When splint therapy stabilizes the storm, what comes next? This post marks a transitional point in the TMJ series by TMJ splint follow-up, shifting from symptom management to long-term rehabilitation. We’ll explore what clinicians should evaluate post-splint, how to detect residual instability, and when it’s time to advance to occlusal reconstruction.
Understanding the Stabilization Phase
A well-designed occlusal splint can reduce joint loading, relax hyperactive muscles, and improve mandibular coordination. However, splints are not a cure. They are diagnostic and therapeutic tools—a way to buy time, reduce inflammation, and observe the system’s adaptive capacity.
After 6–12 weeks of consistent use (typically nocturnal), patients often report:
- Decreased joint noise or clicking
- Less morning muscle fatigue
- Improved opening range
- Fewer tension headaches or referred facial pain
This suggests that functional stability has been partially restored. But here’s the critical question: Has the system returned to equilibrium—or merely adapted to a less harmful pattern?
Key Assessments After Splint Use (TMJ splint follow-up evaluation)
At this stage, clinical reevaluation is vital. The goal is to determine whether the TMJ-masticatory system is now functioning within physiological limits without external support.
Checklist:
- Repeat Range of Motion Tests
- Measure opening, protrusion, and lateral excursions.
- Check for midline deviation, end-feel quality.
- Joint Load Testing
- Palpate TMJ during resisted movements.
- Listen for clicking or crepitus.
- Muscle Palpation
- Trigger points in masseter, temporalis, lateral pterygoid?
- Evaluate symmetry in tension.
- Intraoral Occlusal Mapping
- Premature contacts? Guiding vs. interfering pathways?
- Stability in centric occlusion?
- Functional Stress Simulation
- Simulate chewing, yawning, long conversations.
- Look for functional pain thresholds.
Indicators for Moving to Occlusal Reconstruction (CR-CO discrepancy post-splint)
Not all patients require occlusal rehabilitation. But if symptoms recur after splint removal, or if the occlusion remains unstable, a deeper structural intervention is warranted.
You might consider transitioning to occlusal reconstruction when:
- Muscle symptoms reappear within 1–2 weeks post-splint
- CO ≠ CR discrepancy persists (>2mm slide)
- Occlusal interferences are repeatable
- Functional envelope shows restriction or instability
- Patient exhibits dental wear or shifting
This is when CR (centric relation) vs CO (centric occlusion) analysis becomes relevant. For many, the splint has acted like a temporary orthotic—revealing the true misalignment underneath.
Red Flags Post-Splint: Don’t Miss These
- New-onset asymmetrical pain: May indicate condylar compression
- Worsening tinnitus or dizziness: Neuromuscular link
- Persistent anterior open bite on splint removal: Posterior extrusion?
- Increased parafunction at night: Emotional/stress triggers still active
These signals may suggest that structural imbalance was masked, not resolved.
Clinical Case Snapshot: Post-splint occlusal instability
A 38-year-old female patient with nocturnal bruxism used a maxillary hard splint for 8 weeks. Clicking resolved, and she reported better sleep quality. Upon splint removal, palpation revealed bilateral masseter tightness. Intraoral exam showed premature contact on 26 during lateral excursions. Final diagnosis: postural occlusal interference, requiring selective adjustment and CR-mounted wax-up.
Internal & External Links
Explore previous and upcoming content in the TMJ series:
- 1 story : TMJ Dislocation Case Study
- 2 story : Muscle Dysfunction Overview
- 3 story : Occlusal Instability and Myalgia
- 5 story : TMJ Splint Therapy
Further reading:
Subscribe to the Goldeners Clinical TMJ Series for full case reviews, expert diagrams, and downloadable checklists for post-splint assessment.
