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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 -
Journal of Personalized Medicine Oct 2023We aimed to investigate whether the collaboration of shear wave elastosonography (SWE) and B-mode ultrasonography (US) could be offered as diagnostic tools to assess the...
We aimed to investigate whether the collaboration of shear wave elastosonography (SWE) and B-mode ultrasonography (US) could be offered as diagnostic tools to assess the presence, severity, and progress of bruxism, as well as a biomarker for the effectiveness of treatment in daily clinical practice. The study was designed as a quantitative evaluation of the masseter muscles (MMs) of the clinically diagnosed bruxism patients suffering from myofascial pain and MMs of the healthy individuals. Clinical examinations were made according to the diagnostic criteria for temporomandibular disorders (DC/TMD), and pain was assessed using a visual analog scale (VAS). Painful MMs with VAS scores ≥ 4 were assigned to Group A, and healthy MMs were assigned to Group B. Also, the MMs of the painful bruxers were analyzed based on wearing occlusal splints. Group A was divided into two subgroups as splint users (Group AI) and non-users (Group AII). All the participants were scanned with dynamic US and SWE to quantify the size and stiffness of the MMs. Measurements of each muscle pair while the jaw is in a resting position (relaxation) and clenching position (contraction) were recorded. The significant differences in stiffness and thickness became visible in the relaxation state. Bruxism patients with myofascial pain had significantly harder and thinner MMs than healthy individuals. During the relaxation, the mean thickness and elasticity values were 9.17 ± 0.40 mm and 39.13 ± 4.52 kPa for Group A and 10.38 ± 0.27 and 27.73 ± 1.92 for Group B, respectively. Also, stiffer MMs were measured in Group AII (38.16 ± 3.61 kPa) than in Group AI (26.91 ± 2.13 kPa). In conclusion, the combination of SWE and US using a dynamic examination technique has the potential to be a valuable tool for the management of bruxism patients suffering from myofascial pain.
PubMed: 37888078
DOI: 10.3390/jpm13101467 -
Clinical Oral Investigations Sep 2023To compare the effects of mandibular advancement device (MAD) therapy on upper airway dimensions between responders and non-responders with mild to moderate obstructive... (Clinical Trial)
Clinical Trial
STUDY OBJECTIVES
To compare the effects of mandibular advancement device (MAD) therapy on upper airway dimensions between responders and non-responders with mild to moderate obstructive sleep apnea (OSA).
METHODS
Thirty-one participants (21 men and 10 women) with a mean ± SD apnea-hypopnea index (AHI) of 16.6 ± 6.7 events/h, and aged 48.5 ± 13.9 years, were included in this study. Polysomnographic recordings and cone beam computed tomography (CBCT) scans in supine position were performed for every participant at baseline and at 3-month follow-up with their MAD in situ. Responders were defined as having ≥ 50% reduction in baseline AHI with a residual AHI < 10 events/h. The primary outcome variable was the minimal cross-sectional area of the upper airway (CSAmin).
RESULTS
No significant differences were found between responders (n = 15) and non-responders (n = 16) in age, gender distribution, body mass index, and neck circumference (P = 0.06-0.93), nor in AHI and CSAmin (P = 0.40 and 0.65, respectively) at baseline. The changes of the CSAmin with MAD in situ in the responder group were not significantly different compared to those in the non-responder group (P = 0.06).
CONCLUSION
Within the limitations of this study, we conclude that the changes of the upper airway dimensions induced by MADs are not significantly different between responders and non-responders with mild to moderate OSA.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02724865. https://clinicaltrials.gov/ct2/show/NCT02724865.
Topics: Female; Humans; Male; Body Mass Index; Cone-Beam Computed Tomography; Nose; Occlusal Splints; Sleep Apnea, Obstructive; Adult; Middle Aged
PubMed: 37589748
DOI: 10.1007/s00784-023-05186-w -
Journal of Indian Prosthodontic Society Jan 2024Disc displacement with reduction (DDwR) is among the common disc disorders of temporomandibular joint (TMJ), which can be managed conservatively by splint therapy.... (Meta-Analysis)
Meta-Analysis Review
Effectiveness of anterior repositioning splint versus other occlusal splints in the management of temporomandibular joint disc displacement with reduction: A meta-analysis.
BACKGROUND
Disc displacement with reduction (DDwR) is among the common disc disorders of temporomandibular joint (TMJ), which can be managed conservatively by splint therapy. Anterior repositioning splint (ARS) is the most commonly prescribed splint by dental practitioners, but not getting a normal disc-condyle relationship always and other side effects lead to need of comparing with other occlusal splints. This review will help in informed decision-making by clinicians in choosing an appropriate splint type for patients.
AIM
The aim is to compare the effectiveness of ARS in the management of DDwR with other occlusal splints for TMJ and muscle pain, TMJ noise, any adverse effects, regaining normal disc-condyle relationship.
MATERIALS AND METHODS
We followed published protocol in the International prospective register of systematic reviews. Databases were searched till May 2023 using different search strategies as per the database. Title and abstract screening, followed by full-text screening and data extraction with risk of bias, was done by two independent reviewers in Covidence. Outcomes were reported as risk ratio (RR) or mean difference (MD) for dichotomous or continuous outcomes, respectively, using RevMan 5.4 (Review Manager 5.4) software. We used a random effect model for statistical analysis. Certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation Guideline Development Tool (GRADEpro GDT) software.
RESULTS
A total of 1145 reports were found from a database search. After screening, four studies were included for systematic reviews. Other occlusal splints reported were sagittal vertical extrusion device and mandibular ARS, full hard stabilization splint of canine or centric stabilization type. Data of only two studies could be used for meta-analysis having 30 participants received ARS and 40 received other occlusal splints. We did not find evidence of any difference between ARS and other occlusal splints for TMJ clicking in short term (RR 1.25, 95% confidence interval [CI] 0.91-1.72) but a small difference in favor of other occlusal splint in long term (RR 2.40, 95% CI 1.04-5.55). No evidence of any difference was found between both treatments for TMJ pain in short term (MD-5.68, 95% CI-17.31-5.95) and long term (MD 0.00, 95% CI-2.86-2.86) and muscle pain in short term. The certainty of evidence for comparison of two treatments for different outcomes was of low or very low level.
CONCLUSION
Evidence is uncertain that other occlusal splints reduced TMJ clicking slightly in comparison to ARS. For the remaining outcomes, no evidence of any difference was found between the two splints and it may be biased due to selection bias, inadequate blinding of participants, and outcome assessor.
Topics: Humans; Occlusal Splints; Splints; Dentists; Myalgia; Temporomandibular Joint Disc; Professional Role; Systematic Reviews as Topic; Temporomandibular Joint Disorders; Cartilage Diseases
PubMed: 38263554
DOI: 10.4103/jips.jips_355_23 -
Clinical Oral Investigations May 2024Material chemistry and workflow variables associated with the fabrication of dental devices may affect the biocompatibility of the dental devices. The purpose of this...
OBJECTIVES
Material chemistry and workflow variables associated with the fabrication of dental devices may affect the biocompatibility of the dental devices. The purpose of this study was to compare digital and conventional workflow procedures in the manufacturing of acrylic-based occlusal devices by assessing the cytotoxic potential of leakage products.
METHODS
Specimens were manufactured by 3D printing (stereolithography and digital light processing), milling, and autopolymerization. Print specimens were also subjected to different post-curing methods. To assess biocompatibility, a human tongue epithelial cell line was exposed to material-based extracts. Cell viability was measured by MTT assay while Western blot assessed the expression level of selected cytoprotective proteins.
RESULTS
Extracts from the Splint 2.0 material printed with DLP technology and post-cured with the Asiga Flash showed the clearest loss of cell viability. The milled and autopolymerized materials also showed a significant reduction in cell viability. However, by storing the autopolymerized material in dHO for 12 h, no significant viability loss was observed. Increased levels of cytoprotective proteins were seen in cells exposed to extracts from the print materials and the autopolymerized material. Similarly to the effect on viability loss, storing the autopolymerized material in dHO for 12 h reduced this effect.
CONCLUSIONS/CLINICAL RELEVANCE
Based on the biocompatibility assessments, clinical outcomes of acrylic-based occlusal device materials may be affected by the choice of manufacturing technique and workflow procedures.
Topics: Humans; Materials Testing; Cell Survival; Biocompatible Materials; Printing, Three-Dimensional; In Vitro Techniques; Acrylic Resins; Cell Line; Blotting, Western
PubMed: 38748326
DOI: 10.1007/s00784-024-05707-1 -
Medicine and Pharmacy Reports Jan 2024Bruxism is associated with a variety of factors, some of which are oral (occlusion, joint, face shape) while others are of a systemic nature (respiratory, cardiac,...
BACKGROUND AND AIMS
Bruxism is associated with a variety of factors, some of which are oral (occlusion, joint, face shape) while others are of a systemic nature (respiratory, cardiac, neurotransmitters, stress). The relationship between bruxism and occlusion has received great attention, but it still has a lot of ambiguity. This study aimed at investigating the parameters that may affect bruxism: dental interferences or premature contacts, vicious habits, temporomandibular joint (TMJ) pain, TMJ noises, TMJ morning fatigue, snoring, obstructive sleep apnea, which may occur before bruxism, or because of chronic parafunction.
METHODS
We conducted an observational, analytical case-control study to determine the association between bruxism and oral cavity factors as well as general factors. Participants were chosen from a group of middle-aged Romanian population. An online questionnaire was used for data collection. A total of one hundred subjects were included in the sample. Fifty cases with bruxism were chosen as a study group, and another fifty persons of similar ages were chosen as a control group. Statistical analysis was performed using the MedCalc version 20.110 software.
RESULTS
The study comprised subjects between 18 and 42 years old. The most prevalent age range was between 20-25 years. The female-male ratio was almost similar; 62% of the participants had sleep bruxism, 10% had awake bruxism and 28% had a combined form. The arithmetic means of the daily stress levels for both research groups' scores were 3.0 for the bruxism group and 3.24 for the control group, while the work stress was 3.04 for the bruxism group and 3.41 for the control group. Dental interferences or premature contacts, vicious habits, TMJ pain, TMJ noises, TMJ morning fatigue, snoring, and obstructive sleep apnea were evaluated. The majority of subjects received an oral splint (n=26).
CONCLUSIONS
Bruxism was associated with stress, occlusal parameters (premature contacts and occlusion interferences), and joint pathologies. Bruxism was not found to be positively correlated with obstructive sleep apnea syndrome. There was a moderately significant association between bruxism and snoring. There was no evidence of an association between bruxism and vicious habits, dental aesthetics, or obstructive sleep apnea. Treatment significantly improved the quality of life, the masticatory and joint functions.
PubMed: 38344337
DOI: 10.15386/mpr-2548 -
Materials (Basel, Switzerland) Sep 2023The development of digital technologies has allowed for the fabrication of new materials; however, it makes it difficult to choose the best methods to obtain occlusal...
UNLABELLED
The development of digital technologies has allowed for the fabrication of new materials; however, it makes it difficult to choose the best methods to obtain occlusal splints with optimal properties, so it is essential to evaluate the effectiveness of these materials. The aim of the study is to compare the fracture resistance of occlusal splints made of different materials after thermo-mechanical aging.
METHODS
A total of 32 samples were made from 4 materials (two 3D printed polymeric materials, a PMMA disc for CAD/CAM, and a conventional heat-cured acrylic resin); subsequently, the fracture test was performed using the load compression mode applied occlusally on the splint surface.
STATISTICAL ANALYSIS
Four statistical tests were used (Shapiro-Wilk, Levene's test, ANOVA, and Tukey's HSD test).
RESULTS
The following study showed that there are differences in fracture strength among the four materials investigated, where the highest strength was observed in the milled splint, with a mean of 3051.2 N (newton) compared to the strength of the flexible splint with 1943.4 N, the printed splint with 1489.9 N, and the conventional acrylic splint with 1303.9 N.
CONCLUSIONS
The milled splints were the most resistant to fracture. Of the printed splints, the splint made with flexural rigid resin withstood the applied forces in acceptable ranges, so its clinical indication may be viable. Although the results of this research indicated differences in the mechanical properties between the CAD/CAM and conventional fabrication methods, the selection may also be influenced by processing time and cost, since with a CAD/CAM system there is a significant reduction in the production time of the splint material.
PubMed: 37763547
DOI: 10.3390/ma16186269 -
Journal of Oral Science Oct 2023Scientific evidence pertaining to the evaluation of trueness of occlusal splints fabricated using different three-dimensional (3D) printers and build orientations...
PURPOSE
Scientific evidence pertaining to the evaluation of trueness of occlusal splints fabricated using different three-dimensional (3D) printers and build orientations compared to subtractive technologies is lacking.
METHODS
Overall, one hundred and ten occlusal splints were manufactured using two different 3D printers and a dental mill. Five groups of ten were fabricated using the 3D printers at different build orientations (0, 30, 45, 60, and 90 degrees). In addition, a comparison group of ten occlusal splints was subtractively manufactured using a five-axis dental mill. All occlusal splints were scanned and exported as a standard tessellation language file. Analysis was conducted with metrology software with root mean square estimate average positive deviation and average negative deviation used as the measured outcome.
RESULTS
The 0 degree printing orientation was the most accurate for printer one with the root mean square value of 0.05 ± 0.01 mm, and 60 degree printing orientation was most accurate for printer two with the RMS value of 0.11 ± 0.01 mm. Subtractively manufactured occlusal splint had significantly higher trueness with the lowest RMS value of 0.03 ± 0.05 mm.
CONCLUSION
Build orientations influence the trueness of additively manufactured occlusal splints while occlusal splints produced by subtractive manufacturing were statistically significantly more accurate.
Topics: Occlusal Splints; Computer-Aided Design; Printing, Three-Dimensional; Software
PubMed: 37690838
DOI: 10.2334/josnusd.23-0115 -
Journal of International Society of... 2023The study was carried out to evaluate the efficacy of four conservative therapeutic modalities on the mandibular range of motion (MRM) in subjects with anterior disc...
AIMS AND OBJECTIVES
The study was carried out to evaluate the efficacy of four conservative therapeutic modalities on the mandibular range of motion (MRM) in subjects with anterior disc displacement with reduction (ADDwR) of the temporomandibular joint (TMJ).
MATERIALS AND METHODS
One hundred patients (64 women and 36 men) were selected, and randomly distributed into four groups. Group I: Subjects receiving behavioral therapy (BT). Group II: Subjects receiving low-level laser therapy (LLLT). Group III: Subjects receiving maxillary anterior repositioning splint (MARS). Group IV: Subjects receiving stabilization splint (SS). The MRM was evaluated for each patient before treatment and after 6 months. Paired test and one-way analysis of variance (ANOVA) tests were used for statistical analysis followed by a Tukey test ( ≤ 0.05).
RESULTS
All groups showed significant improvement in MRM after 6 months of treatment ( ≤ 0.05) except for BT. There was a significant improvement for SS and MARS on the different movements of MRM, more than for LLLT and BT ( ≤ 0.05).
CONCLUSION
The MARS and the SS are effective in increasing the MRM for patients with ADDwR.
PubMed: 37564171
DOI: 10.4103/jispcd.JISPCD_159_22 -
Biomedicines Jul 2023Dental 3D-printing technologies, including stereolithography (SLA), polyjet (triple-jetting technology), and fusion deposition modeling, have revolutionized the field of...
Statistical Comparison of the Mechanical Properties of 3D-Printed Resin through Triple-Jetting Technology and Conventional PMMA in Orthodontic Occlusal Splint Manufacturing.
Dental 3D-printing technologies, including stereolithography (SLA), polyjet (triple-jetting technology), and fusion deposition modeling, have revolutionized the field of orthodontic occlusal splint manufacturing. Three-dimensional printing is now currently used in many dental fields, such as restorative dentistry, prosthodontics, implantology, and orthodontics. This study aimed to assess the mechanical properties of 3D-printed materials and compare them with the conventional polymethylmethacrylate (PMMA). Compression, flexural, and tensile properties were evaluated and compared between PMMA samples ( = 20) created using the "salt and pepper" technique and digitally designed 3D-printed samples ( = 20). The samples were subjected to scanning electron microscope analysis. Statistical analysis revealed that the control material (PMMA) exhibited a significantly higher Young's modulus of compression and tensile strength ( < 0.05). In the flexural tests, the control samples demonstrated superior load at break results ( < 0.05). However, the 3D-printed samples exhibited significantly higher maximum bending stress at maximum load (MPa) ( < 0.05). Young's modulus of tensile testing (MPa) was statistically significant higher for the control samples, while the 3D-printed samples demonstrated significantly higher values for elongation at break ( < 0.05). These findings indicate that 3D-printed materials are a promising alternative that can be effectively utilized in clinical practice, potentially replacing traditional heat-cured resin in various applications.
PubMed: 37626652
DOI: 10.3390/biomedicines11082155