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The International Journal of... May 2024Mandibular deviation (MD) is a common reconstruction sequela after segmental mandibulectomy. Although proper postoperative rehabilitation is critical for MD management...
Mandibular deviation (MD) is a common reconstruction sequela after segmental mandibulectomy. Although proper postoperative rehabilitation is critical for MD management and minimization, the information available is limited. This report describes postoperative rehabilitation with an occlusal splint fabricated using computer-aided design (CAD) and computer-aided manufacturing (CAM) (CAD/CAM-OS) and the results of a threedimensional occlusal analysis using an intraoral scanner after hemimandibulectomy and plate reconstruction. Despite the short follow-up, adherence to postoperative rehabilitation with CAD/CAM-OS for MD correction, even during radiotherapy, was demonstrated by the digital workflow and analysis results.
PubMed: 38727621
DOI: 10.11607/ijp.8904 -
The prevalence of treatment-emergent central sleep apnea with mandibular advancement device therapy.Journal of Clinical Sleep Medicine :... Dec 2023Treatment-emergent central sleep apnea (TECSA) describes the appearance or persistence of central sleep apnea while undergoing treatment for obstructive sleep apnea....
STUDY OBJECTIVES
Treatment-emergent central sleep apnea (TECSA) describes the appearance or persistence of central sleep apnea while undergoing treatment for obstructive sleep apnea. TECSA is well studied in continuous positive airway pressure therapy with an estimated prevalence of 8%. Based on a few case reports, mandibular advancement devices (MAD) may also provoke TECSA. This study aims to gain insight into the prevalence of TECSA with MAD therapy.
METHODS
This retrospective study includes a total of 129 patients with moderate to severe obstructive sleep apnea who were treated with a custom-made titratable MAD. Baseline and follow-up sleep studies were compared to identify patients with TECSA. Since different diagnostic criteria to define TECSA are used in literature, prevalence was calculated according to three definitions (TECSA-1, -2, and -3). Demographics, MAD treatment variables, and findings of the diagnostic polysomnography were compared between TECSA and non-TECSA patients to identify possible predictors.
RESULTS
Depending on the definition used, TECSA was found in 3.1%-7.8% of patients undergoing MAD therapy. TECSA patients had a higher apnea index (9.2 vs 2.0 events/h, = .042), central apnea-hypopnea index (4.1 vs 0.2 events/h, = .045) and oxygen desaturation index (23.9 vs 16.3 events/h, = .018) at baseline compared to non-TECSA patients. No differences were found in demographics and treatment variables.
CONCLUSIONS
These findings demonstrate that TECSA also occurs in patients starting MAD treatment. Patients with TECSA had a higher apnea index, central apnea-hypopnea index, and oxygen desaturation index at baseline compared to non-TECSA patients.
CITATION
Hellemans S, Van de Perck E, Braem MJ, Verbraecken J, Dieltjens M, Vanderveken OM. The prevalence of treatment-emergent central sleep apnea with mandibular advancement device therapy. . 2023;19(12):2035-2041.
Topics: Humans; Occlusal Splints; Sleep Apnea, Central; Retrospective Studies; Prevalence; Mandibular Advancement; Sleep Apnea, Obstructive; Oxygen; Treatment Outcome
PubMed: 37539639
DOI: 10.5664/jcsm.10742 -
Journal of Dentistry Jul 2024To evaluate the effect of polishing and layering thickness on the wear resistance of 3D-printed occlusal splint materials.
OBJECTIVE
To evaluate the effect of polishing and layering thickness on the wear resistance of 3D-printed occlusal splint materials.
METHODS
Specimens with 3 different layer thicknesses (50, 75, 100 µm) were produced in the form of a disc 3 mm thick using V-Print splint resin on a 3D-printer with digital light processing technology. (n = 16 for each thickness) All specimens were washed and cured according to the manufacturer's instructions. Half of the specimens of each layer thickness were polished with silicon carbide papers. All specimens were subjected to 120.000 cycles of a chewing simulator for 2-body wear tests. Before and after the wear test, the specimens were scanned with a laser scanner, and the images were overlaid using a 3D analysis program and the volume loss was calculated. The wear patterns of the specimens were examined under a scanning electron microscope. Statistical evaluation was performed using a Shapiro-Wilk test, 2-way ANOVA, 1-way ANOVA, and Tukey post hoc test (α = 0.05).
RESULTS
While polishing had a significant effect (p = 0.003) on the wear volume of the occlusal splints, layer thickness (p = 0.105) and their interaction between polishing and layer thickness (p = 0.620) did not significantly affect the wear volume. Regardless of the polishing, the lowest mean wear was observed for D50 (0.064 mm), followed by D75 (0.078 mm), and D100 (0.096 mm). However, a significant difference was observed only between polished D50 and unpolished D100.
CONCLUSION
The polished 3D-printed occlusal splint resin showed higher wear resistance than the unpolished one, regardless of the layer thickness.
CLINICAL SIGNIFICANCE
Since different layer thicknesses of 50 µm and greater had no effect on the wear resistance of the material, a layer thickness of 100 µm may be preferred for faster printing. However, polishing occlusal splints may reduce the amount of wear and improve clinical performance.
Topics: Materials Testing; Surface Properties; Occlusal Splints; Dental Polishing; Humans; Printing, Three-Dimensional; Microscopy, Electron, Scanning; Carbon Compounds, Inorganic; Silicon Compounds; Dental Restoration Wear; Lasers; Dental Materials; Computer-Aided Design; Mastication
PubMed: 38801940
DOI: 10.1016/j.jdent.2024.105101 -
European Journal of Oral Sciences May 2024This study aimed to investigate the bisphenol A (BPA) release from four CAD/CAM splint materials: three polycarbonate-based (DD BioSplint C, Splint Plus Biostar, Temp...
This study aimed to investigate the bisphenol A (BPA) release from four CAD/CAM splint materials: three polycarbonate-based (DD BioSplint C, Splint Plus Biostar, Temp Premium Flexible) and one polymethylmethacrylate-based (Temp Basic) material. From each material, ten cylindrical samples (n = 40) were immersed in high-performance liquid chromatography (HPLC) grade water following ISO 10993-12 and incubated for 24 h in an incubation shaker at 37°C and 112 rpm. Following BPA derivatization, analysis was performed by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). After 24 h of incubation, all investigated materials released significant amounts of BPA compared to water blanks. The material-dependent elution increased in the following order: DD BioSplint C < Splint Plus Biostar < Temp Basic < Temp Premium Flexible. Subtracting extraneous BPA, the concentrations ranged between 2.27 ng/mL and 12.65 ng/mL. After extrapolating the concentrations in relation to the average surface area of occlusal splints, the amount of BPA per mL exceeded the Tolerable Daily Intake (TDI) set by the European Union for a person weighing 70 kg by 1.32-6.16 times. Contrary to the release from previously investigated materials, BPA elution from CAD/CAM splint materials was highly elevated. Considering the increasing adaptation of CAD/CAM techniques, elution from them may represent a relevant BPA source in daily dental practice.
PubMed: 38778467
DOI: 10.1111/eos.12993 -
Ozone for the treatment of temporomandibular joint disorders: a systematic review and meta-analysis.Medical Gas Research 2023Temporomandibular joint disorders (TMD) generate pain and difficulties for mouth opening affecting the patients' quality of life. Ozone is an emerging therapy that has... (Meta-Analysis)
Meta-Analysis
Temporomandibular joint disorders (TMD) generate pain and difficulties for mouth opening affecting the patients' quality of life. Ozone is an emerging therapy that has been proposed as a potential treatment, due to that, the evidence about its efficacy should be reviewed. Therefore, this work aimed to conduct a comprehensive systematic review to address the efficacy of ozone therapy for the treatment of pain and limited mouth opening in patients with TMD. The design of the included studies was clinical trials and observational studies, whereas, a series of cases, in vivo, and in vitro studies were excluded. The search was performed in PubMed, ClinicalTrials, Web of Science, and Scopus. Gray literature was searched at Google Scholar. Relevant data of all included studies were recorded. The risk of bias (using RoB 2) and the quality (using Grading of Recommendations Assessment, Development, and Evaluation) assessments were carried out. Meta-analyses using random-effects models of pain and maximal mouth opening data were performed. This review included 8 studies with 404 participants suffering limited function and pain related to TMD. At the overall bias of the studies, 25% exhibited some concerns and 75% had high risk; and the quality of the studies was low. The analysis of the included studies suggests that ozone therapy can diminish pain and improve the maximal mouth opening in TMD patients. However, there is no conclusive evidence of ozone therapy as a superior treatment for TMD compared with occlusal splint and pharmacotherapy.
Topics: Humans; Ozone; Quality of Life; Treatment Outcome; Pain; Temporomandibular Joint Disorders
PubMed: 36571381
DOI: 10.4103/2045-9912.345174 -
Acta Odontologica Scandinavica May 2024Temporomandibular joint (TMJ) pathologies are prevalent, affecting approximately 40% of the worldwide population, with nearly 80% involving intracapsular disorders....
OBJECTIVE
Temporomandibular joint (TMJ) pathologies are prevalent, affecting approximately 40% of the worldwide population, with nearly 80% involving intracapsular disorders. Despite this, standardized treatment protocols are lacking. This study aimed to compare the efficacy of conservative and surgical approaches in managing intracapsular TMJ disorders.
METHODS
Eighty-six patients diagnosed with intracapsular TMJ disorders were included in the study, with 40 males and 46 females, averaging 52.4 ± 4.7 years. Patients were recruited from polyclinics in Beijing, China (n = 36), and Kyiv, Ukraine (n = 50). A comprehensive examination protocol was conducted, including assessment of patient complaints, medical history, jaw mobility measurements, TMJ palpation, and magnetic resonance imaging (MRI) screening.
RESULTS
The main outcomes of our study revealed significant improvements in patients undergoing surgical intervention for intracapsular TMJ disorders, particularly in cases of disc displacement. Conservative mouth guard/occlusal splint treatment showed limited effectiveness, primarily improving joint effusion and disc displacement. Surgical intervention led to notable enhancements in various TMJ parameters, with significant improvements observed in joint function and pain reduction. Based on these findings, orthodontic rehabilitation was recommended to ensure long-term efficacy, focusing on optimizing occlusion and restoring TMJ function. These results highlight the importance of tailored treatment approaches for managing intracapsular TMJ disorders, emphasizing the role of surgical intervention coupled with comprehensive rehabilitation strategies.
CONCLUSIONS
Future research should consider demographic factors and explore innovative examination methods, such as optical systems, to enhance understanding and management of intracapsular TMJ disorders.
Topics: Humans; Temporomandibular Joint Disorders; Male; Female; Middle Aged; Adult; China; Ukraine; Magnetic Resonance Imaging; Treatment Outcome
PubMed: 38712696
DOI: 10.2340/aos.v83.40633 -
The Journal of Evidence-based Dental... Sep 2023Minakuchi H, Fujisawa M, Abe Y, Iida T, Oki K, Okura K, Tanabe N, Nishiyama A. Managements of sleep bruxism in adult: A systematic review. Jpn Dent Sci Rev. 2022;...
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION
Minakuchi H, Fujisawa M, Abe Y, Iida T, Oki K, Okura K, Tanabe N, Nishiyama A. Managements of sleep bruxism in adult: A systematic review. Jpn Dent Sci Rev. 2022; 58:124-36.
SOURCE OF FUNDING
None was reported.
TYPE OF STUDY/DESIGN
Systematic review.
Topics: Adult; Humans; Occlusal Splints; Sleep Bruxism
PubMed: 37689458
DOI: 10.1016/j.jebdp.2023.101890 -
Journal of Oral Rehabilitation Aug 2023Digital occlusal splint is a novel approach in the treatment of temporomandibular disorders (TMD) and there is a lack of evaluation.
BACKGROUND
Digital occlusal splint is a novel approach in the treatment of temporomandibular disorders (TMD) and there is a lack of evaluation.
OBJECTIVE
To introduce Kovacs digital occlusal splint (KDOS) and evaluate its clinical and magnetic resonance imaging (MRI) outcomes and influencing factors in the treatment of TMD.
PATIENTS AND METHODS
Patients diagnosed of TMD by MRI and treated with KDOS from June 2020 to December 2021 were retrospectively reviewed. They were divided into three groups: anterior disc displacement with reduction (ADDwR), anterior disc displacement without reduction (ADDwoR) and ADDwoR + osteoarthritis (ADDwoR + OA). Visual analogue scales (VAS) scores of pain, diet, mandibular function, quality of life (Qol) and maximum interincisal opening were compared before and at least 8 weeks after treatment. Binary logistic regression was used to analyse the influence of four factors including age, gender, Wilkes stage and the severity of symptoms on treatment. MRI was used to evaluate the condylar bone status and disc length after at least 3 months treatment.
RESULTS
One hundred and eighty-four patients were included in the study. The average age was 30.9 ± 14.2 years and the average follow-up was 19.8 ± 10.0 weeks. Pain, diet, mandibular function and Qol were all significantly improved after KDOS treatment (p < .05), with the effective rates of 71.6%, 56.4%, 55.3% and 54.1%. Binary logistic regression showed that higher probabilities of improvement were related to the patients with older age, ADD without OA and higher VAS scores before treatment. MRI showed that 94.1% of the condylar bone status remained stable or improved and the disc length was unchanged after treatment.
CONCLUSION
KDOS is effective for the treatment of TMD. Older age, ADD without OA and higher VAS scores before treatment had better results.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Occlusal Splints; Cross-Sectional Studies; Retrospective Studies; Quality of Life; Temporomandibular Joint Disorders; Pain; Joint Dislocations; Osteoarthritis
PubMed: 37067077
DOI: 10.1111/joor.13466 -
Journal of Oral Rehabilitation May 2024Myogenic temporomandibular disorders (M-TMD) commonly involve occlusal splint (OS) therapy and musculoskeletal physiotherapy (MPT).
BACKGROUND
Myogenic temporomandibular disorders (M-TMD) commonly involve occlusal splint (OS) therapy and musculoskeletal physiotherapy (MPT).
OBJECTIVES
To compare the effects of combining OS with MPT and education (EG) against OS and education (CG), in chronic M-TMD patients.
METHODS
In this double-blind randomised controlled trial, 62 participants were assigned to either EG or CG. The primary outcomes, pain levels at rest (VAS rest), maximum oral opening (VAS open) and during chewing (VAS chew), were measured by Visual Analogue Scale (VAS) in cm. The secondary outcome was the range of motion (ROM) for maximum oral opening. Both interventions lasted 3 months, with outcomes assessed at baseline (T0), post-treatment (T1) and 3 months post-treatment (T2).
RESULTS
Intention-to-treat analysis revealed significant improvements favouring EG (VAS rest = -1.50 cm [CI: -2.67, -0.32], p = .04; VAS open = -2.00 cm [CI: -3.23, -0.75], p < .01; VAS chew = -1.71 cm [CI: -2.90, -0.52], p = .01; ROM = 4.61 [CI: 0.93, 8.30], p = .04). Additionally, VAS measures were influenced by follow-up times (VAS rest = -0.73 cm [CI: -1.30, -0.17], p = 0.03; VAS open = -0.97 cm [CI: -1.57, -0.37], p < .01; VAS chew = -1.15 cm [CI: -1.73, -0.58], p < .01). At T1, EG demonstrated higher number of responders compared to CG for VAS open (χ(1) = 4.39, p = .04) and VAS chew (χ(1) = 11.58, p < .01).
CONCLUSION
Adding MPT to education and OS yields better outcomes in terms of pain reduction and ROM improvement, in chronic M-TMD.
TRIAL REGISTRATION NUMBER
NCT03726060.
PubMed: 38757854
DOI: 10.1111/joor.13729 -
Journal of Oral Rehabilitation Dec 2023Patients undergoing mandibular advancement device (MAD) therapy for obstructive sleep apnea (OSA) may experience changes in jaw position and altered occlusion. This... (Review)
Review
Occurrence of Temporomandibular Disorders among patients undergoing treatment for Obstructive Sleep Apnoea Syndrome (OSAS) using Mandibular Advancement Device (MAD): A Systematic Review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions.
BACKGROUND
Patients undergoing mandibular advancement device (MAD) therapy for obstructive sleep apnea (OSA) may experience changes in jaw position and altered occlusion. This could potentially contribute to the development or exacerbation of TMD symptoms. The literature on the long-term impact of MAD treated for OSA on TMD is scarce. Hence, this review was undertaken to ascertain the occurrence of TMD in MAD users.
METHODS
A comprehensive search protocol was implemented across several online databases using MeSH keywords and Boolean operators. A standardised data extraction form was developed specifically for this review. Two reviewers independently extracted the data. RoB-2 was used to evaluate the methodological quality of the included studies.
RESULTS
A total of 13 clinical studies were selected for this review. Some studies reported a significant reduction in the severity and frequency of TMD symptoms following MAD treatment. However, other studies did not observe significant changes in TMD symptoms or TMJ-related parameters from baseline to follow-up intervals. Temporary increases in TMJ-related pain or symptoms at the beginning of the follow-up period, which later subsided, were reported in some studies. Overall, MAD was not discontinued in any OSA patient due to TMDs.
CONCLUSION
The findings reveal that different outcomes associated with TMD are affected differently by MAD treatment for OSAS. According to a few studies, MAD therapy significantly reduced the severity and frequency of TMD symptoms. Other research, however, found no appreciable modifications in TMD symptoms or TMJ-related indicators. Although the overall results point to no significant effect of MAD treatment on TMD symptoms, the disparity in results between studies highlights the need for additional studies using standardised approaches.
Topics: Humans; Occlusal Splints; Sleep Apnea, Obstructive; Temporomandibular Joint Disorders; Pain; Mandibular Advancement; Treatment Outcome
PubMed: 37644889
DOI: 10.1111/joor.13574