Occlusal Splint After Ceramic Restorations — Protecting e.max and Zirconia from Bruxism

After delivering extensive ceramic restorations — e.max, zirconia — a patient with bruxism or parafunctions must have a protection plan. A night-time occlusal splint is part of the protocol, not an option.

Why a splint is necessary

Ceramics are hard, but not immune to cyclic, uncontrolled forces. In bruxism, occlusal forces can reach 400-800 N — several times more than during normal chewing (70-150 N). These forces act horizontally and cyclically, which is precisely the worst direction for ceramics.

Without an occlusal splint, a bruxism patient risks:

• Fracture or chipping of ceramic — especially e.max on posterior teeth
• Chipping of porcelain veneer on a zirconia substructure
• Attrition of antagonists — ceramic is harder than natural enamel
• Loosening of cement — cyclic micro-vibrations weaken the adhesive bond

Types of occlusal splints

Michigan splint (stabilization splint) — covers the entire arch, evenly distributes occlusal forces. The most common and best-documented. Recommended as standard after ceramic restorations.

NTI splint (anterior) — contact only on incisors, reduces masticatory muscle activity. Used short-term, not as permanent protection.

Tanner-Appliance / Brux Checker type splint — diagnostic, for evaluating bruxism patterns before selecting the definitive splint.

For ceramic protection, the best option is a Michigan stabilization splint on the maxillary arch, milled from PMMA or a controlled-hardness resin.

Milled vs. thermoformed splint

Thermoformed (foil) splints are quick and inexpensive but have limitations:

• Uneven thickness after forming
• Lack of precise occlusion — contacts are incidental
• Faster material wear
• Not suitable for occlusal adjustments

PMMA splint milled using CAD/CAM:

• Uniform, controlled thickness (1.5–2.0 mm)
• Occlusion digitally designed — even contacts
• Durability of 2–3 years with regular use
• Ability for precise adjustments on the articulator

At deltalabs., we mill splints from PMMA blocks based on digital scans or models. Occlusion is verified on an articulator.

Clinical protocol — when to order a splint

Ideally: take the scan for the splint 2–4 weeks after cementation of the ceramic restoration. Why not immediately? The patient needs time to adapt to the new occlusion. A splint made too early might perpetuate contacts that the patient would naturally correct within the first few weeks.

Exception: patient with documented severe bruxism — the splint should be ordered concurrently with the definitive restoration and delivered immediately.

Treatment sequence:

1. Cementation of ceramic restoration
2. Occlusion check after 2 weeks
3. Scan/impression for splint after 2–4 weeks
4. Splint delivery + patient instructions

Patient instructions

The patient should know:

• Wear the splint every night — no exceptions
• Clean the splint with a brush and water in the morning (without toothpaste)
• Store in a dry case (not in a glass of water)
• Splint check with the dentist every 6 months
• Replace the splint every 2–3 years or sooner if visible wear

How to order a splint from deltalabs.

For the order, we need:

• Digital scan of both arches + bite registration
• Or silicone impression of both arches + wax bite
• Information about bruxism type (night/day, dominant side)

We produce the splint in 5–7 business days. We send it on a model with marked occlusal contacts.

1. Does an occlusal splint cure bruxism?

No. A splint does not eliminate bruxism — it protects teeth and prosthetic restorations from its effects. It's mechanical protection, not causal therapy.

2. Is a thermoformed splint sufficient?

As a temporary solution — yes. As permanent protection for costly ceramic restorations — no. A milled splint is more precise, durable, and does not cause unwanted tooth movement.

3. Can I order a splint together with the prosthetic restoration?

Yes. For severe bruxism, this is recommended. We design the splint based on the definitive occlusion (from the CAD design of the final restoration).