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Oral Surgery, Oral Medicine, Oral... Jan 2023To determine the best disocclusion guidance in occlusal splints (OSs) to manage and treat temporomandibular disorder (TMD) and sleep bruxism (SB). (Review)
Review
OBJECTIVE
To determine the best disocclusion guidance in occlusal splints (OSs) to manage and treat temporomandibular disorder (TMD) and sleep bruxism (SB).
STUDY DESIGN
The research was conducted on 7 major electronic databases and 3 gray literature sources. We included randomized trials, nonrandomized clinical trials, and before-and-after studies. The risk of bias (RoB) was assessed by Joanna Briggs Institute of Critical Appraisal Tools. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to grade the certainty of evidence.
RESULTS
Qualitative synthesis included 16 surveys reporting data from 620 participants. Canine guidance (CG) was widely searched. Bilateral balanced occlusion (BBO) and CG significantly decreased pain levels compared with the placebo splint. Comparing between OS and absence of therapy, only CG was assessed and showed significant improvements on mouth opening, pain, sleep quality, and muscle activity. When compared different guide types among themselves, no significant improvement was founded in any evaluated outcome. Three studies presented high RoB, 7 presented moderate RoB, and 6 presented low RoB.
CONCLUSIONS
It is suggested there is not enough evidence to support that there are any specific kind of guidance responsible for improving evaluated outcomes on TMD and SB.
Topics: Humans; Occlusal Splints; Sleep Bruxism; Temporomandibular Joint Disorders; Splints; Pain
PubMed: 36241594
DOI: 10.1016/j.oooo.2022.07.009 -
Dentistry Journal Aug 2023Data regarding the mechanical properties of three-dimensionally (3D) printed materials for occlusal splint manufacturing are scarce. The aim of the present study was to...
Data regarding the mechanical properties of three-dimensionally (3D) printed materials for occlusal splint manufacturing are scarce. The aim of the present study was to evaluate the flexural strength and surface hardness of modern 3D-printed occlusal splint materials and compare them with two control groups, namely, milled and conventional cold-polymerized occlusal splint materials. A total of 140 rectangular specimens were manufactured for the present study. The specimens were prepared in accordance with the International Organization for Standardization standards (ISO 20795-1:2013). Five 3D-printed (NextDent Ortho Rigid, Dental LT Clear, Dentona Flexisplint, Cosmos Bite Splint, and ProArt Print Splint), one milled (ProArt CAD Splint), and one cold-polymerized (ProBase Cold) occlusal splint materials were used to determine flexural strength and surface hardness values. The three-point flexure test was used for the determination of flexural strength values, while Vickers hardness was measured to determine surface hardness. Ten specimens ( = 10) of each material were tested using these procedures. One-way ANOVA and Tukey's post-hoc test were used to analyze the obtained results (α = 0.05). The values of flexural strength ranged from 46.1 ± 8.2 MPa to 106 ± 8.3 MPa. The Vickers hardness values ranged from 4.9 ± 0.5 VHN to 20.6 ± 1.3 VHN. Significant differences were found among the tested materials ( < 0.0001). The milled and cold-polymerized materials yielded higher values for both flexural strength (only one 3D-printed resin had comparable results to cold-polymerized acrylics) and surface hardness. There are differences in the mechanical properties of the various tested occlusal splint materials. The flexural strength of most of the 3D-printed materials and their surface hardness values are still inferior when compared to the milled or cold-polymerized materials.
PubMed: 37623295
DOI: 10.3390/dj11080199 -
International Journal of Environmental... Sep 2021The role of the dento-mandibular apparatus and, in particular, occlusion and jaw position, received increased attention during last years. In the present study, we aimed... (Review)
Review
The role of the dento-mandibular apparatus and, in particular, occlusion and jaw position, received increased attention during last years. In the present study, we aimed to systematically review, on the light of the new potential insights, the published literature covering the occlusal splint (OS) applications, and its impact on exercise performance. A structured search was carried out including MEDLINE/PubMed and Scopus databases with additional integration from external sources, between March and June 2021. To meet the inclusion criteria, studies published in the English language, involving humans in vivo, published from 2000 to 2021 and that investigated the role of occlusal splints on athletes' performance were selected. Starting from the 587 identified records, 17 items were finally included for the review. Four main aspects were considered and analyzed: (1) occlusal splint characteristics and occlusion experimental conditions, (2) jump performance, (3) maximal and explosive strength, and (4) exercise technique and biomechanics. The results of the systematic literature analysis depicted a wide heterogenicity in the experimental conditions and suggested the application of the OS as a way to improve athletes' or individuals' oral health, and as a potential tool to optimize marginal aspects of exercise performance.
Topics: Athletes; Exercise; Humans; Mandible; Occlusal Splints
PubMed: 34639640
DOI: 10.3390/ijerph181910338 -
Journal of the Korean Association of... Apr 2021Bruxism is defined as a parafunctional activity during sleep or while awake that includes locking and grinding of teeth and clenching. It generates excessive occlusal...
Bruxism is defined as a parafunctional activity during sleep or while awake that includes locking and grinding of teeth and clenching. It generates excessive occlusal force that may lead to implant failure. Therefore, diagnosis of bruxism and providing specific protocols such as occlusal splint and/or injection of botulinum toxin before implant installation are important to prevent increases the risk of implant failure in bruxism patients.
PubMed: 33911049
DOI: 10.5125/jkaoms.2021.47.2.149 -
Journal of Oral Rehabilitation Feb 2024To evaluate the impact of occlusal splint plus laser therapy (OS + LT) compared with OS alone on the patient-reported outcomes and clinical parameters of patients... (Randomized Controlled Trial)
Randomized Controlled Trial
Occlusal splint and combined multiwave locked system laser therapy demonstrated differential patient-reported outcomes and clinical parameters: A randomized controlled trial in patients with temporomandibular disorder.
PURPOSE
To evaluate the impact of occlusal splint plus laser therapy (OS + LT) compared with OS alone on the patient-reported outcomes and clinical parameters of patients with temporomandibular disorders (TMDs).
METHODS
Twenty-three patients with TMDs were randomly assigned to two treatment approaches: OS and OS + LT (multiwave locked system). The two outcomes were clinical parameters (mouth-opening distances, number of muscles and TMJs with pain) and patient-reported outcomes (pain score and oral health-related quality of life [OHRQoL] determined using the 14-item oral health impact profile [OHIP-14]). The outcomes were measured at four time points: baseline, 2 weeks, 1 and 3 months after treatment. According to DC/TMD Axis I classification, the participants were diagnosed as having pain only and pain with intraarticular joint disorder. Adjusting for age and sex, the outcome changes were analysed using generalized estimating models at a 5% significance level.
RESULTS
The pain-free mouth-opening distance of the patients who received OS + LT continuously increased from 2 weeks to 3 months. However, the value was significantly increased at 3 months in patients who received OS alone. The unassisted mouth-opening distance significantly increased after 3 months in both groups. In both treatment approaches, the number of muscles and TMJs with pain, as well as the pain and OHIP-14 scores gradually decreased from baseline to 3 months.
CONCLUSIONS
The patients who received OS and OS + LT demonstrated better OHRQoL and clinical parameters during 3 months after treatment. An improvement in the pain-free mouth-opening distance at 2 weeks was found only in OS plus LT group; however, this difference may not be clinically significant.
Topics: Humans; Occlusal Splints; Quality of Life; Treatment Outcome; Temporomandibular Joint Disorders; Pain; Laser Therapy
PubMed: 37727026
DOI: 10.1111/joor.13593 -
BMC Oral Health May 2023Occlusal splints are always applied on individuals with bruxism to reduce tooth wear and relieve orofacial symptoms such as myofascial pain. The stomatognathic system is...
OBJECTIVE
Occlusal splints are always applied on individuals with bruxism to reduce tooth wear and relieve orofacial symptoms such as myofascial pain. The stomatognathic system is mainly composed of tooth, occlusion, masticatory muscles, and temporomandibular joint. The occlusion and masticatory muscles function are regarded as the important parameters for evaluating the stomatognathic system state objectively. However, the effects of occlusal splints on individuals with bruxism is rarely elucidated from accurate neuromuscular analysis and occlusion evaluation. The aim of the present study was to estimate the effects of three different splints (two clinically common full coverage occlusal splint and an modified anterior splint) on subjects with bruxism using K7-J5 neuromuscular analysis system and Dental Prescale II (DP2) to evaluate occlusion.
METHODS
Sixteen subjects claimed to be suffering from nocturnal bruxism,with complete dentition and stable occlusal relationship, were selected for study.The intermaxillary space and the baselines of EMG-activity of the anterior temporalis and masseter were recorded for all the subjects. The participants was treated with three different splints, and outcomes were estimated by comfort index, occlusion and surface electromyography of anterior temporalis and masseter.
RESULTS
At teeth clenched position, EMG data were significantly lower in the participants with use of modified anterior splint than with hard, soft occlusal splint or without splint (p < 0.05). The maximum bite force and bite area occur in subjects without use of splint, while the minimal occur in subjects with use of modified anterior splint. Intermaxillary space increased and masticatory muscles presented significant reduction of EMG data at rest position as a result of J5 (p < 0.05).
CONCLUSION
Modified anterior splint seems to be more comfortable and effective in reducing occlusion force and electromyographic activity of anterior temporalis and masseter for subjects with bruxism.
Topics: Humans; Splints; Bruxism; Dental Occlusion; Masticatory Muscles; Masseter Muscle; Electromyography
PubMed: 37231466
DOI: 10.1186/s12903-023-03044-5 -
Journal of the Mechanical Behavior of... Feb 2022To investigate the volumetric and vertical loss of occlusal splints manufactured by conventional (heat-cure), subtractive (CAD/CAM) and additive (3D-printing) methods.
OBJECTIVES
To investigate the volumetric and vertical loss of occlusal splints manufactured by conventional (heat-cure), subtractive (CAD/CAM) and additive (3D-printing) methods.
METHODS
Six occlusal splint materials were investigated (n = 126), using three manufacturing methods: heat-cured, CAD/CAM and 3D-printed built-in three different printing angles (0°,45°and 90°). Block-on-ring wear testing was performed with extracted human molars as the antagonist. All samples were tested with an applied force of 49N at 1 Hz and 60RPM in artificial saliva at 37 °C for six and 12 months. Scanning electron microscopy images were analysed to evaluate the wear on the tooth enamel and in the splint material. Volumetric and vertical wear loss were statistically analysed.
RESULTS
The lowest volumetric and vertical loss was observed in CAD-CAM materials (6.44 ± 1.77 mm and 48.3 ± 7.14 μm) with no statistical significance to the heat-cured material (17.22 ± 9.23 mm and 148 ± 121.1 μm) after 12 months (p < 0.172). The mean volumetric loss of 3D printed materials ranged from 0.25 ± 0.15 mm to 0.29 ± 0.1 4mm with no statistical difference, whereas, the differences in vertical loss from 131.63 ± 44.1 μm to 493 ± 79.19 μm were statistically significant (p < 0.001). The highest vertical loss was observed in the KeySplint Soft 3D printed at 90° (385.35 ± 82.37 μm), whereas FreePrint Splint 2.0 with a build angle of 0° had the highest volumetric loss (204.59 ± 25.67 mm).
CONCLUSION
CAD-CAM material had the highest wear resistance followed by heat-cured material.KeySplint Soft and FreePrint Splint 2.0 3D printed materials would be preferred for patients that do not have severe bruxing episodes. No significant wear of human enamel after six and 12 months was observed under SEM for any tested materials.
Topics: Computer-Aided Design; Humans; Materials Testing; Occlusal Splints; Printing, Three-Dimensional; Surface Properties
PubMed: 34998068
DOI: 10.1016/j.jmbbm.2021.105053 -
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 -
The Journal of Sports Medicine and... Feb 2021The aim of the study was to evaluate how muscular performances, balance and posture were influenced applying Occlusal Splints and Taopatch 8 (Tao Technologies Srls,... (Clinical Trial)
Clinical Trial
BACKGROUND
The aim of the study was to evaluate how muscular performances, balance and posture were influenced applying Occlusal Splints and Taopatch 8 (Tao Technologies Srls, Cittadella, Padua, Italy) devices in athletes.
METHODS
Eighteen athletes, 7 females and 11 males, with an average age of 23.8 years, were included. Two devices were used: 1) a customized soft occlusal splint to be applied to the lower ach; 2) nanotechnological devices based on carbon nanotubules and quantum dots (Taopatch) positioned on C7 and xiphoid process. Four functional tests were performed: surface electromyography (sEMG), kinesiography, the squat jump and counter movement jump and handgrip test. The tests were performed in the following order: at the baseline (no treatments), and after having applied the bite alone, the occlusal splint and Taopatch devices together and the Taopatch devices alone.
RESULTS
The sEMG showed an increased maximum clenching voltage in respect of the baseline for all treatments that included the occlusal splint. The kinesiography showed an improvement of the movements of the occlusal muscles. The squat jump increased the height of 10-14 mm, the best results registered with the bite. The handgrip showed an increased strength, that was higher with the bite and the Taopatch devices used alone (~5 lbs.).
CONCLUSIONS
The use of an occlusal splint and Taopatch devices use alone or in conjunction immediately influenced strength and balance of the occlusal postural muscles.
Topics: Adult; Cross-Over Studies; Electromyography; Female; Hand Strength; Humans; Italy; Male; Movement; Occlusal Splints; Posture; Young Adult
PubMed: 32744040
DOI: 10.23736/S0022-4707.20.11053-3 -
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