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Annals of Palliative Medicine Jun 2021This systematic review of the literature was to compare the effects of exercise therapy and occlusal splint therapy on pain and mobility in individuals with painful... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review of the literature was to compare the effects of exercise therapy and occlusal splint therapy on pain and mobility in individuals with painful temporomandibular disorders (TMD).
METHODS
PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched for English publications from database root to March 1, 2020. Search terms were [("temporomandibular joint disorders" or "temporomandibular disorders" or "craniomandibular disorders" or "orofacial pain" or "myofascial pain" or "myofascial pain" or "facial pain") AND (exercise or "physical therapy modalities" or physiotherapy or "exercise therapy") AND ("splints" or "occlusal splints" or "stabilization splint" or "occlusal appliance" or "occlusal splint therapy")]. We included randomized controlled trials that evaluated the effects of therapeutic exercise therapy and occlusal splint therapy, and were published in English. Trial quality was assessed with the Physiotherapy Evidence Database scale.
RESULTS
Six studies were included (498 patients: 251 occlusal splint therapy, 247 therapeutic exercise). The results revealed that exercise therapy was not superior to occlusal splint therapy for pain reduction in patients with painful TMD (P=0.08; weighted standardized mean difference -0.29; 95% CI, -0.62 to 0.04). The effectiveness of occlusal splint therapy and exercise therapy was found to be equivalent in the maximum mouth-opening range (P=0.51; weighted standardized mean difference 0.12; 95% CI, -0.24 to 0.48), right laterotrusion (P=0.99; weighted standardized mean difference -0.00; 95% CI, -0.31 to 0.31), left laterotrusion (P=0.32; weighted standardized mean difference 0.16; 95% CI, -0.16 to 0.48), and protrusion (P=0.77; weighted standardized mean difference 0.06; 95% CI, -0.32 to 0.43) for painful TMD patients.
CONCLUSIONS
Given the limitations of the study, the small number of studies included in the sub-analysis for pain relief and the maximum mouth-opening range, and the small overall standardized mean difference for pain relief and mandibular movement observed, no high-quality evidence was found to distinguish the clinical effectiveness between occlusal splint therapy and exercise therapy for painful TMD patients. It appears that more randomized controlled trials comparing the effects of exercise therapy and occlusal splint therapy need to be implemented.
Topics: Exercise Therapy; Humans; Occlusal Splints; Pain; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 33977737
DOI: 10.21037/apm-21-451 -
General Dentistry 2017Occlusal splints, also known as bite guards, oral orthotics, and oral appliances, are utilized frequently in dental practices. They are commonly used to relax jaw... (Review)
Review
Occlusal splints, also known as bite guards, oral orthotics, and oral appliances, are utilized frequently in dental practices. They are commonly used to relax jaw muscles, prevent temporomandibular jaw trauma, protect dentition, and control headaches. How well occlusal splints work is another matter. Numerous studies, when taken as a whole, suggest only a modest indication that they are useful. This review applies principles of neurophysiology to analyze the usefulness of several types of occlusal splint in relation to their design and function. A unique occlusal splint with a design based on neurophysiology is described.
Topics: Dental Prosthesis Design; Humans; Occlusal Splints; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 28253183
DOI: No ID Found -
Clinical and Experimental Dental... Apr 2019The aim of this study was to investigate the effects of the use of an occlusal splint on postural balance considering the occlusal splint as a device for treating... (Randomized Controlled Trial)
Randomized Controlled Trial
The aim of this study was to investigate the effects of the use of an occlusal splint on postural balance considering the occlusal splint as a device for treating temporomandibular joint disorder. A randomized, controlled, prospective clinical trial was conducted. The research group consisted of 49 patients (36 as test group and 13 as control group) between 18 and 75 years old, both genders, diagnosed as temporomandibular disorder by Research Diagnostic Criteria/Temporomandibular Disorders questionnaire and magnetic resonance imaging of the temporomandibular joints. Test group was treated with orientations for physiotherapeutic exercises and occlusal splint, whereas control group received orientation for physiotherapeutic exercises only. Postural equilibrium was evaluated by means of a force plate. After 12 weeks, the groups were re-evaluated. Patients from both groups presented a significant increase in antero-posterior speed with eyes closed, test group ( < 0.001) and control group ( = 0.046). Only patients of the test group presented a significant increase in antero-posterior speed with eyes opened ( = 0.023). We concluded that the use of occlusal splint affected the postural balance.
Topics: Adolescent; Adult; Aged; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Occlusal Splints; Physical Therapy Modalities; Postural Balance; Sensation Disorders; Single-Blind Method; Temporomandibular Joint Disorders; Young Adult
PubMed: 31049212
DOI: 10.1002/cre2.136 -
International Journal of Oral and... Aug 2020A network meta-analysis (NMA) of randomized controlled trials (RCTs) was performed to assess the effectiveness of various types of occlusal splint in the management of... (Meta-Analysis)
Meta-Analysis
A network meta-analysis (NMA) of randomized controlled trials (RCTs) was performed to assess the effectiveness of various types of occlusal splint in the management of temporomandibular disorders (TMDs) and to rank them according to their effectiveness. An electronic search was undertaken to identify RCTs published until August 2019. Predictor variables were control, non-occluding splint, hard stabilization splint (HSS), soft stabilization splint (SSS), prefabricated splint, mini-anterior splint, anterior repositioning splint (ARS), and counselling therapy (CT) with or without HSS. Outcome variables were pain improvement, post-treatment pain intensity, improvement in mouth opening, and disappearance of temporomandibular joint (TMJ) sounds. Forty-eight RCTs were included. There was a significant decrease in post-treatment pain intensity in arthrogenous TMDs after ARS (low quality evidence), CT+HSS (moderate quality evidence), mini-anterior splints (very low quality evidence), and HSS alone (low quality evidence), when compared to the control. There was a significant decrease in post-treatment pain intensity in myogenous TMDs with mini-anterior splints (very low quality evidence), SSS (very low quality evidence), CT alone (moderate quality evidence), CT+HSS (moderate quality evidence), and HSS alone (moderate quality evidence), when compared to control. ARS and CT were superior in decreasing TMJ clicking than control and HSS alone. The three highest-ranked treatments for post-treatment pain reduction in arthrogenous TMDs were ARS (92%, very low quality evidence), CT+HSS (67.3%, low quality evidence), and HSS alone (52.9%, moderate quality evidence). For myogenous TMDs, they were mini-anterior splints (86.8%, low quality evidence), CT+HSS (61.2%, very low quality evidence), and HSS alone (59.7%, moderate quality evidence). Based on this NMA of 48 RCTs, there is moderate to very low quality evidence confirming the effectiveness of occlusal splint therapy in the treatment of TMDs. Multimodal therapy consisting of CT+HSS may produce the maximum improvement for TMD patients.
Topics: Humans; Network Meta-Analysis; Occlusal Splints; Pain; Randomized Controlled Trials as Topic; Splints; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 31982236
DOI: 10.1016/j.ijom.2020.01.004 -
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 Cochrane Database of Systematic... Oct 2007Sleep bruxism is an oral activity characterised by teeth grinding or clenching during sleep. Several treatments for sleep bruxism have been proposed such as... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sleep bruxism is an oral activity characterised by teeth grinding or clenching during sleep. Several treatments for sleep bruxism have been proposed such as pharmacological, psychological, and dental.
OBJECTIVES
To evaluate the effectiveness of occlusal splints for the treatment of sleep bruxism with alternative interventions, placebo or no treatment.
SEARCH STRATEGY
We searched the Cochrane Oral Health Group's Trials Register (to May 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1); MEDLINE (1966 to May 2007); EMBASE (1980 to May 2007); LILACS (1982 to May 2007); Biblioteca Brasileira de Odontologia (1982 to May 2007); Dissertation, Theses and Abstracts (1981 to May 2007); and handsearched abstracts of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from article reviews about treating sleep bruxism. There were no language restrictions.
SELECTION CRITERIA
We selected randomised or quasi-randomised controlled trials (RCTs), in which splint therapy was compared concurrently to no treatment, other occlusal appliances, or any other intervention in participants with sleep bruxism.
DATA COLLECTION AND ANALYSIS
Data extraction was carried out independently and in duplicate. Validity assessment of the included trials was carried out at the same time as data extraction. Discrepancies were discussed and a third review author consulted. The author of the primary study was contacted when necessary.
MAIN RESULTS
Thirty-two potentially relevant RCTs were identified. Twenty-four trials were excluded. Five RCTs were included. Occlusal splint was compared to: palatal splint, mandibular advancement device, transcutaneous electric nerve stimulation, and no treatment. There was just one common outcome (arousal index) which was combined in a meta-analysis. No statistically significant differences between the occlusal splint and control groups were found in the meta-analyses.
AUTHORS' CONCLUSIONS
There is not sufficient evidence to state that the occlusal splint is effective for treating sleep bruxism. Indication of its use is questionable with regard to sleep outcomes, but it may be that there is some benefit with regard to tooth wear. This systematic review suggests the need for further investigation in more controlled RCTs that pay attention to method of allocation, outcome assessment, large sample size, and sufficient duration of follow up. The study design must be parallel, in order to eliminate the bias provided by studies of cross-over type. A standardisation of the outcomes of the treatment of sleep bruxism should be established in the RCTs.
Topics: Humans; Occlusal Splints; Randomized Controlled Trials as Topic; Sleep Bruxism
PubMed: 17943862
DOI: 10.1002/14651858.CD005514.pub2 -
Journal of Dentistry May 2021Bruxism is a commonly reported oral parafunctional activity characterised by excessive tooth grinding or clenching outside normal functional activity. The present... (Review)
Review
OBJECTIVES
Bruxism is a commonly reported oral parafunctional activity characterised by excessive tooth grinding or clenching outside normal functional activity. The present systematic review aims to examine the available literature to determine the effectiveness of occlusal splints in the treatment of bruxism compared to no treatment and alternative treatment modalities.
DATA
Data extraction was undertaken in conjunction with quality of evidence assessment.
SOURCES
A literature search of the following databases was undertaken: MEDLINE via OVID, Pubmed (Medline), Cochrane Oral Health Group's Trials, The Cochrane Central Register of Controlled Trials and EMBASE.
STUDY SELECTION
Randomised Controlled Trials (RCT) and quasi-RCTs which met the inclusion criteria were selected for analysis. These included studies comparing occlusal splints to no treatment or other interventions.
RESULTS
Twenty-two studies were identified for review with fourteen meeting the inclusion criteria. Only a small number of studies were available in each comparison (one or two for some) all of which had a medium to high risk of bias.
CONCLUSIONS
There is insufficient evidence to determine whether occlusal splint therapy for the treatment of bruxism provides a benefit over no treatment, other oral appliances, TENS, behavioural or pharmacological therapy. Furthermore, there is a lack of studies in each comparison with many suffering from a high risk of bias. There is a need for further research in this area and improvement in trial quality.
CLINICAL SIGNIFICANCE STATEMENT
This systematic review aimed to determine the effectiveness of occlusal splints in the treatment of bruxism. It found there was insufficient evidence to recommend occlusal splint therapy over no treatment or other treatment modalities. This is relevant to dental clinicians who may provide such appliances and cautions them in treatment provision.
Topics: Bruxism; Humans; Occlusal Splints; Splints
PubMed: 33652054
DOI: 10.1016/j.jdent.2021.103621 -
Clinical Oral Investigations Dec 2023To systematically review studies on various occlusal splint materials and describe their mechanical and chemical properties. (Review)
Review
OBJECTIVE
To systematically review studies on various occlusal splint materials and describe their mechanical and chemical properties.
METHODS
MEDLINE (PubMed), Scopus, and Web of Science searches were conducted for in vitro studies focusing on occlusal splint materials. Two reviewers performed an assessment of the identified studies and data abstraction independently, and this was complimented by an additional hand search. The articles were limited to those in the English language that were published between January 1, 2012, and December 1, 2022.
RESULTS
The initial search yielded 405 search results of which 274 were selected for full-text review following abstract evaluation. 250 articles that did not meet the inclusion criteria were excluded, and the remaining 25 articles (with 1 article identified from the reference lists of included articles) providing mechanical and chemical values were used in this review. Poly methyl methacrylate (PMMA) -based occlusal splint materials showed the highest values in terms of hardness, wear resistance, flexural strength, flexural modulus, e-modulus, and fracture toughness. The material group with the highest water sorption and water solubility was 3D printed (PR) splint materials. In addition, the lowest degree of double bond conversion was also observed in this group of materials.
CONCLUSIONS
The outcome of this review suggests that mechanically and chemically acceptable properties can be attained with PMMA-based occlusal splint materials using both conventional and digital production methods. PR splint materials should not be considered as the primary choice for long-term treatments due to their low mechanical and chemical properties.
CLINICAL RELEVANCE
This review provides clinical recommendations for selecting the appropriate material and fabrication method for occlusal splints while taking the patients' needs and the materials´ mechanical and chemical properties into account.
Topics: Humans; Occlusal Splints; Polymethyl Methacrylate; Flexural Strength; Splints; Water
PubMed: 37910242
DOI: 10.1007/s00784-023-05360-0 -
The Journal of Headache and Pain 2015Pain related to temporomandibular disorders (TMD) is a common problem in modern societies. The aim of the article is to present the concepts of TMD pain clinical... (Review)
Review
BACKGROUND
Pain related to temporomandibular disorders (TMD) is a common problem in modern societies. The aim of the article is to present the concepts of TMD pain clinical management.
METHODS
A survey was performed using the PubMed, SCOPUS and CINAHL databases for documents published between 1994 and 2014. The following search keywords were selected using MeSH terms of the National Library of Medicine in combination: TMD pain, TMD, TMJ, TMJ disorders, occlusal splint, TMD physiotherapy, TMJ rheumatoid disorders and TMJ surgery. Original articles and review papers which presented the clinical relevance and practical validity regarding the possibility of application in TMD management have been included. Authors have excluded articles without outstanding practical aspect and evidence-based background. A first selection was carried out by reviewing titles and abstracts of all articles found according to the criteria. After that the full texts of potentially suitable articles were assessed. In line with these criteria, among 11467 results the writers have included 66 papers.
RESULTS
The most commonly reported conservative treatments are massage therapy and individually fabricated occlusal splints. In addition to massage, other popular methods include manual therapy and taping, warming/cooling of aching joints, and light and laser therapy. Drugs are also commonly used. In the most severe cases of the temporomandibular joint degeneration, surgical restoration of the joint is sometimes applied.
CONCLUSIONS
The authors concluded that conservative treatment including counselling, exercises, occlusal splint therapy, massage, manual therapy and others should be considered as a first choice therapy for TMD pain because of their low risk of side effects. In the case of severe acute pain or chronic pain resulting from serious disorders, inflammation and/or degeneration pharmacotherapy, minimally invasive and invasive procedures should be considered.
Topics: Chronic Pain; Exercise Therapy; Facial Pain; Humans; Massage; Occlusal Splints; Pain Management; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 26644030
DOI: 10.1186/s10194-015-0586-5 -
Acta Otorhinolaryngologica Italica :... Feb 2022This retrospective study aimed to verify the outcomes of stabilising occlusal splint therapy prescribed to 22 patients with unilateral definite Ménière's disease and...
OBJECTIVE
This retrospective study aimed to verify the outcomes of stabilising occlusal splint therapy prescribed to 22 patients with unilateral definite Ménière's disease and comorbid temporomandibular joint disorder.
METHODS
The results of a battery of audiometric and vestibular tests were recorded before and after 6 months of treatment, as well as the scores of disease-specific questionnaires.
RESULTS
The average hearing threshold in the affected ear and the acoustic immittance were unchanged. No spontaneous and positional nystagmus were recorded. Caloric hypo-responsiveness and vestibular myogenic evoked responses did not vary. No changes of stabilometric body sway parameters in eyes opened condition and with optokinetic stimulation delivered to the unaffected labyrinth were observed. A significant reduction was recorded in eyes closed condition and with the optokinetic stimulation toward the affected ear. The Tinnitus Handicap Inventory, the Situational Vertigo Questionnaire and the Numeric Pain Rating Scale scores improved. The number of vertigo attacks was reduced.
CONCLUSIONS
Occlusal splint therapy is a favourable option to reduce aural symptoms of Ménière's disease and comorbid temporomandibular joint disorder, even if its pathophysiological mechanism remains elusive.
Topics: Humans; Meniere Disease; Occlusal Splints; Retrospective Studies; Temporomandibular Joint Disorders; Vestibule, Labyrinth
PubMed: 35129540
DOI: 10.14639/0392-100X-N1641