Why Your Splint Hits on the Second Molar at Delivery

You deliver an occlusal splint and the patient closes. To your dismay they close and only hit on their second molars. You use articulating paper and begin to mark, grind and reseat the appliance again and again and again trying to achieve posterior point contact on all of the posteriors all the while praying that you do not end up grinding through your brand-new splint before you achieve a balanced occlusion.

It isn't a fabrication error, and it usually isn't bad luck. It's geometry.

When a case arrives at the laboratory without a construction bite, the models are articulated in centric occlusion and then opened until there's enough room for the prescribed splint thickness. That opening happens on the articulator's hinge — and the hinge sits behind the teeth. Rotating around a posterior hinge doesn't separate the arches evenly. The anterior segment opens more than the posterior segment.

The splint is then built to that geometry.

But the patient doesn't close on the articulator's hinge. They close on their own arc, around their own condylar position. The two arcs don't match. Relative to the patient's real closing path, the appliance is too thick posteriorly — so it contacts first exactly where you keep finding it: the second molar region.

The laboratory built precisely what the articulated relationship described. The problem is that the articulated relationship was never the patient's relationship.

The fix is upstream, not chairside. Send a construction bite that captures the exact vertical and anteroposterior position you want, and the arbitrary opening step disappears. So does most of that posterior grinding.

Read the full technique in our Talon Splint Practice Building Bulletin. 

Written by Dr. Rob Veis, DDS. President of SML