My hygienist just informed me that she now has an anterior open bite from an NTI she had made many years ago. What am I supposed to do?

I took the occlusion workshop and we fabricated the night guard with anterior occlusion only. I always leave these courses with lots of new exciting knowledge and some confusion.

Are these appliances meant to be permanent? I didn’t think they were permanent but what do I do when this appliance works and helps the patient feel better? I have a handful of patients who have an NTI (which I no longer offer), and some patients who have a full coverage night guard with occlusion only canine to canine. I know an anterior open bite is a risk associated with these appliances. Should I be making an opposing retainer? Is this an appliance that is only temporary? What should I do if this appliance relieves the muscle pain from clenching and the patient doesn’t need any restorative work? For my patients who clench and grind their teeth at night should I be making a night guard with occlusion even on all teeth including molars?

I’m confused so any help would be greatly appreciated!

Thank you!!

Victoria Spindel Rubin