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Journal of Pain Research 2020Bruxism, specifically sleep bruxism (SB), is a worldwide discussed topic in the literature; however, there is insufficient evidence to define and support a standard... (Review)
Review
Bruxism, specifically sleep bruxism (SB), is a worldwide discussed topic in the literature; however, there is insufficient evidence to define and support a standard approach for the treatment of SB. The purpose of this overview was to map the evidence from systematic reviews (SR), examining the effects of interventions to improve chronic pain related to bruxism. The methodological quality of SRs was assessed using the AMSTAR-2 tool. We conducted a comprehensive literature search in April 2020, in the following databases: Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, LILACS, BBO, and Epistemonikos. Nine SRs with critically low to high methodological quality were included. Considering the main findings, botulinum toxin type A (BTX-A) showed a significant pain and sleep bruxism frequency reduction when compared to placebo or conventional treatment (behavioral therapy, occlusal splints, and drugs), after 6 and 12 months. Occlusal splints combined to muscle massage showed some benefit in pain reduction. There was no difference in pain and bruxism frequency between biofeedback therapy and an inactive control group. Regarding drug therapy, there is no difference when amitriptyline, bromocriptine, clonidine, propranolol, and levodopa were compared to placebo. In conclusion, there is some evidence to support the use of occlusal splints plus massage, and BTX-A to reduce chronic pain related to SB. No evidence was provided to support the recommendation of biofeedback therapy and drug therapy. There is still a need for more methodologically rigorous randomized clinical trials (RCT) to be conducted on the efficacy and safety of different therapies for SB.
PubMed: 33061557
DOI: 10.2147/JPR.S268114 -
Life (Basel, Switzerland) Dec 2022Occlusal splints are used as a non-invasive treatment for patients diagnosed with temporomandibular disorders (TMD). Another non-invasive treatment option for TMD...
Occlusal splints are used as a non-invasive treatment for patients diagnosed with temporomandibular disorders (TMD). Another non-invasive treatment option for TMD patients is kinesiotherapy, which may be used alone or in conjunction with occlusal splint therapy. The aim of this study was to evaluate the changes in the intra-articular spaces of the temporomandibular joint (TMJ) after occlusal splint therapy combined with cranio-temporomandibular kinesiotherapy in TMD patients. Twenty-four patients ( = 24) diagnosed with TMD according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were included. Cone beam computed tomography (CBCT) images were taken before and after treatment. The anterior, superior, posterior, and medial joint spaces were measured on the CBCT images, and the condylar ratio was calculated using Pullinger and Hollender's formula. Additionally, the thickness of the glenoid fossa (GFT), condylar medio-lateral widths (MLW), and condylar height (HCo) were measured. The condylar ratio was significantly higher after treatment ( = 0.049). The changes in dimensions of the anterior, superior, posterior and medial joint spaces were not statistically significant after treatment. No statistically significant differences were found in the dimensions of the GFT, MLW, and HCo post treatment. The condylar position did not shift anteriorly in a statistically significant way after occlusal splint therapy combined with cranio-temporomandibular kinesiotherapy in TMD patients.
PubMed: 36556507
DOI: 10.3390/life12122143 -
Dental Materials : Official Publication... Oct 2023To evaluate and compare the mechanical properties, water sorption, water solubility, and degree of double bond conversion of three different commercially available...
OBJECTIVE
To evaluate and compare the mechanical properties, water sorption, water solubility, and degree of double bond conversion of three different commercially available three-dimensional (3D) printing resins used for the fabrication of flexible occlusal splints.
METHODS
A digital printer was used to generate specimens from the evaluated splint materials (KeySplint Soft, IMPRIMO LC Splint flex, and V-Print splint comfort). The specimens were equally divided and tested either dry or after water storage at 37 °C for 30 days. A three-point bending test was used to assess flexural strength, elastic modulus, and fracture toughness. A two-body wear test was performed using a dual-axis chewing simulator. Water sorption and water solubility were measured after 30 days. The degree of double bond conversion was determined by FTIR-spectrometry. All data for the evaluated properties were collected and statistically analyzed.
RESULTS
Both material and storage conditions had a significant effect on the flexural strength (P < 0.001), elastic modulus (P < 0.001), fracture toughness (P < 0.001), and wear (P < 0.001). The highest water sorption was noticed with IMPRIMO LC Splint flex (1.9 ± 0.0 %), while V-Print splint comfort displayed the lowest water solubility (0.2 ± 0.0 %). For the degree of conversion, it was statistically non-significant among the different materials (P = 0.087).
SIGNIFICANCE
Different flexible 3D-printed splints available in the market displayed variations in the evaluated properties and clinicians should consider these differences when choosing occlusal device materials. Among the tested flexible splint materials, KeySplint Soft had the greatest flexural strength, elastic modulus, fracture toughness, wear resistance, and degree of conversion. It also showed the lowest water sorption.
Topics: Occlusal Splints; Research Design; Elastic Modulus; Printing, Three-Dimensional; Water
PubMed: 37666693
DOI: 10.1016/j.dental.2023.08.178 -
Head & Face Medicine Jan 2007The paradigmatic shift to evidence-based dentistry (EBD) that relates to occlusal therapy, selective occlusal adjustment (OA) and stabilization splints therapy (SS) for... (Review)
Review
The paradigmatic shift to evidence-based dentistry (EBD) that relates to occlusal therapy, selective occlusal adjustment (OA) and stabilization splints therapy (SS) for TMDs has had an unfavourable impact on the teaching of many of the important aspects of occlusion needed in dental practice. The teaching of OA systematically in dental schools has been nearly abandoned because of the belief that OA is an irreversible procedure and gives the impression that it is without merit elsewhere in the management of occlusion. However, a particular dose of knowledge and practice of occlusion that is necessary for all aspects of dental care should be taught systematically in dental schools. The uses and misuses of OA and SS and their limitations should be emphasized because of their importance to bring clinical reality into the dental curriculum. Thus, and irrespective of EBD induced contradictions, OA and SS should still have a significant place in systematically teaching of occlusal therapy. However, there are many more aspects of the management of occlusion that should to be considered. Hopefully, because of their importance, other aspects of the management of occlusion will once again become a significant part of the dental curriculum.
Topics: Dental Occlusion; Education, Dental; Humans; Malocclusion
PubMed: 17201917
DOI: 10.1186/1746-160X-3-1 -
BMC Oral Health Jun 2020This study aimed to demonstrate that the material of the occlusal splint can be chosen according to the needs of individual patients and contribute to the knowledge of...
BACKGROUND
This study aimed to demonstrate that the material of the occlusal splint can be chosen according to the needs of individual patients and contribute to the knowledge of the wear rate of these materials.
METHODS
In this study, four occlusal splint materials (Sr Ivocap Heat Cured, Valplast, SR Ivocap Elastomer and Eclipse) and three antagonists (natural tooth enamel, inCoris TZI and IPS e.max Press ceramic materials) were used. Each wear test was performed using a chewing simulator (n = 16; test load: 50 N; number of cycles: 10,000, 20,000 and 30,000; continuous rinsing with water at 30 °C for the wet condition). The Shapiro Wilk test was used for normal distribution suitability. Antagonist on average wear quantities both main effects and interactions of material, cycle and condition factors were investigated by Univariate variance analysis. Multiple comparisons were examined using the Games-Howell test.
RESULTS
There was a statistically significant effect of the difference in materials on the amount of wear (p < 0.001). Furthermore, there was a statistically significant difference among the mean values of all materials (p > 0.001). The highest mean value was obtained with Eclipse (0,318 μm), and the lowest mean value was obtained with Valplast (0,134 μm).
CONCLUSION
Our study found differences in the in vitro wear rate among various occlusal splint materials.
Topics: Ceramics; Dental Enamel; Humans; Materials Testing; Occlusal Splints; Surface Properties
PubMed: 32571384
DOI: 10.1186/s12903-020-01165-9 -
Biomedical Papers of the Medical... Dec 2015Arthrocentesis of the temporomandibular joint is a minimally invasive method of treatment located at the boundary between conservative and surgical therapy. It is...
OBJECTIVE
Arthrocentesis of the temporomandibular joint is a minimally invasive method of treatment located at the boundary between conservative and surgical therapy. It is usually performed on an out-patient basis under local anaesthesia. These days, arthrocentesis of the temporomandibular joint is used not only in cases of acute closed lock but also in the treatment of various temporomandibular disorders. The most frequent indication is acute anterior displacement of the articular disc without reduction. Treatment using occlusal splint is one of the most frequently used methods of conservative treatment. It is used mainly in the case of discopathies and myofascial pain.
AIM
The aim of the study was to confirm that simultaneous use of the occlusal splint and arthrocentesis makes the treatment more effective in the case of detected disc dislocation without reduction.
MATERIALS, METHODS AND RESULTS
From 2008 to 2013, 144 patients underwent arthrocentesis simultaneously using occlusal splint in the treatment of chronic closed lock. The study group consisted of a 130 (90.3%) women and 14 (9.7%) men. After 3 months of therapy, a good treatment outcome was found in 98 (68.1%) patients, 12 (85.7%) men and 86 (66.2%) women. The treatment did not have any effect in 46 (31.9%) patients, 2 (14.3%) men and 44 (33.8%) women.
CONCLUSION
The simultaneous use of the occlusal splint and arthrocentesis makes the treatment more effective in the case of detected joint disc dislocation without reduction.
Topics: Adolescent; Adult; Arthrocentesis; Combined Modality Therapy; Female; Humans; Joint Dislocations; Male; Middle Aged; Occlusal Splints; Range of Motion, Articular; Temporomandibular Joint Disc; Temporomandibular Joint Disorders; Treatment Outcome; Young Adult
PubMed: 25270107
DOI: 10.5507/bp.2014.044 -
Journal of Audiology & Otology Sep 2016Here, the author presents a case of bruxism-induced otalgia in a 29-year-old female patient. The pain was sharp and penetrating in character. It was usually worse in the...
Here, the author presents a case of bruxism-induced otalgia in a 29-year-old female patient. The pain was sharp and penetrating in character. It was usually worse in the morning and frequently radiated to the right temporal area. She had received unsuccessful medical treatments for migraine headache. The otoendoscopic examination revealed a normal tympanic membrane. A thorough inspection of her teeth revealed excessive wear on the incisal edges, and the cause of her otalgia was identified as bruxism-related temporomandibular joint disorder. After the use of an occlusal splint and repeated botulinum toxin injections in the masseter and anterior temporalis muscles, along with good sleep hygiene, she experienced significant relief of pain and symptoms. The author suggests that multidisciplinary cooperation between ENT clinicians and dentists is necessary for the quick and accurate diagnosis and treatment of bruxism and the consequential referred otalgia.
PubMed: 27626088
DOI: 10.7874/jao.2016.20.2.123 -
Craniomaxillofacial Trauma &... Dec 2021Free fibula flaps are nowadays the gold standard for the surgical reconstruction on large mandibular defects. Malocclusion is an important complication of this type of...
STUDY DESIGN
Free fibula flaps are nowadays the gold standard for the surgical reconstruction on large mandibular defects. Malocclusion is an important complication of this type of reconstruction and many of these patients end up requiring subsequent orthognathic corrective surgery. This is a descriptive retrospective case series study.
OBJECTIVE
To describe the demographic data, operative techniques, corrective methods and postoperative results in the management of malocclusion following mandibular reconstruction with free fibula flap.
METHODS
This case series study included patients who underwent free fibula flap mandibular reconstructions and who that subsequently developed malocclusion requiring orthognathic corrective surgery, from June 2010 to December 2019. Panoramic X-rays, cephalometries and/or 3-D facial reconstruction CT scans were used for surgical planning to create surgical cutting guides, templates and occlusal splints in all the patients that underwent corrective orthognathic surgery.
RESULTS
There were 46 patients who underwent a free fibula flap mandibular and maxillary reconstruction at San Jose Hospital between June 2010 and December 2019 of these, 5 patients (10.9%) developed postoperative malocclusion. One case from another institution was added to this study for a total of 6 patients with malocclusion following mandibular reconstruction surgery with a fibula free flap. During the orthognathic surgery, vertical osteotomies were performed in 3 patients and bilateral sagittal split osteotomies were necessary in 2 patients and L-shape in 1 patient. Osteogenic distraction was performed in 3 patients as part of their orthognathic treatment. The fixation methods were based in miniplates for 3 of the patients and lag screws for the remaining 3 patients. With this approach, all patients had an adequate occlusion correction with a 100% consolidation at their 6-month follow up.
CONCLUSION
Malocclusion is a significant complication following mandibular reconstruction surgery that must be identified and managed. In severe cases, it requires corrective orthognathic surgery in severe cases. We have developed a protocol to avoid pitfalls during the primary reconstruction and in case an orthognathic surgery is required for malocclusion correction, preoperative planning with cutting guides and occlusal splints should be assessed, to guarantee favorable results through a reproducible technique.
PubMed: 34707786
DOI: 10.1177/1943387520980246 -
Indian Journal of Dental Research :... 2010Obstructive sleep apnea (OSA) is an increasingly common disorder. It is characterized by frequent episodes of airway obstruction associated with a reduced caliber of the... (Review)
Review
Obstructive sleep apnea (OSA) is an increasingly common disorder. It is characterized by frequent episodes of airway obstruction associated with a reduced caliber of the upper airway and is vulnerable to further narrowing and collapse. Acute and repetitive effects of apnea and hypopnea include oxygen desaturation, reduction in intrathoracic pressure, excessive daytime sleepiness, impaired executive function and central nervous system arousals. The apnea-hypopnea index and respiratory distress index help quantify the severity of the condition. The condition is associated with several clinical symptoms of which daytime sleepiness is considered the cardinal symptom. Obesity is one of the major predisposing factors. Three types of apneas have been recognized--obstructive, central and mixed; OSA is the commonest. This review will cover aspects of their radiologic features, diagnosis and management.
Topics: Antidepressive Agents, Tricyclic; Continuous Positive Airway Pressure; Glossectomy; Humans; Mandibular Advancement; Obesity; Occlusal Splints; Palate, Soft; Patient Positioning; Sleep Apnea, Obstructive; Tonsillectomy; Weight Loss
PubMed: 20427921
DOI: 10.4103/0970-9290.62806 -
The Angle Orthodontist 1989The clinician must frequently make treatment decisions with limited knowledge of the appropriateness and consequences of the different options. Patients have specific... (Review)
Review
The clinician must frequently make treatment decisions with limited knowledge of the appropriateness and consequences of the different options. Patients have specific expectations: that the treatment they receive is the usual one, that they have been informed of the alternatives and the consequences, and most importantly that the treatment has a reasonable chance of success. In TMJ therapy, as with most treatments, the patient's improvement is closely connected to a proper diagnosis based on sound physiologic principles. This investigation will review four basic splint types and discuss their success in the resolution of various temporomandibular disorders. Since the position of the condyle-disc-fossa, the occlusal contact pattern and the masticatory muscle dynamics are interrelated, this study will focus on the physiologic changes splints may cause with modification of this tooth, joint and muscle relationship. Hopefully, selection of a specific splint design appropriate to the patient's disorder will be facilitated by better understanding of its physiologic and therapeutic effects.
Topics: Bruxism; Dental Occlusion; Equipment Design; Humans; Masticatory Muscles; Splints; Temporomandibular Joint; Temporomandibular Joint Dysfunction Syndrome; Vertical Dimension
PubMed: 2672904
DOI: 10.1043/0003-3219(1989)059<0165:TPOSTA>2.0.CO;2