A concept to transfer a therapeutic splint position into permanent occlusion with a customized lingual appliance

Fixed acrylic bite planes on lower molars were used to maintain a symptom-free condyle position prior to orthodontic treatment. Silicone impressions of the arches including the fixed bite planes were used for the Incognito laboratory procedure. Two digital setups were made. One setup represents the target occlusion. A second setup including the bite planes was used to fabricate an additional set of lower molar brackets. In the leveling stage all teeth except the lower molars were settled to maintain the therapeutic condyle position. Finally, the fixed bite planes were stepwise removed and molar brackets were replaced to establish the permanent occlusion planned with the first setup.The advantage of an individual lingual appliance consists in the high level of congruence between the fabricated setups and the final clinical result. Both the individual scope for design and the precision of the appliance were vitally important in the treatment of a patient with a functional disorder of the masticatory system.Temporomandibular disorder (TMD) is a widespread and common disease and therefore also an economic problem for the health care system. The prevalence of pain associated with muscles of the temporomandibular region is about 10% and 11.4% of the population suffer from a disc displacement with reduction [1]. Women are more likely to suffer from TMD than men [2].The clinical signs and symptoms of TMD are heterogenous. Most patients report of pain in the muscles of the stomathognathic system (i.e. myalgia) or pain or dysfunction of the temporomandibular joint (i.e. arthralgia, arthritis, disc displacement with/without reduction). Additionally other factors, like trauma, psychological or orthopedic disturbances can affect TMD [3].The modern aetiological concept of TMD is mainly based on research by Dworkin and LeResche in the 1990s. Their research diagnostic criteria for temporomandibular disorders (RDC/TMD) considers somatic as well as psychological and social co-factors