Direct-indirect heat-cured occlusal splint fabrication for a patient with limited mouth opening

There are several conditions that can cause limited mouth opening. Recent literature on some of the most common conditions is discussed in this article. The difficulty in making alginate impressions may prevent indirect laboratory fabrication of heat-cured occlusal splints for patients with limited mouth opening. This article presents a combined direct-indirect technique for fabricating a heat-cured laboratory-processed maxillary occlusal splint in a case where making a mandibular alginate impression would have been extremely difficult. An extra-hard baseplate wax interocclusal record was used as a template for occlusal splint fabrication. The wax record was fitted to the maxillary side, then the mandible was gently manipulated to provide light imprints of the opposing teeth. The wax record provided the therapeutic vertical dimension as well as the therapeutic interocclusal relationship for the occlusal splint. The wax record was seated and sealed to the maxillary cast and modified on the palatal and facial aspects for the appropriate splint shape. The splint was processed using clear heat-cured acrylic resin. It required minimum adjustment on delivery. This procedure spared the patient from having a lower impression, which would have been required for the traditional laboratory-made occlusal splint. Increased adjustment time and excessive exposure to unoccurred acrylic resin, which would have occurred with direct intraoral fabrication, were minimized or eliminated using this technique.