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Sleep & Breathing = Schlaf & Atmung Jun 2024The aim of this systematic review and meta-analysis was to analyze whether or not mandibular advancement devices (MADs) produce changes in blood pressure in patients... (Meta-Analysis)
Meta-Analysis
UNLABELLED
The aim of this systematic review and meta-analysis was to analyze whether or not mandibular advancement devices (MADs) produce changes in blood pressure in patients with obstructive sleep apnea (OSA) in relation to use time and if the device is used at night or day.
MATERIALS AND METHOD
A systematic review of the literature and meta-analysis was carried out in accordance with PRISMA guidelines. In the bibliographic search, a total of four databases were consulted: PubMed-Medline, Scopus, Web of Science, and Cochrane. Of the 622 articles initially revealed, 160 duplicates were eliminated. After applying the selection criteria, 17 articles were included for the qualitative analysis and 4 for the meta-analysis. The studies were combined using a random effects model with the inverse method of variance, determining the mean differences in systolic and diastolic pressure before and after treatment using the MAD splint as the effect size. Day/night circadian effect and treatment time were analyzed using meta-regression with a mixed-effects model.
RESULTS
MAD treatment was not found to affect diastolic pressure. By combining the four studies with the control group in a meta-analysis (I = 75%; z = - 0.15; p-value = 0.882), the mean difference in diastolic pressure between the MAD group and the control group was estimated at - 0.06 (- 0.86; 0.74). The meta-regression also showed no significant effect of day/night (p = 0.560) or treatment time (p = 0.854) on diastolic pressure. When combining the four studies with the control group (I = 84%%; z = - 1.47; p-value = 0.142), a non-significant mean difference in systolic pressure between the MAD group and the control group of - 0.99 (- 2.31; 0.33) was estimated in the meta-analysis. However, when assessing the effect of day/night or treatment time on systolic blood pressure using a meta-regression, the latter showed significant covariates that reduce systolic blood pressure values in the model at night (p < 0.001) and in relation to treatment time (p < 0.001).
CONCLUSIONS
Only systolic pressure appears to be affected by the use of the MAD in patients with OSA, and this decrease in systolic pressure is greater at night and when treatment time is longer.
Topics: Humans; Blood Pressure; Circadian Rhythm; Mandibular Advancement; Occlusal Splints; Sleep Apnea, Obstructive
PubMed: 38180683
DOI: 10.1007/s11325-023-02984-0 -
Cureus Dec 2023This case report demonstrates an innovative technique involving concomitant correction of a traumatic extrusive luxated tooth, the mobility of which was being aggravated...
This case report demonstrates an innovative technique involving concomitant correction of a traumatic extrusive luxated tooth, the mobility of which was being aggravated by anterior occlusal contacts, along with transverse rapid maxillary expansion to capitalize on the advantage of residual growth and simplify the need for comprehensive fixed orthodontic appliance. By incorporating a molar tube into the acrylic splint of the bonded Hyrax expander adjacent to the buccal surfaces and parallel to the buccal cusps of the maxillary first molars, effective intrusion of traumatically extruded upper incisor was achieved concomitantly using a modified intrusion arch during the passive stabilization period after expansion, thereby reducing treatment time. This enabled the immediate correction of extruded tooth and reduced the overall treatment duration and the complexity of post-expansion fixed mechanotherapy, improving compliance and uplifting the self-esteem of the patient. The modified bonded Hyrax assembly can serve as a versatile interim appliance for the simultaneous management of a variety of orthodontic problems such as crowding, spacing, and incisor proclination without compromising the basic integrity of the bonded assembly.
PubMed: 38179356
DOI: 10.7759/cureus.49938 -
Journal of the World Federation of... Feb 2024This article examines the characteristics of hypodivergent craniofacial patterns and explores treatment modalities in response to these features. It discusses the impact...
This article examines the characteristics of hypodivergent craniofacial patterns and explores treatment modalities in response to these features. It discusses the impact of robust masticatory muscles, which produce heavy occlusal forces. In addition, it examines the use of Botox or splints to reduce gonial angles in individuals with a square face. A nonextraction treatment approach supported by temporary skeletal anchorage devices is recommended; however, if anatomical limitations persist, extraction may be necessary when arch expansion, molar distalization, incisor proclination, or interproximal reduction cannot create the necessary space. In hypodivergent cases where a nonextraction approach is impractical, a single-arch extraction strategy may be considered to prevent a reduction in the vertical dimension. Emphasizing esthetics, particularly maxillary incisor display, a protocol of total arch extrusion of the maxillary dentition assisted with temporary skeletal anchorage device, bite raisers, and interarch elastics is suggested.
Topics: Humans; Mandible; Malocclusion, Angle Class II; Tooth Movement Techniques; Esthetics, Dental; Molar
PubMed: 38171974
DOI: 10.1016/j.ejwf.2023.12.007 -
Sleep Medicine: X Dec 2023Mandibular advancement devices (MAD) are used in sleep apnea with varying results. We aimed to examine whether or not a MAD should be an integral treatment modality in...
Mandibular advancement devices (MAD) are used in sleep apnea with varying results. We aimed to examine whether or not a MAD should be an integral treatment modality in the care of our patients with obstructive sleep apnea. We designed a feasibility study and included 32 patients after meeting inclusion criteria. Only 3 patients did not finish the second sleep study exam. The intervention was an individually designed MAD and a sleep study exam was performed prior and post treatment. The outcome objective was an apnea-hypopnea index of under 10 and with a 50% reduction. Patient population had a baseline AHI of 19.0 and mean reduction of AHI with MAD treatment to 13.3 yielding a MAD efficacy rate of 31% when outcome objectives were applied. The average reduction in AHI was 24.8% with 9 of the 29 patients actually experiencing an increase in AHI with MAD treatment. When there was a reduction in AHI using the MAD device the AHI reduction rate was 49.1% and there was a tendency for better treatment outcome when apnea-hypopnea was predominantly supine. A mandibular advancement device serves as an important treatment modality in the care of patients with obstructive sleep apnea due to patient satisfaction and compliance. The broad range of treatment response to our MAD device highlights the importance of performing a sleep study exam after initiation of treatment with a MAD but also illustrates the complexity and need for individually tailored treatment for patients with obstructive sleep apnea.
PubMed: 38162591
DOI: 10.1016/j.sleepx.2023.100076 -
Journal of Dentistry Feb 2024This study was conducted to present a completely digital workflow for the fabrication of occlusal stabilization splints using CAD/CAM systems and a digital face bow...
OBJECTIVE
This study was conducted to present a completely digital workflow for the fabrication of occlusal stabilization splints using CAD/CAM systems and a digital face bow based on optical sensor technology.
METHODS
Digital scans of the maxillary and mandibular arches of 20 volunteers were obtained using an intraoral scanner. Jaw relation and mandibular movements were recorded with a digital face bow via optical sensors. The virtual increase of the vertical dimension of occlusion (VDO) was then performed, after which computer-aided design (CAD) of the occlusal stabilization splints was carried out. The corresponding splints were then manufactured using digitally controlled technology.
RESULTS
A completely digital workflow for the manufacturing of occlusal stabilization splints was found to be clinically feasible. The corresponding data analysis revealed high congruence between virtual and physical occlusal contacts on the occlusal splint. Moreover, the appropriate guidance of the anterior teeth area was easily obtainable, and the time for adjusting the occlusion was less.
CONCLUSIONS
This study demonstrated that the fabrication of occlusal stabilization splints using a fully digital workflow is feasible. Compared to traditional impression-based manufacturing, several advantages of digital manufacturing include easy accessibility, time-efficient manufacturing, high-level accuracy in splint quality, and potential to manufacture duplicate splints.
CLINICAL SIGNIFICANCE
The proposed fully digital approach may help young dentists fabricating stable occlusal splints with beneficial curative effects. Meanwhile, it could also improve the production efficiency of stable occlusal splints, saving time for both doctors and patients while reducing labor costs.
Topics: Humans; Occlusal Splints; Splints; Workflow; Mandible; Dental Occlusion; Computer-Aided Design
PubMed: 38157975
DOI: 10.1016/j.jdent.2023.104826 -
Clinical Oral Investigations Dec 2023This study is to evaluate the color stability, surface roughness, and hardness of additively manufactured and hand-cast splint materials after a 6-month commercially...
OBJECTIVES
This study is to evaluate the color stability, surface roughness, and hardness of additively manufactured and hand-cast splint materials after a 6-month commercially available denture cleaning tablet immersion simulation.
MATERIALS AND METHODS
Disc-shaped additively manufactured and hand-cast auto polymerizing acrylic resin specimens were prepared (N = 40 each). All specimens were exposed to coffee solution totally 2 days. Thereafter, all specimens were immersed into three different effervescent solutions that simulated 6 months of clinical use. The total color change (ΔE*), surface roughness (R), and Vickers hardness (V) were measured at baseline and after immersion protocols. A two-way ANOVA and Bonferroni's post hoc test were used for color change. The dependent t-test and ANOVA were used for roughness and hardness evaluation.
RESULTS
Additively manufactured splint materials were more affected by coffee immersion. It was observed that all denture cleaning tablets induced a noticeable alteration in color of the specimens (p < 0.05). Roughness and hardness measurement changes after solution immersions were statistically significant for both splint groups (p < 0.05). On the other hand, distilled water and denture cleaning tablets created similar roughness and hardness measurements at baseline and after immersion.
CONCLUSIONS
After 6 months use of tested cleaning tables, the color stability, surface roughness, and hardness of both groups were affected. The evaluation of the surface properties of splint materials could be recommended to the dentists in periodic controls during splint treatments.
CLINICAL RELEVANCE
The use effervescent denture cleaning tablets altered the surface characteristics of tested splint materials over time with nonsignificant difference between each other. After 6 months, awareness should be raised about surface characteristics of splint materials.
Topics: Denture Bases; Coffee; Splints; Acrylic Resins; Surface Properties; Materials Testing; Color
PubMed: 38157078
DOI: 10.1007/s00784-023-05433-0 -
Oral Surgery, Oral Medicine, Oral... Apr 2024Aligning dental arches in orthognathic treatment after undergoing LeFort I osteotomy or bilateral sagittal split osteotomy (BSSO) relies on occlusal splints, which do... (Clinical Trial)
Clinical Trial
INTRODUCTION
Aligning dental arches in orthognathic treatment after undergoing LeFort I osteotomy or bilateral sagittal split osteotomy (BSSO) relies on occlusal splints, which do not provide precise control over the condylar head.
AIM OF THE STUDY
To clinically and radiographically assess the accuracy of computer-assisted design and manufactured (CAD/CAM) surgical guide for condylar positioning in a BSSO.
MATERIALS AND METHODS
The study recruited 8 patients with a non-syndromic dentofacial deformity who underwent a BSSO. Surgery was planned according to CAD/CAM technology. After osteotomy, a pre-operative guide was used, followed by a repositioning guide. Computed tomography scans were conducted on all patients 1 week pre-operatively, immediately, and 3 months postoperatively.
RESULTS
The data are presented as median values with the 25th and 75th percentiles. Eight patients (37.50% females and 62.50% males) between the ages of 19 and 24 underwent BSSOs. The surgical procedure successfully corrected their skeletal deformities. The absolute change between immediate postoperative and pre-operative condylar angle was 0.15 (0.00-0.3). The absolute change between 3 months postoperative and pre-operative condylar angle was 0.20 (0.00-0.30).
CONCLUSION
The stability of the condylar head in position is well assessed by 3-dimensional condylar positioning devices designed and manufactured by CAD/CAM technology in the mandibular BSSO.
Topics: Adult; Female; Humans; Male; Young Adult; Computer-Aided Design; Mandible; Mandibular Condyle; Mandibular Osteotomy; Osteotomy, Sagittal Split Ramus; Tomography, X-Ray Computed
PubMed: 38155012
DOI: 10.1016/j.oooo.2023.11.001 -
Clinical Oral Investigations Dec 2023This clinical study aims to analyze the levels of cortisol, dehydroepiandrosterone (DHEA), and tumor necrosis factor alpha (TNF-α) in the gingival crevicular fluid... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
This clinical study aims to analyze the levels of cortisol, dehydroepiandrosterone (DHEA), and tumor necrosis factor alpha (TNF-α) in the gingival crevicular fluid (GCF) of persons with bruxism and to compare the efficacy of botulinum toxin (botox) and occlusal splint treatments through biomarkers.
MATERIALS AND METHODS
A total of 40 patients with bruxism were selected according to the clinical examination and anamnesis of which 20 received occlusal splint treatment and 20 botox treatment. GCF samples were taken from the patients before and after treatment. Cortisol, DHEA, and TNF-α levels were measured by enzyme-linked immunosorbent assay test. The change in measurements between time and groups and the time-group interaction were tested by repeated measures ANOVA.
RESULTS
There was a statistically significant difference between the cortisol levels before and after treatment in both groups (p = 0.001). In individuals with bruxism, a statistically significant decrease in cortisol levels was observed after both treatments (p < 0.05), while DHEA levels increased after treatment but were not statistically significant (p > 0.05). There was no statistically significant difference between TNF-α intra-group measurements (p > 0.05).
CONCLUSIONS
Stress and inflammatory biomarkers were found to be associated with bruxism. Cortisol levels decreased in people with bruxism after treatment with both occlusal splint and botox.
CLINICAL RELEVANCE
Both splint and botox treatments were effective for bruxism by reducing the stress levels.
Topics: Humans; Splints; Bruxism; Botulinum Toxins, Type A; Hydrocortisone; Tumor Necrosis Factor-alpha; Treatment Outcome; Biomarkers; Dehydroepiandrosterone
PubMed: 38153567
DOI: 10.1007/s00784-023-05453-w -
Cureus Nov 2023Condylar resorption is a condition of progressive and significant mandibular head resorption. We treated two patients with condylar resorption caused by...
Condylar resorption is a condition of progressive and significant mandibular head resorption. We treated two patients with condylar resorption caused by temporomandibular joint (TMJ) osteoarthritis. The first patient was a 22-year-old female at the time of the initial examination. She had a history of orthodontic treatment and came to the clinic with a number of symptoms, including difficulty opening the mouth. Idiopathic condylar resorption was diagnosed, an occlusal splint was placed for approximately one year, and the patient was followed up for 12 years. The second patient was a 20-year-old female who had completed non-extraction orthodontic treatment by the age of 17 years. She came to the clinic with esthetic issues, such as an anterior open bite. Implant anchor screws were placed in the alveolar bone of the anterior teeth and intermaxillary fixation was performed. Case 1 had 12 years of follow-up, with CT scan results showing remodeling of the condylar. Case 2 is expected to shorten treatment time. However, the CT scan showed remodeling and improvement in the chief complaint.
PubMed: 38143608
DOI: 10.7759/cureus.49322 -
Bioengineering (Basel, Switzerland) Nov 2023The increasing demand for dental aesthetics, articulation corrections, and solutions for pain and frequent bruxism demands quick and effective restorative dental...
The increasing demand for dental aesthetics, articulation corrections, and solutions for pain and frequent bruxism demands quick and effective restorative dental management. The biomedical research aimed to create a beneficial, ecological, and readily available anterior deprogrammer to determine the centric relation (CR) of cases. This medical device is additively manufactured from a biocompatible material. Size is customizable based on the width of the patient's anterior central incisors. This is a pilot study with two subjects. The task was to develop a complete data protocol for the production process, computer-aided design (CAD), and three-dimensional (3D) printing of the anterior deprogrammers. The research focused on creating simple and practically applicable tools for the dentist's prescription (anterior deprogrammer in three sizes), and secondly for the communication between the dentist and the patient (computer application). The tested hypothesis was whether, according to these novel tools, it is possible to produce functional occlusal splints, which could be manufactured using current technologies. This study compared a traditional splint with a digitally designed and 3D-printed one. The tested hypothesis was whether manufactured occlusal splints differ in patients' subjective perception of comfort. Each conservative treatment was monitored for ten weeks. Initial results are promising; no statistically significant difference was found between the productive technologies.
PubMed: 38135970
DOI: 10.3390/bioengineering10121379