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PubMedDate not supplied

Aggravation of respiratory disturbances by the use of an occlusal splint in apneic patients: a pilot study.

PURPOSE: This pilot study was designed to test the hypothesis that the use of a single oral splint may aggravate respiratory disturbance in sleep apneic patients. MATERIALS AND METHODS: A group of 10 patients with a history of snoring and a recording night confirming a diagnosis of sleep apnea were included. Patients were then invited to spend 2 nights in the sleep laboratory: night 2 to establish baseline data (baseline night) and night 3, 1 week later, to assess the influence of an occlusal maxillary splint on sleep (splint night). The following variables were analyzed under blind conditions: total sleep time, sleep efficiency and number of awakenings, microarousals, apnea-hypopnea index per hour of sleep (AHI), respiratory disturbances index per hour of sleep (RDI), and percentage of sleeping time with snoring. RESULTS: No statistically significant difference in AHI was noted between baseline and splint nights. However, four patients experienced an aggravation in apnea diagnosis category on the night they used the splint. The AHI was increased by more than 50% in 5 of the 10 patients. The RDI showed a 30% increase from baseline to splint nights. The percentage of sleeping time with snoring also increased by 40% with the splint. CONCLUSION: This open study suggested that the use of an occlusal splint is associated with a risk of aggravation of respiratory disturbances. It may therefore be relevant for clinicians to question patients about snoring and sleep apnea when recommending an occlusal splint.

Adult↗
PubMed2004

Clinical versus electrodiagnostic effectiveness of splinting in the conservative treatment of carpal-tunnel syndrome.

BACKGROUND: Splinting is known as one of the most effective non-aggressive treatments for carpal-tunnel syndrome (CTS). Early and accurate diagnosis of CTS is critical for effective non-surgical management. Nerve-conduction studies confirm the diagnosis of CTS with a high degree of sensitivity and specificity. Many patients report that their symptoms decrease after splinting; consequently, improved electrophysiological findings are expected. OBJECTIVE: The aim of the study was to evaluate the clinical and neurophysiological effectiveness of splinting in patients with CTS. METHODS: In a prospective study of 77 hands with CTS symptoms, neurophysiological tests were performed before and after 12 weeks of using a splint. A custom-made volar thermoplastic wrist splint was fabricated in a neutral wrist position to maximize carpal-tunnel space and minimize the compressive forces on the median nerve. Each patient was provided with a custom-made splint, and was asked to wear it during sleep and whenever possible when awake. The case history was taken, and a physical examination and repeated nerve conduction studies were performed at the start and after 12 weeks. Data were analysed statistically. RESULTS: We calculated the mean and the range for each electrophysiological test before and after 12 weeks of splint use. There was no significant difference between pre- and post-measurement of each parameter (p > 0.05). Good relief of symptoms occurred soon after the patients began wearing the splint; however, the electrodiagnostic test remained pathological. CONCLUSION: Even though immobilization (wrist splint in neutral position) does not affect the common electrodiagnostic parameters in CTS diagnostics, it caused the disappearance of clinical symptoms in 75% of the patients. There is therefore a need for further research regarding the usefulness of repeated electrodiagnostic studies.

Adult↗
PubMed2005

Controlled assessment of the efficacy of occlusal stabilization splints on sleep bruxism.

AIMS: To assess the efficacy of occlusal stabilization splints in the management of sleep bruxism (SB) in a double-blind, parallel, controlled, randomized clinical trial. METHODS: Twenty-one participants were randomly assigned to an occlusal splint group (n = 11; mean age = 34.2 +/- 13.1 years) or a palatal splint (ie, an acrylic palatal coverage) group (n = 10; mean age = 34.9 +/- 11.2 years). Two polysomnographic recordings that included bilateral masseter electromyographic activity were made: one prior to treatment, the other after a treatment period of 4 weeks. The number of bruxism episodes per hour of sleep (Epi/h), the number of bursts per hour (Bur/h), and the bruxism time index (ie, the percentage of total sleep time spent bruxing) were established as outcome variables at a 10% maximum voluntary contraction threshold level. A general linear model was used to test both the effects between splint groups and within the treatment phase as well as their interaction for each outcome variable. RESULTS: Neither occlusal stabilization splints nor palatal splints had an influence on the SB outcome variables or on the sleep variables measured on a group level. In individual cases, variable outcomes were found: Some patients had an increase (33% to 48% of the cases), while others showed no change (33% to 48%) or a decrease (19% to 29%) in SB outcome variables. CONCLUSION: The absence of significant group effects of splints in the management of SB indicates that caution is required when splints are indicated, apart from their role in the protection against dental wear. The application of splints should therefore be considered at the individual patient level.

Adolescent↗
PubMed1987

Splinting.

The definitions of splinting, occlusal trauma, and mobility have been described. The history of splinting as a treatment for periodontal disease has been noted along with the current concepts of the indications and rationale for splinting. Splints have been classified according to their expected length of service: short-term splints, provisional splints, and long-term splints. The disadvantages of splinting have been enumerated, and examples of the various types of splints currently employed have been demonstrated.

Dental Occlusion, Traumatic↗
PubMed1997

Management of dental trauma: development of a 2D data acquisition system to evaluate passivity of dental splints.

Management of dental trauma in children sometimes requires the use of dental splints, which can be constructed from orthodontic materials. Past studies of the mechanical properties of dental splints have only been interested in their flexibility and not passivity. The purpose of this study is to determine the passivity of splints constructed from orthodontic materials. A specific data acquisition system, with a 2D transducer, is developed for evaluation of its neutrality. The transducer detects the displacements of the splinted tooth generated by the splint. The splints are constructed with 0.406 mm round, straight or Arch Blank preformed stainless-steel wires, with 0.559 mm standard edgewise brackets and with 0.254 mm stainless-steel or 3.05 mm elastomeric ligatures. Results show that mean output voltages generated by the splints range from 1.13 V to 2.48 V. The best control of passivity is obtained with the splints constructed with a preformed archwire and with elastomeric ligatures (p < 0.05), and the worst control is obtained with those constructed with a straight wire and with stainless-steel ligatures (p < 0.05).

Humans↗
PubMed1994

The effect of wearing a flexible wrist splint on carpal tunnel pressure during repetitive hand activity.

We investigated how repetitive hand activity normally affects carpal tunnel pressure and whether a flexible wrist splint can influence this effect. Nineteen healthy subjects were evaluated under four test conditions: at rest with and without a wrist splint (baseline) and while performing a repetitive task with and without a wrist splint. The task involved loading and unloading 1 lb. cans from a box at a rate of 20 cans per minute for period of 5 minutes. Carpal tunnel pressure and wrist angles were continuously monitored by means of a fluid-filled catheter inserted into the carpal canal and a two-channel electrogoniometer mounted on the dorsum of the hand and forearm. Without the splint, carpal tunnel pressure rose from a median baseline level of 8 +/- 6 mmHg to 18 +/- 13 mmHg during activity. With the splint, carpal tunnel pressure rose from a baseline of 13 +/- 5 mmHg to 21 +/- 12 mmHg during activity. Median carpal tunnel pressure during activity with the splint was no different from that without the splint. Our data indicate that the median nerve is subjected to increased pressure within the carpal tunnel during repetitive hand activity. Wearing a flexible wrist splint during activity limits the range of wrist motion but has no significant effect on carpal tunnel pressure.

Adult↗
PubMed2005

The effect of wearing a wrist splint on shoulder kinematics during object manipulation.

OBJECTIVES: To test the hypotheses that (1) wearing a flexible wrist splint while taking an object from a box increases known postural risk factors for shoulder disorders and (2) that the height of the front of the box modulates the effect on shoulder kinematics of wearing a wrist splint. DESIGN: A controlled laboratory experiment with 2 factors (splint wearing, box height). SETTING: Human performance laboratory. PARTICIPANTS: Ten consecutive healthy volunteers (5 men, 5 women; age range, 19-32 y). INTERVENTIONS: Experimental manipulation of wrist immobilization and box height. MAIN OUTCOME MEASURES: Humeral plane of elevation, humeral elevation, and humeral axial rotation. RESULTS: Wearing a wrist splint increased the maximum humeral elevation angle (P<.001), and the height of the barrier also increased the maximum humeral elevation angle (P<.001). The average difference in maximum humeral elevation between the splint and the no splint conditions was 6.8 degrees . CONCLUSIONS: Wearing a wrist splint while performing a job that requires removing objects from a box can increase risk factors for shoulder disorders. Workplace analysis should be performed to avoid secondary injuries before a patient wearing a wrist splint returns to work.

Adult↗
PubMed2006

Mechanical interactions of an implant/tooth-supported system under different periodontal supports and number of splinted teeth with rigid and non-rigid connections.

OBJECTIVES: This study investigated the mechanical interactions of implant-teeth splinting systems under different periodontal supports and number of splinted teeth with rigid and non-rigid connectors using non-linear finite element (FE) approach. METHODS: Two FE models with normal and compromised periodontal supports containing a Frialit-2 implant splinted to the first and second premolars were constructed. Non-linear contact elements were used to simulate a realistic interface fixation within the implant system and the sliding function of the non-rigid connector. ANOVA was used to test for relative importance of the investigated factors and main effects for each level of the three investigated factors (periodontal supports, teeth splinting and connector designs) in terms of the stress values were performed. RESULTS: The simulated results indicated that the cross-interaction of the periodontal support and the splinting situation was a major factor affecting the stress value in alveolar bone. An additional splinting decreased the stress values of bone significantly for a compromised periodontal support. The individual factor of periodontal support also influenced the stress found in the alveolar bone (28%) and implant (72%), and the stress values increased when the periodontal support was reduced. Using different connectors affected the stresses found in bone (15%), implant (21%) and prosthesis (99%). The stress values of the implant and prosthesis increased, but were decreased in bone when the splinting system used non-rigid connectors. The mobility of natural teeth and the implant system between non-rigid and rigid connections showed only small differences. CONCLUSIONS: A non-rigid connector should be used with caution since it breaks the stress transfer and increases the unfavorable stress values in the implant system and prosthesis. The tooth/implant-supported system with an additional splinting is more efficient in compromised periodontal supports.

Alveolar Process↗
PubMed2006

Night splinting does not increase ankle range of motion in people with Charcot-Marie-Tooth disease: a randomised, cross-over trial.

QUESTION: What is the effect of wearing splints at night to stretch the plantarflexors on dorsiflexion range of motion (ROM) in people with Charcot-Marie-Tooth disease? DESIGN: Randomised, assessor-blinded, cross-over trial. PARTICIPANTS: 14 people (1 dropout) aged 7 to 30 years with Charcot-Marie-Tooth disease Type 1A and with < or = 15 degrees dorsiflexion range of motion (ROM). INTERVENTION: A splint holding the ankle in maximum dorsiflexion was worn nightly on one leg for 6 weeks followed by the opposite leg for the subsequent 6 weeks. OUTCOME MEASURES: The primary outcome was dorsiflexion ROM; secondary outcomes were eversion ROM, and dorsiflexion, eversion, and inversion strength, measured before and after splinting, and three months later. RESULTS: There was no significant difference between the experimental and the control intervention in terms of ROM or strength. Wearing the splint at night increased dorsiflexion ROM by 1 degree (95% CI -3 to 4; p = 0.72) and eversion ROM by 1 degree (95% CI -1 to 3; p = 0.28) compared to not wearing the splint. Wearing the splint increased dorsiflexion strength by 41 N (95% CI -53 to 135; p = 0.38), reduced eversion strength by 6 N (95% CI -112 to 101; p = 0.92) and reduced inversion strength by 8 N (95% CI -110 to 95; p = 0.88) compared to not wearing the splint. CONCLUSION: Wearing night splints does not increase ankle ROM or strength in people with Charcot-Marie-Tooth disease Type 1A.

Adolescent↗
PubMed1983

The effect of splinting upon periodontal and pulpal healing after autotransplantation of mature and immature permanent incisors in monkeys.

The effect of splinting upon periodontal and pulpal healing after autotransplantation of teeth with complete and incomplete root formation was studied in 16 green Vervet monkeys (Cercopithecus aethiops). 2 maxillary incisors were extracted in each monkey and autotransplanted to the contralateral socket. One of these teeth was stabilized with an acrylic splint for either 2 or 6 weeks, while the other incisor was non-splinted. The animals were sacrificed 8 weeks after autotransplantation and the autotransplanted teeth were examined histologically. The following histologic parameters were registered for each tooth: surface resorption, inflammatory resorption, replacement resorption (ankylosis), downgrowth of pocket epithelium, periapical inflammatory changes and extent of pulp necrosis. The histometric analysis demonstrated that splinting increased the extent of pulp necrosis and inflammatory root resorption compared to non-splinting. Furthermore, the extent of normal periodontium was decreased among the splinted teeth, when compared to the non-splinted teeth. It is concluded that splinting not only failed to improve healing but apparently exerted a harmful effect upon periodontal and pulpal healing after autotransplantation.

Animals↗
PubMed1986

The reaction of the periodontium to different types of splints. (II). Histological aspects.

To study the influence of splints on periodontal tissues, Obwegeser and Merkx splints were applied to beagles. Histological evaluation was performed after splinting periods of 48 h and 6 weeks. After 48 h, gingivitis had developed when using both types of splints. After 6 weeks, the adverse effects of the splints were more predominant. Gingivitis had become severe and mild periodonitis had developed. In the case of Merkx splints, the periodontal ligament appeared to be somewhat less affected but the condition of the gingiva appeared to be somewhat worse than in the case with Obwegeser splints. For both types of splints, it is important that clinical application should be attended by measures not only to reduce plaque accumulation, but also to minimize trauma due to their application and continuous mechanical irritation of the tissues.

Alveolar Process↗
PubMed1999

Nasal splints, revisited.

A study was carried out to compare the effectiveness of nasal splints (in preventing intranasal adhesions) with the morbidity associated with their use in nasal surgery. One hundred and ten patients undergoing a routine nasal operation were randomly allocated into two equal groups, one with splints and the other without. Post-operative pain and discomfort was assessed by a visual analogue scale at 48 hours and a week following surgery when either nasal suction (non-splinted group) or removal of splints was carried out. All patients were examined after six weeks for development of adhesions. Results showed that there was no significant difference in the incidence of adhesions between the splinted and non-splinted patient groups. However, the patients with splints had significantly more pain and nasal discomfort when assessed one week after surgery. It is concluded that the morbidity associated with nasal splints does not justify their use in routine nasal surgery if the aim is to prevent nasal adhesions, but they may still be indicated for enhancing the stability of the septum following septoplasty.

Humans↗
PubMed2002

Use of a removable splint in the treatment of subluxated, luxated and root fractured anterior permanent teeth in children.

AIM: The aim of this study was to evaluate the prognosis of subluxated, luxated and root fractured teeth in children treated by removable splints, designed to stabilize mobile anterior teeth and eliminate occlusal trauma due to malocclusion. MATERIAL AND METHODS: A total of 227 traumatized anterior teeth (91 subluxated, 105 luxated and 31 root fractured teeth) treated with a removable splint were observed for 3 years. The traumatized teeth were from 79 children aged between 6-12 years (mean 8 years 5 months). If a traumatized tooth was extremely mobile, a fixed splint was first made before the impression was taken for the removable splint. Two weeks after completion of the removable splint treatment, an impression was taken again to evaluate the occlusal relationship of pre- versus post-treatment of removable splint. RESULTS: The treatment period with a removable splint averaged 3 weeks in subluxated teeth, 3-5 weeks in luxated teeth, 4-6 weeks in apical third root fracture injuries, and more than 5 weeks in middle third root fracture injuries. All the subluxated teeth and 74.1% of the luxated teeth maintained their pulp vitality during the 3-year follow-up period. Two of 21 (9.5%) apical third root fracture teeth and three of five (60%) middle third root fracture teeth had pulp necrosis in the coronal fragments. Internal resorption was not found in any of the traumatized teeth. External replacement resorption was not found in subluxated and luxated teeth. All the root fractured teeth displayed transient external resorption around the fracture lines. The surface resorption appeared to be self-limiting and not to threaten the retention of the tooth. Inflammatory resorption was observed in teeth with pulp necrosis, but in all cases this was reversed with endodontic treatment. Eight of 23 (39%) apical third root fractured teeth displayed replacement resorption in their apical fragments, but the resorption was not serious enough to extract the tooth. No obvious alteration in the occlusal relationship was found comparing pre- and post-treatment casts. The removable splints appeared to positively affect healing after traumatic injuries, as evidenced by the low number of complications at the 3-year follow-up period.

Child↗
PubMed2003

Is bruxism severity a predictor of oral splint efficacy in patients with myofascial face pain?

Both the efficacy and mechanism of any effect of oral splint therapy for patients with temporomandibular disorders (TMDs) are a matter of controversy. To address these issues, this study tested the hypothesis that oral splints produce the most marked pain relief for those TMD patients with myofascial face pain (MFP) who also brux (i.e. grind or clench) more than other MFP patients. In a 6-week randomized controlled clinical trial, 52 women with MFP were randomly assigned to receive either a full-coverage hard acrylic splint or a palatal-only splint. Bruxism was assessed both by self-report and by an objective assessment of molar microwear changes over a 2-week period prior to the start of the trial. Tested across multiple outcome measures, results indicated that those receiving the full-coverage splint had marginally better improvement on some pain-related measures than those receiving the palatal splint, but severity of bruxism did not moderate the therapeutic effect of the full-coverage splint. These findings strongly argue against the belief that oral splints reduce MFP by reducing bruxism and raise questions about the importance of bruxism in the maintenance of MFP.

Adult↗
PubMedDate not supplied

The effect of corrective splinting on flexion contracture of rheumatoid fingers.

This paper reports a matched-pair experimental study to investigate the effect of corrective splinting on flexion contracture of rheumatoid fingers. Twenty-four patients with rheumatoid arthritis and finger flexion contracture participated in the study. After a 6-week baseline measurement of hand function-including measurement of grip strength and range of motion and administration of the Jebsen Hand Function Test-the patients were randomly placed into two groups. Patients in the first group were given dynamic (Capener) splints, and those in the second group were given static (belly gutter) splints. Hand function was re-assessed 6 weeks after the splinting program. Results indicated significant improvement in both groups, not only in the correction of the finger flexion contracture (p < 0.0005) but also in grip strength (p = 0.001) and hand function (p < 0.0005). Patients with dynamic finger extension splints did not differ from those with static splints in extension gains, but they did have better flexion than patients with static splints. Both types of splints can be recommended for flexion contracture of rheumatoid fingers, depending on patients' preferences and comfort.

Adolescent↗
PubMed1991

Influence of occlusal splints on bilateral anterior temporal EMG activity during swallowing of saliva in patients with craniomandibular dysfunction.

A full-arch maxillary stabilization occlusal splint was made for each of 10 patients with craniomandibular dysfunction. These splints were divided into three sections (one anterior and two posterior). This procedure allowed variation in the anteroposterior centric localization of occlusal contacts, thus permitting the recording of the EMG effects produced by the different occlusal splint sections. The integrated EMG activity was recorded from the right and left anterior temporal muscles during swallowing of saliva in habitual occlusion and with the different occlusal splint sections inserted. EMG activity during swallowing of saliva was significantly lower with the different occlusal splints than in habitual occlusion. This supports the rationale for diurnal wear of the occlusal splint. No differences in EMG activity were found during swallowing of saliva when different sections of the occlusal splints were used. This fact points out the possibility for therapeutic use of different occlusal splints for improving swallowing function.

Adolescent↗
PubMed1998

Effect of two types of mandibular advancement splints on snoring and obstructive sleep apnoea.

Snoring and obstructive sleep apnoea (OSA) both seem at least to be associated with narrowing of the upper airway and sleep-induced loss of muscle-tone. Mandibular advancement splints (MAS) have been proposed as a relatively simple method to increase oro- and hypo-pharyngeal dimensions thereby increasing the size of the airway. However, data on their effectiveness are conflicting and there are no clear indications as to which design is most effective or when they should be used. The effects of two designs of splint (types A and B) have been evaluated in 14 and nine subjects, respectively, using the Epworth Sleepiness Score (ESS) and domiciliary sleep monitoring on separate nights. Both splints reduced the median ESS (type A from 12 to 4.5; P = 0.003, type B from 7 to 4; P = 0.005). The apnoea-hypopnoea index was not affected by type A, but was reduced from 7.1 to 0.8; P = 0.005 by type B splints. There was evidence of a small improvement in overnight oxygen saturation for type B splints (P = 0.02). The splints were well tolerated and continued to be used nightly by 18 subjects. Mandibular advancement splints may offer a simple and effective alternative for the treatment of snoring and mild OSA in selected patients. Splint design may have considerable bearing on efficacy.

Adult↗
PubMed1994

The use of splints in the treatment of joint stiffness: biologic rationale and an algorithm for making clinical decisions.

The purpose of this article are (1) to discuss the rationale for using splints to increase range of motion (ROM) and (2) to describe an algorithm that can guide therapists' clinical decisions when splints are used to treat patients who have limited ROM. The primary rationale for using splints is to apply relatively long periods of tensile stress to shortened connective tissues to induce tissue lengthening through biologic remodeling. The process of remodeling is contrasted with more temporary mechanical phenomena that occur in biologic tissues. The proposed algorithm guides the use of splints based on measurements of pain and ROM. We describe three variables of splint use that may be adjusted: frequency, duration, and intensity. The relative importance of each of these variables is discussed. The algorithm is not joint or injury specific and requires continual modification of splint use based on a patient's response to treatment. Deciding which patients are appropriate for end-range splinting and deciding when to discontinue splint use are also discussed.

Algorithms↗