Michael DiTolla, DDS, FAGD
Occlusal splints are one of thefastest-growing products in our laboratory. Recently, I had the chance to interview Dr. Anton Misleh, one of Glidewell Laboratories’ top customers for splints. Dr. Misleh shares his thoughts on the importance of bite splints and how he implements their use into his practice.
Dr. DiTolla: Anton, let’s talk today about occlusal splints. I have always liked them, and think that using occlusal splints is one of the most conservative things we do. What did you learn about TMD and splints when you attended dental school?
Dr. Misleh: Well, that’s easy for me to answer - not a lot. But to be honest, I did not pay much attention to the subject. At the time, it was kind of boring to me. While I am sure that the information was there, I did not give it the attention it needed. When I began practicing dentistry, I saw a lot of broken teeth and traumatic occlusion so I had to think about occlusal splints. After doing a thorough TMD exam instead of just a cursory one, I took the subject seriously. A thorough TMD exam is the key. I also have learned which cases should be referred to specialists.
Dr. DiTolla: That’s interesting. I ask many dentists, “Why don’t you provide more splints in your practice?” Many will answer that TMD patients are crazy, or they say that you end up being married to those patients. Yet you still do many splints despite referring TMD patients to specialists.
Dr. Misleh: Yes, I am doing a considerable number of splints. Here’s my philosophy on splints. I do occlusal splints to prevent wear to the dentition and not so much to treat TMD. That’s important. If a patient has TMD, then you are married to the patient. Dentists charge different amounts for these splints. I charge $450. I don’t know where that stands in the range. But you do not want to be married to a patient for $450. The interesting thing about this is that if you get proficient at diagnosing TMD issues and properly refer these patients, specialists are inclined to charge a much higher fee. So, they are happy to be married to the patient.
Dr. DiTolla: What types of splints do you use now? Is there one that you use as your “go-to” splint?
Dr. Misleh: I have settled on Glidewell Lab’s splint, the Comfort H/S. For the most part, the H/S can be inserted relatively easily. There might be some adjustments to make but nothing like the acrylic splints we learned to make in the past.
Dr. DiTolla: Dentists don’t tend to enjoy the delivery appointment if they have to make a lot of adjustments. What tips do you follow to deliver these appliances? How long does it typically take you to deliver a splint?
Dr. Misleh: We schedule 15 minutes. Most of the time, I don’t even need 15 minutes because the splint goes in with no problem. If I make an adjustment, I use the Brasseler Denture Adjustment Kit.
Dr. DiTolla: Do you heat up, or dip, most splints in hot water before you try them in, or do you try them in first to see how the fit is?
Dr. Misleh: I always try it in dry first. Your tip and technique is to dip it in hot water first, but I always just try it in because I want to find out how the splint “feels” on the patient. If the “feel” is good to me, then I ask the patient if the fit is fine. Experience is part of the game. As I became more experienced with occlusal splints, they required less and less adjustment on my part. If anything, if the fit is just a little too tight, we put some water in a small cup, place the cup in a microwave, heat the water, and soak the splint for about 10 seconds. Then I take the splint and reinsert it. After doing this, patients almost always tell me that the splint’s fit is better.
Dr. Michael DiTolla is the Director of Clinical Research and Education at Glidewell Laboratories in Newport Beach, Calif. He lectures nationwide on both restorative and cosmetic dentistry. Dr. DiTolla has several clinical programs available on DVD through Glidewell. For more information on this article, or to receive a free copy of one of Dr. DiTolla’s clinical DVDs, e-mail him at email@example.com.