About The Bangkok Splint
The Bangkok Splint (บทความเกี่ยวเนื่อง)
The Bangkok Splint is an orthopedic appliance designed by Schwan Somsiri, D.D.S. for elimination of signs and symptoms of TMD patients.
The Bangkok Splint is a full coverage type of splint seated in the mandible to provide orthopedic effect or stretching of the mandibular muscles by providing a spontaneous mandibular position changes e.g. increasing of vertical dimension and advancing the mandible.
Splint therapy should be the introductory treatment in all cases of temporomandibular joint disorders and migraines before other dental cares can be performed.
- All of the cases share the same clinical characteristics, e.g.
- Mutilated dentition
- Clicking sound
- Difficulties during jaw movement
- Limited mouth opening
- Deviation of mouth opening and closing
- Muscle spasm
- Molar loss (Loss of posterior support)
- Molar tipping
- Molar fulcrum
- Trauma from occlusion
- Group interferences
- No canine guidance
- Migraines (20 % of the case)
- Condylar resorption & Crepitus
- Mandibular entrapment
- Mandibular shifting
- Unilateral chewing
- The Course Of Internal Derangements
Once the injuries occur to the joints e.g. extraction of molar teeth in different time line, and no restoration took place or after an accident the patient received improper treatment. The condylar head
The normal joint will gradually undergo through these pathological process:
Stage 1-2 Started with clicking sound Deviation of mouth opening and closing path
Stage 3 Difficulties during jaw movement Limited mouth opening One day the pain came Disc perforation Clicking sound diminished Tinitus
Stage 4 Clicking sound disappear Crepitus. Mouth opening regained
Stage 5 Crepitus Function without disc Degenerative joint diseases
The Bangkok Splint
- The Bangkok splint is a horse-shoe shaped mandibular full coverage orthopedic splint.
- Constructed in the patient’s individual NON-Clicking mandibular position (Stretching position or Orthopedic treatment) by having the patient bite onto the wafer waxed.
- Raised Vertical Dimension (Thickness): At least 2 mm at the molar area
- The amount of mandibular advancement approximately 1-3 mm or at edge to edge bite (bite registration in Class III is rare).
- Mandibular shift is not taken into consideration.
- It has 6-8 triangle clasps for optimal retention, and it can still function even though 2 clasps are broken.
- It will program the mandible into –only one maximal centric stop (CO) with freedom of mandibular movement.
- It has Bilateral Symmetrical Canine Guidance when possible.
- It has Anterior Guidance when possible.
- It was born in Frankfurt/M., Germany in 1982 and become the 8th World Wonder.
Clinical Management Of The Bangkok Splint
1st visit Examination and Consultation
Inform Consent signed
Impression taking (2 Sets of Dental models are needed)
Wax bite registration
1st in CO
2nd in NON-Clicking mandibular position
2 Weeks after: 2nd visit: Insertion of The Bangkok Splint
4 Weeks after: 3rd visit: Check up. Grinding for better canine guidance and
freedom of movement
6 Weeks after: 4th visit
8 Weeks after: 5th visit
8 Weeks after: 6th visit
6 months later, if ready, the signs and symptoms do not return, move to phase II treatment e.g. orthodontic treatment.
Problem with The Bangkok Splint
After insertion – Most of the patient become non-clicking immediately on the splint.
24-48 hours later
The patient with muscular pain or acute posterior capsulitis, as well as migraines, supposed to get better in 48 hours without medication.
4 weeks later, in some cases “Clicking” supposed to disappear with “Migraines” or less attack with milder degree.
- If this is not the case, the patient did not wear the appliance as prescribed !
- If they say they have been wearing the splint as prescribed ! Go on using the splint !
- If they say wearing the splint is uncomfortable, grind the splint for better freedom of movement.
- If muscle fatigue is experienced, the amount of advancement is too great.
3 months after insertion
Clicking is persisted on one side only.
Reline that side higher or grind the opposite side down (pivoting effect)
Clicking is still there on both sides.
Reline the splint for higher VD raised and better canine guidance or Fabricate a new splint.
3 months after insertion
Obvious occlusal changes occur. The bite may get worse due to muscle relaxation
Bilateral canine guidance is smooth, but at the end of closing path, there is a click in one joint. This means that the healing is getting better, now at the moment, the canine relationship on the splint is OK, but one of the disc (on that side) is medially displaced. Go on using the splint.
4-6 months after insertion:
Everything should be OK. The condylar-disc assembly is stable.
The patient is ready for Phase II treatment.
6 months or more after insertion:
Clicking is still there. This means that the condylar-disc assembly is not stable or the pathology has gone too far (Stage 3-4) or the patient is a nocturnal Bruxism.
Reline the splint for more advancement, and hope that it will work.
Fabricate a new splint
6-8 months or more after insertion:
Light clicking sound or crushing sound is there. This means that the pathology has gone too far (Stage 4-5)
12 months after insertion:
Clicking disappear. This means that the condylar-disc assembly is stable, but stability test is recommended. The patient is a nocturnal Bruxism.
The patient is ready for Phase II treatment.
Another reaction that could be found
2 mouths after insertion:
Obvious occlusal changes occur! The patient (Class II division 2) cannot function. Perform phase II treatment with fixed multiband and bracket appliances (MBB)
The Bangkok splint should be wearing for another 6 months, in the phase II treatment by cutting the stainless steel triangle clasps off. Grooves should be cut into the splint in the premolar area and use “RAM” elastics to fix the splint with the mandibular brackets.
Inform the patient that the Bangkok Splint will work when the splint is in the mouth for at least 8 hours up/day. Inconsistent splint wear will not help at all especially the first 84 hours.
About The Author
Name: Schwan Somsiri
Born 13.03.1951 in Bangkok, Thailand
Triam-U-Dom Suksa School (2511)
B.Sc., D.D.S. Faculty of Dentistry, Chulalongkorn University, Thailand
Department of Orthodontics, Hamburg University, Germany
Department of Orthodontics, Frankfurt University, Germany
1982-1994 Lecturer, Senior Staff, Research Fellow at Department of Orthodontics, Frankfurt University, Germany
Differential Diagnosis and Treatment for Temporomandibular Joint Disorders and development of a new orthopedic Splint
Dentofacial-Orthopedics. Early Treatment for young children with abnormal growth and development (Class II and III) without surgery
Treatment for young children with Chronic Allergic Rhinitis and Upper airway obstruction syndrome and mouth breather by Rapid maxillary Expansion
Treatment of Migraine without medicine
Surgical Orthodontic Treatment for Dentofacial-Deformities in 3 Dimension
1996-now Part time staff at Bangkok General Hospital
1996-now Founder and President of the S.O.S. Orthodontic Study Club
2000-now Founder and Managing Director of the Orthodontic and Jaw Joint (TMD) Center, Jaeng Wattana Road, Nonthaburi
2005-now Part time staff at Medical Unit of Kasetsart University
Author of 7 Clinical Orthodontic Manuals used at the Department of Orthodontics, Frankfurt University, Germany and the S.O.S. Orthodontic Study Club
สงวนลิขสิทธิ์ ทันตแพทย์ ชวาล สมศิริ
The S.O.S. Orthodontic Study Club
โทร. 02-574-0555, 02-574-6556, 087-700-9919
More about TMD & The Bangkok Splint visit our
website : www.dental-tmd.com
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File : About The Bangkok Splint 2012.03 for Doctor version.doc
Code BKK Splint 02E