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Acta Odontologica Scandinavica Nov 2020This systematic review aimed to assess the efficacy of occlusal splints in the treatment of temporomandibular disorders (TMDs). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review aimed to assess the efficacy of occlusal splints in the treatment of temporomandibular disorders (TMDs).
MATERIAL AND METHODS
This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Four databases (Medline Pubmed, Web of Science, Embase and Scopus) were searched, the last search was conducted on April 2020. Randomised controlled trials (RCTs) employing the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) or Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) as diagnostic criteria and including occlusal splint as one of the experimental groups were included in the present study. The data from the included studies were extracted and assessed for risk of bias.
RESULTS
Eleven studies were included. The sample size ranged from 12 to 96 subjects. The male to female ratio was 0 to 25%. The mean length of follow-up was 4 months. Occlusal splint had a positive effect on mandibular movements in all included studies. Seven studies showed a positive effect of occlusal splint on chronic pain reduction and pain intensity, while two others showed improvement of temporomandibular joint clicking sounds and locking of the jaws. Moreover, improvements in mouth opening, depression, and anxiety symptoms, were reported in four studies.
CONCLUSIONS
An occlusal splint can be considered as a non-invasive treatment approach for patients with TMD, especially those with signs and symptoms of restriction of mandibular movement and pain. Moreover, the present findings highlighted an urgent need of a standardised consensus regarding the prognostic evaluation of TMD.
Topics: Female; Humans; Male; Mandible; Occlusal Splints; Randomized Controlled Trials as Topic; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 32421379
DOI: 10.1080/00016357.2020.1759818 -
International Journal of Oral and... Aug 2020A network meta-analysis (NMA) of randomized controlled trials (RCTs) was performed to assess the effectiveness of various types of occlusal splint in the management of... (Meta-Analysis)
Meta-Analysis
A network meta-analysis (NMA) of randomized controlled trials (RCTs) was performed to assess the effectiveness of various types of occlusal splint in the management of temporomandibular disorders (TMDs) and to rank them according to their effectiveness. An electronic search was undertaken to identify RCTs published until August 2019. Predictor variables were control, non-occluding splint, hard stabilization splint (HSS), soft stabilization splint (SSS), prefabricated splint, mini-anterior splint, anterior repositioning splint (ARS), and counselling therapy (CT) with or without HSS. Outcome variables were pain improvement, post-treatment pain intensity, improvement in mouth opening, and disappearance of temporomandibular joint (TMJ) sounds. Forty-eight RCTs were included. There was a significant decrease in post-treatment pain intensity in arthrogenous TMDs after ARS (low quality evidence), CT+HSS (moderate quality evidence), mini-anterior splints (very low quality evidence), and HSS alone (low quality evidence), when compared to the control. There was a significant decrease in post-treatment pain intensity in myogenous TMDs with mini-anterior splints (very low quality evidence), SSS (very low quality evidence), CT alone (moderate quality evidence), CT+HSS (moderate quality evidence), and HSS alone (moderate quality evidence), when compared to control. ARS and CT were superior in decreasing TMJ clicking than control and HSS alone. The three highest-ranked treatments for post-treatment pain reduction in arthrogenous TMDs were ARS (92%, very low quality evidence), CT+HSS (67.3%, low quality evidence), and HSS alone (52.9%, moderate quality evidence). For myogenous TMDs, they were mini-anterior splints (86.8%, low quality evidence), CT+HSS (61.2%, very low quality evidence), and HSS alone (59.7%, moderate quality evidence). Based on this NMA of 48 RCTs, there is moderate to very low quality evidence confirming the effectiveness of occlusal splint therapy in the treatment of TMDs. Multimodal therapy consisting of CT+HSS may produce the maximum improvement for TMD patients.
Topics: Humans; Network Meta-Analysis; Occlusal Splints; Pain; Randomized Controlled Trials as Topic; Splints; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 31982236
DOI: 10.1016/j.ijom.2020.01.004 -
Clinical Oral Investigations Nov 2020The purpose of the present study was to analyze treatment outcome with a full-occlusion biofeedback (BFB) splint on sleep bruxism (SB) and TMD pain compared with... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
The purpose of the present study was to analyze treatment outcome with a full-occlusion biofeedback (BFB) splint on sleep bruxism (SB) and TMD pain compared with treatment with an adjusted occlusal splint (AOS).
MATERIALS AND METHODS
Forty-one patients were randomly allocated to a test (BFB) or a control (AOS) group and monitored over a 3-month period. Output variables were frequency and duration of bruxing events (bursts) and various pain symptoms.
RESULTS
The BFB group showed a statistically significant reduction in the frequency and duration of bursts and a statistically significant improvement in the patients' global well-being and the facial muscle pain parameter. After the treatment was stopped, the BFB group showed a statistically significant reduction in the average and maximum duration but no statistically significant change in the frequency of bursts.
CONCLUSIONS
The tested BFB splint is highly effective in reducing SB at the subconscious level, i.e., without waking the patient, and in achieving improvements in global pain perception. The results suggest that the BFB splint also provides a better treatment option for bruxism-related pain than an AOS. However, further research is needed, and specifically studies with a larger patient population displaying higher levels of pain at baseline.
CLINICAL RELEVANCE
By reducing burst duration and therefore the pathological load on the masticatory apparatus, the BFB splint reduces TMD and bruxism-related symptoms and improves patients' physical well-being. In the long term, this could prevent damage to the TMJ. This study confirms the effectiveness and safety of this splint.
THE UNIVERSAL TRIAL NUMBER
U1111-1239-2450 DRKS-ID REGISTRATION: DRKS00018092.
Topics: Biofeedback, Psychology; Bruxism; Facial Pain; Humans; Occlusal Splints; Sleep Bruxism; Splints
PubMed: 32430774
DOI: 10.1007/s00784-020-03270-z -
Journal of Oral and Maxillofacial... May 2020
Topics: Botulinum Toxins; Bruxism; Humans; Occlusal Splints
PubMed: 32035025
DOI: 10.1016/j.joms.2020.01.002 -
Journal of Oral Rehabilitation Feb 2020The best treatment strategy for disturbing temporomandibular clicking sounds is not known. The aim was to evaluate the effect of exercise and bite splint therapy,... (Randomized Controlled Trial)
Randomized Controlled Trial
Treatment outcome of supervised exercise, home exercise and bite splint therapy, respectively, in patients with symptomatic disc displacement with reduction: A randomised clinical trial.
The best treatment strategy for disturbing temporomandibular clicking sounds is not known. The aim was to evaluate the effect of exercise and bite splint therapy, respectively, in patients with symptomatic disc displacement with reduction. The study was a randomised clinical trial of subjects with temporomandibular joint (TMJ) clicking sounds with a reported severity/intensity of ≥4 on a numerical rating scale (0-10) and signs fulfilling the Research Diagnostic Criteria (RDC/TMD) for disc displacement with reduction. Thirty subjects each were randomised to bite splint, home exercise, or supervised exercise programme at the clinic. Two examiners (authors), blinded to the treatment modality, examined the same subject at baseline and at a 3-month follow-up. Non-parametric statistical methods were applied for analyses. A P-value <.05 was considered statistically significant. The dropout rate was highest in the home exercise group. About 50% of the participants reported improvement of their TMJ sounds with no significant difference between treatments. In the supervised exercise and the bite splint groups, approximately 2/3 of the patients reported 30% or more improvement of their TMJ sounds and half reported 50% improvement or more. The supervised exercise group also showed reductions in TMD pain, neck disability, mood disturbances and somatisation. Jaw exercise programmes and bite splint treatments had positive effects on TMJ clicking. The supervised exercise programme had an additional effect on the subject's well-being and thus may help to encourage patient's empowerment and coping strategies.
Topics: Humans; Joint Dislocations; Occlusal Splints; Splints; Temporomandibular Joint Disc; Treatment Outcome
PubMed: 31520538
DOI: 10.1111/joor.12888 -
General Dentistry 2017Occlusal splints, also known as bite guards, oral orthotics, and oral appliances, are utilized frequently in dental practices. They are commonly used to relax jaw... (Review)
Review
Occlusal splints, also known as bite guards, oral orthotics, and oral appliances, are utilized frequently in dental practices. They are commonly used to relax jaw muscles, prevent temporomandibular jaw trauma, protect dentition, and control headaches. How well occlusal splints work is another matter. Numerous studies, when taken as a whole, suggest only a modest indication that they are useful. This review applies principles of neurophysiology to analyze the usefulness of several types of occlusal splint in relation to their design and function. A unique occlusal splint with a design based on neurophysiology is described.
Topics: Dental Prosthesis Design; Humans; Occlusal Splints; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 28253183
DOI: No ID Found -
Journal of the International Academy of... Jan 2019Occlusal trauma, defined as an injury to the tooth or implant supporting tissues, is a resultant of parafunctional habits such as bruxism. It has been shown to... (Review)
Review
BACKGROUND
Occlusal trauma, defined as an injury to the tooth or implant supporting tissues, is a resultant of parafunctional habits such as bruxism. It has been shown to accelerate periodontal breakdown and also contribute to implant complications, thereby adversely affecting the long-term success of periodontal and implant therapy. This review aims to discuss the effects of bruxism on periodontal and implant treatment. In addition, the effectiveness of occlusal splints to manage bruxism will be examined.
METHODS
An electronic literature search using PubMed and Scopus databases and a manual search for relevant papers published in English from January 1965 up to August 2017 was performed..
RESULTS
An occlusal splint appears to be effective in reducing symptoms related to temporomandibular disorder and bruxism. However, high quality evidence is severely lacking to support its use. Therefore, as it is a non-invasive and reversible therapy, its use in patients with bruxism is proposed.
CONCLUSIONS
Therefore, as it is a non-invasive and reversible therapy, occlusal splint use in patients with bruxism is proposed.
Topics: Bruxism; Humans; Occlusal Splints; Temporomandibular Joint Disorders
PubMed: 31522162
DOI: No ID Found -
Clinical Oral Investigations Dec 2023To systematically review studies on various occlusal splint materials and describe their mechanical and chemical properties. (Review)
Review
OBJECTIVE
To systematically review studies on various occlusal splint materials and describe their mechanical and chemical properties.
METHODS
MEDLINE (PubMed), Scopus, and Web of Science searches were conducted for in vitro studies focusing on occlusal splint materials. Two reviewers performed an assessment of the identified studies and data abstraction independently, and this was complimented by an additional hand search. The articles were limited to those in the English language that were published between January 1, 2012, and December 1, 2022.
RESULTS
The initial search yielded 405 search results of which 274 were selected for full-text review following abstract evaluation. 250 articles that did not meet the inclusion criteria were excluded, and the remaining 25 articles (with 1 article identified from the reference lists of included articles) providing mechanical and chemical values were used in this review. Poly methyl methacrylate (PMMA) -based occlusal splint materials showed the highest values in terms of hardness, wear resistance, flexural strength, flexural modulus, e-modulus, and fracture toughness. The material group with the highest water sorption and water solubility was 3D printed (PR) splint materials. In addition, the lowest degree of double bond conversion was also observed in this group of materials.
CONCLUSIONS
The outcome of this review suggests that mechanically and chemically acceptable properties can be attained with PMMA-based occlusal splint materials using both conventional and digital production methods. PR splint materials should not be considered as the primary choice for long-term treatments due to their low mechanical and chemical properties.
CLINICAL RELEVANCE
This review provides clinical recommendations for selecting the appropriate material and fabrication method for occlusal splints while taking the patients' needs and the materials´ mechanical and chemical properties into account.
Topics: Humans; Occlusal Splints; Polymethyl Methacrylate; Flexural Strength; Splints; Water
PubMed: 37910242
DOI: 10.1007/s00784-023-05360-0 -
Journal of the Mechanical Behavior of... Mar 2021To measure polishability of occlusal splint materials manufactured by various methods.
OBJECTIVES
To measure polishability of occlusal splint materials manufactured by various methods.
METHODS
Seven occlusal splint materials manufactured by four different methods - Heat cured (Vertex Rapid simplified Clear), CAD-milled (Ceramill a-splint), Vacuum-formed (Proform splint) and 3D-printed (Freeprint Ortho, KeySplint Soft, DentaClear and FreePrint Splint 2.0) were tested for gloss, roughness, and surface hardness and elastic modulus. For all groups, the tests were repeated with the materials polished with three different polishing burs, pumice and high shine. All polishing procedures were standardised by applying the force of 1 N for 1 min at the set speed. 3D printed materials were further tested with additional specimens manufactured at different printing angles of 0°, 45° and 90°. Data was statistically analysed using ANOVA (SPSS Version 26) and MatLab (R2020a). Polished surfaces of each specimen were analysed under scanning electron microscope.
RESULTS
Vacuum-formed materials showed the highest polishability (80.61 ± 0.98 GU) with no statistical significance to heat-cured or CAD-milled (p = 1.00). Pumice and high shine polish significantly improved the gloss for all groups. The mean gloss and surface roughness for all 3D-printed materials ranged from 75.24 ± 25.05 GU to 0.18 ± 0.21 GU and 2.73 ± 3.18 μm to 0.06 ± 0.01 μm, which was significantly lower (p < 0.001) than heat-cured, CAD-milled and vacuum-formed materials. The highest hardness (0.40 ± 0.009 GPa), elastic modulus (6.06 ± 1.49 GPa) and gloss were found when materials were 3D-printed at 45°, with the lowest surface roughness.
CONCLUSION
Statistically significant differences in polishability were found among the different occlusal splint materials. The polishability and surface hardness of 3D-printed occlusal splint materials was influenced by the print angle. The 0° 3D-printed occlusal splint materials produced the highest gloss and the lowest surface roughness pre-polished, indicating that no polishing is required. While the 3D-printed occlusal splint materials at 45and 90° required polishing with burs, pumice and high shine to reduce the surface roughness, there were layering structures created during printing.
Topics: Dental Polishing; Hardness; Materials Testing; Occlusal Splints; Surface Properties
PubMed: 33341739
DOI: 10.1016/j.jmbbm.2020.104270 -
Dental Materials Journal Nov 2022The aim of this in vitro study was to evaluate the wear and surface hardness of nine materials for conventional manufacturing, subtractive milling, and 3D printing of...
The aim of this in vitro study was to evaluate the wear and surface hardness of nine materials for conventional manufacturing, subtractive milling, and 3D printing of occlusal splints, as well as to evaluate the differences in wear and surface hardness between rigid and flexible 3D-printed occlusal splint materials. Two-body wear and Vickers hardness tests were performed. The vertical wear depth and Vickers hardness values were statistically analyzed. Vertical wear depth and surface hardness values were statistically significant among the investigated materials (p<0.05). The lowest vertical wear depth was observed for the heat-cured resin (27.5±2.4 μm), PMMA-based milled material (30.5±2.8 μm), and autopolymerizing resin (36.7±6.3 μm), with no statistical difference (p<0.05). Flexible 3D-printed and CAD-CAM milled polycarbonate-based splint materials displayed lower surface hardness and higher wear than the PMMA-based materials. PMMA-based splint materials displayed the most consistent surface hardness and wear resistance regardless of the manufacturing technology.
Topics: Occlusal Splints; Hardness; Polymethyl Methacrylate; Materials Testing; Computer-Aided Design; Printing, Three-Dimensional; Surface Properties
PubMed: 36288940
DOI: 10.4012/dmj.2022-100