Diagnostic Hard Occlusal Guard Helps Rule Out Pathology Prior to Definitive Restotations

Take-Homa Pearl: Maxillary hard occlusal guards are the appropriate treatment fot patients with myofacial pain and/or parafunctional activity.

Article Reviewed: Antonelli J, Hottel TL, et al. The Occlusal Guard: A Simplified Technique for Fabrication and Equilibrium. Gen Dent 2013;61 (May/June):49-54.

Background: Numerous treatment modalities exist to treat temporomandibular disorders (TMDs) of various etiologies. However, occlusal guards have been proven to treat TMD due to occlusal interferences that create myofacial pain.

Objective: To "... teach the reader how to construct a customized occlusal guard for a patient with myofacial pain initiated by deflective occlusal interferences."

Methods: Review of the literature and case presentation.

Results: Maxillary hard occlusal guards are preferred by the author, as they have more occlusal contact with all the teeth, creating stability, and they do not crowd the tongue. First, obtain void-free alginate impressions and pour them up in Resin Rock (a resin-fortified die stone that exhibits less setting expansion.) A centric relation record (CR) should then be obtained with softened extra hard base plate wax and Aluwax. Next, outline the peripheral extent of the appliance on the maxillary cast. The anterior labial border should end between the incisal and middle thirds of the anterior teeth, while the posterior labial borders may be longer. The lingual borders should extend 10 mm beyond the free gingival margins. Create the appropriate appliance thickness and accentric movements by lowering an anterior guide pin on either a custom incisal guide table or a mechanical incisal guide table and raising the wings on the guide table to create 1.5 to 2.0 mm of opening in the molar region. Then, adapt a 2-piece thick and 15-mm wide base plate wax strip over the maxillary cast until the border extends beyond the penciled facial border. Reheat the wax and occlude the casts until the mandibular cusp tips are imprinted, removing excess wax until the indentations of the mandibular buccal cusps remain. Mark all centric relation contacts with articulating paper and remove heavy contacts untl all mandibular bucca cusps have equal CR marks bilaterally. Then use the opposite side of the articulating paper to mark lateral excursive and protrusive movements. Remove all excursive markings, preserving the cuspid markings for future canine guidance. Shape and smooth the developing anterior ramp and eminences for canine guidance, making sure the occlusal table is wide enough to provide contact in all full excursive/protrusive movements. A commercial lab can invest and process the occlusal guard. Upon delivery, remove all binding acrylic on the intaglio surface, mark centric contacts with the blue side of the articulating paper, and remove all excursive prematurities by marking them in red.

Conclusions: A diagnostic hard occlusal guard may be necessary to rule out pathhology prior to placement of definitive restorations. Also, occlusal guards are the appropriate treatment for patients with myofacial pain and/or parafunctional activity.

Reviewer's Comments: This is a good "how to" article for the fabrication of an acclusal guard for patients with myofacial pain due to occlusal interferences.

Reviewer: Kelly Halligan, DDS, PC


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