A patient has jaw pain, develops painful popping/locking and has used a flat splint in the past. What appliance would you try next?

• A. Nightguard
• B. Soft resilience splint
• C. Anterior repositioning appliance
• D. Hard stabilization splint

Answer: (C)

When a patient has jaw pain plus painful popping or locking, the issue is often disc displacement with reduction, where the disc sits anterior to its normal position and causes a click or temporary lock during movement. The goal is to restore normal disc-condyle relationship, which is best achieved by guiding the jaw forward to recapture the disc.

An anterior repositioning appliance does exactly this: it positions the mandible forward (and slightly downward) so the articular disc can return to its proper place in front of the condyle during closing. This can reduce or eliminate the popping/locking and associated pain, addressing the mechanical derangement rather than just relaxing the muscles or stabilizing the bite.

A flat stabilization (hard) splint may help with muscle relaxation and occlusal stabilization, but it doesn’t actively reposition the mandible to reduce disc displacement, so it’s less effective for a disc displacement with reduction. A nightguard is typically used for bruxism or general grinding and doesn’t specifically address the disc in a forward position. A soft resilience splint may be more forgiving and helpful for some patients, but it similarly lacks the forward guidance needed to recapture the disc.

In this scenario, choosing an appliance that provides anterior guidance to reposition the jaw is the most targeted next step to relieve the clicking/locking and pain.