By: Will Kelly DMD
Article Originally Appeared on PankeyGram.org
My experience with splint therapy was like most dentists prior to developing the skills taught at Pankey. In fact, my appliance was not really therapy at all. Perhaps just a shot in the dark “helmet” that protected teeth against collisions with very little intention.
Throughout the years there have been many facets of my experience I value greatly in guiding patients to health using plastic.
Splint Therapy and Appliance Design
Appliance design is a provisional analog (that is, a practice replacement) for any changes we make to the teeth and ultimately the stomatognathic system. The splint is a great diagnostic tool that is capable of healing, but it’s also an iconic part of the behavioral interaction between the provider and the patient.
Aside from physically being an orthotic analog, the splint is a training tool, maybe even the greatest reversible “do-no-harm” in our profession. Case by case, each patient experiences changes and familiarizes themselves with my touch and caring.
Month by month and year by year dentists educate themselves and develop an understanding of bite relationships by using therapy. This happens case by case too, much like waxing cars and painting fences for Mr. Miyagi. As the experiences compile, sometimes our questions do as well. Sometimes we turn to our mentors for answers, much like the Karate Kid.
For the learning dentist, different parts come together when bringing splint therapy from the classroom to the operatory. There is the initial understanding of the “why” that can be conceptualized in theory, but not realized in practice until the “how” of the technical piece arrives through experiential understanding.
Each provider comes into their own by developing skills to have patients relate needs and eventually invite them confidently to enter appliance therapy.
Time Is on Our Side
Early in my career, I became frustrated with splint therapy. In the clinical area, it was working. In theory, it made sense to me that I should be able to take the appliance back through well-articulated CR casts and ultimately to my patient’s mouth.
Turned out, that patients treated with splints were not beating down my door for definitive dentistry. Like Mick Jagger, I Couldn’t Get No Satisfaction. A decade later, I have experienced something magical happening and am singing a new Rolling Stones song in my head, Time is On My Side. (Yes it is!)
Time and Splint Therapy
Perhaps I was not waiting on my patients or more than likely they were waiting on me.
I have hundreds of splints on unrestored patients who visit me a couple of times a year. They bring along the plastic to have it ultrasonically cleaned, sometimes tweaked, sometimes repaired.
There was a time when I believed the transition to treatment was a given once the appliance was well-adjusted on a patient willing to trust me with their investment in therapy. (I mean geez, that happens every time for the folks who taught me how to make one, right?) The presentation of the next phase was a conversation that probably sounded a whole lot like a sales pitch and generally fell flat on its face.
Time is on our side. I’ve grown to realize the virtue of patience and listening. Specifically, I listen for compliments, appreciation of the appliance, and sometimes simply a statement of dependency on the plastic. Sometimes this takes years. This is the time to ask, “Would you like to discuss dentistry that can make your teeth feel this way?” Sometimes they outright ask me.
Time is on our side. Appliance therapy is a seed. Our caring attention is a well-nurtured garden. Patients will bloom when they are ready.
