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October 2009 | Dental Products Report How to: Fabricate an occlusal guard Using the Erkoform-3d unit and Erkoloc-pro to construct a hard-soft guard alternative.
Glidewell Dental Occlusal guards are the treatment for bruxism, clenching, as well as the treatment of temporomandibular joint discomfort. Debate has ensued as to whether the occlusal guard should be hard, soft or a combination of the two consistencies. Soft materials used for occlusal guards provide a more comfortable fit but are less wear resistant than their hard counterparts. They also, because of their resilient nature, may increase clenching activity due to their rebound effect when the patient occludes on them. Occlusal guards constructed of hard resins offer better wear resistance, prolonging the life of the guard, and eliminate the rebound effect seen with the softer materials. Unfortunately, they are not as comfortable to the patient when inserted or removed. An alternative is a hard-soft occlusal guard. These offer the benefits of the soft guard, more comfortable to wear, insert and remove, with the benefits of the hard guard, better wear resistance and elimination of the rebound effect. Case report A 44-year-old female with moderate chronic clenching and bilateral TMJ popping on opening had an 8-year history of use of a mandibular occlusal guard. When she presented to the practice on initial consult, it was learned that her first occlusal guard was a soft material and lasted approximately two years before she wore through the material. Her complaint at the time was the “chewiness” of the guard made her feel like she had chewing gum in her mouth and was increasing the symptomology of the TMJ issues. A hard guard was fabricated and she successfully wore that for 6 years, until the posterior developed an occlusal crack on the right side. 
During discussion with the patient regarding the need for a new occlusal guard, she expressed that she felt the hard guard she had been using had eliminated her increased chewing, but was difficult at times to insert and remove, and she felt that it was pressing on the teeth when worn. It was determined that a hard-soft occlusal guard would meet the patient’s desires and clinical needs. Vacuform challenges Standard vacuform units are a challenge when using thicker plastic sheet materials and can be a greater challenge when using a dual laminate plastic. These units also tend to be weak in the vacuum (negative pressure) available during the forming portion of the technique. At the other end of the spectrum with regard to units for vacuforming are the pressure units. These require an airline be hooked to the unit and use positive pressure to form the plastics to the cast. They tend to be more complex and technique sensitive to fabricate occlusal guards, and as with the standard vacuform units, the user has to guess the temperature and time required for ideal use of the plastic material. Glidewell’s Erkoform-3d is a self-contained, computerized “sudden vacuum” precharged chamber former that does not require an airline for operation (Fig. 1). It has a computer touchscreen that is preprogrammed for the various materials available to use in the unit. After inserting the appropriate plastic into the holder, the user selects which material and plastic thickness is being used, and the unit sets the appropriate temperature and heating time, instructing the user when each step should be performed. The vacuum is activated automatically before the programmed temperature and time are reached, and the unit indicates to the user when it is ready to form the occlusal guard. CONTINUED ON NEXT PAGE
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