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Pilot and Feasibility Studies Feb 2024Temporomandibular disorders (TMD) are a collective term for pain and dysfunction of the masticatory muscles and the temporomandibular joints. The most common types of...
Transcutaneous auricular vagus nerve stimulation for the treatment of myoarthropatic symptoms in patients with craniomandibular dysfunction - a protocol for a randomized and controlled pilot trial.
BACKGROUND
Temporomandibular disorders (TMD) are a collective term for pain and dysfunction of the masticatory muscles and the temporomandibular joints. The most common types of TMD are pain-related, which may impact the psychological behavior and quality of life. Currently, the most popular methods for the treatment of TMD patients are occlusal splint therapy, often in combination with physical- and/or pharmacotherapy. However, due to the complexity of etiology, the treatment of chronic TMD remains a challenge. Recently, CE-certified systems for non-invasive VNS (transcutaneous auricular vagus nerve stimulation, taVNS) have become available and show positive effects in the treatment of chronic pain conditions, like migraine or fibromyalgia, with which TMD shares similarities. Therefore, it is the main purpose of the study to evaluate the feasibility of daily taVNS against chronic TMD and to assess whether there is an improvement in pain severity, quality of life, and kinetic parameters.
METHODS
This study is designed as a single-blinded, double-arm randomized controlled trial (RCT) in a 1:1 allocation ratio. Twenty adult patients with chronical TMD symptoms will be enrolled and randomized to stimulation or sham group. In the stimulation group, taVNS is performed on the left tragus (25 Hz, pulse width 250 µs, 28 s on/32 s off, 4 h/day). The sham group will receive no stimulation via a non-functional identical-looking electrode. Validated questionnaire data and clinical parameters will be collected at the beginning of the study and after 4 and 8 weeks. The compliance of a daily taVNS of patients with chronical TMD will be evaluated via a smartphone app recording daily stimulation time and average intensity. Additionally, the treatment impact on pain severity and quality of life will be assessed with different questionnaires, and the effect on the mandibular mobility and muscle activity will be analyzed.
DISCUSSION
This is the first clinical trial to assess the feasibility of taVNS in patients with chronic TMD symptoms. If taVNS improves the symptoms of TMD, it will be a significant gain in quality of life for these chronic pain patients. The results of this pilot study will help to determine the feasibility of a large-scale RCT.
TRIAL REGISTRATION
This study has been registered in the DRKS database (DRKS00029724).
PubMed: 38331976
DOI: 10.1186/s40814-024-01447-x -
Clinical Oral Investigations Jan 2024To evaluate the temporomandibular joint (TMJ), condylar and mandibular movements in obstructive sleep apnea (OSA) patients treated with mandibular advancement device...
OBJECTIVES
To evaluate the temporomandibular joint (TMJ), condylar and mandibular movements in obstructive sleep apnea (OSA) patients treated with mandibular advancement device (MAD) and to identify the influence of these anatomic factors on upper airway (UA) volume and polysomnographic outcomes after treatment.
MATERIALS AND METHODS
Twenty OSA patients were prospectively treated with MAD. Clinical examinations, cone-beam computed tomography, and polysomnography were performed before MAD treatment and after achieving therapeutic protrusion. Polysomnographic variables and three-dimensional measurements of the TMJ, mandible, and upper airway were statistically analyzed.
RESULTS
Condylar rotation, anterior translation, and anterior mandibular displacement were directly correlated with total UA volume, while vertical mandibular translation was inversely correlated with the volume of the inferior oropharynx. MAD treatment resulted in an increase in the volume and area of the superior oropharynx. There was no statistically significant correlation between condylar rotation and translation and polysomnographic variables. With MAD, there was a significant increase in vertical dimension, changes in condylar position (rotation and translation), and mandibular displacement. The central and medial lengths of the articular eminence were inversely correlated with condylar rotation and translation, respectively. The lateral length of the eminence was directly correlated with condylar translation, and the lateral height was directly correlated with condylar rotation and translation.
CONCLUSION
Condylar and mandibular movements influenced UA volume. The articular eminence played a role in the amount of condylar rotation and translation.
CLINICAL RELEVANCE
Individualized anatomical evaluation of the TMJ proves to be important in the therapy of OSA with MAD.
Topics: Humans; Occlusal Splints; Mandible; Sleep Apnea, Obstructive; Temporomandibular Joint; Cone-Beam Computed Tomography; Mandibular Advancement; Treatment Outcome
PubMed: 38286954
DOI: 10.1007/s00784-024-05513-9 -
Journal of Prosthodontic Research Jan 2024To investigate the effects of the number of ethylene oxide units in bis-EMA on the physical properties of additively manufactured occlusal splints.
PURPOSE
To investigate the effects of the number of ethylene oxide units in bis-EMA on the physical properties of additively manufactured occlusal splints.
METHODS
Seven experimental materials containing bis-EMAs with three and 10 ethylene oxide units (BE3 and BE10, respectively) were prepared at different BE10 content rates (BE10-0%, -20%, -30%, -40%, -50%, -60%, and -80%). Half the specimens of each material were aged in boiling water. Flexural strength (FS), flexural modulus (FM), fracture toughness (FT), microwear depth (MD), degree of conversion (DC), water sorption (WSP), water solubility (WSL), color difference between non-aged and aged series (ΔE), and translucency (TP) were evaluated. All the evaluated properties other than FS and MD were analyzed by 1-way ANOVA and Tukey's post hoc analysis, while FS and MD were analyzed by Kruskal-Wallis's test and Bonferroni correction (α=0.05).
RESULTS
BE10-80% revealed the lowest FS (P < 0.01 for BE10-0%, -20%, and -30%) and FM (P < 0.01, for all), while revealing the highest DC, WSP, WSL (P < 0.01 for all) and TP (P < 0.01 for all other than BE10-60%). BE10-50% showed the highest FT (P < 0.01 for all). BE10-50%, -60%, and -80% revealed significantly lower ΔE than others (P < 0.01) and lower MD than BE10-0% (P < 0.05). Regardless of the BE10 content, FS, FM, and FT decreased with aging.
CONCLUSIONS
The number of ethylene oxide units affects the physical properties of additively manufactured occlusal splints. The higher number of ethylene oxide units in bis-EMA enhanced the microwear resistance, DC, WSP, WSL, color stability, and translucency, whereas it deteriorated the FS and FM.
PubMed: 38281759
DOI: 10.2186/jpr.JPR_D_23_00203 -
Journal of Indian Prosthodontic Society Jan 2024Occlusal splint treatment is commonly used to treat a variety of temporomandibular disorders (TMDs), with efficacy ranging between 70% and 90%. Centric splints are... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
Occlusal splint treatment is commonly used to treat a variety of temporomandibular disorders (TMDs), with efficacy ranging between 70% and 90%. Centric splints are effective in relieving muscular soreness in individuals with TMD. Electromyography (EMG) quantifies muscle activity and can be used as an accessory diagnostic tool to evaluate the efficiency of the splint on the masticatory complex. Electromyography is used for assessing patients with TMD and observing muscle electromyography. TMD patients have altered electromyographic (EMG) masticatory muscle activity because of its change in electrical activity index or because of the compensatory mechanism for the disorder. Therefore, this study serves to evaluate the efficacy of the centric stabilization splint on TMD using EMG.
SETTINGS AND DESIGN
This cross-sectional study enrolled Ten TMD Patients with TMD, who underwent treatment with centric stabilization splint.
MATERIALS AND METHODS
The study involved ten young adults with TMD aged 18-45 years who were recruited without regard to sex, religion, caste, or socioeconomic background. The participants were randomized to receive a flat-contact upper stabilization splint and pregelled EMG electrodes to assess the immediate impact of centric splints on TMDs. After 3 months of follow-up, muscle activity and muscle symmetrical activity were measured to assess improvement in the symptoms of TMD.
STATISTICAL ANALYSIS USED
The Shapiro-Wilk test was used to assess the normality of the variables' distribution using SPSS 26.0. Symmetrical activity and treatment response were investigated using the Wilcoxon signed-rank test.
RESULTS
It showed an improvement in the temporalis, masseter, and sternocleidomastoid muscles' resting EMG activity. A statistically significant improvement was seen in the EMG activity of the bilateral temporalis, right masseter, right sternocleidomastoid, and left digastric muscles while clenching. The masseter, sternocleidomastoid, and digastric muscles all displayed significantly enhanced symmetrical activity (P < 0.05).
CONCLUSIONS
This research concludes that a centric stabilizing splint assists in relieving TMD symptoms. There was enhanced masticatory muscle activity both at rest and during function. Furthermore, there was an improvement in symmetrical activity of the masticatory muscles, which improved balance and enhanced the effective functioning of the masticatory complex.
Topics: Adolescent; Adult; Female; Humans; Male; Middle Aged; Young Adult; Cross-Sectional Studies; Masticatory Muscles; Neck Muscles; Splints; Temporomandibular Joint Disorders
PubMed: 38263561
DOI: 10.4103/jips.jips_431_23 -
Journal of Indian Prosthodontic Society Jan 2024Disc displacement with reduction (DDwR) is among the common disc disorders of temporomandibular joint (TMJ), which can be managed conservatively by splint therapy.... (Meta-Analysis)
Meta-Analysis Review
Effectiveness of anterior repositioning splint versus other occlusal splints in the management of temporomandibular joint disc displacement with reduction: A meta-analysis.
BACKGROUND
Disc displacement with reduction (DDwR) is among the common disc disorders of temporomandibular joint (TMJ), which can be managed conservatively by splint therapy. Anterior repositioning splint (ARS) is the most commonly prescribed splint by dental practitioners, but not getting a normal disc-condyle relationship always and other side effects lead to need of comparing with other occlusal splints. This review will help in informed decision-making by clinicians in choosing an appropriate splint type for patients.
AIM
The aim is to compare the effectiveness of ARS in the management of DDwR with other occlusal splints for TMJ and muscle pain, TMJ noise, any adverse effects, regaining normal disc-condyle relationship.
MATERIALS AND METHODS
We followed published protocol in the International prospective register of systematic reviews. Databases were searched till May 2023 using different search strategies as per the database. Title and abstract screening, followed by full-text screening and data extraction with risk of bias, was done by two independent reviewers in Covidence. Outcomes were reported as risk ratio (RR) or mean difference (MD) for dichotomous or continuous outcomes, respectively, using RevMan 5.4 (Review Manager 5.4) software. We used a random effect model for statistical analysis. Certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation Guideline Development Tool (GRADEpro GDT) software.
RESULTS
A total of 1145 reports were found from a database search. After screening, four studies were included for systematic reviews. Other occlusal splints reported were sagittal vertical extrusion device and mandibular ARS, full hard stabilization splint of canine or centric stabilization type. Data of only two studies could be used for meta-analysis having 30 participants received ARS and 40 received other occlusal splints. We did not find evidence of any difference between ARS and other occlusal splints for TMJ clicking in short term (RR 1.25, 95% confidence interval [CI] 0.91-1.72) but a small difference in favor of other occlusal splint in long term (RR 2.40, 95% CI 1.04-5.55). No evidence of any difference was found between both treatments for TMJ pain in short term (MD-5.68, 95% CI-17.31-5.95) and long term (MD 0.00, 95% CI-2.86-2.86) and muscle pain in short term. The certainty of evidence for comparison of two treatments for different outcomes was of low or very low level.
CONCLUSION
Evidence is uncertain that other occlusal splints reduced TMJ clicking slightly in comparison to ARS. For the remaining outcomes, no evidence of any difference was found between the two splints and it may be biased due to selection bias, inadequate blinding of participants, and outcome assessor.
Topics: Humans; Occlusal Splints; Splints; Dentists; Myalgia; Temporomandibular Joint Disc; Professional Role; Systematic Reviews as Topic; Temporomandibular Joint Disorders; Cartilage Diseases
PubMed: 38263554
DOI: 10.4103/jips.jips_355_23 -
Polymers Nov 2023Three-dimensional (3D)-printed occlusal splints are becoming more prevalent in the treatment of tooth substance loss due to their fast and cost-effective production. The...
Three-dimensional (3D)-printed occlusal splints are becoming more prevalent in the treatment of tooth substance loss due to their fast and cost-effective production. The purpose of this in vitro study was to investigate whether the mechanical properties (tensile strength-TS, modulus of elasticity in tension-ME, and Vickers hardness-HV) vary between the materials (printed dimethacrylate-based resins: Keyprint KeySplint soft-KEY, Luxaprint Ortho Plus-LUX, V-Print splint-VPR, printed methacrylate-based resins Freeprint splint 2.0-FRE, and milled methacrylate-based material, CLEAR splint-CLE), and the influence of aging processes (extraoral storage conditions and nightly or daily use) was examined. The printed methacrylate-based resins (FRE, LUX, and VPR) had much higher TS (43.7-48.5 MPa compared to 12.3-13.3 MPa), higher ME (2.01-2.37 GPa compared to 0.43-0.72 GPa), and higher HV (11.8-15.0 HV compared to 3.3-3.5 HV) than both of the methacrylate-based resins (KEY and CLE) after the production process. Although the TS, ME, and HV of the printed dimethacrylate resins (FRE, LUX, and VPR) decreased significantly under humid conditions with possibly elevated temperatures (thermocycling as well as 37 °C), these mechanical properties were significantly higher than both methacrylate-based resins (KEY and CLE). Therefore, printed dimethacrylate resins should be used rather than methacrylate-based resins for high expected masticatory forces, low wall thicknesses, or very long wearing times (≥6 months).
PubMed: 38232021
DOI: 10.3390/polym15234574 -
Journal of Movement Disorders Apr 2024
PubMed: 38219737
DOI: 10.14802/jmd.23249 -
Sleep Science (Sao Paulo, Brazil) Sep 2023Sleep Bruxism (SB) is a common condition in childhood that can cause multiple consequences such as abnormal tooth wear, tensional headaches, masticatory muscle pain,... (Review)
Review
Sleep Bruxism (SB) is a common condition in childhood that can cause multiple consequences such as abnormal tooth wear, tensional headaches, masticatory muscle pain, or fatigue. The literature reports some interventions, however the treatment for SB in children is not well-established. A systematic review was performed to investigate the effectiveness of the treatments described for SB in children and adolescents: pharmacological and psychological treatments; behavioral guidelines; and dental approaches. Randomized clinical trials comparing different SB treatments with a control group were searched in the electronic databases PubMed, Scopus, Web of Science, Cochrane Library, and VHL until August 04, 2021. Two independent reviewers selected the studies, extracted the data, and assessed the risk of bias. After a two-phase selection process, 07 articles were selected. The methodology of the selected studies was analyzed using the Cochrane Risk of Bias Tool. The criteria used to qualify the studies were based on randomization, allocation, blinding of participants and evaluators, and analysis of results. The signs and symptoms of SB were reduced with pharmacotherapy (hydroxyzine/diazepam) and medicinal extracts ( ), but with occlusal splints and physiotherapy, this improvement was not statistically significant when compared to control groups. Some evidence of the efficacy of pharmacotherapy (hydroxyzine/diazepam) and medicinal extracts ( ) was found. However, this systematic review is not enough to establish a protocol for the treatment of SB. Besides, the individualized management of SB in this population should be considered, emphasizing the management of risk factors.
PubMed: 38196770
DOI: 10.1055/s-0043-1772826 -
BMC Oral Health Jan 2024Sleep bruxism is a prevalent condition in dentistry practice, characterized by involuntary grinding or clenching of the teeth during sleep. Several therapies, including...
BACKGROUND
Sleep bruxism is a prevalent condition in dentistry practice, characterized by involuntary grinding or clenching of the teeth during sleep. Several therapies, including occlusal splints, have been used to manage sleep bruxism and temporomandibular disorders, including occlusal splints. This study aimed to compare the effectiveness of different occlusal splints in managing sleep bruxism.
METHODS
The PICO framework encompasses the characterization of the population, intervention, comparison, and pertinent outcomes. A comprehensive and systematic literature review was conducted on PubMed, Scopus, and Google Scholar to identify grey literature. The search specifically targeted scientific studies published before September 20, 2023. The Cochrane Collaboration Risk of Bias Tool assessed the accuracy of the included Randomized Control Trials (RCTs). The modified Newcastle-Ottawa Scale assessed non-randomized studies. Data were systematically extracted, synthesized, and reported thematically.
RESULTS
Out of the total of 808 articles that were evaluated, only 15 articles were found to meet the specified inclusion criteria. Adjustable splints, such as full-occlusion biofeedback splints, were more effective in reducing sleep bruxism episodes, improving patient-reported symptoms, and enhancing overall well-being. The impact of different occlusal sprints on electromyographic activity varies, and potential adverse effects should be considered individually.
CONCLUSIONS
This review provides valuable insights into the effectiveness of occlusal splints in managing sleep bruxism. The results of this study indicate that occlusal splint therapy is a viable treatment approach for sleep bruxism.
Topics: Humans; Occlusal Splints; Sleep Bruxism; Sleep
PubMed: 38182999
DOI: 10.1186/s12903-023-03782-6 -
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