Occlusal splints.
A splint is a therapeutic appliance rather than a protective one. It is designed to a specific occlusal scheme for a specific clinical purpose, which is what distinguishes it from a night guard.
Splint or night guard
The distinction is purpose. A night guard protects teeth and restorations from the forces of parafunction. A splint aims to change something — muscle activity, condylar position, or the distribution of occlusal load — as part of managing a temporomandibular disorder.
That difference shows in the design. A protective guard needs durability and comfortable full-arch coverage. A therapeutic splint needs a defined occlusal scheme: flat plane, even simultaneous contacts, and guidance designed rather than incidental.
Prescribing one when you wanted the other is a common source of disappointment, so say which it is.
Full coverage, always
A splint that covers only part of an arch allows the uncovered teeth to over-erupt, and over weeks to months that produces an occlusal change the patient did not consent to and which is difficult to reverse.
This applies to anterior-only devices in particular. They have specific short-term indications in experienced hands, and used unsupervised or long term they cause posterior over-eruption and anterior intrusion.
Unless there is a clear reason otherwise, prescribe full-arch coverage and review the patient.
Design
A stabilization splint is typically a flat occlusal plane with even, simultaneous contacts from all opposing cusps, canine or anterior guidance in excursion, and immediate posterior disclusion.
TMJ appliances such as Gelb and MORA designs work on a different principle and are prescribed for different presentations. Name the design you want rather than describing a general intent.
Say which arch. Maxillary splints are more commonly prescribed and are easier to make stable; mandibular splints are often better tolerated for speech and are preferred by some patients.
Records
A splint designed to a specific occlusal scheme needs mounted casts, and usually a facebow record so the articulator approximates the patient's condylar geometry rather than an average.
The jaw relation record is the critical element. A splint fabricated to an arbitrary position will need extensive chairside adjustment and may not achieve what it was prescribed for.
Where the patient has no reproducible position, or where the intended position is not maximum intercuspation, say so explicitly. It changes how the case is mounted.
Delivery and review
Expect to adjust at fit. A splint should seat without rocking, contact evenly, and provide the guidance intended — verify all three with articulating paper rather than by feel.
Review the patient. Splint therapy is a treatment being monitored, not an appliance being dispensed, and both the appliance and the occlusion can change over the wearing period.
Where symptoms do not respond, the splint is diagnostic information rather than a failed product.
Splint therapy is monitored, not dispensed
A splint is part of managing a condition, which means the patient is reviewed and the appliance is adjusted as things change. Muscle activity settles, the occlusion on the splint alters as it wears, and the condylar position the splint was made to may no longer be the position it produces.
Review at intervals and re-verify the contacts and guidance each time. A splint that has developed uneven contacts is loading unevenly, which is the opposite of what it was prescribed to do.
Where symptoms have resolved, that is worth documenting alongside the appliance. Where they have not, the splint has given diagnostic information even if it has not been therapeutic.
What to put on the prescription
Tick Night Guard under Procedure and specify that the case is a splint, naming the design — stabilization, Gelb, MORA or otherwise — and the arch.
State the jaw position it is being made to, the guidance scheme you want, and whether mounted casts and a facebow are included. Note any existing restorations the splint must accommodate.
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