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Chest Jan 2016Sleep bruxism (SB) consists of involuntary episodic and repetitive jaw muscle activity characterized by occasional tooth grinding or jaw clenching during sleep.... (Review)
Review
Sleep bruxism (SB) consists of involuntary episodic and repetitive jaw muscle activity characterized by occasional tooth grinding or jaw clenching during sleep. Prevalence decreases from 20% to 14% in childhood to 8% to 3% in adulthood. Although the causes and mechanisms of idiopathic primary SB are unknown, putative candidates include psychologic risk factors (eg, anxiety, stress due to life events, hypervigilance) and sleep physiologic reactivity (eg, sleep arousals with autonomic activity, breathing events). Although certain neurotransmitters (serotonin, dopamine, noradrenalin, histamine) have been proposed to play an indirect role in SB, their exact contribution to rhythmic masticatory muscle activity (RMMA) (the electromyography marker of SB) genesis remains undetermined. No specific gene is associated with SB; familial environmental influence plays a significant role. To date, no single explanation can account for the SB mechanism. Secondary SB with sleep comorbidities that should be clinically assessed are insomnia, periodic limb movements during sleep, sleep-disordered breathing (eg, apnea-hypopnea), gastroesophageal reflux disease, and neurologic disorders (eg, sleep epilepsy, rapid eye movement behavior disorder). SB is currently quantified by scoring RMMA recordings in parallel with brain, respiratory, and heart activity recordings in a sleep laboratory or home setting. RMMA confirmation with audio-video recordings is recommended for better diagnostic accuracy in the presence of neurologic conditions. Management strategies (diagnostic tests, treatment) should be tailored to the patient's phenotype and comorbidities. In the presence of sleep-disordered breathing, a mandibular advancement appliance or CPAP treatment is preferred over single occlusal splint therapy on the upper jaw.
Topics: Continuous Positive Airway Pressure; Humans; Mandibular Advancement; Occlusal Splints; Polysomnography; Sleep Apnea Syndromes; Sleep Bruxism
PubMed: 26225899
DOI: 10.1378/chest.15-0822 -
Journal of Orofacial Orthopedics =... May 2024This study aims to evaluate the efficacy of occlusal splint and botulinum toxin (BTX) therapies for improving the pain scores and mouth opening in patients with... (Comparative Study)
Comparative Study
PURPOSE
This study aims to evaluate the efficacy of occlusal splint and botulinum toxin (BTX) therapies for improving the pain scores and mouth opening in patients with temporomandibular disorders (TMD) with sleep bruxism (SB).
MATERIALS AND METHODS
A retrospective cohort study was conducted based on clinical record reviews of patients with TMD symptoms (e.g., temporomandibular joint [TMJ] pain, masticatory muscle pain, TMJ internal derangements, joint sounds, and limited mouth opening) and SB. The patients were divided into two groups: occlusal splint group and BTX group. Maximum unassisted mouth opening (MMO) and pain score on a visual analogue scale (VAS) before treatment and at 1‑, 3‑, and 6‑month follow-up were analyzed to evaluate the clinical outcomes.
RESULTS
A total of 60 patients (49 women and 11 men, mean age 34.63 ± 11.85 years) were enrolled. Each group had 30 patients. The comparisons of the groups at 1 and 3 months after treatment indicated that the BTX group had higher MMO values (P = 0.013 and 0.034, respectively) and lower VAS scores than the occlusal splint group (P = 0.000 and 0.001, respectively). No difference between the two groups was observed 6 months after treatment (P > 0.05).
CONCLUSIONS
Both occlusal splint and BTX treatment methods were successful in treating TMD with SB. BTX provided patients with rapid relief in the early period; therefore, BTX can be recommended as a primary treatment option in patients with greater pain.
Topics: Humans; Occlusal Splints; Female; Male; Temporomandibular Joint Disorders; Adult; Treatment Outcome; Sleep Bruxism; Retrospective Studies; Botulinum Toxins; Pain Measurement; Botulinum Toxins, Type A; Middle Aged; Neuromuscular Agents; Cohort Studies
PubMed: 37843582
DOI: 10.1007/s00056-023-00498-8 -
Dental Update 2016TMDs are a complex collection of conditions which can have a significant impact on an individual's quality of life. The aetiology, diagnosis and management of TMDs will... (Review)
Review
TMDs are a complex collection of conditions which can have a significant impact on an individual's quality of life. The aetiology, diagnosis and management of TMDs will be described in this article with the hope of increasing a general dental practitioner's knowledge of these problems, thus helping them to institute simple, initial, conservative therapies for such patients. Diagnosis of TMDs can be simplified by following recent published clinical diagnostic criteria such as those outlined in this article. CPD/CLINICAL RELEVANCE: Pain and functional disturbances related to TMDs are common and require simple and pragmatic interventions for most patients. After providing a diagnosis, reassure patients that they do not have a sinister disease, and explain that the condition is usually self-limiting.
Topics: Analgesics; Diagnosis, Differential; Facial Pain; Humans; Occlusal Splints; Physical Therapy Modalities; Temporomandibular Joint Disorders
PubMed: 27024901
DOI: 10.12968/denu.2016.43.1.39 -
Journal of Prosthodontics : Official... Jul 2022To systematically review studies on various materials and methods used for wear testing of occlusal devices and their antagonists in vitro and in vivo. (Review)
Review
PURPOSE
To systematically review studies on various materials and methods used for wear testing of occlusal devices and their antagonists in vitro and in vivo.
METHODS
An electronic search in OVID, Web of Science, PubMed and Scopus was conducted using the following terms (MeSH words) with any synonyms and closed terms: "Splint*" OR "occlusal splint*" OR "night guard" OR "occlusal device" OR "occlusal devices" OR "deprogrammer" OR "bite splint" OR "bite plane" OR "orthotic appliance*" OR "orthotic devices" AND "wear" OR "two-body wear" OR "three-body wear" OR "tooth wear" OR "wear measurement*" OR "wear behaviour" OR "wear behavior" OR "abrasion" AND "Polymethyl Methacrylate" OR "PMMA" OR "acrylic resin*" OR "dental material*" OR "dental enamel" OR "CAD" OR "CAM" OR "PEEK" OR "material* testing". Database search was limited to English-language publications and published between 2001 and 1st of September 2021. A further hand search was done to ensure all materials were captured.
RESULTS
After the removal of duplicates, 115 studies were identified, and 11 were chosen for review. Studies showed that the lowest volumetric loss was observed in PEEK occlusal device materials, whereas heat-cure, CAD-milled, and 3D printed occlusal device materials had no significant difference in wear. Vacuum-formed materials showed the highest wear among all groups. Testing parameters were found to be inconsistent across all studies.
CONCLUSION
There is a need for standardization of in vitro and in vivo wear measurement and testing protocols as this study revealed a wide variety of testing protocols which potentially could influence the outcome. Polishing procedures are required for the material. Limited studies are available on 3D printed occlusal device materials and would therefore require further investigation, especially on printing build angles and settings. Further clinical studies would be advantageous to provide guidance on the selection of the best occlusal device material that would last the longest without remake.
Topics: Acrylic Resins; Humans; Materials Testing; Occlusal Splints; Polymethyl Methacrylate; Tooth Wear
PubMed: 34516696
DOI: 10.1111/jopr.13432 -
Clinical Oral Investigations Sep 2022To investigate the two-body wear of occlusal splint materials fabricated from subtractive computer-aided manufacturing (CAM) compared to three-dimensional printing (3DP).
OBJECTIVES
To investigate the two-body wear of occlusal splint materials fabricated from subtractive computer-aided manufacturing (CAM) compared to three-dimensional printing (3DP).
MATERIAL AND METHODS
Forty-eight substrates (n = 12/material) in the design of a mandibular first molar were fabricated using CAM (CAM-TD, Thermeo, pro3dure medical GmbH, Iserlohn, Germany; CAM-CL, CLEARsplint, Astron Dental Corporation, Lake Zurich, USA) and 3DP (3DP-GI, GR22 flex, pro3dure medical GmbH; 3DP-KY, KeySplint soft, Keystone Industries, Gibbstown, USA). The substrates were subjected to mastication simulation (120,000 cycles, 37 °C, 50 N, 1.3 Hz) opposed to enamel antagonists. The two-body wear was measured through matching of the scanned substrates before and after aging using Gaussian best-fit method. The damage patterns were categorized and evaluated based on microscopic examinations. Data was analyzed using Kolmogorov-Smirnov test followed by 1-way analysis of variance (ANOVA). Pearson correlation was calculated between vertical and volumetric material loss. The failure types were analyzed with Chi-test and Ciba Geigy table.
RESULTS
No difference in two-body wear results between all materials was found (p = 0.102). Fatigue substrates showed a perforation for CAM and a fracture for 3DP. No abrasion losses on the antagonists were detected.
CONCLUSIONS
3DP substrates showed no differences in two-body wear compared to CAM ones but are more likely to show a fracture. None of the tested materials caused an abrasion on human teeth structure.
CLINICAL RELEVANCE
While therapies with occlusal splint materials are rising, 3DP offers a promising alternative to CAM in terms of production accuracy and therapeutic success at reduced costs.
Topics: Ceramics; Computer-Aided Design; Dental Enamel; Dental Porcelain; Humans; Materials Testing; Molar; Occlusal Splints; Printing, Three-Dimensional
PubMed: 35612645
DOI: 10.1007/s00784-022-04543-5 -
Advances in Experimental Medicine and... 2022Mandibular advancement splint (MAS) therapy is the leading alternative to continuous positive airway pressure (CPAP) therapy for the treatment of obstructive sleep...
Mandibular advancement splint (MAS) therapy is the leading alternative to continuous positive airway pressure (CPAP) therapy for the treatment of obstructive sleep apnoea. A MAS is an oral appliance which advances the mandible in relation to the maxilla, thus increasing airway calibre and reducing collapsibility. Although it is less effective than CPAP in reducing the apnoea-hypopnoea index (AHI), it has demonstrated equivalence to CPAP in a number of key neurobehavioural and cardiovascular health outcomes, perhaps due to increased tolerability and patient adherence when compared to CPAP. However, response to MAS is variable, and reliable prediction tools for patients who respond best to MAS therapy have thus far been elusive; this is one of the key clinical barriers to wider uptake of MAS therapy. In addition, the most effective MAS devices are custom-made by a dentist specialising in the treatment of sleep disorders, which may present financial or accessibility barriers for some patients. MAS devices are generally well tolerated but may have side effects including temporomandibular joint (TMJ) dysfunction, hypersalivation, tooth pain and migration as well as occlusal changes. A patient-centred approach to treatment from a multidisciplinary team perspective is recommended. Evidence-based clinical practice points and areas of future research are summarised at the conclusion of the chapter.
Topics: Continuous Positive Airway Pressure; Humans; Mandibular Advancement; Occlusal Splints; Patient Compliance; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 36217096
DOI: 10.1007/978-3-031-06413-5_22 -
Journal of Oral Rehabilitation Jul 2018Tooth wear in bruxing patients often results in a need for treatment with composite restorations. In some cases, bruxing patients receive an occlusal splint as a... (Comparative Study)
Comparative Study
Tooth wear in bruxing patients often results in a need for treatment with composite restorations. In some cases, bruxing patients receive an occlusal splint as a protective means as well. However, the wear between these opposing materials has not been investigated yet. The aim of this in vitro study was to assess the wear of different splint materials against resin composite materials. A two-body wear test was conducted using the ACTA wear machine. The materials selected for this study were three composites used for direct restorations (Filtek Z250, CLEARFIL AP-X, and Filtek Supreme XT) and four occlusal splints materials, viz. a polyamide resin (ThermoSens) an conventional (hand-processed), milled and printed polymethylmethacrylate (PMMA). As antagonistic materials, stainless steel, Filtek Supreme XT and CLEARFIL AP-X were used. The wear rate of the seven materials was determined after 200 000 cycles, using a profilometry. The rates were analysed using two-way ANOVA and post hoc Tukey's tests. The wear rates were significantly higher for the conventional and milled PMMA materials than for all other materials (P < .001). The wear rates of printed PMMA and the polyamide resin were comparable to composite wear rates. The antagonist materials have minor or no influence on the amount of wear of the various splint materials (P < .001). In conclusion, different splint materials yielded different wear rates for all antagonist materials tested. Keeping in mind that this study is an experimental in vitro study, this finding enables practitioners to choose the splint material necessary according to their patients' needs.
Topics: Composite Resins; Dental Materials; Dental Restoration Wear; Humans; In Vitro Techniques; Materials Testing; Methacrylates; Microscopy, Electron, Scanning; Occlusal Splints; Polymethyl Methacrylate; Surface Properties
PubMed: 29663496
DOI: 10.1111/joor.12636 -
The Journal of Sports Medicine and... Mar 2022Several studies have been proposed with the aim to demonstrate correlations between the dento-mandibular apparatus and the skeletal muscle system of the human body even... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Several studies have been proposed with the aim to demonstrate correlations between the dento-mandibular apparatus and the skeletal muscle system of the human body even in regions distant from the oral cavity. However, a definite conclusion cannot be drawn. The aim of this paper is to demonstrate a possible correlation between dental occlusion and sport performances in track and field athletes.
METHODS
Sixteen track and field athletes were enrolled for the study and were randomly divided in three groups: Untreated control group, Placebo group (with a lower plaque without occlusal coverage) and Treated group (with occlusal splint). Changes in sprint and jump performance were assessed on a weekly basis for 5 consecutive weeks, during which athletes had to wear oral devices, except for the first week of baseline, for at least 3 trainings lasting 2 hours per week . All participants performed the countermovement jump (CMJ), the drop jump (DJ), the 10m and 30m sprint tests, always on the same day on the week.
RESULTS
No statistically significant difference resulted between Control group and Placebo group and between Control group and Treated group. However, it was possible to observe a clinical improvement of measurements obtained, especially for CMJ, 10m and 30m sprint tests. No variation neither statistical neither clinical was observed in DJ test analysis.
CONCLUSIONS
Even if statistically it was not possible to demonstrate an improvement in sport performance, most of the athlete analyzed showed better results during training session with occlusal splint compared to athlete without occlusal splint, in countermovement jump, in 10m and 30m sprint tests.
Topics: Athletes; Athletic Performance; Humans; Muscle Strength; Occlusal Splints; Track and Field
PubMed: 33871235
DOI: 10.23736/S0022-4707.21.12081-X -
Dental Materials : Official Publication... Apr 2021The elution of unpolymerized (co-)monomers and additives from methacrylic resin-based materials like polymethyl methacrylate (PMMA) can cause adverse side effects, such...
OBJECTIVE
The elution of unpolymerized (co-)monomers and additives from methacrylic resin-based materials like polymethyl methacrylate (PMMA) can cause adverse side effects, such as mutagenicity, teratogenicity, genotoxicity, cytotoxicity and estrogenic activity. The aim of this study was to quantify the release and the cytotoxicity of residual (co-)monomers and additives from PMMA-based splint materials under consideration of real splint sizes. Three different materials used for additive (3D printing), subtractive (milling) and conventional (powder and liquid) manufacturing were examined.
METHODS
The splint materials SHERAprint-ortho plus (additive), SHERAeco-disc PM20 (subtractive) and SHERAORTHOMER (conventional) were analysed. 16 (n = 4) sample discs of each material (6 mm diameter and 2 mm height) were polished on the circular and one cross-section area and then eluted in both distilled water and methanol. The discs were incubated at 37 °C for 24 h or 72 h and subsequently analysed by gas chromatography/mass spectrometry (GC/MS) for specifying and quantifying released compounds. XTT-based cell viability assays with human gingival fibroblasts (HGFs) were performed for Tetrahydrofurfuryl methacrylate (THFMA), 1,4-Butylene glycol dimethacrylate (BDDMA) and Tripropylenglycol diacrylate (TPGDA). In order to project the disc size to actual splint sizes in a worst-case scenario, lower and upper jaw occlusal splints were designed and volumes and surfaces were measured.
RESULTS
For SHERAeco-disc PM20 and for SHERAORTHOMER no elution was determined in water. SHERAprint-ortho plus eluted the highest THFMA concentration of 7.47 μmol/l ±2,77 μmol/l after 72 h in water. Six (co-)monomers and five additives were detected in the methanol eluates of all three materials tested. The XTT-based cell viability assays resulted in a EC of 3006 ± 408 μmol/l for THFMA, 2569.5 ± 308 μmol/l for BDDMA and 596.7 ± 88 μmol/l for TPGDA.
SIGNIFICANCE
With the solvent methanol, released components from the investigated splint materials exceeded cytotoxic concentrations in HGFs calculated for a worst-case scenario in splint size. In the water eluates only the methacrylate THFMA could be determined from SHERAprint-ortho plus in concentrations below cytotoxic levels in HGFs.
Topics: Composite Resins; Humans; Materials Testing; Methacrylates; Occlusal Splints; Polymethyl Methacrylate; Printing, Three-Dimensional
PubMed: 33648744
DOI: 10.1016/j.dental.2021.01.024 -
Cranio : the Journal of... Jul 2021: Assessment of clinical symptoms and condylar position of TMD patients using CBCT imaging with deprogramming splint therapy and occlusal equilibration. The hypothesis...
: Assessment of clinical symptoms and condylar position of TMD patients using CBCT imaging with deprogramming splint therapy and occlusal equilibration. The hypothesis tested was the alleviation of symptoms of TMD with possible changes in condylar position occurs with this treatment.: The condylar position of 12 TMD patients was observed from CBCT images, and clinically, symptom severity score, mouth opening, and range of motion were compared pre- and post-treatment.: All patients reported a statistically significant decrease in the symptom severity score and increase in mouth opening and range of motion ( < .05). A significant decrease was only achieved in the left anterior joint space ( < .05).: Deprogramming splint therapy and occlusal equilibration benefitted patients with a reduction in clinical symptoms, and minor changes in condylar position were observed.
Topics: Humans; Occlusal Adjustment; Occlusal Splints; Spiral Cone-Beam Computed Tomography; Splints; Temporomandibular Joint Disorders
PubMed: 31451061
DOI: 10.1080/08869634.2019.1650216