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BMC Musculoskeletal Disorders May 2024To compare the treatment effectiveness of digitized and 3D-printed repositioning splints with that of conventional repositioning splints in the treatment of anterior... (Comparative Study)
Comparative Study
OBJECTIVE
To compare the treatment effectiveness of digitized and 3D-printed repositioning splints with that of conventional repositioning splints in the treatment of anterior displacement of the temporomandibular joint disc.
METHODS
This retrospective study included 96 patients with disc displacement of the anterior temporomandibular joint. They were treated with either digitally designed and 3D-printed repositioning splints or traditional splints and followed up for at least six months. Changes in signs and symptoms such as pain and mouth opening before and after treatment were recorded to evaluate treatment outcomes.
RESULTS
During the first month of treatment, both the digitally designed and 3D-printed repositioning splint groups (Group B) and the traditional repositioning splint group (Group A) showed significant increases in mouth opening, with increases of 4.93 ± 3.06 mm and 4.07 ± 4.69 mm, respectively, and there was no significant difference between the two groups. Both groups had a significant reduction in visual analog scale (VAS) pain scores, with Group B showing a greater reduction of 1.946 ± 1.113 compared to 1.488 ± 0.978 in Group A (P < 0.05). By the sixth month, Group B's mouth opening further improved to 38.65 ± 3.22 mm (P < 0.05), while Group A's mouth opening did not significantly improve. Regarding pain, Group A's VAS score decreased by 0.463 ± 0.778 after one month, and Group B's score decreased by 0.455 ± 0.715; both groups showed significant reductions, but there was no significant difference between the two groups.
CONCLUSION
Compared with traditional repositioning splints, digitally designed and 3D-printed repositioning splints are more effective at reducing patient pain and improving mouth opening. 3D-printed repositioning splints are an effective treatment method for temporomandibular joint disc displacement and have significant potential for widespread clinical application.
Topics: Humans; Printing, Three-Dimensional; Male; Retrospective Studies; Female; Adult; Temporomandibular Joint Disc; Middle Aged; Temporomandibular Joint Disorders; Treatment Outcome; Joint Dislocations; Occlusal Splints; Young Adult; Pain Measurement; Range of Motion, Articular; Splints
PubMed: 38702659
DOI: 10.1186/s12891-024-07477-z -
BMC Oral Health Jun 2023The efficacy of mandibular advancement devices (MAD) and maxillomandibular advancement (MMA) in improving upper airway (UA) patency has been described as being...
BACKGROUND
The efficacy of mandibular advancement devices (MAD) and maxillomandibular advancement (MMA) in improving upper airway (UA) patency has been described as being comparable to continuous positive airway pressure (CPAP) outcomes. However, no previous study has compared MAD and MMA treatment outcomes for the upper airway enlargement. This study aimed to evaluate three-dimensionally the UA changes and mandibular rotation in patients after MAD compared to MMA.
METHODS
The sample consisted of 17 patients with treated with MAD and 17 patients treated with MMA matched by weight, height, body mass index. Cone-beam computed tomography from before and after both treatments were used to measure total UA, superior/inferior oropharynx volume and surface area; and mandibular rotation.
RESULTS
Both groups showed a significant increase in the superior oropharynx volume after the treatments (p = 0.003) and the MMA group showed greater increase (p = 0.010). No statistical difference was identified in the MAD group considering the inferior volume, while the MMA group showed a significantly gain (p = 0.010) and greater volume (p = 0.024). Both groups showed anterior mandibular displacement. However, the mandibular rotation were statistically different between the groups (p < 0.001). While the MAD group showed a clockwise rotation pattern (-3.97 ± 1.07 and - 4.08 ± 1.30), the MMA group demonstrated a counterclockwise (2.40 ± 3.43 and 3.41 ± 2.79). In the MAD group, the mandibular linear anterior displacement was correlated with superior [p = 0.002 (r=-0.697)] and inferior [p = 0.004 (r = 0.658)] oropharynx volume, suggesting that greater amounts of mandibular advancement are correlated to a decrease in the superior oropharynx and an increase in the inferior oropharynx. In the MMA group, the superior oropharynx volume was correlated to mandibular anteroposterior [p = 0.029 (r=-0.530)] and vertical displacement [p = 0.047 (r = 0.488)], indicating greater amounts of mandibular advancement may lead to a lowest gain in the superior oropharynx volume, while a great mandibular superior displacement is correlated with improvements in this region.
CONCLUSIONS
The MAD therapy led to a clockwise mandibular rotation, increasing the dimensions of the superior oropharynx; while a counterclockwise rotation with greater increases in all UA regions were showed in the MMA treatment.
Topics: Humans; Occlusal Splints; Nose; Body Mass Index; Cone-Beam Computed Tomography; Mandible
PubMed: 37391785
DOI: 10.1186/s12903-023-03125-5 -
Cranio : the Journal of... Mar 2024: To investigate the reasons for poor adaptation to mandibular advancement splint (MAS) treatment. The study consisted of 44 patients with obstructive sleep apnea who...
: To investigate the reasons for poor adaptation to mandibular advancement splint (MAS) treatment. The study consisted of 44 patients with obstructive sleep apnea who had unsuccessful MAS treatment. Data were collected on age, body mass index, gender, general and mental diseases, continuous positive airway pressure (CPAP) tryout, usage of occlusal splint, dental overjet, temporomandibular disorders, shortened dental arch, sleep apnea severity, and Apnea-Hypopnea Index. Sixty patients who underwent successful MAS treatment were controls. Patients with missing molars failed significantly more often in MAS therapy than the controls (). Patients with CPAP tryout prior to MAS treatment had a tendency to fail MAS treatment. MAS treatment was more likely to be successful in patients with prior occlusal splint experience (). The study could not identify a single reason for MAS failure.
Topics: Humans; Occlusal Splints; Mandibular Advancement; Sleep Apnea, Obstructive; Sleep Apnea Syndromes; Continuous Positive Airway Pressure; Treatment Outcome
PubMed: 33956581
DOI: 10.1080/08869634.2021.1922810 -
Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi... Apr 2024The aim of this study was to demonstrate a novel jaw position adjustment technique derived from digital twins and evaluate the application effect of digital...
OBJECTIVES
The aim of this study was to demonstrate a novel jaw position adjustment technique derived from digital twins and evaluate the application effect of digital technology-assisted optimization in the process of adjusting jaw position on patients with temporomandibular disorders (TMD).
METHODS
A total of 74 patients with TMD who attended the Department of Temporomandibular Joint, West China Hospital of Stomatology, Si-chuan University, between June 2022 and May 2023 were selected. The patient's initial computed tomography (CT) and bilateral temporomandibular joint data obtained by magnetic resonance imaging (MRI) were collected. The 148 joints were divided into the normal disc-condyle relationship (N) group, disc displacement with reduction (DDWR) group, and disc displacement without reduction (DDWoR) group. Assisted by digital technology, the patient's CT data were reconstructed, and a personalized reference plane was established to adjust the jaw position. A three-point bite guiding splint was designed by the adjusted occlusal space and then fabricated by 3D printing technology. It was worn by the patients and then reviewed by MRI. Before and after the adjustment of jaw position, the amount and direction of condyle and disc displacement and the angle between condyle and disc were measured as the evaluation indexes of the effect of the adjustment. The correlation with condylar displacement was evaluated.
RESULTS
In the N group, the disc moved backward and downward along the X and Z axes by (-0.60±0.62) and (0.51±0.71) mm, respectively. In the DDWR group, the disc moved backward and upward along the X and Z axes by (-1.33±1.38) and (-0.09±1.31) mm, respectively. In the DDWoR group, the disc moved forward and downward along the X and Z axes by (0.49±1.76) and (1.35±1.76) mm, respectively. The angle between the condyle and the disc decreased after adjustment of the jaw position in all three groups. All patients showed improvement in symptoms after adjustment.
CONCLUSIONS
Digital technology-assisted jaw position adjustment can simplify the process, reduce the sensitivity of the technique, and improve patients' disc-condyle structure and symptoms. Therefore, its application in the treatment of patients with TMD is of great clinical significance.
Topics: Humans; Temporomandibular Joint Disc; Mandibular Condyle; Digital Technology; Joint Dislocations; Temporomandibular Joint; Temporomandibular Joint Disorders; Magnetic Resonance Imaging
PubMed: 38597088
DOI: 10.7518/hxkq.2024.2023327 -
Clinical Oral Investigations Jan 2024To evaluate the temporomandibular joint (TMJ), condylar and mandibular movements in obstructive sleep apnea (OSA) patients treated with mandibular advancement device...
OBJECTIVES
To evaluate the temporomandibular joint (TMJ), condylar and mandibular movements in obstructive sleep apnea (OSA) patients treated with mandibular advancement device (MAD) and to identify the influence of these anatomic factors on upper airway (UA) volume and polysomnographic outcomes after treatment.
MATERIALS AND METHODS
Twenty OSA patients were prospectively treated with MAD. Clinical examinations, cone-beam computed tomography, and polysomnography were performed before MAD treatment and after achieving therapeutic protrusion. Polysomnographic variables and three-dimensional measurements of the TMJ, mandible, and upper airway were statistically analyzed.
RESULTS
Condylar rotation, anterior translation, and anterior mandibular displacement were directly correlated with total UA volume, while vertical mandibular translation was inversely correlated with the volume of the inferior oropharynx. MAD treatment resulted in an increase in the volume and area of the superior oropharynx. There was no statistically significant correlation between condylar rotation and translation and polysomnographic variables. With MAD, there was a significant increase in vertical dimension, changes in condylar position (rotation and translation), and mandibular displacement. The central and medial lengths of the articular eminence were inversely correlated with condylar rotation and translation, respectively. The lateral length of the eminence was directly correlated with condylar translation, and the lateral height was directly correlated with condylar rotation and translation.
CONCLUSION
Condylar and mandibular movements influenced UA volume. The articular eminence played a role in the amount of condylar rotation and translation.
CLINICAL RELEVANCE
Individualized anatomical evaluation of the TMJ proves to be important in the therapy of OSA with MAD.
Topics: Humans; Occlusal Splints; Mandible; Sleep Apnea, Obstructive; Temporomandibular Joint; Cone-Beam Computed Tomography; Mandibular Advancement; Treatment Outcome
PubMed: 38286954
DOI: 10.1007/s00784-024-05513-9 -
Healthcare (Basel, Switzerland) Feb 2024This study explores orthodontists' perspectives on risks associated with orthodontic treatment, as described by Greek and Slovak orthodontists. Informed by the...
This study explores orthodontists' perspectives on risks associated with orthodontic treatment, as described by Greek and Slovak orthodontists. Informed by the foundational importance of effective communication of risk perspectives in health sciences, particularly in facilitating valid consent and shared decision-making, this research addresses gaps identified in the literature concerning the consistent communication of potential treatment risks based on demographic and cultural characteristics. This study identifies 15 potential critical risks during orthodontic treatment. These risks include root resorption; temporary undesired changes to the occlusion; sleep difficulties; not achieving an ideal result; development of black triangles between teeth; taking additional X-rays; speech difficulties; using a protective splint during sports; duration of treatment; number of visits; transmission of infectious diseases; and swallowing orthodontic appliances. A questionnaire, distributed electronically to orthodontists in Greece (N1 = 570) and Slovakia (N2 = 210) from September 2022 to December 2022, aimed to assess risk communication practices, taking into consideration socio-demographic factors, such as country, gender, age, and academic-degree-related variations. A total of 168 valid questionnaires (91 from Slovakia and 77 from Greece) were obtained, indicating significant disparities in the risks emphasized and preferred forms of consent. The Greek orthodontists focused more on the risks involved, such as relapse, root resorption, temporal occlusal changes, and failure of desired movement, while the Slovak practitioners tended to be more interested in sleeping difficulties, temporal occlusal changes, and not achieving an ideal result. They also obtained written or digital consent from patients or their parents/guardians more frequently than the Greek team. Male orthodontists discussed specific risks more frequently, including relapse and extractions, whereas females preferred written or digital consent. PhD-trained orthodontists prioritized certain risks, indicating the need for tailored approaches. This study underscores the dynamic nature of risk assessment in orthodontic practice, emphasizing its ethical and strategic dimensions. The findings advocate for tailored risk communication strategies that recognize individual, contextual, and cultural factors, and the need for an orthodontic informed consent protocol for a tailored communication approach for patients to elevate the standard of care in European orthodontics. The reliance on digital tools reflects contemporary trends in enhancing patient understanding, thereby supporting ongoing innovation in orthodontic practices.
PubMed: 38391867
DOI: 10.3390/healthcare12040492 -
Frontiers in Chemistry 2024Polymethyl methacrylate is a polymer commonly used in clinical dentistry, including denture bases, occlusal splints and orthodontic retainers. To augment the...
Polymethyl methacrylate is a polymer commonly used in clinical dentistry, including denture bases, occlusal splints and orthodontic retainers. To augment the polymethyl methacrylate-based dental appliances in counteracting dental caries, we designed a polymer blend film composed of polymethyl methacrylate and polyethylene oxide by solution casting and added sodium fluoride. Polyethylene oxide facilitated the dispersion of sodium fluoride, decreased the surface average roughness, and positively influenced the hydrophilicity of the films. The blend film made of polymethyl methacrylate, polyethylene oxide and NaF with a mass ratio of 10: 1: 0.3 showed sustained release of fluoride ions and acceptable cytotoxicity. Antibacterial activity of all the films to Streptococcus mutans was negligible. This study demonstrated that the polymer blends of polyethylene oxide and polymethyl methacrylate could realize the relatively steady release of fluoride ions with high biocompatibility. This strategy has promising potential to endow dental appliances with anti-cariogenicity.
PubMed: 38406557
DOI: 10.3389/fchem.2024.1356029 -
JPMA. the Journal of the Pakistan... Aug 2023This case report demonstrates the full mouth prosthetic rehabilitation of a patient with generalised compensated tooth wear and oral sub-mucous fibrosis (OSMF). A 50-...
This case report demonstrates the full mouth prosthetic rehabilitation of a patient with generalised compensated tooth wear and oral sub-mucous fibrosis (OSMF). A 50- year-old female with advanced tooth wear and concomitant OSMF presented to the clinic. She was managed in a sequential manner using an occlusal splint, extractions of hopeless teeth, root canal treatment of strategically important teeth, surgical crown lengthening of abutment teeth, and dental implants to replace missing dentition, followed by crown and bridgework to rehabilitate the dentition. All procedures were done on the principles of re-organised occlusal intervention. The outcome was a functional dentition with an aesthetic smile and a satisfied patient. The regaining of mouth opening among OSMF subjects is a challenge. The usual management is prescribing muscle stretching exercises, drugs, or surgery. In the present case, we managed to achieve significant improvement in mouth opening with occlusal splints. The use of such occlusal orthotics has never been reported.
Topics: Female; Humans; Middle Aged; Tooth Wear; Mouth; Ambulatory Care Facilities; Anodontia; Esthetics
PubMed: 37697769
DOI: 10.47391/JPMA.6509 -
Journal of Prosthodontic Research Jan 2024To investigate the effects of the number of ethylene oxide units in bis-EMA on the physical properties of additively manufactured occlusal splints.
PURPOSE
To investigate the effects of the number of ethylene oxide units in bis-EMA on the physical properties of additively manufactured occlusal splints.
METHODS
Seven experimental materials containing bis-EMAs with three and 10 ethylene oxide units (BE3 and BE10, respectively) were prepared at different BE10 content rates (BE10-0%, -20%, -30%, -40%, -50%, -60%, and -80%). Half the specimens of each material were aged in boiling water. Flexural strength (FS), flexural modulus (FM), fracture toughness (FT), microwear depth (MD), degree of conversion (DC), water sorption (WSP), water solubility (WSL), color difference between non-aged and aged series (ΔE), and translucency (TP) were evaluated. All the evaluated properties other than FS and MD were analyzed by 1-way ANOVA and Tukey's post hoc analysis, while FS and MD were analyzed by Kruskal-Wallis's test and Bonferroni correction (α=0.05).
RESULTS
BE10-80% revealed the lowest FS (P < 0.01 for BE10-0%, -20%, and -30%) and FM (P < 0.01, for all), while revealing the highest DC, WSP, WSL (P < 0.01 for all) and TP (P < 0.01 for all other than BE10-60%). BE10-50% showed the highest FT (P < 0.01 for all). BE10-50%, -60%, and -80% revealed significantly lower ΔE than others (P < 0.01) and lower MD than BE10-0% (P < 0.05). Regardless of the BE10 content, FS, FM, and FT decreased with aging.
CONCLUSIONS
The number of ethylene oxide units affects the physical properties of additively manufactured occlusal splints. The higher number of ethylene oxide units in bis-EMA enhanced the microwear resistance, DC, WSP, WSL, color stability, and translucency, whereas it deteriorated the FS and FM.
PubMed: 38281759
DOI: 10.2186/jpr.JPR_D_23_00203 -
BMJ Open Aug 2023Just under half of patients with obstructive sleep apnoea (OSA) also have gastro-oesophageal reflux disease (GORD). These conditions appear to be inter-related and...
Single-centre, single-blinded, randomised, parallel group, feasibility study protocol investigating if mandibular advancement device treatment for obstructive sleep apnoea can reduce nocturnal gastro-oesophageal reflux (MAD-Reflux trial).
INTRODUCTION
Just under half of patients with obstructive sleep apnoea (OSA) also have gastro-oesophageal reflux disease (GORD). These conditions appear to be inter-related and continual positive airway pressure (CPAP) therapy, the gold standard treatment for OSA to prevent airway collapse, has been shown to reduce GORD. As the impact of mandibular advancement devices, a second-line therapy for OSA, on GORD has yet to be investigated, a feasibility study is needed prior to a definitive trial.
METHODS
This will be a single-centre, single-blinded, tertiary-care based, interdisciplinary, parallel randomised controlled study. Potential OSA participants presenting to the sleep department will be pre-screened for GORD using validated questionnaires, consented and invited to receive simultaneous home sleep and oesophageal pH monitoring. Those with confirmed OSA and GORD (n=44) will be randomly allocated to receive either CPAP (n=22) or MAD therapy (n=22). Following successful titration and 3 weeks customisation period, participants will repeat the simultaneous sleep and oesophageal pH monitoring while wearing the device. The number of patients screened for recruitment, drop-out rates, patient feedback of the study protocol, costs of interventions and clinical information to inform a definitive study design will be investigated.
ETHICS AND DISSEMINATION
Health Research Authority approval has been obtained from the Nottingham 2 Research Ethics Committee, ref:22/EM/0157 and the trial has been registered on ISRCTN (https://doi.org/10.1186/ISRCTN16013232). Definitive findings about the feasibility of doing 24 hour pH oesophageal monitoring while doing a home sleep study will be disseminated via clinical and research networks facilitating valuable insights into the simultaneous management of both conditions.
TRIAL REGISTRATION NUMBER
ISRCTN Reg No: 16013232.
Topics: Humans; Feasibility Studies; Occlusal Splints; Gastroesophageal Reflux; Sleep Apnea, Obstructive; Sleep; Randomized Controlled Trials as Topic
PubMed: 37620257
DOI: 10.1136/bmjopen-2023-076661