Hande Biceroglu Demir

Can we use clear aligners as a treatment mechanics after splint therapy?

Hello everybody my name is Hande Biceroglu Demir and I am an orthodontist from Istabul, Turkey. I would like to share a case that we first stabilize with splint and after we treated with clear aligners.
She applied to our clinic with a consistant headache for nearly two years and limited mouth opening and pain in tmj. Her mother is a dentist and also she has many dentist relatives in her family. Before applying to our clinic she used soft/hard night guards for 1 years and muscle relaxants which didn’t help her situation. Also she is living in 600km away from our clinic.

She has a small asymmetry in her face with good incisor exposure at rest and a good smile line. Intraorally she presents Class1 occlusion with mild crowding in lower anterior. During examination we found out clicking in both tmj and her mandible was very hard to manipulate.

After we mounted the case on articulator she presented a Class 2 occlusion with a fulcrum in the posterior. In the cbct scan we saw resorption on her right condyle.

We offered her full time splint therapy because of pain and resorption and they accepted the treatment plan. She used full coverage splint nearly for one year 7/24. She visited our clinic every 2 week until her pain is relieved and after every 3 weeks until we reached the stabilization. (For the last 3 appointment we have taken wax records and checked on mpi).

After splint therapy all the complaints were releaved but she became more class 2 and we wanted to correct her bite and alignment. She did not want to wear braces so even the clear aligners are not our favorite treatment mechanics, we decided to use aligners. And inform the patient that if we fail with aligners we might use fix appliances to finish the treatment.

With the aligners the treatment plan was distalization for correction of class 2 and correcting the torque of second molars. For initial 29 aligners we achieved distalization and mounted the case to check if everything is well. We wanted additional 11 aligners for final refinement and after we mounted the case again.
As a result we achieved Class1 occlusion with good alignment which is in harmony with her TMJ. Once again clear aligner therapy are not our first choice but we can not refuse patients expectations many times. If we can achieve a stable occlusion we can utilize clear aligners in orthodontic treatment.

Best regards from Turkey

Ps: Her mother didn’t give permission for final cbct.