Surgical Protocols

Splint Schedule

The Splint Schedule instructs patients on how often they can take the splint out during their 9 month recovery.

Taking Care of Your Splint

Make sure your splint is in its case at all times when it is not in your mouth. It can break in half if it hits the floor or the sink. You need to brush it with toothpaste when removed and soak it in mouthwash containing fluoride while performing range of motion exercises and eating.

Dental Protocol

The Dental Protocol provides guidelines on opening the mouth and dental procedures following surgery.

Download Dental Protocol

Preparing for Surgery

This document is for patients that have had a consultation with Dr. Piper or Dr. Shah and identified as a surgical patient. It informs the patient of what they should do and can expect before and after surgery.

Download Discharge Post-op Instructions

Fixation Protocol After Surgery

Braces are placed pre-operatively on the teeth. These braces are used for fixation afterwards. In essence, we need to immobilize the mandible to help to protect the fat grafts and repaired disks. This immobilization also helps the fat grafts to revascularize and the repaired disk to heal. We use a splint along with elastics and the orthodontic appliances when we want to minimize jaw movement. The total healing time from the fat graft procedure and disk repairs is approximately nine months. During that time, the bite is maintained in the splint.

Diet Restrictions Defined

Until the splint is removed, liquids only: You will need to get between 1600-1800 liquid calories daily. A minimum of TWO LITERS of fluid is expected daily. This should consist of 50% nutritional supplements (Boost, Ensure, Protein Powder, Carnation Instant Breakfast), 25% water, 25% other (tea, coffee, juices, soft drinks, Gatorade). Your diet intake should consist of good balanced nutrition, including protein and fat. After splint removal: No Chewing: You may have anything that can be swallowed without chewing, or using your tongue against the roof of your mouth to process the food (scrambled eggs, mashed potatoes, pasta). You may drink from a regular cup or sippy cup. Straws should not be used if you have had any teeth extracted.

Cleaning Your Teeth

For the first 4-5 days post-op you should brush the outer surfaces of your teeth 4-5 times per day. You will be brushing over the elastic bands that will be in there. You may use a Water Pik to remove particles from the braces before brushing. Mouthwash may be used and can be put in the Water Pik. Once the splint is removed on the 4th or 5th day post- op, you will soak the splint in fluoride at bedtime and also rinse teeth with fluoride. When changing elastics new ones should be used each time. We will give you a supply to take home. If you have had a tooth extraction(s), DO NOT USE MOUTHWASH. Each time you brush your teeth, use a warm salt water rinse. Stir half a teaspoon of salt into 8 ounces of warm water, swish and gently spit.

Range of Motion

The goal is to get your vertical opening into the upper 30 millimeters or lower 40 millimeters and your side to side (excursion) to 5-6 millimeters. This is achieved by using the Therabite and once you start chewing.