Appliance Therapy

The occlusal guard: a simplified technique

for fabrication and equilibration
John Antonelli, DDS, MS n Timothy L. Hottel, DDS, MS, MBA n Sharon C. Siegel, DDS, MS n Robert Brandt, DDS, MS
Gladston Silva, DDS, DMD
Hard occlusal guards have been used effectively to treat myofacial pain
originating from parafunctional activities. They can also protect the
natural dentition when it opposes porcelain restorations, help to evaluate
changes in occlusal vertical dimension during full mouth rehabilitation,
minimize further tooth loss in patients with abfraction lesions, and
redirect occlusal loads more favorably onto dental implant-supported

t is generally agreed that hard occlusal

guards play an important role in the
treatment of temporomandibular disorders (TMD), particularly where myofacial
pain is a prominent symptom.1-6 Occlusal
guards are also useful in the treatment of
nocturnal bruxism, clenching, and the
associated occlusal-incisal attrition seen in
adults and children.6,7
This article does not propose to address
the role that apnea, GERD, and other
sleep disorders may have in the etiology of
parafunction. The goal of this article is to
teach the reader how to construct a customized occlusal guard for a patient with
myofacial pain initiated by deflective occlusal interferences. The authors recognize
that there are numerous appliances used to
treat various classifications of TMD, which
might involve intra-articular problems,
derangement of the temporomandibular
joint, arthritis, trauma, disk derangements,
degenerative joint disease, inflammatory
disorders, and others. A comprehensive
treatment of TMD, however, is beyond
the scope of this article; therefore, the
authors have, by design, chosen to limit the
discussion to treating masticatory muscle
disorders, protecting dental restorations,
evaluating lost occlusal vertical dimension
(OVD) non-invasively with an occlusal
guard, limiting the advance of abfraction
lesions, and protecting dental implants.
A well-constructed appliance allows
the condyles to seat in their most anterior
superior position [that is, centric relation
(CR)], provides anterior disclusion (canine
guidance), provides even and simultaneous incisal and posterior occlusal point
contacts with opposing functional cusps,

prostheses. A simplified technique is described to fabricate a properly

designed wax model of an occlusal guard that can be processed in acrylic
in the same manner used to construct a complete denture.
Received: March 15, 2012
Revised: August 2, 2012
Accepted: September 24, 2012

and prevents posterior contact in all

excursive movements. The guard should
not have any occlusal or cuspal indentations into which opposing teeth can lock
and exert heavy lateral or thrusting forces;
a smooth occlusal surface removes sensory
feedback from interfering with tooth
contacts and allows elevator muscles to
move the mandible so that the condyles
can slide posteriorly and up the slopes of
the eminentiae for complete seating in
CR. If the condyles are healthy and can
accept occlusal loading, then an appliance
that permits the condyles to seat during
a clench will eliminate lateral pterygoid
resistance to the masseter and temporalis
muscles, and provide relief from myofacial
pain. Dawson refers to this design as
permissive.8 Permissive guards are also
referred to as muscle deprogrammers.
A proper occlusal guard should be made
of highly polished heat-polymerized acrylic
resin. In the authors experience, maxillary guards are preferred as they are better
tolerated, more stable, avoid crowding the
tongue, and achieve occlusal contact with
all opposing teeth regardless of the maxillomandibular relationship. Obtaining
proper anterior contact and incisal guidance with a mandibular appliance can be
difficult in patients with Class II and III
maxillomandibular relationships.9

Materials and methods

Constructing a hard occlusal guard is relatively uncomplicated. This article describes

a simple technique that uses few materials
to process a wax model in acrylic according to the same technique used in the
construction of complete dentures.

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The first step in this technique is to

obtain a set of irreversible hydrocolloid
(alginate) impressions that are free of
voids. A snap removal from the mouth is
recommended, as rocking upon removal
causes distortion and tearing, and leads to
an ill-fitting appliance. Pour impressions
immediately into Resin Rock (Whip Mix
Corporation). Resin Rock is ideal for producing accurate casts as it provides 2 major
advantages: it is a resin-fortified die stone
that is more abrasion-resistant than other
gypsum products, and it exhibits less setting expansion (0.08%) than conventional
model stones (setting expansion range
0.9% to 0.16%).
Use a facebow transfer to relate the
maxillary cast to a semi-adjustable articulator. Arbitrary hand articulation and
subsequent mounting of casts on an articulator should be avoided as they generally
result in significant occlusal discrepancies
and the need for additional chairside
adjustments of the appliance at the delivery appointment. Chairside adjustments
can be minimized further by making a
CR bite record to mount the mandibular
cast. To record CR, soften a piece of extra
hard pink base plate wax (Beauty Pink
Wax, Miltex, Inc.) and then cut to the
shape of the maxillary arch. Place the
softened wax over the maxillary teeth to
index the wax (that is, record indentations
of the cusps). Remove and chill the wax
and then replace over the teeth and check
for stability. Attach two thicknesses of
green Aluwax (Aluwax Dental Products
Co.) to the premolar-molar regions of the
pink wax. Soften the Aluwax and place
the indexed wax intraorally to record the

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Appliance Therapy The occlusal guard: a simplified technique for fabrication and equilibration

Fig. 1. Frontal view of the maxillary cast with soft

wax. The soft wax adapts accurately to the buccal,
lingual, and occlusal surfaces of the cast.

Fig. 2. Occlusal view of the maxillary cast with soft wax. A thin
articulating ribbonblue side facing the waxwas placed on the
wax to record all occlusal contacts in shallow depressions.

Fig. 4. Occlusal view of the maxillary cast with

soft wax. Broad mandibular laterotrusive canine
contacting surfaces (red) in wax were narrowed prior
to investing and processing the guard.

Fig. 5. Side view of the articulated casts. Wax has

been shaped and smoothed to develop an anterior
ramp and canine eminences.

bite. Remove the wax record after approximately 45 seconds and chill in cold water
prior to articulating the mandibular cast.
Verify that the articulated casts conform
identically to the patients CR bite.
The next step is to outline in pencil on
the maxillary cast the peripheral extent of
the appliance. The lingual border should
extend approximately 10 mm apical to the
free gingival margins. For adequate retention of the guard, the labial border should
terminate between the incisal and middle
thirds of the anterior teeth; the border
around posterior teeth may be slightly
longer. Survey the maxillary cast to detect
deep undercuts that could prevent seating
of the appliance in the mouth; undercuts
may be blocked out by applying stone

or plaster directly to the cast. Block-out

procedures may be omitted if undercuts or
embrasures are minimal and subsequent
interferences to seating the guard can be
removed at the time of insertion.
With both casts on the articulator,
eccentric guidance and the thickness of the
guard are best developed by using an anterior guide pin in contact with the patients
previously constructed custom incisal guidance table. If a custom guidance table is not
available, then a mechanical incisal guidance table may be inserted on the articulator and set flat initially. Open the occlusal
vertical dimension of the articulator by
extending the incisal pin downward. An
interocclusal space of approximately 1.5 to
2.0 mm should exist in the molar region of

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Fig. 3. Close-up occlusal view of the

maxillary cast after a new piece of
articulating ribbonred side facing
waxwas placed over the wax. A
working side interference (arrow)
was detected.

the casts; this should be approximately the

same OVD as the one at which the wax CR
record was made and should provide sufficient room for the anticipated thickness of
the appliance. A pin extension of approximately 5.0 to 6.0 mm is in the range of
opening for this purpose. Check the clearance between opposing casts during protrusive movement. If there is less than 1.5
mm clearance, then increase it by tilting the
mechanical guidance table. Raise the wings
of the mechanical guidance table until there
is 1.5 to 2.0 mm of clearance in all lateral
excursions. Next, soften 2 pieces of pink
base plate wax (Henry Schein Dental) in
hot water; avoid overheating as melted wax
is difficult to manipulate. Superimpose the
pieces and then fold lengthwise to produce
a strip approximately 15 mm wide. Adapt
the wax strip over the teeth of the maxillary
cast and exert pressure to extend the edges
up to the facial/buccal and palatal borders
outlined previously (Fig. 1). Use a warm,
sharp knife to cut wax that extends beyond
the pencil lines.
It might be necessary to resoften the
wax at this time. Replace the softened wax
strip over the maxillary cast and close the
articulator until the incisal pin contacts
the guidance table; imprints of mandibular tooth surfaces should appear in the
wax strip. Use a sharp blade to remove
excess wax until only the indentations

Fig. 6. Acrylic guard. Note pinpoint CR contacts

(blue) can be seen on the occlusal surface of the
acrylic guard.

Fig. 7. Occlusal view of acrylic guard. Note the

narrow protrusive and laterotrusive contacts made
by mandibular incisors and canines, respectively.
Laterotrusive contacts made by mandibular incisors
have been eliminated.

of the functional (buccal) mandibular

cusps remain. Next, use thin (19 m)
articulating ribbon (Exacta-Film, Ardent
International, Inc.)blue side facing the
waxin a Miller forceps to record all
occlusal contacts by alternately closing
and opening the maxillary member of the
articulator. There should be even diameter
blue CR marks on the surface of the wax
strip for each functional cusp. Use a warm
knife to flatten and smooth the wax until
there are solid CR contacts bilaterally for
every mandibular buccal cusp; retain solid
CR marks for as many incisors as possible
(Fig. 2). At this point, all contacts should
be located in shallow wax depressions.
After all occlusal contacts have been
recorded, use a new piece of articulating
ribbon to identify potential working and
balancing side interferences. Release the
centric lock on the articulator. Place the
ribbon on the left side (red side facing
wax) and close the articulator. Move the
incisal pin to the right and left sides to
register any laterotrusive (working) and
mediotrusive (balancing) interferences,
respectively. Repeat the procedure on the
opposite side of the arch to detect and
eliminate all posterior working and balancing interferences; do not eliminate the
blue CR dots (Fig. 3). CR markings are
essential contacts and are used to equilibrate the occlusal guard. Preserve only laterotrusive canine contacts as they will be
needed to develop canine guidance. Also,
eliminate all eccentric contacts made by
the mandibular incisors until the most
prominent marks are those of the canines

(Fig. 4). Preserve only the blue CR marks

in the incisor region. This step establishes
incisal guidance in the occlusal guard.
Protrusive movement should be guided
predominantly by the mandibular
canines. (Mandibular incisors may assist
in protrusive movement; however, no
single incisor should bear the load in
anterior guidance.) Use a new piece of
articulating ribbon to detect (in red) and
eliminate all posterior interfering contacts
that appear during protrusive movement;
continue to preserve all posterior blue CR
contacts. Shape and smooth the wax as
you develop an anterior ramp and canine
eminences (Fig. 5). They should be angled
approximately 30 to 45 degrees to the
occlusal plane and allow continuous and
smooth contact during protrusive and
laterotrusive excursions. A greater angulation could restrict anterior guidance and
aggravate existing masticatory muscle
pain. Smooth all wax surfaces.
The occlusal table should be at least
half a cusp wider facially and lingually
than the maxillary teeth being covered;
it should extend anteriorly to provide
incisal contact in full protrusive jaw position. Smooth all ridges and irregularities
produced by centric closure and excursive
movements so that wax extends almost to
the deepest portions of the indented tracks
made by the mandibular teeth. At this
point, a commercial dental laboratory can
invest and process the wax pattern with
clear, heat-polymerizing acrylic resin in a
manner similar to the way complete dentures are invested and processed.

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Intraoral delivery and equilibration

of the processed occlusal guard
The success of the therapy will depend
on how accurately the occlusal guard is
equilibrated and on the level of patient
cooperation. There are a few steps to help
ensure a favorable outcome. First, at the
try-in appointment, deep interproximal
embrasures and tooth surface irregularities are likely to interfere with complete
seating of the guard. Soft disclosing wax
can be melted into the intaglio surfaces
of the guard to facilitate identification of
binding areas. White Fit Checker (GC
America, Inc.), a silicone disclosing material, may also be used to detect binding
sites within the guard. A satisfactory fit
is achieved when the intaglio surfaces
are covered by a uniformly thin film (30
to 120 m) of silicone material. Remove
binding areas with a No. 8 carbide bur
at slow speed. The appliance should fit
comfortably and be adequately retentive
without rocking; lip and tongue movements should not unseat the guard.
Another way to ensure a favorable outcome is to place the patient in a reclined
position to simulate the sleeping posture,
then use articulating ribbon intraorally
over occluding surfaces of all opposing
teeth to equilibrate the guard. Be aware
that gravitational effects will likely cause a
slight posterior repositioning of the mandible. Register all mandibular CR functional cusp tip and incisal edge contacts
with the blue side of the ribbon facing
acrylic. If contacts are detected predominantly on one side of the arch, then flatten
areas of heavy or premature contacts until
there are solid CR contacts bilaterally
throughout the posterior areas of the
occlusal guard (Fig. 6). Eliminate all premature contacts on the appliance outside
the mouth. A pear-shaped laboratory
acrylic finishing bur (Komet H77E-029,
Komet USA LLC) is recommended to
eliminate CR prematurities and deflective
contacts in all mandibular excursions until
each CR functional cusp has a relatively
even diameter mark.
Identify anterior protrusive sliding
contacts with the red side of the articulating ribbon. Then identify and eliminate
posterior interfering contacts that occur
during protrusion; preserve all blue
CR dots. Establish broad, continuous
curved contacts on the guard, guided

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Appliance Therapy The occlusal guard: a simplified technique for fabrication and equilibration

All patients should be examined routinely, 1 or 2 days after guard placement,

to ensure proper use of the guard and to
ascertain possible problems. If symptoms
are relieved by use of the guard, then
diagnosis and treatment may be assumed
to be correct, and direct selective occlusal
adjustment and restorative dentistry, or
both, will probably succeed. If symptoms
fail to abate, then the occlusion should
be reevaluated. If symptoms persist, then
the initial diagnosis must be questioned.
Inform the patient that wearing the guard
will likely cause an increase in salivation,
which can last for as long as 2 weeks.
Speech will likely be affected initially but
will return to normal in 2 to 3 days.
Fig. 8. Side view of acrylic guard in mouth. Note posterior teeth are clearly disoccluded from the guard during
canine guided movement.

by the mandibular canines and as many

incisors as possible during protrusive
movement. In canine guidance, movements must be smooth as posterior
teeth are disoccluded.
Eliminate all posterior laterotrusive and
mediotrusive contacts on both sides of
the appliance without eliminating blue
CR contacts (Fig. 7). Remove all eccentric
contacts made by incisors so that the predominant laterotrusive marks are those of
the mandibular canines. Occlusal equilibration should avoid selective spot grinding; instead, planar grinding is preferred to
eliminate occlusal locks and indentations
that can trigger an increase in muscle
activity. Adjust anterior contacts until they
are lighter than posterior contacts.
After adjusting the guard in the
reclined position, raise the patient to the
upright position. Re-evaluate the occlusion to account for potential anterior
reshifting of the mandibular arc of closure
that can produce anterior contacts that
are heavier than those in the posterior
areas. Readjust all anterior contacts until
they are lighter than those in posterior
sextants. Do not polish areas where contacts were adjustedpolishing can result
in the loss of contacts. The slight roughness produced by the multi-fluted carbide
bur will not harm opposing teeth, nor will
it be uncomfortable for the patient.

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The following design features should be

incorporated in an occlusal guard: (1) all
functional cusp tips should contact evenly
and simultaneously in CR, (2) only the
mandibular canines should contact during
canine-guided movements, (3) mandibular
canines and as many incisors as possible
should contact during protrusive movement, (4) and the occlusal guard should
not move during CR closure or any eccentric movement (Fig. 8).
Postinsertion instructions
Instruct the patient to use finger pressure
to seat and remove the occlusal guard.
Once inserted over the teeth, inform the
patient that biting force should be used
to achieve final seating. The guard should
be worn during various time intervals,
depending on the patients diagnosis.
Patients with myofacial pain should wear
the guard 24 hours a day, except to eat
and brush, until symptoms are relieved.
Muscle discomfort is usually relieved over
the course of a few days. Asymptomatic
bruxers may wear the guard during
sleeping hours only. Patients who report
myofacial pain upon awakening should
be advised to wear the guard at night. If
wearing the guard leads to pain at any
time, the patient should discontinue use
immediately and schedule a follow-up
visit to reevaluate the guard.

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Maintenance of the occlusal guard

Instruct the patient to brush the guard
thoroughly after it is removed from
the mouth; a soft toothbrush is recommended to remove food debris. After a
guard is washed and is not going to be
placed immediately back in the mouth,
the patient should immerse the guard in
water to avoid warping. To reduce biomass
levels, the guard should be soaked in
sodium hypochlorite, or denture cleansers
containing sodium hypochlorite, for no
longer than 10 minutes.10 During maintenance care visitsevery 4 to 6 months
is recommendedexamine the guard for
previously undetected or newly developed
wear facets; re-equilibrate if necessary or
remake if occlusal wear results in perforation. Oral hygiene instructions must be
reinforced during maintenance care visits.

Discussion

The greatest harm to the teeth and supporting structures occurs during parafunction, not during normal function.1 In a
study of 60 subjects who reported symptoms of myofacial pain associated with
clenching and bruxing, Clark et al found
that 82.2% exhibited attrition of enamel
on 3 or more teeth; 41.7% of the subjects exhibited wear of both enamel and
dentin.11 As many as 90% of nocturnal
bruxers have reported clenching.1,11
Bruxing or clenching is the first indication for treatment with an occlusal guard.
Bruxers and clenchers may report the
following symptoms: (1) tightness of the
masticatory muscles upon awakening
(diurnal bruxing and clenching can also

produce this sensation) and (2) myofacial

pain. During normal chewing, the loads
applied to teeth are small, ranging from
2.25 lbs. to 4.5 lbs. Typically humans
can only place approximately 25 lbs. of
pressure on a central incisor, gradually
increasing as one moves posteriorly to
approximately 125 lbs. at the premolars
and 200 lbs. at the molars.12 Bruxing
and clenching have been found to have
increasing effects on bite force.11 To
add to these increased loads, total tooth
contact time for bruxers was found to
range from 30 minutes to 3 hours in a
24-hour period; total tooth contact time
for nonbruxers was approximately 17.5
minutes.13,14 Myofacial pain is related to
prolonged jaw closing muscle hyperactivity. Patients who exhibit greater levels
of nocturnal electromyographic (EMG)
activity are more likely to have signs
and symptoms of jaw dysfunction (i.e.,
restricted range of mandibular movement,
muscle pain on palpation, temporomandibular joint pain on palpation, and pain
during mandibular border movements).12
Manns et al examined EMG activity
when the masseter muscles clenched
in various situations.15 Their study first
measured muscle activity when patients
clenched only on natural teeth and then
compared muscle activity when the same
patients clenched on an occlusal guard.
The authors observed an increase in
muscle activity when patients clenched
on a guard. When the design of the
guard was altered to permit only the 6
anterior teeth to contact, muscle activity
decreased by 40%. When the premolars and the incisors were permitted to
contact, they observed a 20% decrease
in maximum bite force. Maximum
muscle activity was recorded when only
the molars were in contact. A properly
designed occlusal guard manages these
forces by loading the temporomandibular
joints with all teeth touching simultaneously.15 The authors concluded that
muscle activityand joint healthis
dependent on the most posterior tooth
contacts and anterior guidance functions to prevent posterior tooth contact.
Therefore, reduction of posterior tooth
contact will reduce muscle activity.15
In an earlier study, Manns et al undertook to determine how excursive contacts
affect muscle activity.16 Electromyographic

activity in patients displaying canine guidance was compared to those with group
function. The authors discovered that in
laterotrusive and mediotrusive movements,
the masseter and temporalis muscles work
half as much in canine guidance as in group
function. This was attributed to decreased
contacts among posterior teeth during
canine guidanceit is not the contact of
the canines that decreases EMG activity of
the elevator muscles, but the elimination of
posterior contacts.16 The case was presented
for designing canine guidance in occlusal
guards for patients with myofacial pain.
When this objective is achieved, then the
temporalis and masseter muscles release
their contractions and are unable to exert a
magnitude of harmful force when posterior
interferences are present.4
A second indication for the need to
provide an occlusal guard is the increasing
use of porcelain in dental restorations.
Porcelain is more abrasive to opposing
natural enamel than metal; its destructive
capacity is well-known.17 When porcelain
surfaces are adjusted to the extent that
the glaze is removed and the underlying
opaque porcelain is exposed, the opaque
porcelain poses a greater danger than
the body porcelain for the destruction
of opposing enamel and restorations
during function.17 Also, while porcelain is
strongest under compression, it is weakest under the tensile and shear forces that
occur during excursive mandibular movements. Invisible microcracks exist on the
surface of porcelain.17 Tensile stresses on
porcelain serve as a wedge to concentrate
the stress, enlarge the cracks, and eventually promote crack propagation through
the body of the porcelain. Parafunctional
activity is also responsible for loosening
prostheses.18 It is recommended to provide
an occlusal guard for all patients with
porcelain reconstructions to preserve the
natural dentition and to protect porcelain
restorations when they oppose one other.
A third indication for an occlusal guard
is prior to full mouth rehabilitation, when
the OVD will be re-established and the
teeth will be restored with full or partial
coverage crowns. An occlusal guard is
a non-invasive way to assess a patients
tolerance to the restored OVD while
preventing further loss of tooth structure.
A maxillary appliance is provided after all
restorative treatment is completed. After

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all definitive restorations are placed, a new

appliance is constructed to protect the
restorations and natural tooth structure,
and to decrease myofacial pain when there
is evidence of parafunctional activity.
The fourth indication for an occlusal
guard is the presence of tooth abfraction
lesions.19 Abfractions are noncarious,
V-shaped hard tissue lesions located at the
cemento-enamel junction. Evidence suggests that abfractions are produced when
occlusal loads applied outside the long axis
during lateral excursions causes teeth to
flex.20 Abfraction lesions are seen in bruxers and clenchers as they commonly apply
large eccentric occlusal loads to their teeth.
The efficacy of direct occlusal equilibration
in these cases is still controversial, and
the elimination of occlusal interferences
will not necessarily eliminate bruxing or
clenching habits. Providing an occlusal
guard for patients with abfractions is considered a reasonable protective measure.19
A fifth possible indication for use of
occlusal guards is in patients with dental
implants. Lobbezoo et al acknowledged a
lack of evidence implicating parafunctional
activity as contributing to overloading
implants or their superstructures; however,
they credited occlusal guards with being
able to redirect occlusal loads to the long
axes of implant-supported crowns.21
Maxillary occlusal guards can also be used
to eliminate occlusal loading of maxillary
or mandibular implant-supported restorations. As implants do not extrude in the
absence of opposing contacts, occlusal loads
on maxillary implant-supported restorations may be eliminated by hollow grinding
the intaglio surfaces of maxillary guards
covering the implants. When mandibular
implants are present, the occlusal surfaces
of maxillary guards opposing implants can
be relieved to eliminate occlusal loads.18
Soft occlusal guards are not recommended because they tend to produce
an increase in masseter muscle activity
during maximum clenching activity;
hard occlusal guards decrease EMG
activity in both masseter and temporalis
muscles. When al-Quran & Lyons tested
hard appliances, the decrease in activity
was more pronounced in the temporalis
muscles.2 Okeson reported that soft
occlusal guards do not significantly
decrease nocturnal bruxism.3 In his study,
80% of the participants experienced a

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53

Published with permission by the Academy of General Dentistry. Copyright 2013

by the Academy of General Dentistry. All rights reserved.For printed and electronic
reprints of this article for distribution,please contact rhondab@fosterprinting.com.

25% decrease in nocturnal muscle activity with a hard occlusal guard, whereas
70% of the participants who wore a soft
guard experienced a 25% increase in
nocturnal muscle activity. Soft appliances were shown to increase nocturnal
muscle activity in patients who were
initially asymptomatic; therefore they are
contraindicated for use in symptomatic
patients.2,3,5,22

of Dental Medicine, Nova Southeastern

University, Fort Lauderdale, Florida,
where Dr. Silva is a resident in the
Implant Fellowship Program. Dr. Hottel
is a dean and professor, Department of
Prosthodontics, College of Dentistry,
University of Tennessee, Memphis, where
Dr. Brandt is a professor and director,
AEGD Program at Lutheran Medical/
Dental Center.

Conclusion

References

While Christensen estimated that at least

one third of patients in general practice
need an occlusal guard, Dao & Lavigne
cautioned against over-reliance on reports
about the efficacy of occlusal guards as a
therapy for reduction of myofacial pain
and bruxism.23,24 Their data suggests that
occlusion might not be the cause of bruxism, and the decrease in myofacial pain
might not be the result of treatment with
an occlusal guard but, rather due to a
placebo effect. However, the authors recommended using a hard occlusal appliance
as a diagnostic tool to rule out pathology
prior to fabricating definitive restorations.24
Kreiner et al acknowledged that the efficacy
of behavioral modification and occlusal
appliance therapy might be equal; however,
they conceded that when there is a need
to protect the natural dentition from attrition, or symptoms of myofacial pain and
parafunctional activity exist, prescribing an
occlusal guard is a rational treatment.25

Author information

Dr. Antonelli is a professor and director,

Fixed Prosthodontics Courses,
Prosthodontics, College of Dental
Medicine, Nova Southeastern University,
Fort Lauderdale, Florida, and an adjunct
professor, Department of Prosthodontics,
College of Dentistry, University of
Tennessee, Memphis. Dr. Siegel is a professor and chair, Prosthodontics, College

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General Dentistry

1. Yip KH, Chow TW, Chu FC. Rehabilitating a patient

with bruxism-associated tooth tissue loss: a literature
review and case report. Gen Dent. 2003;51(1):70-74.
2. al-Quran FA, Lyons MF. The immediate effect of hard
and soft splints on the EMG activity of the masseter and
temporalis muscles. J Oral Rehabil. 1999;26(7): 559563.
3. Okeson JP. The effect of hard and soft occlusal splints
on nocturnal bruxism. J Am Dent Assoc. 1987;114(6):
788-791.
4. Williamson EH, Lundquist DO. Anterior guidance: its
effect on electromyographic activity of the temporal
and masseter muscles. J Prosthet Dent. 1983;49(6):
816-823.
5. Attanasio R. Bruxism and intraoral orthotics. Texas
Dent J. 2000;117(7):82-87.
6. Solberg WK, Clark GT, Rugh JD. Nocturnal electromyographic evaluation of bruxism patients undergoing
short term splint therapy. J Oral Rehabil. 1975;2(3):
215-223.
7. Hachmann A, Martins EA, Araujo FB, Nunes R. Efficacy
of the nocturnal bite plate in the control of bruxism for
3 to 5 year old children. J Clin Pediatr Dent. 1999;
24(1):9-15.
8. Dawson PE. Occlusal Splints. In: Functional Occlusion
From TMJ to Smile Design. St. Louis, MO: Elsevier Mosby; 2007:380-382.
9. Okeson JP. Management of Temporomandibular Disorders and Occlusion. 7th ed. St. Louis, MO: Elsevier
Mosby; 2013:470.
10. Felton D, Cooper L, Duqum I, et al. Evidence-based
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Manufacturers

Aluwax Dental Products Co., Allendale, MI

616.895.4385, www.aluwaxdental.com
Ardent International, Inc., Ossining, NY
914.923.1216, www.ardentinternationalinc.com
GC America, Inc., Alsip, IL
708.597.0900, www.gcamerica.com
Henry Schein Dental, Melville, NY
800.372.4346, www.henryschein.com
Komet USA LLC, Rock Hill, SC
888.566.3887, www.kometusa.com
Miltex, Inc., York, PA
800.654.2873, www.miltex.com
Whip Mix Corporation, Louisville, KY
800.626.5651, whipmix.com