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The Open Dentistry Journal 2017For patients whose centric relation (CR) has not been considered at the start and during treatment, the task of achieving an occlusal scheme that works together with the... (Review)
Review
BACKGROUND
For patients whose centric relation (CR) has not been considered at the start and during treatment, the task of achieving an occlusal scheme that works together with the temporomandibular joint, the muscles, and the structures of the stomatognathic apparatus becomes a major concern.
OBJECTIVE
This study aims to describe a reproducible, predictable and to date unreported procedure of selective grinding guided by an occlusal splint and to analyze condylar position (CP) based on the skeletal pattern.
METHODS
A total of 72 symptomatic patients (38 females and 34 males) were classified into three groups: hyperdivergent, intermediate and hypodivergent. CP was quantified by mounted casts on a measures condyle displacement (MCD) device. Helkimo index was also performed in order to assess the severity of the temporomandibular joint (TMJ) disorders attending to clinical dysfunction, occlusal state and anamnestic dysfunction. Once the stability had been obtained, the splint was progressively reduced until the maximum intercuspation (MIC) was achieved.
RESULTS
The vertical displacement was found to be significantly different between the hyperdivergent and other two groups (<0.01). Comparisons of MCD analysis before and after the selective grinding procedure identified a statistically significant difference in the horizontal and vertical CP (<0.01) between the different groups whereas the Helkimo Index showed a clear improvement of TMJ disorders.
CONCLUSION
All facial types, specially the hyperdivergent face type, showed a reduction in condylar displacement (CD) and less craniomandibular symptoms using this procedure, making it an excellent technique for clinicians.
PubMed: 28839479
DOI: 10.2174/1874210601711010301 -
Chiropractic & Manual Therapies 2014Temporomandibular disorder (TDM) is the most common source of orofacial pain of a non-dental origin. Sleep bruxism is characterized by clenching and/or grinding the...
Effects of massage therapy and occlusal splint therapy on electromyographic activity and the intensity of signs and symptoms in individuals with temporomandibular disorder and sleep bruxism: a randomized clinical trial.
INTRODUCTION
Temporomandibular disorder (TDM) is the most common source of orofacial pain of a non-dental origin. Sleep bruxism is characterized by clenching and/or grinding the teeth during sleep and is involved in the perpetuation of TMD. The aim of the present study was to investigate the effects of massage therapy, conventional occlusal splint therapy and silicone occlusal splint therapy on electromyographic activity in the masseter and anterior temporal muscles and the intensity of signs and symptoms in individuals with severe TMD and sleep bruxism.
METHODS
Sixty individuals with severe TMD and sleep bruxism were randomly distributed into four treatment groups: 1) massage group, 2) conventional occlusal splint group, 3) massage + conventional occlusal splint group and 4) silicone occlusal splint group. Block randomization was employed and sealed opaque envelopes were used to conceal the allocation. Groups 2, 3 and 4 wore an occlusal splint for four weeks. Groups 1 and 3 received three weekly massage sessions for four weeks. All groups were evaluated before and after treatment through electromyographic analysis of the masseter and anterior temporal muscles and the Fonseca Patient History Index. The Wilcoxon test was used to compare the effects of the different treatments and repeated-measures ANOVA was used to determine the intensity of TMD.
RESULTS
The inter-group analysis of variance revealed no statistically significant differences in median frequency among the groups prior to treatment. In the intra-group analysis, no statistically significant differences were found between pre-treatment and post-treatment evaluations in any of the groups. Group 3 demonstrated a greater improvement in the intensity of TMD in comparison to the other groups.
CONCLUSION
Massage therapy and the use of an occlusal splint had no significant influence on electromyographic activity of the masseter or anterior temporal muscles. However, the combination of therapies led to a reduction in the intensity of signs and symptoms among individuals with severe TMD and sleep bruxism.
TRIAL REGISTRATION
This study is registered in August, 2014 in the ClinicalTrials.gov (NCT01874041).
PubMed: 25512839
DOI: 10.1186/s12998-014-0043-6 -
Turkish Journal of Physical Medicine... Mar 2020This study aims to evaluate the effects of additional low-level laser therapy (940 nm GaAlAs) to the routine occlusal splint therapy on maximal mouth opening (MMO),...
OBJECTIVES
This study aims to evaluate the effects of additional low-level laser therapy (940 nm GaAlAs) to the routine occlusal splint therapy on maximal mouth opening (MMO), visual analog scale (VAS) scores, and passive mouth opening (PMO).
PATIENTS AND METHODS
Between January 2016 and March 2018, a total of 40 patients (10 males, 30 females; mean age 22.35 years; range, 18 to 60 years) with disc displacement with reduction of the temporomandibular joint were included. The patients were divided into two groups. Group 1 (control group, n=20) received routine non-steroidal anti-inflammatory drug (NSAID) therapy and occlusal splint therapy for eight hours per day for a total of three months. Group 2 (laser group, n=20) received NSAID, occlusal splint therapy and 940 nm wavelength diode laser therapy for two sessions per week for a total of four weeks. The MMO, PMO, and VAS scores were recorded before and at one, two, three, four, and 12 weeks after treatment. The joint and muscle examinations were performed.
RESULTS
A constant decrease was found in the VAS scores in both groups. At four (p=0.008) and 12 weeks (p=0.003), a statistically significant difference in the VAS scores was observed. At all time points, PMO and MMO scores increased in both groups. The MMO scores were statistically higher in the laser group at all time points (p<0.005).
CONCLUSION
Our study results suggest that short-term low-level laser therapy additional to conventional treatment may yield satisfactory outcomes.
PubMed: 32318671
DOI: 10.5606/tftrd.2020.3355 -
International Journal of Environmental... Jan 2022Whiplash is a consequence of traumatic injuries, mostly related to road accidents, with variable clinical manifestations, also known as Whiplash Associated Disorders,...
BACKGROUND
Whiplash is a consequence of traumatic injuries, mostly related to road accidents, with variable clinical manifestations, also known as Whiplash Associated Disorders, such as neck, head and temporo-cranio-mandibular pain.
METHODS
The current study aims to evaluate the onset and evolution of temporomandibular joint pain in people with whiplash in a study group treated with the use of Zimmer Collars (adjustable rigid cervical collars for neck immobilization), as compared to a control group. This prospective study included 31 patients followed by the Dental Prosthesis Department of the University of Bari "Aldo Moro": 20 patients with whiplash (age range: 20-39 years) treated with Zimmer collars and 11 patients with whiplash (age range: 20-33 years) who were not. Immediately after the whiplash occurred, a visual analogue scale (VAS) was used to describe the intensity of pain and to complete the chart of the European Academy of Craniomandibular Disorders. Five out of twenty patients, already treated with a Zimmer collar, wore an occlusal splint as well because of persistent pain reported at the 28-day and 60-day follow-up and were supported by pharmacological therapy with analgesics (paracetamol) and muscle relaxants (thiocolchicoside).
RESULTS
During the last follow-up (at six months), three out of five patients displayed a residual VAS score of 3, 4, and 5, respectively, while the remaining two displayed a VAS of 0. In the control group, four out of eleven patients needed to wear an occlusal splint but without muscle relaxants and analgesics pharmacological therapy; these four corresponded to the patients showing a residual painful symptomatology, with VAS reaching value of 2, and also were the oldest patients of the group. Data regarding VAS values and Zimmer collar use, both at the first visit and six months later, were statistically analyzed.
CONCLUSION
Our prospective study highlights how whiplash-associated acute disorders are often self-limiting over a period of few months, thus reducing the possibility of symptom chronicity; the latter seems to be strictly related to lesion severity, pre-existence of a craniomandibular dysfunction and patient age, but appears to be independent from Zimmer collar use, as statistically confirmed.
Topics: Adult; Humans; Neck; Pain; Pain Measurement; Prospective Studies; Whiplash Injuries; Young Adult
PubMed: 35055722
DOI: 10.3390/ijerph19020901 -
Dental Materials Journal Feb 2022This study aimed to determine functionality and mechanical properties of dental splints. Five splints were tested: a control splint Filtek Z350XT (ZF), two splints with...
This study aimed to determine functionality and mechanical properties of dental splints. Five splints were tested: a control splint Filtek Z350XT (ZF), two splints with G-Fix (GF) and Light Fix (LF), and two wire-composite splints with ZF (ZW) and Ortho Connect Flow (CW). Periotest values, elastic modulus, flexural, compressive, and diametral tensile strength were measured. ZW and CW showed no significant differences in flexibility in labial or occlusal pressure of upper central incisors. LF, GF, and ZF did not differ in labial or palatal pressure. ZW and CW had higher flexibility than LF, GF, and ZF. LF had the lowest flexural and compressive strength but the highest diametral tensile strength. This study showed that ZW and CW might be options for flexible splints, whereas LF and GF would be options for rigid splints. Additionally, CW and LF/GF might be simpler alternatives to ZW and ZF, respectively.
Topics: Composite Resins; Dental Stress Analysis; Elastic Modulus; Humans; Incisor; Materials Testing; Splints; Tensile Strength; Tooth Mobility
PubMed: 34471038
DOI: 10.4012/dmj.2021-095 -
Journal of Functional Biomaterials Apr 2021A 3D finite element model of the mandible dentition was developed, including 14 teeth, a periodontal ligament (PDL), and a splint made of polymethylmethacrylate (PMMA)....
A 3D finite element model of the mandible dentition was developed, including 14 teeth, a periodontal ligament (PDL), and a splint made of polymethylmethacrylate (PMMA). The study considered three design options: 1-the case of splint absence; 2-the case of the splint presence installed after manufacture; and 3-the case of splint presence installed after correction (grinding) performed to ensure a uniform distribution of occlusal force between the teeth. For cases of absence and presence of splint, three measurements of the functional load were performed using the T-Scan III software and hardware complex (TekScan, Boston, MA, USA). It was found that the presence of a splint led to a decrease in the total value of the occlusive load and to a uniform distribution between all the mandible teeth. The occlusal force was considered as a static vertical force evenly distributed between the nodes belonging to the occlusive surface of the corresponding tooth for the first design option and the occlusal surface of the splint for the second and third ones, respectively. As a result of the study, it was concluded that the splint usage was effective in order to change the distribution of the functional load during the treatment of proved masticatory muscles' parafunction; the safety of using a splint for teeth and surrounding tissues under the influence of the considered functional load was shown; the potential applicability of PMMA as a structural material of a splint that had been used for the treatment of masticatory muscles' parafunction was established.
PubMed: 33918647
DOI: 10.3390/jfb12020023 -
Journal of Clinical Medicine May 2021The aim of this pilot study was to evaluate the short-term effectiveness of two different occlusal devices and their impact on the pressure pain threshold (PPT) values...
The aim of this pilot study was to evaluate the short-term effectiveness of two different occlusal devices and their impact on the pressure pain threshold (PPT) values among patients who reported to the Dental Prosthetics Outpatient Clinic of Pomeranian Medical University (Szczecin, Poland) and who were diagnosed with probable bruxism. Two groups were formed (A and B) to which patients were assigned randomly. Each group used a different occlusal splint for bruxism management. The occlusal appliance by Okeson, or the bimaxillary splint, was used overnight by each patient for 30 days of the study. The PPT was measured twice, at the first visit and after 30 days of using each occlusal device, with Wagner Paintest FPX 25 algometer. Bruxism was diagnosed based on data from the patient's medical history and from the physical examination. Nocturnal Bruxism Criteria according to the International Classification of Sleep Disorders (Third Edition) was used for the patient's evaluation. Results: similar pain factor (PF) reduction was observed in both the examined groups, regardless of the device used; canine guidance and no guidance were similarly effective in terms of increasing pain resilience.
PubMed: 34071832
DOI: 10.3390/jcm10112342 -
Journal of Dentistry Aug 2022To assess and compare the in vitro biocompatibility of new resins (Keysplint Soft (Keystone Industries), NextDent Ortho Rigid (3D System), and Freeprint Splint (Detax))...
OBJECTIVE
To assess and compare the in vitro biocompatibility of new resins (Keysplint Soft (Keystone Industries), NextDent Ortho Rigid (3D System), and Freeprint Splint (Detax)) and traditional resins (Orthocryl (Dentaurum)) used for dental splints.
METHODS
Standardized discs (n = 40) and 1:1, 1:2, and 1:4 extracts of the tested materials were prepared. Human gingival fibroblasts (hGFs) were isolated from gingival tissues. Different biological tests were carried out, including MTT assays to assess cell metabolic activity, cell migration assays, cell cytoskeleton staining, cell apoptosis, generation of intracellular reactive oxygen species (ROS), and scanning electron microscopy (SEM). Statistical analyses were performed using one-way ANOVA and Tukey's post hoc test (p<0.05).
RESULTS
MTT experiments showed that Freeprint Splint significantly reduces the hGF metabolic activity (***p<0.001), whereas SEM analysis showed almost no cells adhered on its surface. Cell migration was significantly lower after exposure to undiluted extracts of Freeprint Splint at 48 and 72 h (***p<0.001). Cell cytoskeleton staining assays showed fewer attached cells in 1:1 and 1:2 dilutions of Freeprint Splint. Annexin-V and 7-AAD staining assays showed that only cells exposed to Keysplint Soft extracts displayed similar cell viability to the control group. Finally, ROS levels detected in undiluted extracts of all resins were significantly enhanced compared to the control group (***p<0.001).
CONCLUSIONS
The 3D-printed resins and the conventional dental resin showed a similar biocompatibility, except for Freeprint Splint, which was the most cytotoxic on hGFs.
CLINICAL SIGNIFICANCE
3D printing has been on the rise in recent years and its use in daily clinical practice is expanding over time. Two of the three 3D-printed resins tested in this study performed as well in the cytotoxicity tests as the conventional one, supporting their use, but caution and further testing are required.
Topics: Humans; In Vitro Techniques; Materials Testing; Printing, Three-Dimensional; Reactive Oxygen Species; Splints
PubMed: 35577252
DOI: 10.1016/j.jdent.2022.104163 -
Polimery W Medycynie 2023Occlusal splints can protect teeth during bruxism, preventing tooth wear, as well as during sports activities, shielding them from impacts.
BACKGROUND
Occlusal splints can protect teeth during bruxism, preventing tooth wear, as well as during sports activities, shielding them from impacts.
OBJECTIVES
To verify the influence of thermal cycles and disinfection on the roughness, microhardness and color of polyethylene terephthalate glycol/thermoplastic polyurethane (PETG/TPU) and poly(methyl methacrylate) (PMMA).
MATERIAL AND METHODS
Thirty-six PETG/TPU samples and 36 PMMA samples were prepared (ø10 mm × 3 mm). Six groups were created according to the material and the disinfection method used (n = 12 each): PETG/TPU (glister), PETG/TPU (hypochlorite), PETG/TPU (soap), PMMA (glister), PMMA (hypochlorite), and PMMA (soap). Roughness, Knoop microhardness and color evaluations were performed before the experiments (T1), after thermocycling (T2) and after disinfection (T3). Three-way repeated measures analysis of variance (ANOVA) and Tukey's test were used for statistical evaluations.
RESULTS
For roughness and color, ANOVA showed statistical significance based on the interaction between thermal cycling, material and disinfectant factors. In terms of Knoop microhardness, ANOVA showed statistical significance based on the interaction between thermal cycling and material factors.
CONCLUSIONS
Roughness results were clinically acceptable in all groups at all time points, except the PETG/TPU and PMMA groups disinfected with hypochlorite. Microhardness significantly increased for both materials after thermal cycling, and at all time points, the microhardness of PMMA was significantly higher than that of PETG/TPU. After thermal cycling, the color changes were clinically unacceptable in all groups.
Topics: Polymethyl Methacrylate; Disinfection; Hypochlorous Acid; Materials Testing; Soaps; Surface Properties
PubMed: 36929643
DOI: 10.17219/pim/159350 -
Dentistry Journal May 2023This article describes the authors' digital workflow-based method for fabricating intraoral occlusal splints, from planning to the evaluation phase.
INTRODUCTION
This article describes the authors' digital workflow-based method for fabricating intraoral occlusal splints, from planning to the evaluation phase.
MATERIALS AND METHODS
In our protocol, first, we had a registration phase. This included taking digital impressions, determining the centric relation (CR) position with the deprogrammer Luci Jig, and using the digital facebow for measuring the individual values. The laboratory phase was next, which included planning and manufacturing with a 3D printer. The last phase was delivery, when we checked the stability of the splint and adjusted the occlusal part.
RESULT
The average cost is lower for a fully digital splint than for conventional methods. In terms of time, there was also a significant difference between the classic and digital routes. From a dental technical point of view, the execution was much more predictable. The printed material was very rigid and, therefore, fragile. Compared to the analog method, the retention was much weaker.
CONCLUSION
The presented method permits time-efficient laboratory production, and may also be performed chairside in a dental office. The technology is perfectly applicable to everyday life. In addition to its many beneficial properties, its negative properties must also be highlighted.
PubMed: 37232777
DOI: 10.3390/dj11050126