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Australian Dental Journal Dec 2019Obstructive sleep apnoea is a serious medical condition of increasing prevalence that has a multitude of treatment modalities. The aim of this study was to review the... (Review)
Review
BACKGROUND
Obstructive sleep apnoea is a serious medical condition of increasing prevalence that has a multitude of treatment modalities. The aim of this study was to review the results of patients treated with mandibular advancement splints in the Oral and Maxillofacial Surgery Unit of South Australia to inform ongoing practice in this area.
METHODS
The casenotes of patients who received a splint for obstructive sleep apnoea between January 2008 and June 2014 were audited. Data collection included referral and demographic details, sleep study results, splint type and follow-up details.
RESULTS
Three hundred and four patients were identified as having been provided a mandibular advancement splint for obstructive sleep apnoea, of which 82 had diagnostic and splint-in-situ sleep studies available for comparison. It was observed that 27 had clinically significant objective improvement, 40 had no clinically significant change and 15 had clinically worse OSA following MAS therapy. Mean reductions in Apnoea-Hypopnoea Index and Respiratory Disturbance Index were eight events (27%) and 13 events (33%) per hour respectively with treatment.
CONCLUSIONS
Based on this study, mandibular advancement splint therapy is a viable treatment for a subset of patients with obstructive sleep apnoea. Protocol driven, multi-disciplinary care with auditing of results is recommended.
Topics: Humans; Mandibular Advancement; Occlusal Splints; Sleep Apnea, Obstructive; Snoring; South Australia; Splints; Treatment Outcome
PubMed: 31372998
DOI: 10.1111/adj.12712 -
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 -
Folia Medica Cracoviensia Apr 2023Temporomandibular disorder (TMD) is a disease of multifactorial etiology and a complex of symptoms, related to disorders of the masticatory muscles, temporomandibular... (Review)
Review
Temporomandibular disorder (TMD) is a disease of multifactorial etiology and a complex of symptoms, related to disorders of the masticatory muscles, temporomandibular joints and the surrounding orofacial structures. One of the main problems in the course of TMD disorders is the systematic increase in the tension of the masticatory muscles (masseter muscles, temporalis and medial and lateral pterygoid muscles), what is the cause of many damages and the development of pathological conditions in the stomatognathic system. The article discusses the differences in the structure of the masticatory and skeletal muscles, as well as the different nature and isoforms of myosin, which determines the much faster generation of contraction in the masticatory muscles and consequently easier generation of excessive, harmful tensions in the masticatory muscles. The article describes the causes of increased tension in the masticatory muscles and methods of their relaxation used in the basic and supportive treatment of temporomandibular disorders. The use of occlusal splints, physiotherapeutic procedures and TMD treatment with botulinum toxin type A were characterized. A role of psychological support and the methods used for patients with TMD were emphasized.
Topics: Humans; Temporomandibular Joint Disorders; Masticatory Muscles; Masseter Muscle; Temporomandibular Joint; Occlusal Splints
PubMed: 37406276
DOI: 10.24425/fmc.2023.145429 -
Dental Materials : Official Publication... Jun 2024To investigate the flexural strength (FS), elastic modulus (E), Martens hardness (HM), water sorption (w), water solubility (w) and degree of conversion (DC) of...
OBJECTIVES
To investigate the flexural strength (FS), elastic modulus (E), Martens hardness (HM), water sorption (w), water solubility (w) and degree of conversion (DC) of 3D-printed, milled and injection molded splint materials.
METHODS
Specimens (N = 1140) were fabricated from five 3D-printed (GR-22 flex, GR-10 guide, ProArt Print Splint clear, V-Print Splint, V-Print Splint comfort), five milled (BioniCut, EldyPlus, ProArt CAD Splint clear, Temp Premium Flexible, Thermeo) and two injection molded (PalaXPress clear, Pro Base Cold) materials. FS, E, HM, w, w and DC were tested initially (24 h, 37 °C, HO), after water storage (90 d, 37 °C, HO) as well as after thermal cycling (5000 thermal cycles, 5/55 °C). Data were analyzed with Kolmogorov-Smirnov, Kruskal- Wallis, Mann-Whitney U test and Spearman's correlation (p < 0.05).
RESULTS
Initially, the mean flexural strength values ranged from 1.9 to 90.7 MPa for printed, 3.8 to 107 MPa for milled and 99.7 to 102 MPa for injection molded materials. The initial mean elastic modulus values were 0.0 to 2.4 GPa for printed, 0.1 to 2.7 GPa for milled and 2.8 GPa for injection molded materials. The initial mean Martens hardness values were 14.5 to 126 N/mm for printed, 50.2 to 171 N/mm for milled and 143 to 151 N/mm for injection molded materials. Initially, the mean water sorption values ranged from 23.1 to 41.2 μg/mm for printed, 4.5 to 23.5 μg/mm for milled and from 22.5 to 23.3 μg/ mm for injection molded materials. The initial mean water solubility values ranged from 2.2 to 7.1 μg/mm for printed, 0.0 to 0.5 μg/mm for milled and 0.1 to 0.3 μg/mm for injection molded materials. After water storage and thermal cycling most of the values decreased and some increased. The mean DC values ranged initially from 72.3 to 94.5 %, after water storage from 74.2 to 96.8 % and after thermal cycling from 75.6 to 95.4 % for the printed materials.
SIGNIFICANCE
The mechanical and physical properties of printed, milled and injection molded materials for occlusal devices vary and are influenced by aging processes. For clinical applications, materials need to be chosen according to the specific indications.
PubMed: 38851965
DOI: 10.1016/j.dental.2024.05.030 -
Biomedical Journal Jun 2021Previous computer-generated splints were designed and produced without modification than the traditional occlusal splints, which did not facilitate surgeon's...
BACKGROUND
Previous computer-generated splints were designed and produced without modification than the traditional occlusal splints, which did not facilitate surgeon's intraoperative judgment in the single-splint two-jaw orthognathic surgery. Modifications of the digital occlusal splint can be achieved using computer-aided design and computer-aided manufacturing (CAD/CAM) software. This study reported the design, clinical application and validation of a novel CAD/CAM occlusal splint.
METHODS
The maxillary and mandibular segments were fixed into the final occlusal splint and moved to the planned position according to the 3-dimensional simulation. The composite occlusal splint has 4 orthogonal bars to facilitate intraoperative assessment of the dental and skeletal midline, facial soft tissue midline, occlusal plane, upper tooth show, facial symmetry and facial bone position. To validate the surgical outcome, 5 parameters including pitch, roll and yaw rotations, midline deviation and chin position were measured on the virtual plan and the postoperative cone-beam computed tomography images to quantify the difference.
RESULTS
The results showed no significant differences in the 5 parameters between the simulation and postoperative images. The root-mean-square difference between the conventional splints and CAD/CAM surgical splint ranged from 0.18 to 0.31 mm by superimposition of the two image models. All patients were satisfied with the treatment outcomes. Overall, this novel occlusal splint is ideal for verification of the maxillomandibular position during surgery.
CONCLUSION
The novel composite occlusal splint provided useful and informative check to verify the maxillomandibular complex (MMC) position and facial appearance in single-splint two-jaw orthognathic surgery.
Topics: Computer-Aided Design; Humans; Mandible; Occlusal Splints; Orthognathic Surgery; Orthognathic Surgical Procedures; Splints
PubMed: 34144940
DOI: 10.1016/j.bj.2020.03.004 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jan 2022Mandibular condyle fractures can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation. Although many studies have...
BACKGROUND
Mandibular condyle fractures can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation. Although many studies have discussed for the optimal treatment method, the issue remains controversial. In this study, we aimed to compare conservative techniques in the mandibular condyle fractures.
METHODS
Twenty four unilateral condyle fracture patients aged between 18 and 48 years were treated according to one of three different modalities. Bracketing, arch bar or mini screw was applied to all non-surgery patients to obtain IMF. Eight patients were treated with only IMF meanwhile eleven patients were treated with one or double-sided amplifier occlusal splint according to the status of fractured segments, in addition to IMF. Remaining five patients have undergone open reduction and fractured segments immobilized with mini plates. Pre- and post-operative images were recorded with a computerized tomography device. Clinical and radiological examinations were performed by orthodontists and surgeons at baseline and at 6 months of treatment.
RESULTS
The condyle lengths of the patients with unilateral fracture after recovery were compared with the unaffected side. The length between the most protruding point of the condyle and the mandible was measured and the length difference was only 5.94 mm in patients who were treated by IMF. The length difference of patients who used brackets and splints was 3.36 mm (p<0.05). The length difference of patients who were repaired by plate screws was 1.80 mm (p>0.05). However, there was no statistically significant difference (p>0.05) between the groups in the IMF, occlusal splint and IMF and mini plate groups, between the trauma side and the opposite side. None of the patients developed ankylosis, open mouth, limitation of mouth opening, facial asymmetry, laterognathia, and retrognathia. The occlusion of the patients who were not known to have pre-trauma occlusions were directed, repositioned and provided an appropriate occlusion.
CONCLUSION
The use of IMF with an occlusal splint is a more conservative and acceptable treatment modality than open reduction in selected cases.
Topics: Adolescent; Adult; Bone Screws; Follow-Up Studies; Fracture Fixation, Internal; Humans; Jaw Fixation Techniques; Mandibular Condyle; Mandibular Fractures; Middle Aged; Treatment Outcome; Young Adult
PubMed: 34967439
DOI: 10.14744/tjtes.2020.94992 -
The Saudi Dental Journal Nov 2022Occlusal function stimulates different areas of the cerebral cortex. The purpose of this narrative review was to identify the relationship between occlusion and brain... (Review)
Review
OBJECTIVES
Occlusal function stimulates different areas of the cerebral cortex. The purpose of this narrative review was to identify the relationship between occlusion and brain activity so as to provide theoretical support to enable future studies on the subject.
STUDY SELECTION DATA AND SOURCES
Relevant case-control studies, clinical trials, and systematic reviews available in English were retrieved from the following databases: MEDLINE, PubMed, ScienceDirect, Wiley Online Library, and Biblioteca Virtual en Salud (BVS). Of the 53 articles obtained, 12 were included.
CONCLUSION
The sensorimotor cortex is affected by changes in occlusion. It is speculated that occlusion could play an important role in the development of diseases, from anxiety and stress to Alzheimer's disease and senile dementia. Further investigations into the interactions between occlusion and brain function are needed to elucidate the parts of the brain that are affected when occlusion is disturbed and to determine whether brain function is altered.
CLINICAL SIGNIFICANCE
Dentists must consider that alterations in the occlusal pattern during mastication can lead to changes in the activation of different brain regions related to memory, learning, anticipatory pain, and anxiety. This suggests that mastication maintains the integrity of certain brain areas and that it may be a key factor in the onset of neurodegenerative diseases.
PubMed: 36267531
DOI: 10.1016/j.sdentj.2022.09.001 -
International Dental Journal Jun 2024The aim of this superiority trial was to investigate the clinical outcomes of arthrocentesis as an early treatment supported by use of an occlusal splint vs use of an...
OBJECTIVES
The aim of this superiority trial was to investigate the clinical outcomes of arthrocentesis as an early treatment supported by use of an occlusal splint vs use of an occlusal splint only in the management of temporomandibular joint (TMJ) arthralgia.
METHODS
Ninety-five adults presenting with TMJ arthralgia were recruited into the study and randomised into 2 groups: Group 1 received arthrocentesis as an early treatment supported by use of an occlusal splint, whereas group 2 received treatment with an occlusal splint only. Seventy-four patients (group 1: n = 37; group 2: n = 37) completed the 1-year follow-up schedule and were included in the final analysis. Reduction of pain intensity measured by a numeric rating scale and increase in mouth opening distance (unassisted maximal, assisted maximal, and pain-free) was seen in both treatment groups.
RESULTS
In group 1, pain intensity significantly decreased at 6 weeks and all subsequent time points compared with group 2. In terms of mouth opening distance, a significant improvement was observed in both groups during the course of treatment, but statistical significance was not seen between the 2 treatment groups.
CONCLUSIONS
Early arthrocentesis supported by use of an occlusal splint is superior to use of an occlusal splint alone in the treatment of TMJ arthralgia. Arthrocentesis with occlusal splint support could be discussed as first-line treatment for arthralgia of the TMJ, which may co-occur with various painful and nonpainful conditions of TMJ disorders.
PubMed: 38851933
DOI: 10.1016/j.identj.2024.04.015 -
Healthcare (Basel, Switzerland) Apr 2022There is still a gap in the scientific knowledge on the linkage between craniofacial structure and spinal postural control in temporomandibular disorder (TMD) patients.... (Review)
Review
There is still a gap in the scientific knowledge on the linkage between craniofacial structure and spinal postural control in temporomandibular disorder (TMD) patients. This systematic review aimed to assess the role of occlusal splints on spinal posture of TMD patients. PubMed, Web of Science, and Scopus were systematically searched from inception until 5 January 2022 to identify observational studies with a longitudinal study design presenting: patients with diagnosis of TMD according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD); occlusal splint therapy as intervention; postural assessment as outcome. Out of 133 records identified, 104 were suitable for data screening, and only 7 articles were included satisfying the eligibility criteria. We found that occlusal splints might have a positive effect on posture in TMD patients, albeit there is little evidence of appropriate investigation for postural assessment. This systematic review suggested that the occlusal splint might be considered a non-invasive therapeutic approach for patients with TMD. However, the low number of studies with high-quality methodology in these patients showed an urgent need for further research using combined force platform stabilometry and kinematic evaluation of the spine to investigate the impact of occlusal splints on posture.
PubMed: 35455916
DOI: 10.3390/healthcare10040739 -
Journal of Pain Research 2020Bruxism, specifically sleep bruxism (SB), is a worldwide discussed topic in the literature; however, there is insufficient evidence to define and support a standard... (Review)
Review
Bruxism, specifically sleep bruxism (SB), is a worldwide discussed topic in the literature; however, there is insufficient evidence to define and support a standard approach for the treatment of SB. The purpose of this overview was to map the evidence from systematic reviews (SR), examining the effects of interventions to improve chronic pain related to bruxism. The methodological quality of SRs was assessed using the AMSTAR-2 tool. We conducted a comprehensive literature search in April 2020, in the following databases: Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, LILACS, BBO, and Epistemonikos. Nine SRs with critically low to high methodological quality were included. Considering the main findings, botulinum toxin type A (BTX-A) showed a significant pain and sleep bruxism frequency reduction when compared to placebo or conventional treatment (behavioral therapy, occlusal splints, and drugs), after 6 and 12 months. Occlusal splints combined to muscle massage showed some benefit in pain reduction. There was no difference in pain and bruxism frequency between biofeedback therapy and an inactive control group. Regarding drug therapy, there is no difference when amitriptyline, bromocriptine, clonidine, propranolol, and levodopa were compared to placebo. In conclusion, there is some evidence to support the use of occlusal splints plus massage, and BTX-A to reduce chronic pain related to SB. No evidence was provided to support the recommendation of biofeedback therapy and drug therapy. There is still a need for more methodologically rigorous randomized clinical trials (RCT) to be conducted on the efficacy and safety of different therapies for SB.
PubMed: 33061557
DOI: 10.2147/JPR.S268114