary need for splint therapy, physiotherapy, and psychosocial management. (24)

4.7 Protection of Dental Restorations and Implant-Supported Prostheses

Occlusal forces during bruxism can exceed 900 N, which is many times the normal masticatory force of 100-150 N. Such forces can lead to: (7)
  • Fracture of porcelain veneers, ceramic crowns, and indirect composite restorations.
  • Screw loosening or fracture in implant-supported prostheses.
  • Debonding of adhesively cemented restorations.
  • Framework fracture in removable partial dentures.
Hard stabilization splints protect restorations by redirecting parafunctional forces onto the acrylic splint surface, which acts as a sacrificial layer. They are routinely prescribed following complex full-mouth rehabilitation, particularly when the patient has a history of bruxism. (1, 7)

4.8 Juvenile and Pediatric Indications

In children and adolescents, occlusal splint therapy is used more cautiously due to the actively developing dentition and concerns about growth interference. A systematic review by Casazza et al. (2022) on the management of idiopathic sleep bruxism in children and adolescents found limited high-quality evidence, noting that occlusal splints in pediatric patients should be carefully monitored given the risk of influencing dental eruption and arch development. (25) A scoping review by Chisini et al. (2020) similarly noted the need for careful selection of interventions in pediatric bruxism, with splint therapy serving principally a protective role for primary and mixed dentitions rather than a curative one. (26)

5. Comparative Effectiveness: Splint Types

The Cochrane review by Singh et al. (2024) remains the most comprehensive comparative analysis available. (5) Key findings included:
  • There may be little to no difference in self-reported joint pain when chewing between FHSS and placebo (non-occluding) splint (RR 1.88, 95% CI 0.94-3.75), though evidence was very uncertain.
  • FHSS may reduce muscle pain when chewing compared to no treatment.
  • No statistically significant advantage of one type of occlusal splint over another was consistently demonstrated across outcomes.
  • The certainty of evidence was rated very low for all comparisons assessed.
The network meta-analysis by Al-Moraissi et al. (2020) provided a hierarchy of effectiveness for pain reduction: ARS ranked highest in arthrogenous TMD, while mini-anterior splints ranked highest in myogenous TMD; multimodal CT+HSS combinations showed moderate-quality evidence of benefit. (11)

6. Contraindications and Adverse Effects

While generally safe, occlusal splints carry potential risks that must be communicated to patients: (1, 7, 9)
  • Anterior open bite: Posterior open bite from supraeruption of unopposed teeth with partial-coverage or anterior-only splints worn continuously.
  • Tooth movement: All splints worn continuously may allow unintended tooth movement. Full-coverage designs are less likely to cause this than partial coverage designs.
  • Increased bruxism: Soft splints may paradoxically stimulate more forceful clenching in some patients. A one-size-fits-all soft splint can worsen symptoms and is not recommended. (3)
  • Occlusal changes from ARS: Prolonged wear of anterior repositioning splints beyond 6-8 weeks risks permanent posterior open bite. (9)
  • Compliance issues: Patient non-compliance remains the most common cause of treatment failure.

7. Fabrication Considerations

A custom-made, laboratory-fabricated stabilization splint remains the gold standard. The clinical and laboratory protocol typically involves: (1, 7)
  1. Full-arch dental impressions (polyvinylsiloxane or digital intraoral scan).
  2. Facebow transfer and semi-adjustable articulator mounting.
  3. Intra-occlusal records (centric relation record).
  4. Construction of hard acrylic splint in heat-cured PMMA.
  5. Occlusal adjustment at fit appointment to achieve bilateral simultaneous even contacts and anterior guidance in excursion.
  6. Review at 2-4 weeks and at regular intervals thereafter.
Over-the-counter thermoplastic splints are available but are not recommended as they are difficult to fit precisely, may cause permanent occlusal changes through uncontrolled tooth movement, and their "one-size-fits-all" nature can worsen symptoms in some patients. (3)

8. Combined and Multimodal Therapy

Current evidence favours the integration of occlusal splint therapy within a multimodal management package rather than as a standalone treatment. (5, 7, 11) Adjunctive treatments include:
  • Non-steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen 600 mg three times daily for a 2-week trial is a standard first-line pharmacological adjunct for acute TMD pain. (3)
  • Physiotherapy: Exercise therapy has demonstrated equivalent effectiveness to occlusal splint therapy for painful TMD (Zhang et al., 2021). (14) Combining the two modalities may offer additive benefit.
  • Muscle relaxants: Cyclobenzaprine and short-course benzodiazepines for acute myospasm. (3)
  • Low-dose amitriptyline: For chronic myofascial pain and nocturnal bruxism with sleep disturbance. (13)
  • Botulinum toxin (Botox) injections: Emerging evidence suggests similar medium-to-long-term effectiveness to occlusal splints for both TMD-related pain and bruxism-associated jaw muscle pain. (15, 19)
  • Cognitive-behavioural therapy (CBT) and stress management: Particularly relevant given the strong association between psychological stress, anxiety, and both bruxism and TMD. (11)
  • Low-level laser therapy (LLLT) and acupuncture: Studied as comparators to splint therapy for myofascial pain, with mixed results. (21)
In refractory cases not responding to conservative management, referral to an oral and maxillofacial surgeon for further diagnostic evaluation, intra-articular injections (corticosteroid, hyaluronic acid), or surgical management may be necessary. (3, 13)

9. Discussion

The clinical evidence base for occlusal splint therapy, while large in volume, is characterized by heterogeneity, methodological limitations, and low certainty ratings. The 2024 Cochrane review by Singh et al. included 57 RCTs but rated the certainty of evidence as very low for virtually all comparisons, reflecting the challenges of blinding in splint studies, diverse diagnostic criteria, inconsistent outcome measurement tools, and wide variation in splint designs. (5) This does not necessarily mean splints are ineffective - rather, the field requires more rigorous standardized methodology.
What can be stated with reasonable confidence is:
  1. Occlusal splints are the most widely used reversible, non-invasive first-line treatment for TMD, bruxism, and orofacial myofascial pain.
  2. The full hard stabilization splint (Michigan splint) has the strongest and broadest evidence base among all splint types.
  3. Their role in protecting the dentition and restorations from parafunctional forces is well-supported clinically, even without robust RCT evidence.
  4. Splint therapy should not be prescribed in isolation but as part of a multimodal management plan.
  5. Anterior repositioning splints are effective for disc recapture in DDwR but carry risks of permanent occlusal change and should be time-limited.
The emerging evidence on stabilization splint therapy causing measurable anatomical changes - including increased superior joint space, condylar repositioning, and improved bone density - provides mechanistic plausibility beyond placebo explanations. (12)

10. Conclusion

Occlusal splints occupy a central and indispensable position in modern dental practice. They address a wide spectrum of clinical conditions - from temporomandibular disorders and sleep bruxism to orofacial myofascial pain, pathological tooth wear, and prosthodontic preparation. Their reversible, non-invasive nature aligns with the fundamental ethical and clinical principle of first doing no harm before embarking on irreversible dental treatments. Despite ongoing controversy about mechanisms and comparative efficacy, the totality of the evidence from systematic reviews, meta-analyses, and clinical guidelines supports their use as an effective component of a multimodal management strategy. Continued research employing standardised diagnostic criteria, validated outcome measures, and adequate follow-up periods is needed to further strengthen the evidence base and guide clinical decision-making.

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  19. Chisini LA, Pires ALC, Poletto-Neto V, et al. Occlusal splint or botulinum toxin-a for jaw muscle pain treatment in probable sleep bruxism: A randomized controlled trial. J Dent. 2024;151:105423. PMID: 39510242.
  20. Tandon A, Singh BP, Shanker R. Efficacy of occlusal splint versus sleep hygiene and progressive muscle relaxation on perceived stress and sleep bruxism: A randomized clinical trial. J Prosthodont. 2025;34(2):165-72. PMID: 39088703.
  21. Orzeszek S, Waliszewska-Prosol M, Ettlin D, Seweryn P, Straburzynski M, Martelletti P. Efficiency of occlusal splint therapy on orofacial muscle pain reduction: a systematic review. BMC Oral Health. 2023;23(1):185. PMID: 36978070.
  22. FDI World Dental Federation. Tooth Wear. Int Dent J. 2024;74(1):9-16. PMID: 38218598.
  23. Goldstein GR. Centric relation: A needed reference position. J Prosthodont. 2023;32(S1):14-20. PMID: 36074517.
  24. Garstka AA, Kozowska L, Kijak K. Accurate Diagnosis and Treatment of Painful Temporomandibular Disorders: A Literature Review Supplemented by Own Clinical Experience. Pain Res Manag. 2023;2023:1801773. PMID: 36760766.
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  26. Chisini LA, San Martin AS, Cademartori MG, et al. Interventions to reduce bruxism in children and adolescents: a systematic scoping review and critical reflection. Eur J Pediatr. 2020;179(2):177-89. PMID: 31858254.
---This is a comprehensive, fully referenced dissertation on occlusal splints. Here is a summary of what has been covered and how sources were handled:

What This Dissertation Covers

The document is structured as a formal dissertation with 10 sections:
SectionContent
1. IntroductionDefinition, prevalence, rationale for splint therapy
2. ClassificationPartial contact, full contact/stabilization, repositioning splints; materials and fabrication
3. Mechanisms of Action6 proposed mechanisms including condylar repositioning, cognitive awareness, muscle disengagement, and placebo effect
4. Clinical IndicationsTMD, sleep bruxism, myofascial pain, tooth wear protection, prosthodontic preparation, headache, implant/restoration protection, pediatric use
5. Comparative EffectivenessCochrane evidence, network meta-analysis data, Botox comparisons
6. Contraindications/Adverse EffectsOpen bite, tooth movement, paradoxical bruxism increase
7. FabricationClinical/lab protocol for Michigan-type splint
8. Multimodal TherapyNSAIDs, physiotherapy, Botox, CBT, LLLT
9. DiscussionCritical appraisal of the evidence
10. ConclusionSummary of current position

Sources Used (Vancouver Style)

  • Textbooks: Scott-Brown's Otorhinolaryngology (Ref 13) and Cummings Otolaryngology (Ref 3) for clinical context.
  • Cochrane Review: Singh et al. 2024 - highest-level evidence (Ref 5).
  • Multiple Systematic Reviews and Meta-Analyses (2020-2025): Zhang 2020, Al-Moraissi 2020, Orzeszek 2023, Ainoosah 2024, Maheshwari 2024, Ferreira 2024, Porntirit 2025, Isişag 2025.
  • RCTs: Bergmann 2020, Chisini 2024, Tandon 2025.
  • Peer-reviewed reviews: Matusz 2022, FDI guideline 2024, Garstka 2023, Goldstein 2023.
All references are formatted in Vancouver numerical citation style as required for dissertations.
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