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Clinical Case Reports Jul 2024Cemental tears, root cracks, and associated periapical-periodontal lesions may occur simultaneously in one tooth, and can be effectively managed by intentional...
Cemental tears, root cracks, and associated periapical-periodontal lesions may occur simultaneously in one tooth, and can be effectively managed by intentional replantation and etiological control. A durable splint, along with occlusal and periodontal monitoring, is required as healing progresses slowly and may be insufficient.
PubMed: 38933709
DOI: 10.1002/ccr3.9088 -
Polymers Jun 2024The aim of this study is to investigate the influence of printing material, build angle, and artificial aging on the accuracy of SLA- and DLP-printed occlusal devices in...
The aim of this study is to investigate the influence of printing material, build angle, and artificial aging on the accuracy of SLA- and DLP-printed occlusal devices in comparison to each other and to subtractively manufactured devices. A total of 192 occlusal devices were manufactured by one SLA-printing and two DLP-printing methods in 5 different build angles as well as milling. The specimens were scanned and superimposed to their initial CAD data and each other to obtain trueness and precision data values. A second series of scans were performed after the specimens underwent an artificial aging simulation by thermocycling. Again, trueness and precision were investigated, and pre- and post-aging values were compared. A statistically significant influence was found for all main effects: manufacturing method, build angle, and thermocycling, confirmed by two-way ANOVA. Regarding trueness, overall tendency indicated that subtractively manufactured splints were more accurate than the 3D-printed, with mean deviation values around ±0.15 mm, followed by the DLP1 group, with ±0.25 mm at 0 degree build angle. Within the additive manufacturing methods, DLP splints had significantly higher trueness for all build angles compared to SLA, which had the highest mean deviation values, with ±0.32 mm being the truest to the original CAD file. Regarding precision, subtractive manufacturing showed better accuracy than additive manufacturing. The artificial aging demonstrated a significant influence on the dimensional accuracy of only SLA-printed splints.
PubMed: 38932064
DOI: 10.3390/polym16121714 -
Clinical Oral Investigations Jun 2024The aim of this review was to analyze mechanical and biological properties of resin materials used with subtractive or additive techniques for oral appliances... (Meta-Analysis)
Meta-Analysis Comparative Study Review
Mechanical and biological properties of polymer materials for oral appliances produced with additive 3D printing and subtractive CAD-CAM techniques compared to conventional methods: a systematic review and meta-analysis.
OBJECTIVES
The aim of this review was to analyze mechanical and biological properties of resin materials used with subtractive or additive techniques for oral appliances fabrication and compare them to those conventionally manufactured.
MATERIALS AND METHODS
The protocol was registered online at Open Science Framework (OSF) registries ( https://osf.io/h5es3 ) and the study was based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). An electronic search was conducted on MEDLINE (via PubMed), Scopus, and Web of Science from 1 February 2022 to 1 May 2022.
INCLUSION CRITERIA
in vitro and in vivo studies published in the last 10 years, with CAD-CAM or 3D printed resins for occlusal splints. Data considered homogenous were subjected to meta-analysis (95% confidence interval [CI]; α = 0.05) with Stata17 statistical software. Since all variables were continuous, the Hedge g measure was calculated. A fixed-effects model was used for I = 0%, while statistical analysis was conducted using a random-effects model with I > 0%.
RESULTS
13 studies were included after full-text reading. The mechanical properties most studied were wear, flexural strength, surface hardness and surface roughness, while only 1 study investigated biological properties, performing the XTT viability assay. For the meta-analysis, only surface roughness, volume loss, and flexural strength were selected. Considering surface roughness, the subtractive specimen had a lower average value compared to traditional ones (Hedge's g with 95% CI = -1.25[ -1.84, - 0.66]). No significant difference was detected in terms of volume loss (P > 0.05) between the groups (Hedge's g with 95% CI = -0.01 [-2.71, - 2.68]). While flexural strength was higher in the control group (Hedge's g with 95% CI = 2.32 [0.10-4.53]).
CONCLUSION
3D printed materials showed properties comparable to conventional resins, while milled splint materials have not shown better mechanical performance compared with conventional heat-cured acrylic resin. Polyetheretherketone (PEEK) have great potential and needs to be further investigated. Biological tests on oral cell populations are needed to confirm the long-term biocompatibility of these materials.
CLINICAL RELEVANCE
The use of "mixed splints" combining different materials needs to be improved and evaluated in future research to take full advantage of different characteristics and properties.
Topics: Computer-Aided Design; Printing, Three-Dimensional; Humans; Materials Testing; Polymers; Dental Materials; Surface Properties
PubMed: 38916682
DOI: 10.1007/s00784-024-05772-6 -
Current Rheumatology Reviews Jun 2024Temporomandibular joint osteoarthritis (TMJ OA) is a chronic disease that is a consequence of undue occlusal forces and is characterized by irreversible damage to the...
BACKGROUND
Temporomandibular joint osteoarthritis (TMJ OA) is a chronic disease that is a consequence of undue occlusal forces and is characterized by irreversible damage to the articular surfaces. Symptomatic slow-acting so-called nutraceutical drugs have been proposed as a treatment for osteoarthritis in comparison to non-steroidal anti-inflammatory drugs (NSAIDs). Oral glucosamine and chondroitin, slow-acting drugs, have been found to reduce pain and in- crease mouth opening in patients with TMJ OA. However, there is limited scientific evidence to confirm their clinical effectiveness.
AIM
This systematic review was conducted to bolster the evidence supporting the assessment of the efficacy of glucosamine in the context of temporomandibular joint osteoarthritis (TMJ OA).
METHODOLOGY
This review identified four review articles from databases like Medline (via PubMed), Web of Science, Scopus, and EMBASE till September 2023 after screening at the title, abstract, and full-text level. They were assessed for risk of bias with the JBI risk of bias assess- ment tool.
RESULT
This review with meta-analysis focused on pooled estimate mean differences, revealing non-significant but discernible effects of glucosamine on maximum mouth opening (SMD = 0.288, p = 0.15) and pain reduction (SMD = 0.217, p = 0.476) in TMJ-related disorders.
CONCLUSION
Compared to control groups with ibuprofen and tramadol, glucosamine showed slightly more favourable outcomes. However, the variability in methodology and study characteristics warrants further longitudinal studies to confirm its efficacy.
PubMed: 38867545
DOI: 10.2174/0115733971309907240527105306 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2024Aim: To determine the effectiveness of treatment of temporomandibular joints muscle and joint dysfunction with occlusive splints based on the analysis of axiography data.
OBJECTIVE
Aim: To determine the effectiveness of treatment of temporomandibular joints muscle and joint dysfunction with occlusive splints based on the analysis of axiography data.
PATIENTS AND METHODS
Materials and Methods: 274 (two hundred and seventy-four) patients aged 18 to 44 years with a diagnosis of temporomandibular joints dysfunction before and after treatment.
RESULTS
Results: All patients with signs of temporomandibular joints dysfunction before treatment had a violation of the movement trajectory of the lower jaw: deviation - 68.7%, diflexion - 31.3%. When opening and closing the mouth, asymmetric shifts of the lower jaw of more than 2 mm were observed. After treatment with occlusive splints, the correct trajectory of opening and closing the mouth was noted: the number of patients with a trajectory violation decreased by 89.1%, and the amount of displacement of the lower jaw during opening and closing the mouth in 92.4% of patients decreased on average to 0.9 mm. When analyzing the movements of the lower jaw in the sagittal plane, deviations of the trajectory of the lower jaw were found in 79% of clinical cases. After the treatment using occlusive splints, 93.4% of cases of mandibular movement trajectory violations in the transversal plane were eliminated, and 78.1% of patients had a reduction in displacement volume to 0.9 mm. When analyzing the movements of the lower jaw in the sagittal plane, deviations of the trajectory of the lower jaw were found in 79% of clinical cases. After the treatment using occlusive splints, 93.4% of cases of mandibular movement trajectory violations in the transversal plane were eliminated, and 78.1% of patients had a reduction in displacement volume to 0.9 mm.
CONCLUSION
Conclusions: Movement trajectories of the lower jaw in the sagittal plane improved in 80.1% of patients, normalization of the position of the lower jaw in relation to the neuromuscular trajectory was achieved in 93.4% of clinical cases. According to the analysis of the parameters, this treatment should be considered effective.
Topics: Humans; Adult; Male; Female; Young Adult; Adolescent; Temporomandibular Joint Disorders; Range of Motion, Articular; Occlusal Splints; Temporomandibular Joint; Treatment Outcome
PubMed: 38865632
DOI: 10.36740/WLek202404120 -
International Journal of Paediatric... Jun 2024Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood, and temporomandibular joints (TMJs) are involved in 39%-78% of patients. (Review)
Review
BACKGROUND
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood, and temporomandibular joints (TMJs) are involved in 39%-78% of patients.
AIM
The aim of this systematic review was to assess the effectiveness of conservative approaches in improving TMJ arthritis in children and adolescents affected by JIA.
DESIGN
PubMed, Scopus, and Web of Science were systematically searched from the inception until February 25, 2024, to identify observational studies presenting participants with a diagnosis of JIA affecting the TMJ, rehabilitative approaches for TMJ arthritis as interventions, and clinical or radiological assessment of TMJ arthritis as outcome.
RESULTS
Of 478 papers suitable for title/abstract screening, 13 studies were included. The studies evaluated the effectiveness of intra-articular (IA) corticosteroid (CS) injections, IA infliximab injections, arthrocentesis alone or in combination with IACS injections, occlusal splint, functional appliance, and physiotherapy. The effectiveness of IACS injections was shown in eight studies. IA infliximab injections did not appear to significantly improve TMJ arthritis.
CONCLUSION
Results of this systematic review suggested that conservative treatments, especially IACS injections, might be effective in improving TMJ arthritis in patients affected by JIA. Further studies with a higher level of evidence and more representative samples should be conducted.
PubMed: 38863137
DOI: 10.1111/ipd.13225 -
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 -
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 -
Journal of International Society of... 2024Internal disc displacement of the temporomandibular joint (TMJ) is identified by an anomaly between the condylar-disc assembly, which, in many cases, may lead to...
Evaluating the Impact of Various Treatment Modalities on the Chewing Efficiency of Anterior Disc Displacements of Temporomandibular Joint Disorder Cases: A Comparative Study.
AIM
Internal disc displacement of the temporomandibular joint (TMJ) is identified by an anomaly between the condylar-disc assembly, which, in many cases, may lead to discomfort and malfunction of the chewing function. The study's objective was to assess the effects of four distinct treatment approaches on temporomandibular disorder cases with anterior disc displacements focusing on their chewing efficiency.
MATERIALS AND METHODS
One hundred participants suffering from reducible TMJ disc displacement were selected for enrollment in the study. Subjects were divided equally into four groups: group I patients were treated with behavioral therapy; group II patients were treated with low-level laser therapy (LLLT); group III patients were treated with anterior repositioning splints; and group IV patients were treated with flat plane splints. Chewing efficiency was assessed utilizing the fractional sieving method and a synthetic food substitute was created using silicon impression material. The statistical analysis encompassed comparisons of chewing efficiency between groups and between baseline and posttreatment within each group, employing analysis of variance (ANOVA) and paired tests, respectively.
RESULTS
Using the paired test, a significant difference in chewing efficiency values as expressed by the median particle size was observed between the baseline and 6-month values in all groups ( < 0.05), except for group I where no significant change was noted over the 6 months ( > 0.05). The one-way ANOVA test revealed a statistically significant difference among groups following therapies ( ˂ 0.05). The Tukey test was employed for pairwise comparisons and revealed statistically significant variances in the main values of chewing efficiency among all groups at a 95% confidence level ( ˂ 0.05).
CONCLUSION
The study's results suggest that occlusal splints and LLLT are more effective in improving chewing efficiency than behavioral interventions.
PubMed: 38827358
DOI: 10.4103/jispcd.jispcd_151_23 -
Journal of Dentistry Jul 2024To evaluate the effect of polishing and layering thickness on the wear resistance of 3D-printed occlusal splint materials.
OBJECTIVE
To evaluate the effect of polishing and layering thickness on the wear resistance of 3D-printed occlusal splint materials.
METHODS
Specimens with 3 different layer thicknesses (50, 75, 100 µm) were produced in the form of a disc 3 mm thick using V-Print splint resin on a 3D-printer with digital light processing technology. (n = 16 for each thickness) All specimens were washed and cured according to the manufacturer's instructions. Half of the specimens of each layer thickness were polished with silicon carbide papers. All specimens were subjected to 120.000 cycles of a chewing simulator for 2-body wear tests. Before and after the wear test, the specimens were scanned with a laser scanner, and the images were overlaid using a 3D analysis program and the volume loss was calculated. The wear patterns of the specimens were examined under a scanning electron microscope. Statistical evaluation was performed using a Shapiro-Wilk test, 2-way ANOVA, 1-way ANOVA, and Tukey post hoc test (α = 0.05).
RESULTS
While polishing had a significant effect (p = 0.003) on the wear volume of the occlusal splints, layer thickness (p = 0.105) and their interaction between polishing and layer thickness (p = 0.620) did not significantly affect the wear volume. Regardless of the polishing, the lowest mean wear was observed for D50 (0.064 mm), followed by D75 (0.078 mm), and D100 (0.096 mm). However, a significant difference was observed only between polished D50 and unpolished D100.
CONCLUSION
The polished 3D-printed occlusal splint resin showed higher wear resistance than the unpolished one, regardless of the layer thickness.
CLINICAL SIGNIFICANCE
Since different layer thicknesses of 50 µm and greater had no effect on the wear resistance of the material, a layer thickness of 100 µm may be preferred for faster printing. However, polishing occlusal splints may reduce the amount of wear and improve clinical performance.
Topics: Materials Testing; Surface Properties; Occlusal Splints; Dental Polishing; Humans; Printing, Three-Dimensional; Microscopy, Electron, Scanning; Carbon Compounds, Inorganic; Silicon Compounds; Dental Restoration Wear; Lasers; Dental Materials; Computer-Aided Design; Mastication
PubMed: 38801940
DOI: 10.1016/j.jdent.2024.105101