An old adage in carpentry is measure once, cut twice; measure twice, cut once. This idea can be applied to guards and splints.
Fitting a guard or a splint can be tricky, with a lot of grinding. But it does not have to be.
I just had a doctor call complaining that the guard they eventually gave the patient was more fill material than it was guard. I get this call from time to time, while other doctors that I make guards and splints for, I never hear from. The difference can be the bite registration.
The doctor mentioned above did not send one in. I received a set of scans that I processed and printed. The standard articulators are one size fits all. The only thing I can do without a bite registration is place the models into occlusion, articulate it, and then make the requested appliance.
After I heard from the doctor, and explained about the issue with the bite registration, I ran the scans through some diagnostics. The scans, when done correctly, can evaluate contact. In this particular case, there was contact on the molars but no contact in the anterior. So when I put it into what would be considered the natural occlusion, and fabricated it as such, it created a guard that did not even come close to the natural bite of the patient.
The lab can only do as we are asked with what we are sent.
So, measure well and have an easy insert or don’t measure well and have to grind the living hell out of it.
With scans, when directed, we can evaluate them and create a bite registration. It will be inexact, as the technology has not advanced that far yet, and there will be an extra cost to create it and print it, but it will come close.
The other option is to capture the natural bite. I have never been to dental school so do not really understand this, but my research has given me the following articles, most based upon Lucia’s Jig and the website of Dr. Lee Ann Brady.
And a very good article from Great Lakes Orthodontics:
http://www.greatlakesortho.com/commerce/associated_files/UsingtheLuciaJigforAccurateBite_S220.pdf
Could all that grinding be coming from the lab? Possibly. Maybe? I’m not really sure. All of the standard articulators are “one size fits all.” They allow for a particular degree of opening, replicating the standard hinge angle. I am just guessing here, and could be wrong, but I heard that if your patient has a different angled jaw, or lower jaw that juts out longer than normal, it could affect the bite on a guard or splint.
But a good bite registration is a good beginning, saving you valuable chair side time as well as being able to give your patients guards that are more guard than fill material.