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Journal of Clinical Periodontology Jun 2022To evaluate the efficacy of tooth splinting (TS) and occlusal adjustment (OA) compared to no TS or OA in patients with periodontitis exhibiting masticatory dysfunction. (Review)
Review
OBJECTIVE
To evaluate the efficacy of tooth splinting (TS) and occlusal adjustment (OA) compared to no TS or OA in patients with periodontitis exhibiting masticatory dysfunction.
MATERIAL
The primary outcome criterion was tooth loss (TL), and the secondary outcome parameters were change in probing pocket depth (PPD), change in clinical attachment level (CAL), tooth mobility (TM), and patient-reported outcome measures (PROMs). Literature search was performed on three electronic databases (from 01/1965 to 04/2021) and focused on clinical studies with at least 12 months follow-up.
RESULTS
From a total of 1515 publications, 51 articles were identified for full-text reading, of which 2 retrospective case series on TS with low risk of bias and 1 randomized and 2 prospective studies on OA with unclear risk of bias were included. For TS, synthesis of data showed that in 72 patients, 26 out of 311 teeth (weighted mean incidence of TL 8.4%) and 156 out of 1541 teeth with no TS (weighted mean incidence of TL 10.1%) were lost over 2 years following non-surgical periodontal therapy. The randomized controlled clinical trial (RCT) indicated CAL gain for teeth with OA compared to no OA. For the effect of OA on TL, PPD, and TM, heterogeneous data were retrieved from the included studies.
CONCLUSIONS
Within the limitations of this review and based on a low level of evidence, it is concluded that TS does not improve survival of mobile teeth in patients with advanced periodontitis. OA on teeth with mobility and/or premature contacts may lead to improved CAL, while the effect of OA on the remaining periodontal parameters remains unclear.
Topics: Humans; Occlusal Adjustment; Periodontitis; Randomized Controlled Trials as Topic; Tooth Loss; Tooth Mobility
PubMed: 34854115
DOI: 10.1111/jcpe.13563 -
Journal of Dentistry Dec 2012Occlusal adjustment as part of periodontal therapy has been controversial for years, mostly because the literature does not provide enough evidence regarding the... (Review)
Review
OBJECTIVES
Occlusal adjustment as part of periodontal therapy has been controversial for years, mostly because the literature does not provide enough evidence regarding the influence of trauma from occlusion (TfO) on periodontitis. The need for occlusal adjustment in periodontal therapy is considered uncertain and requires investigation. The aim of this systematic review was to identify and analyse those studies that investigated the effects of occlusal adjustment, associated with periodontal therapy, on periodontal parameters.
DATA
A protocol was developed that included all aspects of a systematic review: search strategy, selection criteria, selection methods, data collection and data extraction.
SOURCES
A literature search was conducted using MEDLINE via PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE.
STUDY SELECTION
Three reviewers screened the titles and abstracts of articles according to the established criteria. Every article that indicated a possible match, or could not be excluded based on the information given in the title or abstract, was considered and evaluated. On final selection, four articles were included.
CONCLUSIONS
Although the selected studies suggest an association between occlusal adjustment and an improvement in periodontal parameters, their methodological issues (explored in this review) suggest the need for new trials of a higher quality. There is insufficient evidence at present to presume that occlusal adjustment is necessary to reduce the progression of periodontal disease.
CLINICAL SIGNIFICANCE
Although it is still not possible to determine the role of occlusal adjustment in periodontal treatment, adverse effects have not been related to occlusal adjustment. This means that the decision made by clinicians whether or not to use occlusal adjustment in conjunction with periodontal therapy hinges upon clinical evaluation, patient comfort, and tooth function.
Topics: Biomechanical Phenomena; Bite Force; Dental Occlusion, Traumatic; Disease Progression; Humans; Occlusal Adjustment; Periodontal Diseases
PubMed: 22982113
DOI: 10.1016/j.jdent.2012.09.002 -
Clinical Oral Implants Research Feb 2005Due to lack of the periodontal ligament, osseointegrated implants, unlike natural teeth, react biomechanically in a different fashion to occlusal force. It is therefore... (Review)
Review
Due to lack of the periodontal ligament, osseointegrated implants, unlike natural teeth, react biomechanically in a different fashion to occlusal force. It is therefore believed that dental implants may be more prone to occlusal overloading, which is often regarded as one of the potential causes for peri-implant bone loss and failure of the implant/implant prosthesis. Overloading factors that may negatively influence on implant longevity include large cantilevers, parafunctions, improper occlusal designs, and premature contacts. Hence, it is important to control implant occlusion within physiologic limit and thus provide optimal implant load to ensure a long-term implant success. The purposes of this paper are to discuss the importance of implant occlusion for implant longevity and to provide clinical guidelines of optimal implant occlusion and possible solutions managing complications related to implant occlusion. It must be emphasized that currently there is no evidence-based, implant-specific concept of occlusion. Future studies in this area are needed to clarify the relationship between occlusion and implant success.
Topics: Biomechanical Phenomena; Bite Force; Dental Implantation, Endosseous; Dental Occlusion; Dental Occlusion, Traumatic; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Dental Stress Analysis; Denture, Complete; Denture, Overlay; Denture, Partial, Fixed; Humans; Occlusal Adjustment; Practice Guidelines as Topic
PubMed: 15642028
DOI: 10.1111/j.1600-0501.2004.01067.x -
Journal of Dentistry Jan 2023To investigate the impact of the occlusal contact situation and occlusal adjustment on wear, roughness, and fracture force of molar crowns.
OBJECTIVES
To investigate the impact of the occlusal contact situation and occlusal adjustment on wear, roughness, and fracture force of molar crowns.
MATERIALS AND METHODS
CAD/CAM crowns (lower right first molar, n = 64; 4 groups à 8, 3Y-TZP zirconia and resin composite) and corresponding antagonists (upper right first molar; 3Y-TZP zirconia) were manufactured. Crowns were constructed according to two principles of occlusion (group "T": Peter K. Thomas' "point-centric" cusp-to-fossa tripodization concept, with 15 contact points; group "RA" Sigurd P. Ramfjord and Major M. Ash, "freedom in centric" concept with four contacts). On one half of the crowns, occlusal adjustment was performed (groups "T adjusted" and "RA adjusted"). All crowns underwent combined thermal cycling (TC) and mechanical loading (ML) (ML: 1.2 × 10 cycles, 50 N, 2 Hz, mouth opening 1 mm; TC: 2 × 3000 cycles, 5/55°C). Wear area and depth of each contact point on the occlusal surfaces of crowns and antagonists were determined using a digital microscope. Surface roughness (R, R) was measured in and besides (reference) the worn area (3D laser-scanning microscope). Fracture force of the crowns was determined (statistics: Levene-test, one-way-ANOVA; Bonferroni-post-hoc-test; between-subjects effects, Pearson correlation, α=0.05).
RESULTS
The resin composite crowns yielded significantly higher mean values for wear area and depth (p < 0.001) and lower fracture forces (p < 0.001). Resin composite surfaces showed increased roughness after TCML while zirconia exhibited smoothened surfaces. The occlusal design significantly impacted wear depth (p = 0.012) and fracture force (p < 0.001). Resin composite crowns with fewer contact points (group RA) showed more wear and lower fracture force. Adjusted resin composite crowns showed increased wear areas and depths (p = 0.009-0.013). For zirconia crowns, the adjustment impacted wear area (p = 0.013), wear depth (p = 0.008), and fracture force (p = 0.006), with adjusted zirconia crowns exhibiting more wear and lower maximum forces until fracture. Zirconia wear depth was also impacted by the occlusal design (p = 0.012). Antagonistic wear was influenced by the restorative material, the occlusal contact pattern, and the adjustment.
CONCLUSIONS
The investigated materials show strongly varying performances with zirconia being significantly influenced by the adjustment, while for resin composites, contact design and adjustment had a major impact.
CLINICAL RELEVANCE
The results show the necessity of adapting occlusal design and adjustment in order to improve roughness, wear, and stability of zirconia and resin composite crowns.
Topics: Humans; Dental Porcelain; Occlusal Adjustment; Materials Testing; Crowns; Zirconium; Composite Resins; Computer-Aided Design
PubMed: 36403693
DOI: 10.1016/j.jdent.2022.104364 -
The Cochrane Database of Systematic... 2003There has been a long history of using occlusal adjustment in the management of temporomandibular disorders (TMD). It is not clear if occlusal adjustment is effective in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There has been a long history of using occlusal adjustment in the management of temporomandibular disorders (TMD). It is not clear if occlusal adjustment is effective in treating TMD.
OBJECTIVES
To assess the effectiveness of occlusal adjustment for treating TMD in adults and preventing TMD.
SEARCH STRATEGY
We searched the Cochrane Oral Health Group's Trials Register (April 2002); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2002); MEDLINE (1966 to 8th April 2002); EMBASE (1980 to 8th April 2002) and handsearched journals of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from review articles of treating TMD. There were no language restrictions. Unpublished reports or abstracts were considered from the SIGLE database.
SELECTION CRITERIA
All randomised or quasi-randomised controlled trials (RCTs) comparing occlusal adjustment to placebo, reassurance or no treatment in adults with TMD. The outcomes were global measures of symptoms, pain, headache and limitation of movement.
DATA COLLECTION AND ANALYSIS
Data were independently extracted, in duplicate, by two reviewers, Holy Koh (HK) and Peter G Robinson (PR). Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Oral Health Group's statistical guidelines were followed and relative risk values calculated using random effects models where significant heterogeneity was detected (P<0.1).
MAIN RESULTS
Over 660 trials were identified by the initial search. Six of these trials, which reported results from a total of 392 patients, were suitable for inclusion in the review. From the data provided in the published reports, symptom-based outcomes were extracted from trials on treatment. Data on incidence of symptoms were extracted from trials on prevention. Neither showed any difference between occlusal adjustment and control group.
REVIEWER'S CONCLUSIONS
There is an absence of evidence, from RCTs, that occlusal adjustment treats or prevents TMD. Occlusal adjustment cannot be recommended for the management or prevention of TMD. Future trials should use standardised diagnostic criteria and outcome measures when evaluating TMD.
Topics: Adult; Humans; Occlusal Adjustment; Randomized Controlled Trials as Topic; Temporomandibular Joint Disorders
PubMed: 12535488
DOI: 10.1002/14651858.CD003812 -
The Cochrane Database of Systematic... Jan 2016The Cochrane Oral Health Group withdrew this review as of Issue 1, 2016. The review is out of date and does not meet current Cochrane methodological standards. It will... (Meta-Analysis)
Meta-Analysis Review
The Cochrane Oral Health Group withdrew this review as of Issue 1, 2016. The review is out of date and does not meet current Cochrane methodological standards. It will be superseded by a new Cochrane review on Occlusal interventions for managing temporomandibular disorders. The editorial group responsible for this previously published document have withdrawn it from publication.
Topics: Adult; Humans; Occlusal Adjustment; Randomized Controlled Trials as Topic; Temporomandibular Joint Disorders
PubMed: 26727292
DOI: 10.1002/14651858.CD003812.pub2 -
Medical & Biological Engineering &... Jan 2019The abnormal occlusal contact can disrupt the coordination and health of the oral jaw system. Therefore, the dynamic adjustment of the occlusal surface is of great...
The abnormal occlusal contact can disrupt the coordination and health of the oral jaw system. Therefore, the dynamic adjustment of the occlusal surface is of great significance for assessing the status of occlusal contact and clarifying jaw factors of stomatognathic system diseases. To solve this problem, a trajectory subtraction algorithm based on screw theory to improve the accuracy of the occlusal movement trajectory is proposed in our paper. Driving by the relative trajectory, a virtual dynamic occlusal adjustment system is developed to realize 3D occlusal movement simulating, automatic occluding relation detection, and automatic occlusal adjustment. Furthermore, we adapt an active occlusal adjustment method based on Laplacian deformation to increase the contact areas of the occlusal surface, which can aid dentists to realize the automatic adjustment of the non-interference regions. As a consequence, the proposed subtraction algorithm is feasible and the root-mean-square is 0.097 mm, and the adjusted occlusal surface is more consistent with the natural occlusal morphology. Graphical abstract ᅟ.
Topics: Algorithms; Computer Simulation; Dental Restoration, Permanent; Humans; Occlusal Adjustment
PubMed: 29967936
DOI: 10.1007/s11517-018-1867-3 -
Journal of Oral Rehabilitation Apr 2004To assess the effectiveness of occlusal adjustment (OA) for treating temporomandibular disorders (TMD) in adults and preventing TMD. The Cochrane Controlled Trials... (Review)
Review
To assess the effectiveness of occlusal adjustment (OA) for treating temporomandibular disorders (TMD) in adults and preventing TMD. The Cochrane Controlled Trials Register, MEDLINE and EMBASE were comprehensively searched using the Cochrane methods. Reports and review articles were retrieved. Unpublished reports or abstracts were considered from the SIGLE database. All randomized or quasi-randomized controlled trials comparing OA with placebo, reassurance or no treatment in adults with TMD. The outcomes were global measures of symptoms, pain, headache and limitation of movement. Data collection and analysis followed the Cochrane Oral Health Group's statistical guidelines. Results showed no difference between OA and control group in symptom-based outcomes for treatment or incidence of symptoms for prevention. There is no evidence that OA treats or prevents TMD. OA cannot be recommended for the management or prevention of TMD. Future trials should use standardized diagnostic criteria and outcome measures when evaluating TMD.
Topics: Adult; Headache; Humans; Occlusal Adjustment; Pain Measurement; Randomized Controlled Trials as Topic; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 15089931
DOI: 10.1046/j.1365-2842.2003.01257.x -
Journal of Dentistry Jan 2023This prospective crossover clinical trial aimed to compare the complete-digital and -analog workflows in terms of occlusal adjustment of 3-unit tooth-supported fixed... (Clinical Trial)
Clinical Trial
AIM
This prospective crossover clinical trial aimed to compare the complete-digital and -analog workflows in terms of occlusal adjustment of 3-unit tooth-supported fixed dental prostheses, operator, and patient preferences.
MATERIALS AND METHOD
This study included twelve patients receiving fourteen 3-unit posterior FDPs. 2 FDPs were made for each restoration site: one fabricated in complete-digital workflow comprising intraoral scan with static bite registration (Trios 3) and a monolithic zirconia FDP (test); the other fabricated in complete-analog workflow comprising conventional impression/face-bow transfer and a porcelain-fused-to-metal FDP (control). The FDPs (n=28) were intraorally/provisionally fixed, and quadrant-like intraoral scans were taken for every FDP before & after their occlusal adjustments. Pre- and post-adjustment scans of each FDP were then superimposed using best-fit alignment (GOM Inspect) to measure the volumetric occlusal adjustment amount (mm) (3Matic) (Mann Whitney U, α=0.05). The patient and operator experience for digital and analog workflows were evaluated using visual analog scales (Wilcoxon test, α=0.05).
RESULTS
Mean occlusal adjustments were 7.63 mm [±7.02] and 25.95 mm [±39.61] for test and control groups, respectively. The volumetric adjustment difference was clinically noticeable but not significant (P=0.12). The impression and digital workflow adjustment were perceived more favorably by both operator (P=0.003, P=0.046, respectively) and the patients (P=0.003, P=0.002, respectively).
CONCLUSIONS
Within the limitations of this clinical study, the complete digital workflow with digital static bite-registration provided high occlusal accuracy for short-span tooth-supported FDPs. In addition, the patient and operator preferences significantly favored the digital workflow.
CLINICAL SIGNIFICANCE
Complete-digital workflow employing intraoral scanning and model-free fabrication of monolithic-Zr short-span tooth-supported FDPs offers an effective treatment modality with sufficient occlusal accuracy. Therefore complete-digital workflow is a valid alternative for complete-analog workflow comprising conventional impression, face-bow transfer, and use of a semi-adjustable articulator.
Topics: Humans; Computer-Aided Design; Dental Prosthesis Design; Occlusal Adjustment; Prospective Studies; Workflow; Zirconium; Cross-Over Studies
PubMed: 36403691
DOI: 10.1016/j.jdent.2022.104365 -
Oral Surgery, Oral Medicine, Oral... Jan 1997The use of occlusal adjustment as a treatment for temporomandibular disorders has been questioned because of lack of evidence that occlusal factors play an etiologic... (Review)
Review
The use of occlusal adjustment as a treatment for temporomandibular disorders has been questioned because of lack of evidence that occlusal factors play an etiologic role; lack of evidence that this irreversible treatment modality has sufficient efficacy, when reversible modalities are available; the self-limiting character of the disorders; and the possibility of adverse effects. However, controlled clinical trials have yielded results that are difficult to explain unless occlusal factors have a causal role in temporomandibular disorders. Controlled clinical trials also suggest an effect for occlusal adjustment on chronic headaches and on chronic neck and shoulder pain in comparison with conventional treatments. Moreover, no adverse effects of properly conducted occlusal adjustments have been reported. In view of the possibility that occlusal factors have a causal role in temporomandibular disorders, research efforts on the role of occlusion should be intensified, and teaching should be revised accordingly.
Topics: Dental Occlusion, Traumatic; Humans; Occlusal Adjustment; Temporomandibular Joint Disorders
PubMed: 9007930
DOI: 10.1016/s1079-2104(97)90097-4