Editing Openai/69357ba5-899c-8006-b1f7-01afc4acae67 (section)

== gpt-5-1 ==
=== User: Are  oral splints which can be bought in the supermarket advisable ? ===
Are  oral splints which can be bought in the supermarket advisable ? Dont they change the occlusion to a position which might be unwanted ?

=== Assistant: Short answer: Supermarket/night-market boil-and-bite splints are generally not advisable for long-term use — especially… ===
Short answer: Supermarket/night-market boil-and-bite splints are generally ''not'' advisable for long-term use — especially for someone with your dental background and occlusal awareness — because yes, they can change the occlusion in an undesirable way and even worsen joint/muscle problems.

Here is the detailed explanation:

==== Supermarket or “boil & bite” night guards are not custom-fitted and therefore: ====

===== Because they are thick and uneven: =====
* They force the mandible into a random, non-physiologic position
* This can alter habitual occlusion
* In some people, this creates or worsens TMJ symptoms (clicking, deviation, muscle tension)

===== Soft EVA guards (most OTC types): =====
* Encourage more clenching, not less
* The material “gives way”, stimulating the chewing reflex
* Can lead to more masseter hypertrophy and morning tension

===== A therapeutic splint must have: =====
* Stable, even contacts
* Proper anterior guidance
* Disclusion of posterior teeth during movement

OTC splints cannot provide this — they introduce random contacts.

==== Yes, especially with prolonged nightly use. ====

Possible consequences:
* Posterior open bite after prolonged anterior contact
* Shift of the mandible due to uneven thickness
* Extrusion of unopposed teeth (long-term)
* Changes in muscle memory (myocentric shift)

Even dentists avoid soft splints for themselves because of this.

==== Only temporarily, for: ====
* Short-term bruxism protection during stressful episodes
* Emergencies when waiting for a custom guard
* Patients with intact occlusion who need very short term protection

But still not ideal.

==== As you know from your prosthodontic/implantology background: ====

===== A hard, custom-fitted, full-arch maxillary stabilization splint (Michigan splint / Minnesota splint). =====

It:
* Creates an even occlusal table
* Positions the mandible neuromuscularly
* Protects restorations and implants
* Does not randomly alter occlusion

Given your clinic setup with in-house lab and CAD/CAM, you can easily produce a splint that:
* Has perfectly even contacts
* Is adjusted chairside
* Can be milled in PMMA or printed in rigid resin

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==== - Compare Michigan, Tanner, Fox, or Kois deprogrammer ====
* Provide a clinical guideline for which splint type is ideal based on symptoms (e.g., bruxism, disc displacement, muscle pain)
* Draft a patient information sheet for your clinic
* Show CAD/CAM milling recommendations for splints

Would you like that?

=== User: Are they boil& bite splints advisable for patients with severe erosions ? ===
Are they boil& bite splints advisable for patients with severe erosions ?

=== Assistant: Generally, no — boil-and-bite splints are not advisable for patients with severe erosions. ===
Generally, ''no'' — boil-and-bite splints are ''not'' advisable for patients with severe erosions.
In fact, in severe erosion cases they can do more harm than good.

Let me explain clearly and clinically:

=== ✅ Why boil & bite splints are not suitable for patients with severe erosions ===

===== 1. Severely eroded dentition is already unstable =====

Erosion reduces:
* Occlusal vertical dimension (OVD)
* Enamel support
* Functional tooth height

A boil-and-bite splint:
* Has uneven thickness
* Is soft or semi-soft
* Allows the mandible to “find its own path”

➡️ This can further collapse or shift the OVD, which is the opposite of what an erosion patient needs.

===== 2. These patients often need controlled mandibular repositioning =====

Patients with advanced erosions frequently have:
* Overclosed bites
* Loss of anterior guidance
* Posterior wear facets
* Increased muscle load

Boil-and-bite splints provide zero control of:
* Vertical dimension
* Even occlusal contacts
* Centric relation position
* Disclusion during lateral/protrusive movements

➡️ This increases muscle hyperactivity and TMJ load.

===== 3. Soft splints increase clenching =====

Most boil-and-bite splints are soft EVA.

Soft material:
* Stimulates the jaw to chew
* Leads to increased bruxism
* Can worsen muscle tension and wear

With erosions, you already have weakened enamel/dentin → not ideal to increase forces.

===== 4. They can change the occlusion even faster =====

Because erosion patients have:
* Thin enamel
* Flattened cusps
* Reduced vertical support

Even slight changes in mandibular position from a soft OTC splint can cause:
* Posterior open bite
* Shifts in centric occlusion
* Changes in muscle memory

➡️ Risk of permanent occlusal changes.

=== 🛑 In summary: For severe erosion patients, OTC boil-and-bite splints are contraindicated. ===

=== ✅ What IS advisable for severe erosions ===

===== 1. Hard, custom-made stabilization splint (Michigan-type) =====

Properties:
* Even, flat, hard occlusal table
* Controlled OVD
* Proper canine/anterior guidance
* Disclusion of posterior teeth

===== 2. Consider splint-supported OVD increase =====

Erosion patients often require:
* Testing an increased OVD
* Evaluating muscle comfort
* Preparing for full-mouth rehab

A proper splint can act as:
* A diagnostic tool
* A protective night guard
* A trial increase of vertical dimension

===== 3. Possible second splint for daytime (thin, hard) =====

If the patient heavily parafunctions.

=== 🦷 Clinical Guideline (practical) ===

| Condition           | Boil & Bite OTC    | Custom Hard Splint |
| ------------------- | ------------------ | ------------------ |
| Mild wear           | ⚠️ Short term only | Yes                |
| Severe erosions     | ❌ Never            | Gold standard      |
| Loss of OVD         | ❌ Contraindicated  | Indicated          |
| Muscle pain/bruxism | ❌ Often worsens    | Yes                |
| TMJ symptoms        | ❌ Wrong choice     | Yes                |

=== If you want, I can also help you with: ===

✓ When to use a Kois deprogrammer versus Michigan splint in erosion cases
✓ How to set the OVD for splint therapy
✓ Protocol for full-mouth rehabs after erosive wear

Would you like deeper clinical guidelines?